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The role of family systems in severe and recurrent psychiatric disorders: A developmental psychopathology view

Published online by Cambridge University Press:  01 September 2004

DAVID J. MIKLOWITZ
DAVID J. MIKLOWITZ
Affiliation:
University of Colorado, Boulder
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Abstract

Family systems theory has been highly influential in the study of recurrent psychiatric disorders. This review examines two interrelated domains: research on expressed emotion (EE) attitudes among relatives (criticism, hostility, or emotionally overinvolvement) and relapses of schizophrenia or bipolar disorder, and randomized trials of family intervention in these populations. The literature is discussed in terms of contemporary systems theory and concepts from developmental psychopathology research. Several conclusions are drawn: (a) levels of EE are correlated with caregivers' attributions regarding the controllability of patients' behaviors; (b) EE attitudes are associated with bidirectional, mutually influential cycles of interaction between relatives and patients; and (c) family psychoeducational therapy, when combined with pharmacotherapy, is associated with lower rates of relapse in schizophrenia and bipolar illness. Underlying disturbances in family systems may emerge in response to illness symptoms in a family member, but also have recursive effects on the developmental course of the illness once manifest. The nature and stability of these recursive effects will depend on dynamic processes in the patient, the relative, and their relationship. Future research should elucidate mediating and moderating variables in the pathways from EE to patients' outcomes, and the conditions under which family treatments bring about favorable outcomes of psychiatric disorder.Preparation of this article was supported by Grant MH62555 from the National Institute of Mental Health and a Distinguished Investigator Award from the National Alliance for Research on Schizophrenia and Depression. The author thanks Martha Tompson for her conceptual input.

Type
Research Article
Information
Development and Psychopathology , Volume 16 , Issue 3 , September 2004 , pp. 667 - 688
Copyright
© 2004 Cambridge University Press

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