Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: Results from the Programma2000 (Milan, Italy)
Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milano, Dipartimento di Salute Mentale: Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000. Psychiatry Research
(Impact Factor: 2.47).
04/2011; 189(3):331-8. DOI: 10.1016/j.psychres.2011.03.021
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.
Available from: Rachel Upthegrove
- "The level of carer burden did not correlate with the duration of untreated psychosis, the patients’ anxiety, patients’ insight or severity of illness manifestation. The finding that the manifestation of the patients’ psychosis and the duration of untreated psychosis do not seem to contribute to the level of burden experienced by the carer is surprising, as duration of untreated psychosis has previously been linked with higher levels of expressed emotion . Perhaps most surprising was the lack of negative correlation between patient insight and carer burden. "
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Carer burden is high during First Episode Psychosis (FEP) and evidence suggests that this is a predictor of poor long-term outcome. However our understanding of factors associated with higher burden is poor. We propose that carers’ cultural backgrounds and health belief models will influence their perceived burden of care, over and above that explained by severity of illness.
Patients with FEP and their primary Carers were recruited from the Early Intervention Service. Patients and Carers completed a range of validated measures, self-report ethnicity and demographic information together with the Multidimensional Health Locus of Control and Caregiver Burden Inventory.
Significant correlations were found between carer burden and health beliefs, which differed by ethnicity and gender. High physical burden was experienced by Black carers with an external locus of control; time restrictions and emotional burden correlated with an external locus of control in Asian carers. For White carers, external locus of control correlated with time dependence burden. In all ethnic groups female carers experienced more time dependency, physical and developmental burden. No significant correlations were found between patient measures of severity or duration of illness and carer burden.
The type of burden experienced by carers differed between gender and ethnicity and was related to their health belief models. Thus the explanation and understanding of illness appears to be more salient than simply a patient’s severity of illness when considering the development of carer burden. Interventions to tackle high carer burden, and thus expressed emotion to improve outcome in patients, may need increasing focus here.
Available from: Katerina Koutra
- "Fewer studies included patients with onset of a psychotic disorder within 2 years[46,48], or patients with first or second psychotic episode. Finally, six studies did not use specified criteria for FEP[38,45,52,60,64]. A final limitation is that the research into EE has only examined beliefs about the illness held by the relatives. "
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ABSTRACT: The influential role of family in the outcome of chronic schizophrenia is well documented. However, there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP), a point in time when most of the changes in family dynamics are observed. The aim of this article is to present a review of the literature focusing on the family environment of FEP patients.
We carried out a computerized literature search on MEDLINE and PsycINFO (1990-2013), and a manual search of references of pertinent articles. In total, 27 studies investigating expressed emotion (EE) and family burden (FB) in FEP were identified and fulfilled the inclusion criteria.
Similar to chronic patients, a high prevalence of high-EE in carers of FEP patients was reported. High-EE status appears to be independent of the patient's illness-related characteristics, but dependent of relatives' attributions. In contrast to chronic patients, low levels of FB and psychological distress among family members of FEP patients were observed indicating that in the early stages of the illness family involvement is not yet associated with significant disruption in their lives. Studies assessing FB in chronic patients have found a well-established link of FB with patient's illness-related factors, but in FEP patients the families' appraisal of FB is more closely associated with their coping mechanisms.
Further studies evaluating family functioning in terms of cohesion and adaptability will shed light on the intrafamilial relationships in FEP patients which may be associated with the long-term outcome of this chronic illness.
- "Nelle famiglie di pazienti affetti da schizofrenia sono stati riscontrati elevati livelli di emotività espressa, che descrivono un atteggiamento dei caregiver spesso caratterizzato da ostilità, commenti critici ed eccessivo coinvolgimento emotivo  . Elevati livello di carico emotivo e di emotività espressa, inoltre, sono risultati correlati a un peggior decorso clinico dei pazienti con un aumentato rischio di ricadute  . A partire dagli studi condotti sull'emotività espressa, l'attenzione si è progressivamente indirizzata su interventi informativi-educativi, prevalentemente a breve termine (4-5 incontri di lettura e distribuzione di materiale didattico, successivamente discussi con gli operatori). "
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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.
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