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 × 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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    • "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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    • "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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