Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: Results from the Programma2000 (Milan, Italy)
ABSTRACT Expressed emotion (EE) was examined in a large sample of families of patients with either first-episode psychosis (FEP) within the schizophrenia spectrum, or who met the criteria for ultra high-risk (UHR) of psychosis. The aim of our study was to determine the patterns and relationship of EE with the duration of untreated illness (DUI) or of untreated psychosis (DUP), as well as with illness severity. The sample used in our study included 77 FEP and 66 UHR families. The Camberwell Family Interview was used to assess EE. In both samples, about one-third of patients' families were classified as high EE, with emotional over-involvement (EOI) being the most frequent reason for a family to be classified as high EE. In FEP, higher EE correlated with longer DUI, and higher paternal EOI with longer DUP. DUI, however, was not found to correlate to EE in UHR patients. Severity of illness at the initial assessment did not relate to EE in either FEP or UHR families. Families of FEP and UHR patients were not found to differ in terms of the prevalence of a high EE rating, or of any of its subcomponents. The results of this study only partially support the hypothesis that high EE develops as a reaction to patient status. Patients from families with high EE could possibly benefit from interventions that are targeted at improving their resilience when dealing with problematic family environments.
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ABSTRACT: Expressed emotion (EE) is a measure of the family environment reflecting the amount of criticism and emotional over-involvement expressed by a key relative towards a family member with a disorder or impairment. Patients from high EE homes have a poorer illness prognosis than do patients from low EE homes. Despite EE's well-established predictive validity, questions remain regarding why some family members express high levels of EE attitudes while others do not. Based on indirect evidence from previous research, the current study tested whether shame and guilt/self-blame about having a relative with schizophrenia serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed the Five Minute Speech Sample to measure EE, along with questionnaires assessing self-directed emotions. In line with the hypotheses, higher levels of both shame and guilt/self-blame about having a relative with schizophrenia predicted high EE. Results of the current study elucidate the EE construct and have implications for working with families of patients with schizophrenia.Psychiatry Research 02/2012; 196(1):27-31. DOI:10.1016/j.psychres.2011.08.009 · 2.68 Impact Factor
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ABSTRACT: We discuss recent evidences about schizophrenia (frequency, onset, course, risk factors and genetics) and their influences to some epidemiological myths about schizophrenia diffuse between psychiatric and psychopathology clinicians. The scope is to evaluate if the new acquisitions may change the rehabilitation approaches to schizophrenia modifying the balance about the neurodevelopmental hypothesis of schizophrenia accepting that the cognitive deficits are produced by errors during the normal development of the brain (neurodevelopmental hypothesis) that remains stable in the course of illness and the neurodegenerative hypothesis according of which they derived from a degenerative process that goes on inexorably. RESEARCH METHOD/DESIGN: A review of the literature about epidemiology of schizophrenia has been performed and the contributions of some of these evidence to neurodevelopmental hypothesis and to rehabilitation has been described. It cannot be definitively concluded for or against the neurodevelopmental or degenerative hypothesis, but efforts in understanding basis of schizophrenia must go on. Until now, rehabilitation programs are based on the vulnerability-stress model: supposing an early deficit that go on stable during the life under favorable circumstances. So, rehabilitation approaches (as neuro-cognitive approaches, social skill training, cognitive-emotional training) are focused on the individual and micro-group coping skills, aiming to help people with schizophrenia to cope with environmental stress factors. Coping of cognitive deficits in schizophrenia may represents the starting-point for further research on schizophrenia, cohort studies and randomized trials are necessary to defined the range of effectiveness and the outcome of the treatments.Clinical Practice and Epidemiology in Mental Health 07/2012; 8:52-66. DOI:10.2174/1745017901208010052
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ABSTRACT: IntroductionPsychoeducation, a non-pharmacological strategy recommended by current guidelines for the treatment of schizophrenia, integrates elements from different psychotherapeutic approaches and promotes improvement of knowledge regarding the disease and coping skills. The aim of this review is to describe the main evidence of efficacy on psychoeducation in schizophrenia on the basis of recent reviews and meta-analyses, and recently published studies on new approaches in the field.Discussion and conclusionsPsychoeducation can reduce rates of relapse and rehospitalization, improve adherence to treatment and have other positive effects on patients and their families, such as reduction of burden. Single studies have considered culturally sensitive and other new psychoeducational approaches that would be important for therapeutic interventions especially in multiethnic contexts. Future research should therefore focus patients and their families participate in psychoeducational interventions, but also on the minimum effective psychoeducation dose, on those patients with schizophrenia who do not have supporting families willing to partecipate in family psychoeducation, on standardized outcomes and follow-up periods.Quaderni Italiani di Psychiatria 12/2012; 31(4):157–163. DOI:10.1016/j.quip.2012.10.003