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We examined whether caregivers of bipolar patients reporting current suicidal ideation and/or a history of a suicide attempt reported higher levels of burden and/or poorer health compared to caregivers of patients without these suicidality indices. In a cross-sectional design, caregivers (N = 480) associated with (a) patients with current suicidal ideation or (b) patients with a positive lifetime history of at least one suicide attempt, reported lower general health scores than caregivers associated with patients with neither of these indices. Parents of patients with at least one lifetime attempt reported more burden secondary to role dysfunction than spouses. Levels of depression in caregivers varied with whether the caregiver was a spouse or a parent, and whether patients had a history of suicide attempts, current suicidal ideation, or both.

Levels of familial expressed emotion during an acute episode are consistently associated with rates of recurrence among bipolar patients. This article briefly reviews the evidence for expressed emotion (EE) as a prognostic indicator and then illustrates family-focused treatment (FFT) with adults and adolescents suffering from bipolar disorder. FFT is a time-limited, modularized treatment consisting of psychoeducation, communication enhancement training, and problem-solving skills. Controlled trials indicate that FFT is an efficacious adjunct to pharmacotherapy for patients with bipolar disorder. We describe its recent application to early onset bipolar patients and include a clinical vignette. Keywords: bipolar disorder; expressed emotion; psychosocial treatment; family-focused therapy; adolescents; psychoeducation

Cluster analysis, using TRYSYS key cluster variable analyses, on 59 anger expression items replicated Spielberger's Anger-In and Anger-Control dimensions and revealed seven additional forms of anger expression: Noisy Arguing, Verbal Assault, Physical Assault-People, Physical Assault-Objects, Reciprocal Communication, Time Out, and Direct Expression. Aggressive dimensions (Noisy Arguing, Verbal Assault, Physical Assault-People and -Objects) correlated positively with each other and with trait anger and negatively with non-aggressive forms of expression (Control, Reciprocal Communication, and Time Out). The latter were positively correlated with each other and negatively with trait anger. Forms of expression correlated logically with the frequency of eight types of anger consequences, and there was evidence of distinct relationships between anger expression and anger consequences; e.g. Physical Assault-People correlated most with frequency of physical altercations, and Noisy Arguing and Verbal Assault with the frequency of verbal fights. Males were more likely to utilize aggressive forms of expression and to suffer consequences involving physical and verbal fights and property damage. Results are discussed in terms of convergent and discriminant validity, and in terms of their implications for assessment, treatment, and future research.

Introduction: Tobacco use is a chronic, relapsing condition. While there are proven cessation medications and counselling treatments, uptake of available aids is poor and smokers often do not have access to evidence-based services.Aims: The Association for the Treatment of Tobacco Use and Dependence (ATTUD) is an organisation of tobacco treatment specialists (TTSs) representing a wide array of disciplines and healthcare settings. This case vignette was intended to provide a clinical example of an interdisciplinary approach to tobacco use treatment.Methods: ATTUD Interdisciplinary Committee members representing tobacco-cessation experts from five professions were asked to respond to the same composite case vignette detailing key areas of clinical consideration and treatment.Results/Findings: While there were common treatment themes across professions, each provider also offered a unique treatment perspective addressing different facets of the patient's complex care needs, including attention to other chronic illnesses, mental illnesses, and preventive services. Expert responses highlighted that different treatment approaches across a continuum of healthcare settings are complementary.Conclusions: Responses to this vignette support the need to address tobacco use from an interdisciplinary approach. Existing chronic care and patient-centred models should be utilised to ensure that tobacco users receive a sufficient range of cessation services. [ABSTRACT FROM PUBLISHER]