Family Members In Treatment Research Articles

Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review.

Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full-text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.

Non-diagnostic autopsy findings in sudden unexplained death victims

BackgroundSeveral inherited cardiac diseases may lead to sudden cardiac death (SCD) a devastating event in the families. It is crucial to establish a post mortem diagnosis to facilitate relevant work-up and treatment of family members. Sudden unexplained death (SUD) victims constitute roughly one third of all SCD cases in Denmark.MethodsThis was a single center, retrospective study investigating SUD cases. Victims who died unexplained due to suspected or confirmed cardiac disease were consecutively referred to a third line referral center established in 2005. All autopsy reports were investigated. Victims were divided into two groups: non-diagnostic cardiac findings and normal cardiac findings. None of the included victims had findings consistent with a diagnosis based on existing criteria.ResultsIn total, 99 SUD cases were referred. The mean age of the victims was 37 years (range 0–62 years, 75% males). A total of 14 (14%) victims had a cardiovascular diagnosis pre-mortem. Thirty-seven cases had normal cardiac findings and non-diagnostic cardiac findings were found in 62 cases (63%). The five most common findings included ventricular hypertrophy and/or enlarged heart (n = 35, 35%), coronary atheromatosis (n = 31, 31%), myocardial fibrosis (n = 19, 19%), dilated chambers (n = 7, 7%) and myocardial inflammation (n = 5, 5%).ConclusionOne third of SUD victims had normal cardiac findings and non-diagnostic cardiac findings were seen in almost two thirds of the SUD victims. These non-diagnostic findings may be precursors or early markers for underlying structural cardiac disorders or may be innocent bystanders in some cases. Further studies and improved post-mortem examination methods are needed for optimization of diagnostics in SUD.

STRENGTHENING LATE-LIFE DEPRESSION COLLABORATIVE CARE THROUGH COMMUNITY ENGAGEMENT: CARE PARTNERS INITIATIVE

Despite the availability of effective treatments for late life depression, many older adults with depression either do not access or fully engage in treatment. The goal of this study was to examine the feasibility and two-year outcomes from an Archstone Foundation funded Care Partners Initiative to strengthen depression care for adults 65 years of age and older. Seven sites throughout California implemented evidence-based collaborative care through partnerships between primary care organizations, community-based organizations (CBOs), and families of older adults with depression. Evaluation used a mixed-methods approach incorporating both qualitative and quantitative data. Of the seven sites, six formed partnerships between primary care clinics and CBOs and one site only focused on engaging family members in treatment. In the first two years, 274 patients were enrolled and rates of depression improvement were comparable to prior depression care effectiveness trials. Overall, 49% of patients at CBO sites interacted 3+ times with CBO staff/clinicians, while at the family site, 79% of patients had 3+ contacts including a family member. Using data from key informant interviews, focus groups, and site progress documents, seven core components were identified that facilitated successful implementation and delivery of partnered collaborative care, including three foundational components: strong stakeholder buy-in, effective patient engagement, and the promotion of depression treatment as a core value across organizations. Multiple complexities of partnering between primary care clinics and CBOs or families were identified. Challenges and lessons learned from this initiative will also be discussed.

How social capital influences performance in family firms: the moderating role of nepotism

Although a large body of research has explored how organizational social capital (OSC) benefits organizational performance, results are not conclusive. Consequently, scholars have called for more research on the factors that may moderate the effects of OSC on organizational performance. We address this research gap and examine the role of nepotism, which is the preferential treatment of family members in human resource management (HRM)-related decisions, such as development or rewards, in the relationship between OSC and organizational performance. Using a sample of 77 family firms in Switzerland, we found that the relationship between OSC and organizational performance is stronger in firms with higher nepotism. This research contributes to the HRM literature by exploring how the preferential treatment of family members in HRM-related decisions (i.e. greater nepotism) can provide benefits to family firms in terms of the impact of OSC on organizational performance.

