chapter  14
17 Pages

Integrating the family in the treatment of psychotic disorders

WithWilliam R. McFarlane

The early stages of onset of a psychotic disorder include the cardinal symptoms of all psychoses – major alterations of cognition, affect, sensation and behavior. These are most serious in schizophrenia. However, especially in that disorder, it has become clear that the accompanying deficit syndrome is the source of the most severe disability, lasting for a lifetime in the majority of cases. While the scientific evidence is increasingly strong that the major psychotic disorders are based in genetic or developmental defects involving brain function, there is also abundant evidence that the final development and relapse of psychotic symptoms are the result of psychosocial stress. High levels of criticism and emotional over-involvement are strongly predictive of exacerbation or relapse of symptoms. Stigma is often associated with a withdrawal of social support, demoralization, and loss of self-esteem, and can have far-reaching effects on daily functioning, particularly in the workplace or school.