Eliot H. Rodnick

Bio: Eliot H. Rodnick is an academic researcher from University of California, Los Angeles. The author has contributed to research in topics: Social influence & Schizophrenia (object-oriented programming). The author has an hindex of 14, co-authored 20 publications receiving 1220 citations.

Drug and Family Therapy in the Aftercare of Acute Schizophrenics

Abstract: After a brief inpatient hospitalization, 104 acute, young schizophrenics, stratified by premorbid adjustment, were randomly assigned to one of four aftercare conditions for a six-week controlled trial. Conditions involved one of two dose levels of fluphenazine enanthate (1 ml or 0.25 ml) and presence or absence of crisis-oriented family therapy. Relapses during the six-week period and at six-month follow-up were least in patients who received both high-dose and family therapy (0%) and greatest (48%) in the low-dose-no therapy group. Brief Psychiatric Rating Scale symptom ratings disclosed a significant family therapy effect at six weeks that was sustained at six months only for therapy patients originally receiving the high drug dose. Numerous interactions were found between premorbid adjustment status and response to the two treatment conditions.

Parental Communication Deviance and Affective Style Predictors of Subsequent Schizophrenia Spectrum Disorders in Vulnerable Adolescents

Abstract: \s=b\In an attempt to assess the contributory role of family factors to the development of schizophrenia-like disorders, measures of parental communication deviance and affective styles of communication were obtained for a sample of families of disturbed but nonpsychotic adolescents. Outcome was assessed five years later. Absence of a pathologic affective style was associated with a benign outcome, but neither parental variable alone allowed precise identification of the schizophrenia-spectrum cases. However, an index using a combination of both variables was statistically predictive of subsequent psychiatric status at follow-up. Thus, adolescents whose parents had both a pathologic affective style of communication and a high level of communication deviance had schizophrenia-like disorders develop in young adulthood. Adolescents of parents who had both lower levels of communication deviance and a benign affective style had offspring with healthier outcomes. (Arch Gen Psychiatry 1981;38:679-685) Disordered family relationships may be an important factor in the development of schizophrenia, but meaningful empirical evidence of the process is difficult to obtain. Most of the evidence comes from cross-sectional studies in which families with a diagnosed schizophrenic offspring are contrasted with families with psychiatrically disturbed or normal offspring. Such designs, of course, cannot separate antecedent family patterns from accom¬ modations to the presence of a psychotic offspring. We report a prospective longitudinal study of family relation¬ ships to examine whether specific disordered patterns of intrafamilial relationships antedate the actual onset of schizophrenic and schizophrenia-like symptoms in the offspring. There are several recent reviews of the cross-sectional studies.'-' Those measuring communication disorder have shown the most consistent results. In particular, the Singer and Wynne index of parental communication deviance (CD) has identified parents of schizophrenics and border¬ line schizophrenics in diverse measurement contexts.410 This index reflects an inability of the parent or parents to establish and maintain a shared focus of attention during transactions with another person. The theory maintains that the extent to which parents fail to communicate effectively reflects the extent to which the child will become confused, lost, distressed, and more vulnerable to subsequent breakdown.1 Such findings have been repli¬ cated in several cross-sectional studies, although in one study" the parental-group separation was less sharp than in the Singer-Wynne studies. The implication of these cross-sectional studies is that communication deviance (CD) may play a contributory role in the development of schizophrenia. However, before any etiological role is considered, it is necessary to demonstrate that this parental attribute is present substantially before the onset of prodromal or actual clinical features of a schizophrenic disorder. A basic goal of the present study is to determine whether parental CD does indeed antedate the onset of schizophrenia and related disorders. The subjects in our study were first studied in midadolescence, at a time when all were disturbed but when none showed any prodromal or clinical signs of schizophrenic disor¬ ders. While most of the cross-sectional studies have focused on issues of the family's potential role in the etiology of schizophrenia, Vaughn and Leff,'- building on the work of Brown et al,'3 reported that the course of the disorder may be affected by the affective tone or expressed emotion (EE) of the family environment to which the patient returns after hospitalization. Expressed emotion is a con¬ struct that includes negative attitudes directed toward the target patient, including criticism, hostility, and overinvolvement; the likelihood of relapse is greater when patients return to high-EE environments.

The family's contribution to the etiology of schizophrenia: current status.