P6500Genetics links abdominal and thoracic aorta aneurysm

Abstract Introduction Familial disease, with a genetic cause, occurs in at least 20–30% of the families of patients with an aortic aneurysm. In these families there is an increased risk for relatives. Therefor family screening is recommended around the age of 50–60 years for first degree relatives of patients with an abdominal aneurysm (AAA) and relatives of patients with thoracic aorta aneurysms (TAA). However current guidelines do not specify the extend of aorta screening for relatives of patients with AAA and patients with TAA. Current practice is that first degree relatives of AAA patients are offered abdominal echo screening for AAA and relatives of TAA patients cardiologic echo for TAAA. Although co- occurrence of AAA with TAAA in rare genetic disease is well known, for other familial aneurysm disease, the frequency of the co-occurrence of AAA and TAAA has not been established. Purpose To improve family screening for familial aneurysm, and identify the role of underlying genetic defects. Methods To determine the genetics of AAA, whole exome sequencing and CT family screening of the complete aorta was performed in 391 families with familial aneurysm. These families are nested in a patient cohort ascertained form unselected consecutively diagnosed AAA patients visiting the Vascular Surgery Clinic at the our MC. Results In 391 families, 360 relatives had a dilated aorta. The spectrum of aortic features in the relatives included 210 (58%) relatives with AAA, 102 (28%) relatives with TAA. Co-occurrence of AAA and TAA was noted in 41 (11%) relatives. In addition 66 (18%) and 79 (22%) had a dilation in the arteria iliaca communis sinistra resp. dextra. In 18 families pathogenic mutations in 11 aneurysm genes were detected. Conclusion To reduce underdiagnoses of relatives of AAA patients, CT screening of the total aorta and the iliac arteries is the method of choice, and should replace echo screening of specific parts of the aorta in relatives. Updating the guidelines for family screening for aortic aneurysms is needed to improve early detection and treatment of family members with aorta dilatations. Acknowledgement/Funding Stichting Lijf en Leven

Working with the parents and families of children with developmental language disorders: An international perspective

BackgroundThe relationship between parental input and child language development has had a complex history. It has become clear that indirect parent training for the parents of children with delayed language development is an important feature of interventions offered by speech and language therapists in the anglophone countries. Yet we know less about how this type of approach is realised in other countries. MethodsIn this paper we report the results of a survey of practice undertaken as part of the work of COST Action IS1406, a European Union (EU) funded research network. The focus of this paper is specifically on parent-related questions and responses referring to children under the age of twelve. The survey was devised by members of the Action and circulated electronically during the summer of 2017. In all, 4024 practitioners responded from 60 countries, the majority of whom came from EU member countries. FindingsRespondents to the survey indicated that indirect therapy is commonly carried out via the parent in the early years and via teachers later. A range of professional groups, in addition to speech and language therapists, is likely to adopt this approach; including teachers, pedagogues and psychologists. A variety of interventions is reported, some of which have a reasonable evidence-base underpinning them. It is interesting to see the widespread involvement of fathers and other family members in interventions. Finally, the fact that practitioner characteristics (age, experience, location of practice etc.) are not related to the use of indirect techniques points to the universal recognition of the value of these approaches. ConclusionsDespite the very different traditions in the practice of intervention across countries, there is clearly a widespread recognition of the importance of indirect approaches to intervention and specifically those focusing on parents. The mixture of family members being involved in interventions is a very promising indication of the role sharing commonly associated with the contemporary family. Yet the number of specific intervention approaches identified is relatively small given the number of respondents. There is a need for a better understanding of what exactly practitioners are doing when they involve parents in intervention or carry out parent-child interaction interventions and how well these interventions work in routine practice. This also has implications for the application of evidence-based practice and the precise nature of the interventions concerned (advice to parents, video interaction training etc.).

