Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes.

Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment

Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial.

Recently hospitalized bipolar, manic patients (N = 53) were randomly assigned to a 9-month, manual-based, family-focused psychoeducational therapy (n = 28) or to an individually focused patient treatment (n = 25). All patients received concurrent treatment with mood-stabilizing medications. Structured follow-up assessments were conducted at 3-month intervals for a 1-year period ofactive treatment and a 1-year period of posttreatment follow-up. Compared with patients in individual therapy, those in family-focused treatment were less likely to be rehospitalized during the 2-year study period. Patients in family treatment also experienced fewer mood disorder relapses over the 2 years, although they did not differ from patients in individual treatment in their likelihood of a first relapse. Results suggest that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder

Influence of temporal fluctuations and spatial heterogeneity on pollution transport in porous media

The combined influence of temporal fluctuations and spatial heterogeneity on non-reactive solute transport mechanisms in porous media can be understood by performing simulations of steady and unsteady flow and transport in heterogeneous media. The study focuses on issues such as the degree of heterogeneity, correlation length, separation of the combined effects of temporal and spatial variations, and ergodicity conditions under unsteady flow conditions. It is shown that the effect of temporal variations on solute transport is masked by the strong effect of spatial heterogeneity. There is no obvious difference in plume shape between steady and unsteady flow conditions; the first and the second spatial moments of the plume of the unsteadystate flow condition fluctuate around the steady-state flow condition with the same period of oscillations as the input signal at small storage coefficient (S?0.001). At a relatively high standard deviation in hydraulic conductivity and a small storage coefficient, the unsteady flow condition sharpens the temporal variations in macrodispersion coefficients. The magnitude of the longitudinal macrodispersion coefficient under unsteady flow condition is almost doubled at the maximum values. However, the transverse macrodispersion coefficient fluctuates around zero. The Kubo number and Peclet number ranges are 1.2–64 and 10–250, respectively.Geoscience & EngineeringCivil Engineering and Geoscience