Article

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: 8.49). 08/2005; 31(3):751-8. DOI: 10.1093/schbul/sbi016
Source: PubMed

ABSTRACT 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.

0 Bookmarks
 · 
58 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Understanding cross-cultural aspects of emotional overinvolvement (EOI) on psychosis outcomes is important for ensuring cultural appropriateness of family interventions. This systematic review explores whether EOI has similar impact in different cultural groups and whether the same norms can be used to measure EOI across cultures. Thirty-four studies were found that have investigated the impact of EOI on outcomes across cultures or culturally adapted EOI measures. The relationship between high EOI and poor outcome is inconsistent across cultures. Attempts to improve predictive ability by post hoc adjustment of EOI norms have had varied success. Few studies have attempted a priori adaptations or development of culture-specific norms. Methodological differences such as use of different expressed emotions (EE) measures and varying definitions of relapse across studies may explain a lack of EOI outcome relationship across cultures. However, our findings suggest that the construct and measurement of EOI itself are culture-specific. EOI may not necessarily be detrimental in all cultures. The effect of high EOI may be moderated by the unexplored dimension of warmth and high levels of mutual interdependence in kin relationships. Researchers should reevaluate the prevailing concepts of the impact of family relations on the course and outcome of psychotic disorders, specifically focusing on the protective aspects of family involvement. Clinically, family interventions based on EE reduction should take cultural differences into account when treating families from different ethnocultural groups.
    Schizophrenia Bulletin 12/2011; · 8.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: To define the clinical profile of relapsing patients with schizophrenia attended in daily practice. Method: Patients with schizophrenia/schizoaffective disorder admitted to short-stay/acute-care psychiatric units were eligible provided that data for the previous 3 years and for the next 12 months after discharge were collected. Results: Remarking features in 1646 patients (68% men) included low family support (34%), primary education (48%), schizophrenia as the main diagnosis (77%), duration of illness > 10 years (60%), mean number of previous hospitalizations of 2.74, non-adherence as the main reason of hospitalization (58.6%), treatment with a mean of two different antipsychotics and differences in adherence according to antipsychotic medication (P < 0.0001) (highest rates for depot atypical antipsychotics). The relapse rate was 38.6%. There were no differences in the number of relapsing patients according to antipsychotic drugs. Discussion and conclusion: The profile of relapsing schizophrenic patients may be defined as a male subject, aged 30-45 years, with primary education level, more than 10 years of disease' duration, low family support, moderately and severely ill, treated with multiple antipsychotic drugs, and poor to moderate adherence. Differences in relapse according to antipsychotic types were not observed but long-acting second generation antipsychotic drugs showed the highest percentage of maximum adherence.
    Nordic journal of psychiatry 03/2012; · 0.99 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    Psychiatry Research. 01/2014;

Full-text (2 Sources)

View
11 Downloads
Available from
May 30, 2014