Expressed Emotion in 1991

No correlation among expressed emotion, anxiety, stress and weight loss in patients with overweight and obesity

Background

The onset of some types of obesity may correlate with specific familial relational patterns, and expressed emotion (EE), the family life's 'emotional temperature', may play a role in obesity treatment compliance and outcome.

Objective

The aim of this study is to address the current gap in the literature about EE and obesity, assessing EE in a sample of patients with overweight or obesity and their relatives. A further objective is to assess patients' weight loss, patients' and relatives' anxiety, perceived stress and their possible correlation with EE and diet compliance.

Design

A total of 220 patients with overweight or obesity and 126 relatives were recruited; their socio-demographic and clinical features were collected; and Level of Expressed Emotion Scale (LEE), State-Trait Anxiety Inventory 1 and 2 (STAI-Y1 and STAI-Y2) and Paykel Scale of Stressful Life Events were administered.

Results

Patients' baseline body mass index (BMI) was negatively correlated with educational level, but we failed to find any correlation between BMI and the other variables assessed. We found a positive correlation between EE median and stressful life events, as well as between median EE and state and trait anxiety.

Conclusions

Our results seem to suggest that other factors than the psychological ones we investigated may play a role in treatment adherence and outcome in patients with overweight and obesity.

Expressed emotion across cultures

Expressed emotion has been used as a construct in understanding the interaction between patients and their carers and families. A considerable amount of data from Western cultures suggests that high expressed emotion can lead to relapse in vulnerable individuals, even when they are on medication. However, the data from other cultures are less solid. This paper reviews some of the existing findings and recommends that various components of expressed emotion must be seen in the cultural context and embedded in the normative data of the population before the concept can be considered in association with the pathogenesis of relapse.

Testing the psychometric properties of a Chinese version of the level of expressed emotion scale

This study tested the psychometric properties of a Chinese version of the level of expressed emotion scale in Hong Kong Chinese patients with severe mental illness and their family caregivers. First, the semantic equivalence with the original English version and test-retest reliability at 2-week interval of the Chinese version was examined. After that, the reproducibility, construct validity, and internal consistency of the Chinese version were tested. The Chinese version indicated good semantic equivalence with the English version (kappa values = 0.76–0.95 and ICC = 0.81–0.92), test-retest reliability (r = 0.89–0.95, P < 0.01), and internal consistency (Cronbach's α = 0.86–0.92). Among 262 patients with severe mental illness and their caregivers, the 50-item Chinese version had substantial loadings on one of the four factors identified (intrusiveness/hostility, attitude towards patient, tolerance, and emotional involvement), accounting for 71.8% of the total variance of expressed emotion. In confirmatory factor analysis, the identified four-factor model showed the best fit based on all fit indices (χ²/df = 1.93, P = 0.75; AGFI = 0.96; TLI = 1.02; RMSEA = 0.031; WRMR = 0.78) to the collected data. The four-factor Chinese version also indicated a good concurrent validity with significant correlations with family functioning (r = −0.54) and family burden (r = 0.49) and a satisfactory reproducibility over six months (intraclass correlation coefficient of 0.90). The mean scores of the overall and subscale of the Chinese version in patients with unipolar disorder were higher than in other illness groups (schizophrenia, psychotic disorders, and bipolar disorder; P < 0.01). The Chinese version demonstrates sound psychometric properties to measure families' expressed emotion in Chinese patients with severe mental illness, which are found varied across countries.

Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: results from the Programma2000 (Milan, Italy)

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.

Family expressed emotion in a Javanese cultural context

This study aims at understanding the emotional milieu of families of psychotic patients, focusing on the concept of expressed emotion (EE). A combination of ethnographic and clinical methodology was employed. During the fieldwork in Yogyakarta, Indonesia, nine participants diagnosed as having first episode psychosis and their families were followed closely over the course of 1 year in their natural home setting. Through ongoing engagement with families, the researcher was able to gather data on the diversity of family responses to illness. Despite the fact that most families in this research could be considered to have low EE, ethnographic observation provided a more complex and nuanced picture of family relationships. This article discusses four issues concerning EE in relation to Javanese culture: the role of interpretation, the coexistence of criticism and warmth, the interpretation of boundary transgression, and the cultural concept of warmth and positive remark.

Family and patient predictors of symptomatic status in schizophrenia

OBJECTIVE

To test an interactive hypothesis that, in schizophrenia, a combination of patients' and relatives' characteristics at 1-month postdischarge from hospital (Time 1 [T1]) better predicts the level of psychotic symptoms at follow-up (Time 2 [T2]), than do the characteristics of patients or relatives alone.

