Families and mental illness

Question 1

General systems model

Answer 1

• families are systems where every action in a family produces a reaction in one or more of its members
• everyone has a stable role

Question 2

Family cycle

Answer 2

Stage 1: formation of a new family- two people unite and first child is born
Stage 2: child rearing stage
Stage 3: child launching-child leaves home
Stage 4: return of independence
Stage 5: dissolution of the family due to decline or demise of the partners

Question 3

Family instability

Answer 3

• affects boys more than girls
• affects young children more than older children
• can affect cognitive achievements and behavioural difficulty

Question 4

Lidz

Answer 4

• studied family systems in schizophrenia and described 2 schizophrenogenic family patterns
  1. Marital schism
  2. Marital skew

Question 5

Marital Schism

Answer 5

• Lidz schizophrenogenic pattern
• family is in state of disequilibrium due to repeated threats of parental separation. Parents downgrade roles of each other and may even attempt to collude with children and exclude partners

Question 6

Marital Skew

Answer 6

• Lidz schizophrenogenic pattern
• family is at an equilibrium that is skewed and achieved at an expense of the distorted parental relationship. One parent may be dominant and other submissive, making the marriage a ‘stable fit’

Question 7

Wynne

Answer 7

• certain communication patterns that may later contribute to development of perceptual and thought disorders in schizophrenia
• Pseudo-hostility and pseudo-mutuality refer to the disjointed communication where the child is forced to accept and develop a pattern of communication that will negate and deny the existence of meaningful relationships in the family

Question 8

Bateson

Answer 8

• double-bind relationship where superficial verbal communications contradict the behavioural and deeper communications among the members of a family
• these mixed messages keep a growing child in a double bind that can later increase the risk of psychosis

Question 9

Frieda Fromm-Reichmann

Answer 9

• concept of ‘schizophrenogenic mother’
• these mothers are rejecting, impervious to the feelings of others, rigid in moralism concerning sex and have a significant fear of intimacy
• out of favour, not backed up by research

Question 10

Brown and Rutter

Answer 10

• expressed emotion concept
• part of the Camberwell Family interview and later modified bu Vaughn and Leff
• critical comments, emotional over involvement, hostility =high expressed emotion
• high EE Is seen in 52% carers of someone with schizophrenia (lowest rates in India)
• strength of association between relapse and EE is the same in both genders
• relapse rate in high EE is 50%, low EE is 21%
• in high EE relapse takes place 9 months earlier for both genders
• increased face to face time with a relative with high EE increases the risk of relapse
• Pakistani families are more likely to be rated as High EE- may be cultural

Question 11

Camberwell family interview

Answer 11

• Brown and Rutter
• 5 measures:
  1. critical comments
  2. positive remarks
  3. emotional over involvement
  4. hostility
  5. emotional warmth
• individual members of a family are interviewed
• if one relative is classified as a high EE person then the whole family is