Expressed Emotion: Relevance to Rehospitalization in Schizophrenia Over 7 Years

Tel Aviv University, Tell Afif, Tel Aviv, 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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    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.
    Full-text · Article · Jul 2014
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    • "The majority of the studies aimed to estimate the prevalence of caregiver's EE, explore its relationship to patients' relapse and define the impact of specific patients' and caregivers' characteristics on EE. The findings indicated a high prevalence of high-EE in caregivers of FEP patients[38,39,41,42,44,47,60], whereas most studies on chronic patients with psychosis found a comparable distribution[65,66]. There are multiple perspectives leading to an understanding of the similarity of first-episode and chronic patients' relatives regarding their EE status. "
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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.
    Full-text · Article · Jan 2014 · Social Psychiatry
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    • "Comparatively little was written about communication with psychotic patients, other than ratings of the nature and severity of symptoms. Unhelpful communication (high expressed emotion) by family members or carers was identified as a predictor of relapse [15] [16], but the patient tended to be viewed as passively experiencing the high expressed emotion environment. A shift towards re-engagement with patients with schizophrenia occurred in the 1990s. "
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    ABSTRACT: The research and clinical literature portrays the thought disordered person as incapable of meaningful social interaction. This model views thought disorder exclusively as a brain dysfunction, evidenced by dysfunctions in speech. The study seeks to address this deficit model by investigating the interactional accomplishments of thought disordered people in clinical interviews. An analysis of clinical interview data. We investigate (1) what thought disordered people actually accomplish in interaction, and (2) how thought disordered people and their psychiatrists routinely communicate on matters consequential for treatment. This paper introduces a new perspective on the interactional achievements of people with thought disorder. The skills required by both parties during routine clinical interviews have not previously been recognised or described.
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