Psychosocial Family Treatment for a 10-Year-Old with Schizoaffective Disorder

University of Michigan; The Ohio State University; Private Practice, Columbus, OH; Children’s Hospital, Columbus, OH
Cognitive and Behavioral Practice 01/2008; DOI: 10.1016/j.cbpra.2006.12.003

ABSTRACT Schizophrenia spectrum disorders are rare in childhood and little is known about their psychosocial treatment. Relevant findings from the adult and child literature are reviewed. The case of 10-year-old “Michael” is presented, who participated in a randomized clinical trial of a psychoeducational family treatment for mood disorders. Following treatment, quantitative and qualitative data show that Michael's mood and social functioning improved, utilization of mental health services improved, the overall family emotional climate became more positive, and his parents felt supported. He no longer met criteria for a mood episode but continued to display psychosis. This family's response suggests that group psychoeducation may be an effective treatment for families of children with emerging schizophrenia spectrum disorders.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Expressed emotion (EE) is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. However, in recent years some prominent nonreplications of the EE-relapse relationship have been published. To more fully address the question of the predictive validity of EE, we conducted a meta-analysis of all available EE and outcome studies in schizophrenia. We also examined the predictive validity of the EE construct for mood disorders and eating disorders. An extensive literature search revealed 27 studies of the EE-outcome relationship in schizophrenia. Using meta-analytic procedures, we combined the findings of these investigations to provide an estimate of the effect size associated with the EE-relapse relationship. We also used meta-analysis to provide estimates of the effect sizes associated with EE for mood and eating disorders. The results confirmed that EE is a significant and robust predictor of relapse in schizophrenia. Additional analyses demonstrated that the EE-relapse relationship was strongest for patients with more chronic schizophrenic illness. Interestingly, although the EE construct is most closely associated with research in schizophrenia, the mean effect sizes for EE for both mood disorders and eating disorders were significantly higher than the mean effect size for schizophrenia. These findings highlight the importance of EE in the understanding and prevention of relapse in a broad range of psychopathological conditions.
    Archives of General Psychiatry 07/1998; 55(6):547-52. · 13.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the course and outcome of early-onset psychotic disorders. These are data from a longitudinal, prospective study of youths with psychotic disorders. Standardized diagnostic and symptom rating measures were used. Fifty-five subjects with the following disorders have been recruited: schizophrenia (n = 18), bipolar disorder (n = 15), psychosis not otherwise specified (n = 15), schizoaffective disorder (n = 6), and organic psychosis (n = 1). Follow-up assessments were obtained on 42 subjects at year 1 and 31 subjects at year 2. Youths with schizophrenia had more chronic global dysfunction, whereas subjects with bipolar disorder overall had better functioning, with a cyclical course of illness. However, according to results of a regression model, premorbid functioning and ratings of negative symptoms, but not diagnosis, significantly predicted the highest level of functioning over years 1 and 2. Course and level of functioning differentiated bipolar disorder from schizophrenia. However, premorbid functioning and ratings of negative symptoms were the best predictors of functioning over the follow-up period. These findings are consistent with the adult literature, and they further support that psychotic illnesses in young people are continuous with the adult-onset forms.
    Journal of the American Academy of Child & Adolescent Psychiatry 12/1999; 38(11):1380-8. · 6.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Mania Rating Scale (MRS) was evaluated for use in prepubertal children. Eleven manic and 11 matched controls with attention-deficit hyperactivity disorder were examined. MRS scores were significantly higher in manic versus ADHD children (p less than 0.0001), while scores on hyperactivity rating scales (Conners-Parent and Teacher Forms) did not differ between groups. Most individual MRS item scores differed significantly between groups (p less than 0.05). MRS scores correlated significantly with severity of mania (Clinical Global Impression--Mania, r = 0.84; p less than 0.0001). Age, race, and sex were not correlated with MRS scores. The MRS may be useful in differentiating mania from ADHD and determining the severity of mania in prepubertal children.
    Journal of the American Academy of Child & Adolescent Psychiatry 04/1992; 31(2):252-7. · 6.97 Impact Factor