Results of family-orientated therapy with hospitalized schizophrenics.

Abstract

ME~iBRITISIN 146210 eeme 1965 Pseudoipomia of Bre~ast-ShucksmP~Jit anld LDossett MEDICAL JOURNAL disk. The distribution of pseudolipomas by age-groups emphasizes the importance of the thickness of the breast disk. The pseudolipomas were found in four pre-menopausal and 14 post-menopausal women with cancer, a ratio of 1 to 3.5. This ratio is far higher than the ratio of 1 to 1.8 for the pre-menopausal to post-menopausal distribution of cancer found by Bonser et al. (1961, p. 351) in a series of 220 unselected breast cancers. The breast substance is 2 to 4 cm. thick in the pre-menopausal woman, but after the menopause it is often reduced to a thin sheet, less than 0.5 cm. in thickness. Clearly the cancer which starts in the thin postmenopausal breast can more readily affect the overlying fibrous septa.Although carcinomatous infiltration of the fibrous septa has been observed in this series it plays little part in the production of the pseudolipoma. When it occurs it produces firm adherence of the skin to the tumour.The oedema produced by the chronic inflammatory reaction in and around the expanded cancers seems the likely explanation of the production of the overlying pseudolipoma. When oedema is produced by severe or acute inflammation it may be so intense that oedema of the skin results.A swelling which was sufficiently defined to be easily felt under the pseudolipoma was found in 11 out of 18 cases, but a confident diagnosis of cancer could not have been made from physical examination except in three of these where the overlying skin was adherent. When an indefinite swelling was present under the pseudolipoma the cancer could have been entirely missed, and there were three patients with cancer in whom the only physical sign was the pseudolipoma. Conversely, in one of the patients in whom duct ectasia had produced a pseudolipoma involving nearly the whole of the upper part of the breast a definite swelling was palpated near the nipple and hard axillary nodes were felt.The finding of a pseudolipoma must be regarded as a signal that cancer is likely to be present. If the pseudolipoma is recognized directly over a readily palpable swelling and is symmetrically placed over that swelling, then the lesion is a cancer, and whatever treatment is preferred may be instituted. J., 1965, 2, 1462-1465 This is a report on the results of conjoint family and milieu therapy with hospitalized schizophrenics at two mental hospitals in the Greater London area. During the past 10 years the internal family milieu of schizophrenics has been intensively studied by workers in the United States-for example, Bateson et al. (1956), Lidz et al. (1958), and Wynne et al. (1958)-and by ourselves (Laing and Esterson, 1964. These studies, which have shown how frequently the person diagnosed as schizophrenic is part of a network of extremely disturbed and disturbing patterns of communication, have important implications for prevention, treatment, and aftercare.As a result of this work and that of psychotherapists with experience of prolo...

Family intervention for schizophrenia

“…Outcomes: no usable data. Barrowclough 1999 Allocation: randomised.Participants: families of people with schizophrenia.Intervention: family support versus any appropriate psychosocial intervention and not specifically randomised to family intervention Barrowclough 2002 Allocation: randomised.Participants: people with schizophrenia who are substance misusers.Intervention: routine care versus routine care and integrated psychological and psychosocial treatment programme Birchwood 1992 Allocation: part sequential, part randomised.Participants: families of people with schizophrenia.Intervention: group education versus postal education versus video education - each with/without homework - fewer than 5 sessions.Outcomes: no usable data. Brooker 1992 Allocation: not randomised, case series. Byalin 1985 Allocation: randomised.Participants: people with schizophrenia.Interventions: observational evaluation of treatment refractory patients and a stable group of chronically ill people with schizophrenia.Outcomes: no usable data. Cozolino 1988 Allocation: randomised, stratified for EE.Participants: families of people with schizophrenia or schizoaffective disorder.Intervention: 3-hour family education session (fewer than 5 sessions) versus standard care.Outcomes: part of cohort did not receive FI because of participation in another ongoing study - no separate data available Durell 1968 Allocation: randomised.Participants: people with schizophrenia.Intervention: 3-hour family education session versus standard care - fewer than 5 sessions. Outcomes: no usable data. Durr 1996 Allocation: randomised.Participants: people with schizophrenia.Intervention: psychoeducational treatment with standard care versus psychoeducational treatment with prophylactic premedication Dyck 2000 Allocation: randomised by cohort.Participants: families of people with schizophrenia or schizoaffective disorder.Intervention: group family treatment versus standard care.Outcomes: no usable data because no intra class correlation coefficients given Esterson 1965 Allocation: not randomised, case series. Fowler 2002 Allocation: randomised.Parti...…”

The Effect of Family Interventions on Relapse and Rehospitalization in Schizophrenia--A Meta-analysis

“…As a result, various family intervention programs were developed, such as family therapy in a single-family setting (Esterson et al 1965; Goldstein et al 1978; Falloon et al 1984; Tarrier et al 1988; Hogarty et al 1991) or in a multifamily setting (McFarlane et al 1995 a , 1995 b ), psychoeducational relatives’ groups (Leff et al 1990; Posner et al 1992; Bäuml et al 1996), educational lectures for relatives (Smith and Birchwood 1987; Tarrier et al 1988; Canive et al 1993), counseling groups for relatives (Vaughan et al 1992; Szmukler et al 1996; Buchkremer et al 1997), and group therapy for relatives (Schindler 1958; Köttgen et al 1984; Lewandowski and Buchkremer 1988). Most of these interventions for relatives can be subsumed under the category of “psychoeducation” or at least contain psychoeducation as an essential component.…”

The Efficacy of an Information Group Intervention On Relatives of Schizophrenics

“…Despite the amount of epistemological discussion devoted to the various models of family intervention, most of the studies so far developed, controlled (Langsley et al 1969;Goldstein & Rodnick, 1975), or non-controlled (Jackson & Weakland, 1961;Brown et al 1962;1966;Esterson et al 1965), tend to agree upon the same point: family intervention appears to produce far greater improvement with schizophrenic patients than the mere individual treatment.…”