Alison Heru, MD
Professor and interim chair, Department of Psychiatry, University of Colorado School of Medicine.
Dr. Heru has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Alison Heru, MD, gives the following additional advice for conducting effective family meetings:
Meet with your patient’s family members at the initial assessment. I usually then touch base with the family members intermittently and tell them they are welcome at any time. In a family meeting, you should reassure everyone—including the patient—that the main reason for the meeting is to discuss diagnosis and management of the patient’s illness.
Plan for future emergencies. If family members have concerns, I tell them that they can call me at any time. With the permission of the patient through a release of information (ROI) consent form, I tell them that I can discuss details of the patient’s care and that I am always happy to listen to them. Discussion topics can include examples of medication side effects, other family members’ illnesses, and transportation difficulties.
Consider a psychiatric advance directive. I introduce the topic this way: If Mr. A develops mania, such as impulsive spending, not sleeping, or excessive use of alcohol, then we can all agree that this is serious and that Mr. A needs to come to the hospital. I will say, “Mr. A, I know that you get belligerent and are reluctant to come to the hospital when you are manic. Now that you are stable, what do you think your relative should do when you get manic?” Mr. A will likely say, “They should bring me to the hospital.” At this point, I’ll be able to ask him and his relative to sign an advanced directive indicating that this is his wish.
Take time to clarify coping skills. Ask about individual, dyadic, and family coping skills. Ask, “How does this family cope? Do people use their own individual coping skills, or do they try to cope as a couple or a family together?” If problems arise, facilitate the family in a problem-solving session in your office.
Consider a self-report tool. Examples include the Family Assessment Device (see http://bit.ly/2zCDZNL), which can be used in clinical settings. This tool can differentiate healthy from unhealthy families. The Distress Thermometer, another simple tool that is used in many chronic illness settings, has a brief family section (Donovan KA et al, Psychooncology 2014;23:241–250). The thermometer alerts you to the presence of family problems, but it does not identify family strengths, a crucial component of family-based interventions.
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