Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients

Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, PO Box 951563, 405 Hilgard Avenue, Los Angeles, CA 90095, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 01/2005; 83(2-3):199-206. DOI: 10.1016/j.jad.2004.08.006
Source: PubMed


The expressed emotion (EE) construct has predicted clinical outcomes in schizophrenia and depression, but few studies have been conducted with bipolar patients. Moreover, there is a particular dearth of information regarding the prediction of depressive versus manic episodes in bipolar patients. Questions also remain about the utility of EE compared to other variables (perceived criticism, relationship negativity, and chronic strain in close relationships) that more directly evaluate interpersonal stress and about specific predictions of mania or depression.
Forty-seven outpatients with bipolar I disorder participated in a 1-year longitudinal study. A close collateral of the patient completed the Five Minute Speech Sample (FMSS) to assess EE, and participants completed perceived criticism and negativity ratings of collaterals. Clinical outcomes and chronic interpersonal stress were assessed by interview at 3-month intervals.
High EE predicted depressive, but not manic recurrence. Other variables of close interpersonal relationships were not significant predictors of recurrence.
Participants nominated collaterals, and those who did not have such a confidant were excluded.
The FMSS was sensitive to even mild negativity by the collateral that predicted later depressive episodes. This is the first study to demonstrate polarity-specific effects of EE on the prediction of recurrence in bipolar disorder.

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Available from: Amy N Cohen, Oct 05, 2015
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    • "A prospective follow-up study of participants with a diagnosis of bipolar disorder demonstrated that a critical and hostile family atmosphere, known as high expressed emotion, significantly predicted the rate of relapse into acute mood episodes (Miklowitz et al., 1988). The presence of these family attitudes has been associated with more frequent relapses and worse symptomatic outcomes in a number of studies (Honig et al., 1997; Kim and Miklowitz, 2004; Miklowitz et al., 2000; O'Connell et al. 1991; Yan et al., 2004). Moreover, psychosocial family interventions which focused upon educating family members about bipolar disorder, facilitating better communication, and optimising problem-solving have been associated with better global functioning (Clarkin et al., 1998) in addition to fewer relapses and greater improvements in depressive symptoms (Miklowitz et al., 2000). "
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    • "In addition, researchers have found that low social support predicts increases in both bipolar and unipolar depression (Cohen et al. 2004; Johnson et al. 1999, 2008) as does family conflict (Butzlaff and Hooley 1998; Kim and Miklowitz 2004; Yan et al. 2004). Hence, it is noted that the risk factors that predict unipolar depressive episodes are likely to predict bipolar depression as well. "
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    • "The largely Caucasian sample further limits the generalizability of study findings to those with more diverse racial and ethnic backgrounds. The generalizability of study results to other realms of family functioning that are not assessed by the FAD (e.g., expressed emotion; Kim and Miklowitz, 2004; Yan et al., 2004) also remains unclear. Given the dates of data collection, it is important to note that mood disorder diagnoses were based on DSM-III-R criteria. "
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