Page 1 of 16http://spider.apa.org/ftdocs/abn/1995/may/abn1042268.html 9/15/2000Verbal Interactions in the Families of Schizophrenic and Bipolar Affective Patients David J. MiklowitzDepartment of Psychology University of Colorado at Boulder Michael J. GoldsteinDepartment of Psychology and Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles Keith H. NuechterleinDepartment of Psychiatry and Biobehavioral Sciences University of California, Los Angeles ABSTRACTDo verbal interactions between psychiatric patients and family members covary with the diagnosis of the patient? This study compared relatives (usually parents) of schizophrenic ( n = 42) and bipolar ( n = 22) patients on affective style (AS) or emotional—verbal behavior toward patients in family interaction. Patients were compared on coping style or verbal interactional behavior toward relatives. Relatives of schizophrenic patients made more negative AS (particularly intrusive) statements to patients than relatives of bipolar patients. Schizophrenic patients made fewer supportive statements and more self-denigrating statements to relatives than bipolar patients. Among families of bipolar patients, negative AS in relatives was associated with oppositional, "refusing" styles in patients. Implications for psychosocial interventions with these disorders are discussed. This research was supported by National Institute of Mental Health Grants MH43931, MH42556, MH08744, MH37705, MH14584, and MH30911; a grant from the John D. and Catherine T. MacArthur Foundation on Risk and Protective Factors in the Major Mental Disorders; and a Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression. We thank Jeri Doane, Dorothy Feingold, David Fogelson, Michael Gitlin, Sun Hwang, Charles Judd, David Lukoff, Jim Mintz, Karen Snyder, Angus Strachan, Joseph Ventura, and Sibyl Zaden for their assistance. Correspondence may be addressed to David J. Miklowitz, Department of Psychology, University of Colorado at Boulder, Muenzinger Building, Boulder, Colorado, 80309-0345. Received: July 13, 1993 Revised: August 20, 1994 Accepted: August 20, 1994 Evidence indicates that emotional qualities of the family environment are significant prospective predictors of the course of various psychiatric disorders, even for those disorders for which genetic and other biological variables provide powerful etiological explanations. Specifically, critical, hostile, or emotionally overinvolved attitudes held by key relatives about a hospitalized patient, termed high expressed emotion (EE), are associated with high rates of patient relapse over 9-month to 1-year periods in schizophrenia ( Kavanagh, 1992 ; Parker & Hadzi-Pavlovic, 1990 ), bipolar disorder Journal of Abnormal Psychology © 1995 by the American Psychological Association May 1995 Vol. 104, No. 2, 268 -276 For personal use only--not for distribution.Page 2 of 16http://spider.apa.org/ftdocs/abn/1995/may/abn1042268.html 9/15/2000( Miklowitz, Goldstein, Nuechterlein, Snyder, & Mintz, 1988 ; Priebe, Wildgrube, & Muller-Oerlinghausen, 1989 ), and unipolar depressive disorder ( Hooley, Orley, & Teasdale, 1986 ; Vaughn& Leff, 1976 ). Likewise, negative parent-to-patient verbal interactional behaviors (i.e., criticism, intrusiveness) during the postdischarge period, termed negative affective style (AS), prospectively predict relapses of schizophrenia ( Doane, Falloon, Goldstein, & Mintz, 1985 ) and bipolar disorder ( Miklowitz et al., 1988 ). Levels of EE attitudes and AS behaviors are usually intercorrelated but do not completely overlap in parents of schizophrenic patients ( Miklowitz et al., 1989 ; Miklowitz,Goldstein, Falloon, & Doane, 1984 ; Strachan, Leff, Goldstein, Doane, & Burtt, 1986 ). Despite an extensive literature correlating family attitudes (EE) and interactional behaviors (AS) with the course of patients' psychiatric disorders, little is known about whether their development varies as a function of the patient's diagnostic status. EE and AS may reflect some of the natural emotional reactions of family members to the onset of an acute episode of psychiatric disorder in another family member, as well as the difficulties that arise when this family member, who may still have residual symptoms, returns from the hospital to the home ( Kavanagh, 1992 ; Nuechterlein, Snyder, & Mintz,1992 ). These family attributes have been conceptualized as generalized stressors that in conjunction with other biological and social factors overwhelm a biologically vulnerable family member and contribute to recurrences of his or her disorder ( Nuechterlein & Dawson, 1984 ; Zubin & Spring,1977 ). 1 However, few studies have examined whether high levels of EE or AS are more frequently associated with certain disorders like schizophrenia or whether the development of these attributes is equally common in families coping with other recurrent disorders that are stressful to significant others. In a previous study ( Miklowitz, Goldstein, Nuechterlein, Snyder, & Doane, 1987 ), we found that high- and low-EE attitudes in parents were distributed equally among recent onset, hospitalized schizophrenic and bipolar, manic patients. Likewise, Vaughn and Leff (1976) found that parents of hospitalized schizophrenic patients did not differ from spouses of hospitalized depressed patients in the number of EE criticisms. Thus, high-EE attitudes may reflect a diagnostically nonspecific tendency for some family members to react with negativity or overconcern to an acutely ill family member. However, interactional behavior as assessed during a period of full or partial remission of the patient's disorder may be associated with a different cluster of factors, including the diagnosis of the patient, level or type of residual symptoms, and styles of interacting with family members during the aftercare period. In this study, we examined whether the verbal interactional behavior of relatives (AS) varies with the form of an index patient's psychiatric disorder. Relatives of patients who had recent episodes of schizophrenic or bipolar, manic disorder for which they were hospitalized were asked to discuss with the patient and attempt to resolve a series of family problems. Levels of AS in relatives were then compared across the two diagnostic groups. Conducting these assessments during the posthospital period allowed us to compare the family interactional styles that accompany a
View Full Document
Unlocking...