Predicting the longitudinal effects of the family environment on prodromal symptoms and functioning in patients at-risk for psychosis

University of California at Los Angeles, 300 Medical Plaza, Box 666824, Los Angeles, CA 90095, United States.
Schizophrenia Research (Impact Factor: 3.92). 02/2010; 118(1-3):69-75. DOI: 10.1016/j.schres.2010.01.017
Source: PubMed


The current study examined the relationship between the family environment and symptoms and functioning over time in a group of adolescents and young adults at clinical high risk for psychosis (N=63). The current study compared the ability of interview-based versus self-report ratings of the family environment to predict the severity of prodromal symptoms and functioning over time. The family environmental factors were measured by interviewer ratings of the Camberwell Family Interview (CFI), self-report questionnaires surveying the patient's perceptions of criticism and warmth, and parent reported perceptions of their own level of criticism and warmth. Patients living in a critical family environment, as measured by the CFI at baseline, exhibited significantly worse positive symptoms at a 6-month follow-up, relative to patients living in a low-key family environment. In terms of protective effects, warmth and an optimal level of family involvement interacted such that the two jointly predicted improved functioning at the 6-month follow-up. Overall, both interview-based and self-report ratings of the family environment were predictive of symptoms and functioning at follow-up; however patient's self-report ratings of criticism had stronger predictive power. These results suggest that the family environment should be a specific target of treatment for individuals at risk for psychosis.

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Available from: Danielle A Schlosser,
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    • "Particularly, attitudes related to positive affect predicted improvement in negative symptoms and functioning (O'Brien et al., 2006, 2008), whereas negative affect in the form of criticism predicted worsening of attenuated psychotic symptoms (Schlosser et al., 2010). "
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    ABSTRACT: The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and emotional over-involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives’ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives’ criticism was associated with positive, negative, and general symptoms. EOI was related with negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives’ attributions of blame toward the patient. Relatives’ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients’ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives’ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.
    Psychiatry Research 08/2014; DOI:10.1016/j.psychres.2014.04.012 · 2.47 Impact Factor
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    • "One limitation of the study was to use a small, predominantly university student sample where RS due to close relationships may not be comparable to that of the general population because 93% were single and it is common for students to live away from home. Future research could replicate this study's findings in a larger community-based sample in the context of participants' close relationships, since hostility as rejection from carers increases psychopathology in at-risk individuals (Schlosser et al., 2010). "
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    • "Expressed emotion is measured through the presence of critical comments, hostility, and emotional over-involvement found in spontaneous speech by a family member, and has been linked to poor outcomes in schizophrenia in a meta-analysis of 27 studies (Butzlaff & Hooley, 1998). Rates of expressed emotion appear to be comparable between CHR and first-episode psychosis, and one study that longitudinally demonstrated the positive effects of family support (described above) also showed an association between a critical family environment and more severe positive symptoms at 6-month followup (Schlosser et al., 2010). The family microsystem appears to play a central role as a source of both risk and protection against the development of psychosis , likely reflecting a dynamic family system in which behavior of the at-risk youth may elicit critical behavior from family members, which may in turn further exacerbate symptoms. "
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