Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis

Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA.
Schizophrenia Research (Impact Factor: 3.92). 02/2006; 81(2-3):269-75. DOI: 10.1016/j.schres.2005.10.005
Source: PubMed


This study investigated whether family factors, such as criticism, emotional over-involvement (EOI), warmth, and positive remarks, as measured by the Camberwell Family Interview (CFI), predict symptom change and social outcome for individuals identified as at imminent risk for conversion to psychosis. Twenty-six adolescent patients were administered the Structured Interview for Prodromal Syndromes and the Strauss-Carpenter Outcome Scale at baseline and follow-up assessment approximately three months later. Patients' primary caregivers were administered the CFI at baseline. After controlling for symptom severity at baseline, there were significant associations between caregivers' EOI at baseline and improvement in high-risk youths' negative symptoms and social functioning at follow-up. Similarly, caregivers' positive remarks at baseline were associated with improvement in negative and disorganized symptoms at follow-up, and warmth expressed by caregivers was associated with improved social functioning at follow-up. Although family members' critical comments were not related to patients' symptoms, the majority of critical remarks were focused on patients' negative symptoms and irritability/aggression, which may be important targets for early intervention. These preliminary results provide a first glimpse into the relationship between family factors and symptom development during the prodrome and suggest that positive family involvement predicts decreased symptoms and enhanced social functioning at this early stage. The finding that four-fifths of the youth enrolled in this early intervention clinical research program have shown symptomatic improvement by the three-month assessment point is very encouraging from an early detection/early intervention standpoint.

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    • "Functional impairment (social or role) a Fusar-Poli et al., 2013; Lencz et al., 2004 Depression Fusar-Poli et al., 2014; Lencz et al., 2004 Anxiety Fusar-Poli et al., 2014 Attention problems Lencz et al., 2004 Cognitive deficits Pukrop and Klosterkötter, 2010; Valli et al., 2012 Family stress McFarlane et al., 2015; Miklowitz et al., 2014; O'Brien et al., 2006 Suicidal ideation/behavior Taylor et al., 2014 Substance use Addington et al., 2014 Exposure to trauma Bechdolf et al., 2010a a Characteristics included in criteria for CHR classification. "
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    ABSTRACT: Youth and young adults at clinical high risk (CHR) for psychosis experience a broad range of difficulties, including attenuated psychotic symptoms, comorbid concerns, functional impairments, and family and interpersonal stress. Given emerging evidence that early interventions may improve functioning and reduce symptomatology while also lowering risk of transition to full-threshold psychosis, several randomized controlled trials have systematically evaluated the efficacy of CHR treatment approaches. This article describes and summarizes psychosocial intervention approaches that have demonstrated efficacy in treating people at CHR, with a focus on distilling individual components of these treatments. On the basis of the existing literature, we propose an empirically based, flexible, and comprehensive modularized approach to early intervention that meets the varying needs of individuals experiencing CHR-related distress and dysfunction, many of whom may be on a trajectory toward psychosis.
    The Journal of nervous and mental disease 05/2015; 203(5):342-351. DOI:10.1097/NMD.0000000000000287 · 1.69 Impact Factor
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    • "Family support was predictive of better functioning (O'Brien et al., 2006, 2007, 2008, 2009). Caregiver warmth at baseline interview was significantly associated with patients' improvement in functioning over 3 and 4 months (O'Brien et al., 2006, 2008). ARMS adolescents' conversational problem solving abilities, along with the degree of constructive communication displayed with their primary caregiver also positively correlated with functioning at 6-month follow-up (O'Brien et al., 2009). "
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    ABSTRACT: Background: Transition to psychotic disorder has been the traditional outcome of interest for research in the at-risk mental state (ARMS). However, there is growing recognition that individuals with ARMS may function poorly regardless of whether they develop psychosis. We aimed to review the literature to determine whether there are specific factors associated with, or predictive of, functional impairment in the ARMS population. Method: An electronic database search of MEDLINE, PsycINFO and Embase from inception until May 2014 was conducted using keyword search terms synonymous with the at-risk mental state and functioning. Eligible studies were original peer-reviewed English language research articles with populations that met validated at-risk diagnostic criteria and examined the cross-sectional or longitudinal association between any variable and a measure of functioning. Results: Seventy-two eligible studies were identified. Negative symptoms and neurocognitive impairment were associated with poor functioning in cross-sectional studies. Negative and disorganised symptoms, neurocognitive deficits and poor functioning at baseline were predictive of poor functional outcome in longitudinal studies. Positive symptoms were unrelated to functioning in both cross-sectional and longitudinal studies. Functional disability was persistent and resistant to current treatments. Conclusions: Negative and disorganised symptoms and cognitive deficits pre-date frank psychotic symptoms and are risk factors for poor functioning. This is consistent with a subgroup of ARMS individuals potentially having neurodevelopmental schizophrenia. Treatments aimed at improving functioning must be considered a priority on par with preventing transition to psychosis in the development of future interventions in the ARMS group.
    Schizophrenia Research 09/2014; 159(2-3). DOI:10.1016/j.schres.2014.09.012 · 3.92 Impact Factor
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    • "Particularly, attitudes related to positive affect predicted improvement in negative symptoms and functioning (O'Brien et al., 2006, 2008), whereas negative affect in the form of criticism predicted worsening of attenuated psychotic symptoms (Schlosser et al., 2010). "
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    ABSTRACT: The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and emotional over-involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives’ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives’ criticism was associated with positive, negative, and general symptoms. EOI was related with negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives’ attributions of blame toward the patient. Relatives’ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients’ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives’ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.
    Psychiatry Research 08/2014; DOI:10.1016/j.psychres.2014.04.012 · 2.47 Impact Factor
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