Family functioning among adolescents with bipolar disorder.

This study examined the characteristics of families of adolescents with bipolar disorder during or shortly following a period of mood exacerbation, using measures of family conflict, cohesion, adaptability, and expressed emotion (EE). Demographic, diagnostic, and family functioning data were collected from 58 families (mean age = 14.48; 33 female, 25 male) before entering a randomized trial of family focused treatment. Compared to scale scores reported by healthy adolescents and their families, cohesion and adaptability were more impaired in families with an adolescent with bipolar disorder. Levels of conflict, while higher than normative scores reported by healthy families, were not significantly different from scores gathered from distressed, clinic-referred families. Parents rated high in EE reported less cohesion and adaptability, and more conflict, than parents rated low in EE. Parents expressing greater numbers of critical comments also reported more conflict than those who expressed fewer criticisms. These EE group differences were not accounted for by concurrent adolescent symptom levels. Family adaptability, cohesion, and conflict may be important targets for family treatments administered during the postepisode phases of early onset bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and mood disorders: A comparison between patients with major depressive disorder and bipolar I disorder.

Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to recovery, and (d) whether within-group changes from acute episode to recovery varied by diagnosis. Using a multidimensional model, the authors evaluated interviewer, patient, and family ratings. Overall, patients with MDD and BPAD evidenced similar levels of family impairment at acute episode and recovery. Generally, patients in both groups experienced improvement in family functioning over time, yet mean scores at recovery continued to range from fair to poor. Although certain specific differences emerged, diagnostic groups appeared to be more similar than different in level and pattern of family functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of relationship functioning for patients with bipolar disorder and their partners.

Previous investigations have examined family functioning, including marital functioning, as an important predictor of the course of bipolar disorder, but limited research exists identifying the factors that influence relationship functioning in patients with bipolar disorder. In the current study, 56 patients with bipolar disorder and their partners were assessed for Axis II pathology, general family functioning, and relationship distress. Patient mood symptoms and Axis II pathology variables were examined as predictors of general relationship functioning (Family Assessment Device, McMaster Clinical Rating Scale, and Dyadic Adjustment Scale) in regression models. Analyses indicated that patients' depressive symptomatology was associated with patient ratings of general family functioning and couple functioning, while patients' manic symptoms were associated with partners' ratings of the romantic relationship. Partners' total Axis II pathology, but not patients' Axis II pathology, was associated with patient and partner perception of the couple's relationship. These findings highlight the importance of mood and personality pathology to relationship functioning, and represent one of the first investigations to verify the impact of personality pathology on patients' and partners' perceptions of relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and posttraumatic stress disorder in adolescent survivors of childhood cancer.

This study investigated family functioning and relationships between family functioning and posttraumatic stress disorder (PTSD) in adolescent survivors of childhood cancer. To assess family functioning, 144 adolescent cancer survivors 1 to 12 years post–cancer treatment (M = 5.3 years) and their parents completed the Family Assessment Device (FAD). To assess PTSD, adolescents were administered a structured diagnostic interview. Nearly half (47%) of the adolescents, one fourth (25%) of mothers, and one third (30%) of fathers reported poor family functioning, exceeding the clinical cutoff on 4 or more FAD subscales. Families in which the cancer survivor had PTSD (8% of the sample) had poorer functioning than other families in the areas of problem solving, affective responsiveness, and affective involvement. Three fourths of the adolescents with PTSD came from families with categorically poor family functioning. A surprisingly high rate of poor family functioning was reported in these families of adolescent cancer survivors. Adolescents with PTSD were more than 5 times as likely to emerge from a poorly functioning family compared with a well-functioning one. This study provides evidence that family functioning is related to cancer-related posttraumatic reactions in adolescent survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in neuropsychological performance and social functioning in schizophrenia and bipolar disorder.

Objective: To investigate sex differences in neurocognition and social functioning in schizophrenia and bipolar disorder and the possible role of sex as a moderator of this relationship. Method: Participants with schizophrenia (60 women/94 men), bipolar I disorder (55 women/51 men), and healthy controls (158 women/182 men) were assessed with an extensive neuropsychological test battery and a social functioning questionnaire. Results: We found significant main effects of sex for neuropsychological tests (p     

Family functioning in families of children with anxiety disorders.

The authors examined maternal and paternal reports of family functioning and their relationship with child outcomes as well as the association between anxiety and depression in family members and family functioning. Results reveal that maternal and paternal reports of family functioning were both significantly associated with worse child outcomes, including child anxiety disorder (AD) severity, anxiety symptoms, and child global functioning. Maternal and paternal anxiety and depression predicted worse family functioning, whereas child report of anxiety and depression did not. Parents of children with ADs reported significantly worse family functioning and behavior control, but only fathers reported worse problem solving and affective involvement compared with fathers of children with no psychological disorders. Findings from this study suggest that paternal as well as maternal anxiety and depression play a role in worse family functioning in children with ADs and that unhealthier family functioning is associated with worse child outcomes in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence.