Necessidades dos cuidadores de pacientes vítimas de Acidente Vascular Encefálico após a alta hospitalar

Objetivou-se descrever as necessidades dos cuidadores familiares de pessoas vítimas de acidente vascular encefálico após a alta hospitalar. Pesquisa qualitativa do tipo convergente assistencial, realizada com quatro famílias e operacionalizada por visitas domiciliares de acordo com a necessidade de cada família. Os dados foram coletados por meio de entrevistas abertas e observação participante, transcritos e submetidos à análise de conteúdo, modalidade temática. Os achados foram organizados em duas categorias temáticas, sendo elas: Descobrindo a necessidade de dar continuidade ao tratamento do familiar em casa e; O apoio social à família no enfrentamento do adoecimento.A partir da realidade observada, foi possível identificar dificuldades e orientar as famílias no domicílio, auxiliando-as em suas adaptações logo após alta hospitalar, além de promover a recuperação da pessoa adoecida e a qualidade de vida do cuidador familiar.

Suicidal Risk and Management in Borderline Personality Disorder

This article provides an update from Goodman and colleagues’ 2012 article “Suicidal Risk and Management in Borderline Personality Disorder.” This review will cover the importance of assessing suicide risk in Borderline Personality Disorder (BPD), the differences in “No-Suicide Contracts” versus “Safety Plans,” and treatment options for suicidality in BPD. While there have been developments in treatments for suicide in BPD, up to 84% of patients with BPD display suicidal behaviors and have an average of at least three suicide attempts in their lifetime. Since 2012 limited research has focused on assessment of suicide risk or prevention for those with BPD and more research has focused on treatment. Further research has examined several different types of psychotherapies that have emerged to treat suicidality in patients with BPD, which are discussed including Dialectical Behavioral-Therapy, Collaborative Assessment and Management of Suicidality Treatment, Abandonment Psychotherapy, Mentalization-Based Therapy, and Project Life Force have emerged since the 2012 review. The efficacy of involving family members in treatment and use of medication when treating this population are also reviewed. This literature search suggests there are several well-established modifiable and non-modifiable risk factors for suicide across diagnoses, but there is a paucity of research on BPD specific risk factors or protective factors when treating suicide in BPD patients, which may be helpful to better understand treatment of suicidality in this population. Keywords: Borderline personality disorder, BPD, Suicide, Risk assessment

Feasibility of analysis of the SCN5A gene in paraffin embedded samples in sudden infant death cases at the Pretoria Medico-Legal Laboratory, South Africa.

To determine variations in the SCN5A gene linked to inherited cardiac arrhythmogenic disorders in sudden, unexplained infant death (SUID) cases examined at the Pretoria Medico-Legal Laboratory, South Africa. A retrospective study was conducted on SUID cases and controls, analyzing DNA extracted from archived formalin-fixed, paraffin-embedded (FFPE) myocardial tissue samples as well as blood samples. A total of 48 FFPE tissue samples (cases), 10 control FFPE tissue samples and nine control blood samples were included. DNA extracted from all samples was used to test for variations in the SCN5A gene by using high resolution melt (HRM) real-time PCR and sequencing. Genetic analysis showed 31 different single nucleotide variants in the entire study population (n = 67). Five previously reported variants of known pathogenic significance, and 14 variants of benign clinical significance, were identified. The study found 12 different variants in the cases that were not published in any database or literature and were considered novel. Of these novel variants, two were predicted as "probably damaging" with a high level of certainty (found in four case samples), one (identified in another case sample) was predicted to be "possibly damaging" with a 50% chance of being disease-causing, and nine were predicted to be benign. This study shows the significant added value of using genetic testing in determining the cause of death in South African SUID cases. Considering the high heritability of these arrhythmic disorders, post mortem genetic testing could play an important role in the understanding of the pathogenesis thereof and could also aid in the diagnosis and treatment of family members at risk, ultimately preventing similar future cases.

Using a genetic test result in the care of family members: how does the duty of confidentiality apply?

