Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
J Affect Disord. 2013 Jun;148(2-3):418-23. doi: 10.1016/j.jad.2012.11.017. Epub 2012 Dec 4.
Children and adolescents with bipolar disorder (BD) live in family environments with high levels of expressed emotion (EE), conflict, and tension; as well as low maternal warmth and cohesion. These family characteristics have been evaluated in research settings using different scales. Nonetheless, empirically supported assessment instruments are not always feasible to be used in clinical settings. Our aim was to identify the best characteristics that discriminate BD families from control by building a classifier with the main characteristics found from different scales. We also built a classifier based on the adjective check-list scale (ACL) because this scale would be the most feasible one to be used in clinical setting.
We evaluated 33 families of pediatric BD patients and 29 control families. Two self-report scales, ACL and the Family Environment Scale (FES), and a direct interview scale, the Psychosocial Schedule for School Age Children-Revised (PSS-R), were administered.
BD families presented lower positive EE and higher negative EE, less cohesion, organization, greater conflict and control; lower rate of intact family, higher maternal and paternal tension compared to control families. Both classifiers demonstrated high accuracy. The offspring's EE toward the mother was the family characteristic that best discriminated BD from control families.
Small sample size and cross-sectional design.
Families of BD children presented altered communication and functioning. The high accuracy of the ACL-based classifier highlights a feasible scale to be used in clinical settings. Further studies assessing prognosis associated with the patterns of communication in such families are needed.
患有双相情感障碍（BD）的儿童和青少年生活在情绪表达（EE）水平高、冲突和紧张以及母亲温暖和凝聚力低的家庭环境中。这些家庭特征已在研究环境中使用不同的量表进行了评估。然而，在临床环境中，并非总是可以使用经过实证支持的评估工具。我们的目的是通过使用不同量表发现的主要特征构建分类器，确定将 BD 家庭与对照组区分开来的最佳特征。我们还基于形容词检查表量表（ACL）构建了一个分类器，因为该量表在临床环境中最可行。
我们评估了 33 个儿科 BD 患者家庭和 29 个对照组家庭。使用两种自我报告量表（ACL 和家庭环境量表（FES））和一种直接访谈量表（修订后的学龄儿童心理社会时间表（PSS-R））进行评估。
BD 家庭表现出较低的积极 EE 和较高的消极 EE、较低的凝聚力、组织性、更多的冲突和控制、较低的完整家庭比例、较高的母亲和父亲紧张程度，与对照组家庭相比。两种分类器都表现出很高的准确性。子女对母亲的 EE 是区分 BD 和对照组家庭的最佳家庭特征。
样本量小和横断面设计。
BD 儿童的家庭呈现出沟通和功能的改变。基于 ACL 的分类器的高准确性突出了一种在临床环境中可行的量表。需要进一步研究评估与这些家庭沟通模式相关的预后。