The authors examined whether adolescent major depressive disorder (MDD) was associated with difficulties in young adult functioning and whether differences would remain significant after accounting for nonmood disorder, MDD recurrence, functioning in adolescence, or current mood state. A total of 941 participants were assessed twice during adolescence and at age 24. In unadjusted analyses, adolescent MDD was associated with most young adult functioning measures. Associations were not due to interactions with adolescent comorbidity, but differences in global functioning and mental health treatment appeared as a result of MDD recurrence. Accounting for levels of functioning in adolescence or for current depression at age 24 eliminated the remaining associations. The implications of these findings for efforts to prevent MDD in adolescence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning processes and diabetic ketoacidosis in youths with type I diabetes.

Purpose/Objective: To examine relations between episodes of diabetic ketoacidosis (DKA) and parental warmth, parental negativity, and lack of responsibility for diabetes-related tasks in a sample of youths with Type 1 diabetes (T1D). Research Method/Design: 100 youths with T1D and their caregivers, recruited from an inpatient diabetes unit and an outpatient diabetes clinic, participated. Participants completed disease-specific measures of family functioning (e.g., parental warmth, parent and child perceptions of negativity, family responsibility for diabetes regimen), and medical information (e.g., glycosylated hemoglobin and incidences of DKA) was obtained from medical records. Results: Results showed that higher child perceptions of parental warmth and caring related to the regimen were associated with decreased odds of experiencing a DKA episode. Child reports of higher parental negativity about the regimen were associated with increased odds of experiencing a DKA episode. Reports of who in the family was responsible for the diabetes regimen were not related to episodes of DKA. Conclusions/Implications: Findings suggested that family factors play a significant role in the occurrence or absence of DKA in children's long-term management of diabetes. Future intervention efforts should focus on warmth, caring, and negativity when children and their parents are problem solving and communicating about the diabetes regimen. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Induced Mood Change and Dysfunctional Attitudes in Remitted Bipolar I Affective Disorder.

This study investigated the possibility that, in remitted bipolar I affective disorder, dysfunctional attitudes are mood-state dependent. Participants were 120 individuals with remitted bipolar I disorder, remitted unipolar depression, or no history of affective disorder. The Dysfunctional Attitudes Scale (DAS; Weissman, 1979) was completed before and after positive or negative mood challenge. Following mood increase, the bipolar group changed significantly less in DAS total score than did the other 2 groups, and in goal-striving and achievement attitudes relative to the unipolar group. These findings did not provide clear support for the mood-state dependency theory in bipolar disorder, arguing instead for the presence in bipolar I disorder of dysfunctional cognitions that show characteristic resilience in the face of minor positive mood increase. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive functioning in children with attention-deficit/hyperactivity disorder: Combined type with and without a stimulant medication history.

Behavioral and neuropsychological functioning in unmedicated children with attention-deficit/hyperactivity disorder (ADHD) who have a history of medication treatment (Rx) versus those who are treatment na?ve (TN) has, to our knowledge, not been previously studied. Ninety-four children in four groups (ADHD/Rx, ADHD/TN, learning disabilities [LD], and controls) were evaluated, while unmedicated, on measures of achievement, neuropsychological functioning, and behavior. The ADHD/Rx group performed significantly better than the TN group on writing, Stroop interference, and measures of attention, and performed as well as the control group on executive functioning, verbal working memory, and academics. Behaviorally, the ADHD groups showed more difficulty with mood and externalizing behaviors compared with the LD and control groups, with the ADHD/TN performing the most poorly. Findings suggest that the ADHD/Rx group shows better executive and academic functioning even when unmedicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The consequences of depressive affect on functioning in relation to Cluster B personality disorder features.

The authors examined the effects of depressed affect (DA) on functioning measured by behavioral tasks pertaining to abstract reasoning, social functioning, and delay of gratification in relation to Cluster B personality disorder features (PDs) in a clinical sample. Individuals were randomly assigned to either a DA induction or control condition. Consistent with clinical conceptualizations, the authors expected that Cluster B PD symptoms would be related to maladaptive responding (e.g., poorer delay of gratification) when experiencing DA. As hypothesized, many of the relations between the Cluster B PDs and functioning were moderated by DA (e.g., borderline PD was negatively related to abstract reasoning, but only in the DA condition). However, many of the Cluster B PDs symptom counts were related to more adaptive responses in the DA condition (e.g., less aggressive social functioning, better delay of gratification). The authors speculate that individuals with Cluster B PDs may be more likely to respond maladaptively to alternative negative mood states, such as anger and fear. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse.

Studies have shown differences in neuropsychological functioning between groups with posttraumatic stress disorder (PTSD) and control participants. Because individuals with PTSD often have a history of comorbid alcohol abuse, the extent to which an alcohol confound is responsible for these differences remains a concern. The current study compares neuropsychological testing scores in 4 groups of veterans with and without PTSD (PTSD+ and PTSD-, respectively) and with and without a history of alcohol abuse (ETOH+ and ETOH-, respectively): n for PTSD+/ETOH- = 30, n for PTSD+/ETOH- = 37, n for PTSD-/ETOH+ = 30, and n for PTSD-/ETOH- = 31. Results showed that PTSD, when alcohol, educational level, vocabulary, and depression are controlled for, was associated with decreased verbal memory, attention, and processing speed performance. Alcohol abuse history was associated with decreased visual memory performance. By controlling for alcohol and depression, the authors can more conclusively demonstrate that verbal memory and attention differences are associated with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and interactive patterns in the context of infant psychopathology.