The use of genetic and genomic testing is becoming more widespread in healthcare and more inherited explanations for family history of diseases or conditions are being uncovered. Currently, relevant genetic information is not always used in the care of family members who might benefit from it, because of health professionals’ fears of inappropriately breaching another family member’s confidence. Such examples are likely to increase as testing possibilities expand. Here we present the case for use of familial information in the care and treatment of family members. We argue that whilst a clinical diagnosis in person A is confidential, the discovery of a familial factor that led to this diagnosis should be available for use in depersonalised form by health professionals to inform the testing and clinical care of other family members. The possibility of such use should be made clear in clinical practice at the time of initial testing, but should not require consent from the person in whom the familial factor was first identified. We call for further debate on these questions in the wake of high profile non-disclosure of genetic information cases, and forthcoming Data Protection legislation changes.

Providers' Involvement of Parents, Families, and Family Dynamics in Youth Weight Management Programs.

Family-based interventions are the current standard for the treatment of pediatric obesity, yet the details of how providers are involving family members, and the barriers to family involvement, are largely unknown. The objective of this study is to describe how providers in pediatric weight management (PWM) involve family members, identify barriers to family involvement, and how they address challenging family dynamics. A cross-sectional survey was administered to PWM centers/clinics and their providers in the United States and Canada. Analyses included descriptive statistics at the participant (N = 71) and clinic/center (N = 47) levels. Providers indicated that they assessed patients and parents’ perspectives, not other family members, motivation, weight/medical history, dietary and activity behaviors, goals, and barriers. Providers also reported that they asked patients’ perspectives about their parents’ aforementioned behaviors, and siblings’ dietary, activity, and sedentary/screen time behaviors, and weight/medical history. Providers reported that the balance between the patient and parent changed as children aged, with more focus given to the child, and less to the parent, as the child grew older. The most frequent barrier to involving family members in treatment included challenging family dynamics. The most challenging family dynamics were divorce/separation and parent-child conflicts. Providers often refer to and rely on mental/behavioral health providers to address barriers to family involvement and challenging family dynamics. Further research is needed to determine adequate provider training and comfort in dealing with family dynamics in treatment, and ways to mitigate barriers to involving families in PWM.

Development of a mobile app for family members of Veterans with PTSD: identifying needs and modifiable factors associated with burden, depression, and anxiety

ABSTRACTFamily members of Veterans with posttraumatic stress disorder (PTSD) face high levels of burden that are poorly addressed by existing mental health services. Widely distributed mobile interventions could play a role in addressing these unmet needs. The purpose of this study was to characterize caregiver burden in those seeking a mobile app for self-management of stress symptoms and to develop a model to guide mobile interventions for family members. Those living with a Veteran with PTSD (n = 212) and interested in using a mobile intervention agreed to participate. The majority reported moderate-to-severe levels of depression (60%) and/or caregiver burden (59%). Relationship quality, communication, and self-efficacy for caregiving were the strongest predictors of negative outcomes (p’s < .001), and qualitative results identified several additional unmet needs (e.g. relationship concerns, safety concerns). This study identifies potential mechanisms by which a mobile app could improve family functioning in the context of PTSD.

術後の心身医学的諸問題 : 家族の治療参加をめぐって( 術後の心身医学的諸問題)

術後の心身医学的諸問題 : 家族の治療参加をめぐって( 術後の心身医学的諸問題)

Treatment of alcohol-related disorders in children and adolescents: Age-specific treatment recommendations from the new interdisciplinary S3-guideline

Alcohol-related disorders typically have an early onset. However, current treatment provisions often fail to address developmental aspects adequately. Recently, the new evidence- and interdisciplinary consensus-based German S3-guideline (National Clinical Practice Guideline) was established for the screening, diagnosis, and treatment of alcohol-related disorders in young patients. For the first time it includes population-specific recommendations. For this new S3-guideline, 23 source guidelines, 28 systematic reviews, and 2,213 study reports were analyzed. An interdisciplinary consensus conference devised 174 recommendations with 14 specific recommendations for children and adolescents. Depending on the quality of evidence, they issued “must,” “should,” and “can” recommendations or a “clinical consensus point (CCP).“ For the psychotherapeutic treatment of children and adolescents with alcohol-related disorders, a “must” recommendation was devised for motivational interviewing, cognitive behavior therapy, and inclusion of family members in treatment. Recommendations for family-based therapies are heterogeneous. For psychosocial therapies (psychoeducation, parent counseling, ergotherapy, also hospital schools) a CCP was devised. Concerning pharmacological treatment, the evidence base was insufficient; only for treating comorbid disorders (ADHS) could a CCP be derived. As to differential indications, elevated risks for suicide, for treatment dropout, and for delinquency influenced by copatients should be considered (CCP). Numerous population-specific recommendations have been issued for the treatment of alcohol-related disorders in youths. However, urgent research requirements have been identified especially in medical drug treatment.

Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa

There have been few randomized clinical trials (RCTs) for adolescents with anorexia nervosa (AN). Most of these posit that involving all family members in treatment supports favorable outcomes. However, at least 2 RCTs suggest that separate parent and adolescent sessions may be just as effective as conjoint treatment. This study compared the relative efficacy of family-based treatment (FBT) and parent-focused treatment (PFT). In PFT, the therapist meets with the parents only, while a nurse monitors the patient. Participants (N= 107) aged 12 to 18 years and meeting DSM 4(th)Edition criteria for AN or partial AN were randomized to either FBT or PFT. Participants were assessed at baseline, end of treatment (EOT), and at 6 and 12 months posttreatment. Treatments comprised 18 outpatient sessions over 6 months. The primary outcome was remission, defined as≥95% of median body mass index and Eating Disorder Examination Global Score within 1 SD of community norms. Remission was higher in PFT than in FBT at EOT (43% versus 22%; p= .016, odds ratio [OR]= 3.03, 95% CI= 1.23-7.46), but did not differ statistically at 6-month (PFT 39% versus FBT 22%; p=.053, OR= 2.48, CI= 0.989-6.22), or 12-month (PFT37% versus FBT 29%; p= .444, OR= 1.39, 95% CI= 0.60-3.21) follow-up. Several treatment effect moderators of primary outcome were identified. At EOT, PFT was more efficacious than FBT in bringing about remission in adolescents with AN. However, differences in remission rates between PFT and FBT at follow-up were not statistically significant. A Randomised Controlled Trial of Two Forms of Family-Based Treatment and the Effect on Percent Ideal Body Weight and Eating Disorders Symptoms in Adolescent Anorexia Nervosa; http://www.anzctr.org.au/; ACTRN12610000216011.

Effects of Group Psychoeducational Intervention for Family Members of People with Schizophrenia Spectrum Disorders: Results on Family Cohesion, Caregiver Burden, and Caregiver Depressive Symptoms

:Families constitute a primary source of care for people with severe mental illness but often face substantial difficulties in fulfilling their role. Family psychoeducational interventions have been developed to address these problems with established efficacy and effectiveness. Among the variants of family psychoeducation, the relatives group is particularly understudied internationally, and in Greece no study has explored its effectiveness. The present study endeavors to assess the effectiveness of relatives-group psychoeducation in improving family cohesion, alleviating caregivers’ burdens, and reducing depressive symptomatology in relatives of those suffering from schizophrenia spectrum disorders. In total, 131 people took part in the study, 83 received intervention, and 48 were assigned to the control (treatment as usual). The research instrument consisted of the Family Ritual Scale, the Family Burden Scale, and CES-D. A self-constructed questionnaire was used to collect the sociodemographic data of relatives and patients as well as patient clinical profiles. The research instrument was administered in a face-to-face interview at three time points: baseline, completion of intervention, and one-year follow-up. The results demonstrated that psychoeducation had a beneficial effect for family cohesion, global family burden, objective family burden, and relatives’ depressive symptomatology throughout the study period. A nonsignificant finding was observed for subjective family burdens. Interestingly, linear regression models revealed that relatives of people who had suffered from schizophrenia spectrum disorders for more than ten years displayed the greatest improvement when attending a psychoeducational group. Psychoeducation constitutes a valuable nonstigmatizing intervention that empowers relatives of people with severe mental illness and enables them to cope effectively with the illness.

