The Influence of Family and Social Factors on the Course of Psychiatric Illness

Vaughn, Christine; Leff, Julian

doi:10.1192/bjp.129.2.125

Cited by 1,589 publications

(880 citation statements)

References 5 publications

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“…Relapse was much higher for males (50%) than females (21%). These findings were later replicated by Vaughn & Leff 25 in a prospective cohort of 37 schizophrenic patients. The relapse rate was 48% among high EE relatives and 6% among low EE.…”

Section: Introductionsupporting

confidence: 66%

“…They also found that ratings of EE were significantly associated with lower social functioning particularly with hostility, but they did not explore the differences between the sexes in their study. Indeed, males and females are expected to be equally distributed in high EE homes 24 but more males return to conflicting environments after hospital discharge 4,25 .…”

Section: Discussionmentioning

confidence: 99%

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Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

et al. 1996

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A case series to study factors related to family expectation regarding schizophrenic patients was conducted in an out-patient setting in the city of S. Paulo, Brazil. Patients diagnosed as presenting schizophrenia by the ICD 9th Edition and having had the disease for more than four years were included in the study. Family Expectation was measured by the difference between the Katz Adjustment Scale (R2 and R3) scores based on the relative's expectation and the socially expected activities of the patient (Discrepancy Score), and social adjustment was given by the DSM-III-R Global Assessment Scale (GAS). Outcome assessments were made independently, and 44 patients comprised the sample (25 males and 19 females). The Discrepancy mean score was twice as high for males as for females (p < 0.02), and there was an inverse relationship between the discrepancy score and social adjustment (r =-0.46, p < 0.001). Moreover, sex and social adjustment exerted independent effects on the discrepancy score when age, age at onset and number of psychiatric admissions were controlled by means of a multiple regression technique. There was an interaction between sex and social adjustment, the inverse relationship between social adjustment and discrepancy score being more pronounced for males. These findings are discussed in the light of the potential association between the family environment, gender and social adjustment of schizophrenic patients, and the need for further research, i.e. ethnographic accounts of interactions between patient and relatives sharing households particularly in less developed countries. Pública, 30 (3), 1996

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Section: Introductionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

et al. 1996

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“…(All families had been assessed on Expressed Emotion. For references see Vaughn and Leff, 1976.) It is likely that it is these families who elicit the strong negative reactions in the teams.…”

Section: Discussionmentioning

confidence: 99%

Clinical teams reflect family dysfunction

Berkowitz

Leff

1984

Journal of Family Therapy

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Therapists frequently have strong negative reactions to their patients. The view is put forward in this paper that such reactions may be harmful to patients if they are not acknowledged. However, when we, as therapists, are able to recognize our own reactions, they could prove to be a valuable source of information about those people we are trying to help. Three cases are described in which clinical teams behaved in negative ways towards families, who, as a result, did not receive the appropriate treatment. These descriptions are an attempt to show how t h e teams' behaviour mimicked that of the family. It is suggested, firstly, that these reactions should be recognized so they cannot hinder treatment and, secondly, that they be used as a source of information about the interaction within the family. This phenomenon of reflecting family dysfunction may, if properly approached, be of potential value to those who work in teams and deal with families.

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“…A sceptical interpretation of these data might suggest that the placebo 'relapses', while more frequent, were less severe than the drug 'relapses'-an important distinction for the clinician. The same investigators have pointed out in other publications (Wing, 1968;Vaughn & Leff, 1976) that the decision to admit a patient to hospital is frequently determined by the tolerance of community support systems, especially the family, and is not based exclusively on the severity of illness. This socially mediated effect has not been considered in the presentation of rehospitalization data.…”

Section: (A) Hospital Readmissionmentioning

confidence: 99%

Relapse in schizophrenia: a review of the concept and its definitions

Falloon¹,

Marshall²,

Boyd³

et al. 1983

Psychol. Med.

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The increasingly rigorous attention paid to the diagnosis of schizophrenia has not yet been extended to the development of reliable and valid criteria for describing the course of the illness. Over the past two decades the concept of 'relapse' has become the pre-eminent measure of the success of community treatment programmes of schizophrenia. However, to date there has been little effort to examine this measure critically, or to develop other measures to reflect the wide range of clinical outcome in schizophrenia. This issue is not new. Kraepelin has been faulted for his lack of clarity in discussing the association between the diagnosis of dementia praecox and a poor clinical outcome (WHO, 1975). Stressing that 'the general course of dementia praecox is very variable', he outlined several typical courses of the illness, all of which proceeded to terminal dementia (Kraepelin, 1919). He recognized the lack of specifically defined outcome criteria, citing reports showing recovery rates varying from 0 to 25%.Although Kraepelin remained sceptical that full recovery without any residual defect was possible, Meyer (1922) contended that functional recovery was possible and proposed that, in many cases, schizophrenia could be regarded as episodic, with relapses representing fresh attacks of the disease. Kraepelin acknowledged that 'more than half exhibit marked improvement', but noted that these recoveries 'give way sooner or later to a relapse'. In support of his thesis of incomplete remission, he observed that subsequent relapses almost always consisted of symptoms similar to those presented in the original episode. This consistency of symptom patterns was also reported by Bleuler (1911), who supported the notion that complete restoration of premorbid mental health was a rarity. Bleuler cautioned against attributing much significance to published reports regarding 'cure' rates, not only because of the subjective nature of such determinations, but also because of' the varying conditions of admission and relapse for each institution', which often play a greater role in defining discharge status than objective changes in psychopathology.Concern about the natural course of schizophrenia led these pioneers to focus discussion more upon the definition of remission, than its counterpart, relapse. Although concern regarding the course of the illness has continued (Vaillant, 1964;Huber et al. 1981), little attention has been paid to this matter in studies investigating the effectiveness of clinical interventions. With the advent of newer pharmacological and psychosocial interventions, emphasis has shifted to factors surrounding clinical exacerbation after the patient has been discharged from the hospital in a state of partial or complete clinical remission. The effectiveness of community aftercare has been measured in terms of failure to sustain these 'remissions' and, more often than not, by readmission of the patient to hospital. The latter is primarily a social intervention which, although usually associated with symptom e...

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The Influence of Family and Social Factors on the Course of Psychiatric Illness

Cited by 1,589 publications

References 5 publications

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

Clinical teams reflect family dysfunction

Relapse in schizophrenia: a review of the concept and its definitions

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