Family functioning and mother–infant relational patterns were examined in 38 clinic-referred infants and 34 matched non-referred infants. Referred infants were diagnosed with the Diagnostic Classification for Zero to Three. On the family level, referred families showed significantly lower family functioning in all domains of emotional and instrumental communication, regardless of the specific infant's diagnoses. On the dyadic level, referred mothers were more intrusive and their infants were more withdrawn during dyadic interactions. Clinic-referred mothers reported higher levels of phobia and depression. Global family functioning was predicted by the infant's clinical status, maternal intrusiveness, and maternal psychopathology. Infant mental health clinicians need to address both family level and dyadic level of functioning, regardless of the reason for the infant's referral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality traits and disorder: Predicting prospective patient functioning.

Objective: Decisions about the composition of personality assessment in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM) personality traits and borderline personality disorder (BPD) symptoms for predicting prospective patient functioning. Method: FFM personality traits and BPD features were correlated with one another and predicted 2-, 4-, 6-, 8-, and 10-year psychosocial functioning scores for 362 patients with personality disorders. Results: Traits and symptom domains related significantly and pervasively to one another and to prospective functioning. FFM extraversion and agreeableness tended to be most incrementally predictive of psychosocial functioning across all intervals; cognitive and impulse action features of BPD features incremented FFM traits in some models. Conclusions: These data suggest that BPD symptoms and personality traits are important long-term indicators of clinical functioning that both overlap with and increment one another in clinical predictions. Results support the integration of personality traits and disorders in DSM–V. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimethod investigation of interpersonal functioning in borderline personality disorder.

Even though interpersonal functioning is of great clinical importance for patients with borderline personality disorder (BPD), the comparative validity of different assessment methods for interpersonal dysfunction has not yet been tested. This study examined multiple methods of assessing interpersonal functioning, including self- and other-reports, clinical ratings, electronic diaries, and social cognitions in three groups of psychiatric patients (N = 138): patients with (1) BPD, (2) another personality disorder, and (3) Axis I psychopathology only. Using dominance analysis, we examined the predictive validity of each method in detecting changes in symptom distress and social functioning 6 months later. Across multiple methods, the BPD group often reported higher interpersonal dysfunction scores compared with other groups. Predictive validity results demonstrated that self-report and electronic diary ratings were the most important predictors of distress and social functioning. Our findings suggest that self-report scores and electronic diary ratings have high clinical utility, because these methods appear most sensitive to change. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Development of an empirical typology of African American family functioning.

This study empirically identified types of African American families. Adolescents (N=111) were assessed on family functioning. With cluster analytic methods, 3 types of families were identified. The cohesive-authoritative type was above average on parental education and income, averaged about 2 children, exhibited a high quality of family functioning and high self-esteem in adolescents. The conflictive-authoritarian type had average parental education and income, an average of 2.7 children, exhibited controlling and rigid discipline, and placed a high emphasis on achievement. The defensive-neglectful type was predominately headed by single mothers with below average education and income and averaged about 3 children. Such families displayed chaotic family processes, and adolescents tended to suffer from low self-esteem. The typology exhibited good reliability. The implications of the typology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between formal thought disorder and executive functioning component processes.

In 2 studies, associations between formal thought disorder (FTD) and 2 components of executive functioning, processing of context and interference resolution, were investigated. One study, involving people with schizophrenia, examined associations between performance on processing of context (N-back) and interference resolution (interference in Steinberg probe recognition) tasks and FTD. The second study, involving nonpsychiatric participants, was an analogue study that examined the effects of simulated processing of context (performance of 1-back with distraction) and interference resolution (telling new stories about previously seen pictures) deficits on FTD in a speech production task. In both studies, processing of context deficits predicted FTD. Moreover, in both studies, the effect of processing of context deficits on FTD was especially pronounced when combined with interference resolution deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysregulation of the behavioral activation system in remitted bipolar I disorder.

The current study tests a prediction of the behavioral activation system (BAS) dysregulation theory of bipolar disorder, namely that following high levels of reward or frustration, individuals with bipolar disorder will take longer than will healthy controls to recover to baseline levels of BAS activity. Eighty individuals (40 with bipolar I disorder, currently euthymic; 40 with no history of affective disorder) completed a daily diary over a 28 day period. No differences were found between the 2 groups in terms of the relation among levels of reward or frustration experienced, magnitude of initial response, or time taken to recover. However, examination of the relation between number of previous episodes and time to recover revealed that history of mania was associated with prolonged activation following reward, whereas history of both mania and depression were associated with prolonged recovery following frustration. The findings do not support an association between lifetime diagnosis of bipolar disorder and slow recovery of BAS activity. Nevertheless, they offer tentative support for an association between number of previous episodes and slow recovery of BAS activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)