Siblings of individuals with severe mental illness

Purpose – The importance of providing information, support and interventions for family members and carers of people who have severe mental illness (SMI) has garnered increasing attention in recent years. However, research to date has primarily focused on parents; the purpose of this paper is to review the literature investigating the experiences of siblings of individuals who have SMI. Design/methodology/approach – A literature review was undertaken to summarise the empirical data regarding the experiences and needs of siblings, and their potential contribution to supporting their siblings’ recovery journey. Findings – Sibling views, experiences and needs have thus far been little explored. Yet siblings often make significant contributions to their brother's/sister's care and social and emotional well-being, and their support can positively shape the recovery trajectory. This review finds that siblings require information and support for two reasons: to maintain their own well-being, and to be able to best support their sibling with SMI and the family as a whole. Several implications for clinical practice, workforce development and research are outlined. Originality/value – This paper provides a timely review of the literature to enhance awareness of the needs and experiences of siblings for health and social care professionals. Examples of good practice are proposed for statutory and voluntary service settings.

Estratégias para envolvimento parental em fisioterapia neuropediátrica: uma proposta interdisciplinar

Em diversos contextos, amplas evidências mostram que a participação de familiares em intervenções com crianças é de suma importância. No entanto, nos estudos brasileiros na área de fisioterapia, existem poucas informações acerca da eficácia de diferentes estratégias para promover envolvimento parental, ainda que no atendimento a crianças com distúrbios neurológicos, este envolvimento também seja de fundamental importância. Nesse trabalho, identifica-se formas de envolver pais, relatadas nas áreas de Educação Infantil, Educação Especial, Educação Musical e Psicologia (Treinamento de Habilidades Sociais). Discute-se a possibilidade da adaptação das estratégias encontradas para contextos de intervenção fisioterapêutica, para que os profissionais e gestores de instituições de reabilitação ampliem o uso de mecanismos para promover a participação da família, visando maximizar os resultados na reabilitação de crianças. Em pesquisas futuras, seria importante avaliar a viabilidade e eficácia da adoção dessas estratégias, na área de fisioterapia.

Piloting a Cognitive-Behavioral Intervention for Family Members Living With Individuals With Severe Mental Disorders

Living with a person who experiences mental health problems can have an adverse effect on well-being. The aim of this study is to evaluate the effectiveness of a psychological treatment for relatives of people with mental health problems, byusing an interrupted time-series design. The sample comprised 20 individuals, who completed assessment measures at baseline and 6 months later. Sixteen of these participants then received the treatment and were assessed again at the end of the program. There were no significant changes in outcomes between the baseline and the second assessments done 6 months later and there were significant improvements in well-being following treatment The program shows promise as a treatment for relatives of people with mental health problems and therefore warrants further evaluation in more controlled studies.

Integrated primary care: A systematic review of program characteristics.

The integration of behavioral health services into primary care medical settings may be part of the solution to the fragmented health care system currently found in the United States. Although integrated primary care (IPC) is implemented in various locations across the United States, little information is available about how IPC is specifically practiced. Using a systematic review design, we extracted data from 76 articles to examine 6 categories of IPC program characteristics, including collaboration practices (e.g., shared decision-making, written communication, hallway conversations), program models, behavioral health interventions, behavioral health training and supervision, behavioral health provider type, and setting. Findings show that most IPC programs include psychoeducation, medication, follow-up contact, psychotherapy, and at least 1 care management strategy as part of treatment. Fewer than half of researchers report communication between providers, and even fewer report collaboration as a "shared decision making process." A third of researchers report training and/or supervising behavioral health providers to work in an IPC program, and a fourth report recruiting nurses as behavioral health providers. Of all the studies, family-based interventions were used in 1. We recommend that future researchers report more information about collaboration processes as well as training and supervision of behavioral health providers. We also recommend that researchers develop IPC programs that involve family members in treatment and better implement theory into future IPC programs to support conceptualization and replication of IPC program models.