Abstract: The concept that disordered family relationships may be a significant factor in the development of schizophrenia is not new. Reports of clinicians in the early part of the 20th century were replete with observations of disturbances in the familial environment and of psychopathology in the relatives of their patients (Pollack, Malzberg, and Fuller 1939, Sullivan 1925, and Terry and Rennie 1938). The psychoanalytic treatment of schizophrenic patients revealed specific patterns of feelings and associations about family relationships that, as in theories of neurosis, were believed to be etiologically related to the development of schizophrenia. In particular, the mother-child relationship was hypothesized to be disordered (Arieti 1955), and early clinical studies of mothers of schizophrenics (Gerard and Siegal 1950, Lidz and Lidz 1949, Prout and White 1950, Riechard and Tillman 1950, and Tietze 1959) seemed to confirm this hypothesis of the schizophrenogenic mother, as it was subsequently termed. Further research in the early 1950's broadened the concept of parental influence to include the father as well. But with the appearance of a more sophisticated "systems" view of family relationships in the late 1950's and early 1960's, notions of single parent-child relationships were considered oversimplified conceptualizations, and emphasis was placed instead on disturbances in the total family system.

Premorbid Adjustment, Paranoid Diagnosis, and Remission: Acute Schizophrenics Treated in a Community Mental Health Center

Abstract: Eighty acute schizophrenics, classified as having good or poor premorbid adjustment and paranoid or nonparanoid symptoms, were followed from admission to a crisis-oriented inpatient program until one year after discharge to determine the predictive relationship between premorbid or paranoid status and psychopathological condition, posthospital treatment, and community adjustment.

Resilience and development: Contributions from the study of children who overcome adversity

Abstract: This article reviews the research on resilience in order to delineate its significance and potential for understanding normal development. Resilience refers to the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Three resilience phenomena are reviewed: (a) good outcomes in high-risk children, (b) sustained competence in children under stress, and (c) recovery from trauma. It is concluded that human psychological development is highly buffered and that long-lasting consequences of adversity usually are associated with either organic damage or severe interference in the normative protective processes embedded in the caregiving system. Children who experience chronic adversity fare better or recover more successfully when they have a positive relationship with a competent adult, they are good learners and problem-solvers, they are engaging to other people, and they have areas of competence and perceived efficacy valued by self or society. Future studies of resilience will need to focus on processes that facilitate adaptation. Such studies have the potential to illuminate the range and self-righting properties of, constraints on, and linkages among different aspects of cognitive, emotional, and social development.

A Heuristic Vulnerability/Stress Model of Schizophrenic Episodes

Abstract: A tentative model of schizophrenic psychotic episodes is presented, based on the evidence that certain characteristics of individuals may serve as vulnerability factors and that environmental stressors may precipitate psychotic periods in vulnerable individuals. Certain information-processing deficits, autonomic reactivity anomalies, and social competence and coping limitations are viewed as potential vulnerability factors. Stressors in the form of discrete life events as well as the prevailing level of social environmental stress are seen as factors that interact with preexisting vulnerability characteristics to produce vicious circles, which lead, in turn, to psychotic episodes. A distinction among stable vulnerability indicators, mediating vulnerability factors, and episode indicators is suggested to differentiate types of abnormalities that characterize individuals prone to or manifesting schizophrenic disorder. Some major areas of unresolved questions in relation to this view of schizophrenic psychotic episodes are discussed.

Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a controlled study on relapse and expressed emotion.

Abstract: • Relapse rates averaging 41% in the first year after discharge among schizophrenic patients receiving maintenance neuroleptic treatment led to the development of two disorderrelevant treatments: a patient-centered behavioral treatment and a psychoeducational family treatment. Following hospital admission, 103 patients residing in high expressed emotion (EE) households who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder were randomly assigned to a two-year aftercare study of (1) family treatment and medication, (2) social skills training and medication, (3) their combination, or (4) a drug-treated condition. First-year relapse rates among those exposed to treatment demonstrate a main effect for family treatment (19%), a main effect for social skills training (20%), and an additive effect for the combined conditions (0%) relative to controls (41%). Effects are explained, in part, by the absence of relapse in any household that changed from high to low EE. Only the combination of treatment sustains a remission in households that remain high in EE. Continuing study, however, suggests a delay of relapse rather than prevention.

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

Abstract: Background. While there is a growing body of evidence on the efficacy of psychological interventions for schizophrenia, this meta-analysis improves upon previous systematic and meta-analytical reviews by including a wider range of randomized controlled trials and providing comparisons against both standard care and other active interventions. Method. Literature searches identified randomized controlled trials of four types of psychological interventions: family intervention, cognitive behavioural therapy (CBT), social skills training and cognitive remediation. These were then subjected to meta-analysis on a variety of outcome measures. This paper presents results relating to the first two. Results. Family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication compliance. CBT produced higher rates of 'important improvement' in mental state and demonstrated positive effects on continuous measures of mental state at follow-up. CBT also seems to be associated with low drop-out rates. Conclusions. Family intervention should be offered to people with schizophrenia who are in contact with carers. CBT may be useful for those with treatment resistant symptoms. Both treatments, in particular CBT, should be further investigated in large trials across a variety of patients, in various settings. The factors mediating treatment success in these interventions should be researched.