Expressed Emotion: Relevance to Rehospitalization in Schizophrenia Over 7 Years

Geha Mental Health Center, P.O. Box 102, Petah Tikva 49100, Israel.
Schizophrenia Bulletin (Impact Factor: 8.45). 08/2005; 31(3):751-8. DOI: 10.1093/schbul/sbi016
Source: PubMed


Expressed emotion (EE) is an established factor in short-term relapse in schizophrenia. However, data on its long-term predictive ability are scarce. We extended our short-term investigation over 7 years' followup. The study population consisted of 108 patients, 93 with schizophrenia and 15 with schizoaffective disorder. EE of the key relatives was rated with the Five Minute Speech Sample (FMSS). Patient households were categorized by EE and its two components: criticism (CR) and emotional overinvolvement (EOI). High CR was associated with earlier first and second readmissions (Breslow p = 0.002 and 0.04, respectively). High CR was associated with a higher rate of readmissions (p = 0.01) and a longer hospital stay (p = 0.02) compared with low CR. Both compliance with pharmacotherapy and the interaction of high-CR x poor compliance were additional contributors to time to first readmission. This study is the first to demonstrate the prolonged predictive validity of EE. Our results support the value of CR as a prognostic indicator of the course of schizophrenia. The FMSS appears to have predictive power in respect to psychiatric hospitalization. Therapies aimed at lowering high EE seem warranted as a long-term preventive approach.

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Available from: Peter Jones, Jan 13, 2014
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    • "One important conclusion of the attributional model of EE research is that relatives who judged patients to be responsible for their symptoms are more critical (Barrowclough and Hooley, 2003). Growing evidence suggests that critical comments (CC) are more predictive for the course of the illness than EOI (Marom et al., 2005). Furthermore, relatives with marked emotional overinvolvement (EOI) attribute positive events more often to the patients (Grice et al., 2009), show more self blame (Peterson and Docherty, 2004) and have poorer health (Breitborde et al., 2010). "
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    ABSTRACT: The study tests assumptions from the “cognitive model of caregiving” (Kuipers et al., 2010), which aims to inform interventions for carers of people with psychoses. The sample comprised 61 relatives of patients with schizophrenia. Standardized psychological assessments were conducted twice within 6 months including: Involvement Evaluation Questionnaire (IEQ-EU), a short form of the Symptom Checklist 90-R (SCL K9), the Family Questionnaire (FQ), scales measuring control attributions of the Illness Perception Questionnaire for Schizophrenia (IPQS-R) and emotions toward the ill relative. Structural equation modelling was used to analyse data. We identified two pathways: a) from “attributing control to relatives” to distress, intermediated by anxiety for the patient and emotional overinvolvement (EOI), and b) from “attribution control to patient” to distress, intermediated by anger about the patient and criticism. The model provided a good fit to the data and was successfully replicated at a second point in time. We were able to find supporting evidence for a cognitive model of caregiving. Control attributions and emotions of informal caregivers are important when interventions are planned reducing expressed emotion and burden of caregivers.
    07/2014; 217(3). DOI:10.1016/j.psychres.2014.02.023
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    • "In addition, depression has been shown to have a strong negative correlation with SOC [24] [25] [26] [27]. Another variable found to have prognostic value for course of disease is expressed emotion (EE) [28] [29] [30] [31], which reflects the social climate of the individual. We do not know of any studies combining SOC and EE; however, EE has been shown to be correlated with depression [32] [33] and may add the perspective of the individual's sense of his/her social environment and/or support. "
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    Comprehensive Psychiatry 05/2008; 49(3):288-96. DOI:10.1016/j.comppsych.2007.06.011 · 2.25 Impact Factor
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    • "Active refusal, passive acceptance, active pursual; always, usually, not usually, never Macpherson et al. (1996) 114 Educational intervention* 64 Self-report (SAI) Compliance subscale score Marom et al. (2005) 115 Expressed emotion and 1-year follow-up of next 116 108 Self-report, chart review, recollection Dichotomized at 50% Marom et al. (2002) "
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    ABSTRACT: The definition and assessment of adherence vary considerably across studies. Increasing consensus regarding these issues is necessary to improve our understanding of adherence and the development of more effective treatments. We review the adherence literature over the past 3 decades to explore the definitions and assessment of adherence to oral antipsychotics in schizophrenia patients. A total of 161 articles were identified through MEDLINE and PsycINFO searches. The most common method used to assess adherence was the report of the patient. Subjective and indirect methods including self-report, provider report, significant other report, and chart review were the only methods used to assess adherence in over 77% (124/161) of studies reviewed. Direct or objective measures including pill count, blood or urine analysis, electronic monitoring, and electronic refill records were used in less than 23% (37/161) of studies. Even in studies utilizing the same methodology to assess adherence, definitions of an adherent subject varied broadly from agreeing to take any medication to taking at least 90% of medication as prescribed. We make suggestions for consensus development, including the use of recommended terminology for different subject samples, the increased use of objective or direct measures, and the inclusion in all studies of an estimate of the percentage of medication taken as prescribed in an effort to increase comparability among studies. The suggestions are designed to advance the field with respect to both understanding predictors of adherence and developing interventions to improve adherence to oral antipsychotic medications.
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