Department of Psychology, Yale University.
Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles School of Medicine.
J Fam Psychol. 2018 Jun;32(4):507-516. doi: 10.1037/fam0000393. Epub 2018 Feb 1.
Previous research has found that family problem-solving interactions are more constructive and less contentious when there is a family member with bipolar disorder compared with schizophrenia. The present study extended this research by examining whether family problem-solving interactions differ between clinical high-risk (CHR) stages of each illness. Trained coders applied a behavioral coding system (O'Brien et al., 2014) to problem-solving interactions of parents and their adolescent child, conducted just prior to beginning a randomized trial of family-focused therapy. The CHR for psychosis sample included 58 families with an adolescent with attenuated positive symptoms, brief intermittent psychosis, or genetic risk and functional deterioration; the CHR for bipolar disorder sample included 44 families with an adolescent with "unspecified" bipolar disorder or major depressive disorder and at least one first or second degree relative with bipolar I or II disorder. When controlling for adolescent gender, age, functioning, and parent education, mothers of youth at CHR for psychosis displayed significantly more conflictual and less constructive communication than did mothers of youth at CHR for bipolar disorder. Youth risk classification did not have a significant relationship with youths' or fathers' communication behavior. The family environment among help-seeking adolescents may be more challenging for families with an adolescent at CHR for psychosis compared with bipolar illness. Accordingly, families of adolescents at clinical high-risk for psychosis may benefit from more intensive or focused communication training than is required by families of adolescents at clinical high-risk for bipolar disorder or other mood disorders. (PsycINFO Database Record
先前的研究发现，与精神分裂症相比，当家庭中有成员患有双相情感障碍时，家庭解决问题的互动会更具建设性，也更少争议。本研究通过检查每种疾病的临床高风险（CHR）阶段是否存在家庭解决问题的互动差异，扩展了这一研究。经过培训的编码员应用一种行为编码系统（O'Brien 等人，2014 年）对父母及其青少年子女的解决问题的互动进行编码，这些互动是在开始家庭为重点的治疗随机试验之前进行的。精神病的 CHR 样本包括 58 个家庭，这些家庭的青少年有减弱的阳性症状、短暂间歇性精神病、或遗传风险和功能恶化；双相情感障碍的 CHR 样本包括 44 个家庭，这些家庭的青少年有“未指定”的双相情感障碍或重性抑郁障碍，并且至少有一个一级或二级亲属患有双相 I 型或 II 型障碍。当控制青少年的性别、年龄、功能和父母教育时，处于精神病 CHR 的青少年的母亲表现出明显更多的冲突和较少的建设性沟通，而处于双相情感障碍 CHR 的青少年的母亲则较少。青少年风险分类与青少年或父亲的沟通行为没有显著关系。与患有双相情感障碍相比，寻求帮助的青少年的家庭环境对于处于精神病 CHR 的青少年的家庭可能更具挑战性。因此，与处于双相情感障碍或其他心境障碍的临床高风险青少年的家庭相比，处于精神病临床高风险的青少年的家庭可能需要更密集或更有针对性的沟通培训。