METHODS

Male patients (n = 38) with a diagnosis of schizophrenia, without substance abuse, and in contact with their families, were recruited at the time of hospital discharge. Patients' psychotic symptom levels were monitored every 2 weeks until follow-up, while family measures were administered at T1 and T2. The 4 predictor variables in the regression analysis were T1 symptom levels of the patient and 3 measures of family interaction (expressed emotion, family burden, and family functioning).

RESULTS

The model based on the family variable, family burden at T1, and the patient variable, patients' remitted levels of psychotic symptoms at T1, was found to significantly predict the level of psychotic symptoms at T2. These 2 T1 variables made independent and additive contributions to the level of psychotic symptoms at T2, predicting 19% of the variance. Neither expressed emotion nor family functioning at T1 added to the prediction.

CONCLUSION

This finding suggests a patient-family interactional component to symptomatic relapse in schizophrenia.

Training nurses to support carers of relatives with schizophrenia

Carers have an enormous amount of responsibility for the welfare and management of people with a mental illness in Britain, and many require help if they are to continue caring. Mental health nurses may be in a key position to offer support, but they are often unclear of what is required and how it should be delivered. Existing UK nurse-led psychosocial interventions for families often focus on the needs of the patient rather than the carer. This article describes a needs-led support service that has been designed for carers whose relatives are diagnosed with schizophrenia. It recognizes the importance of a collaborative partnership between carers and nurses. In 2000, 10 mental health nurses were trained to deliver this support to carers. An evaluation is currently underway. This article outlines the principles of the training programme and how it might enable nurses to meet the carers' needs.

The involvement of families in Indian psychiatry

Ethnographic observations and interviews with psychiatrists at two general hospital psychiatric units in northern India reveal the extent of family involvement in the localized adaptation of biomedical psychiatry that occurs in these settings. By assuming many of the roles filled by auxiliary personnel in the USA, families maintain considerable control over many aspects of the psychiatric process: defining disorder, outpatient consultation, record keeping, admissions, inpatient care, discharge, and continuing care. The implications of these observations are considered in relation to theoretical concerns about biomedical hegemony, advantages and disadvantages of family involvement from an applied perspective, and the methodological adequacy of cross-cultural psychiatric epidemiology with respect to studies of "expressed emotion."

A quantitative measure for expressed emotion

The items of the Five Minute Speech Sample, an instrument to elicit relatives' expressed emotion, were investigated in a follow-up study of 120 parents of adolescents with recent-onset schizophrenia. A composite scale was constructed using Mokken scale analysis. From the 9 available items, 6 formed a unidimensional and cumulative scale. This scale was applicable for the total parent group, as well as for fathers and mothers separately. A second scale of 2 items did not meet the criteria for the Mokken model completely and was applicable for the parent group as a whole, but not for fathers and mothers as separate groups. The configuration of the subscales as found with the Mokken scale analysis was comparable with the results of principal component analysis. A quantitative measure may detect smaller differences in expressed emotion than the dichotomous index and expands the possibilities for statistical tests.

Psychiatry and chaos

Chaos theory is the third scientific revolution this century. The first two have revealed previously unexpected 'discontinuity' in continuous speed and mass variables and each placed a new and fundamental bound on man's abilities. Chaos theory argues that the evolution of life on Earth has been achieved economically by random mutation and not in any formal deterministic predetermined pattern. The human reproductive cycle is reduced to nine intrauterine months followed by 15 years of randomly occurring daily interpersonal family relationships of varying degrees of complexity to create each unique individual in the context of interpersonal relationships in that society and culture. Some of the random untoward outcomes that may occur in relationships with others are labelled as psychoses.

Caregivers of Turkish schizophrenic patients: causal attributions, burdens and attitudes to help from the health professionals

The purpose of this study was to examine the causal attributions, difficulties, perceived and expected help behaviour of health care professionals, and hope for the future well-being of the caregivers of Turkish schizophrenic patients in order to form guidelines for forming a collaboration with the families of schizophrenic patients. Sixty caregivers were interviewed by using a semi-structured interview schedule. The responses of the caregivers were categorized within the guidelines of the literature in this area. The caregivers attributed schizophrenia mainly to psychosocial causes, namely stressful events (50%), family conflicts (40%) and patients' characteristics (28%). The most frequently reported difficulties were family conflicts and disruptions of family life, subjective burden (48%), and financial costs due to the patient (27%). The number of difficulties reported by caregivers was related to the duration of the patient's illness. Caregivers perceived pharmacological treatment (42%), interest and support given to the caregiver (28%), and the hospitalization of the patient (20%) as helpful. THeir expectations of help were in similar areas. About half of the caregivers were optimistic about the future well-being of their relatives. Optimistic and pessimistic caregivers differed in the educational level of the caregiver and the duration of the patient's illness. The results suggested that the families of schizophrenics need support of professionals and the establishment of networks focusing on the caregivers and their relationships with their ill relatives and with health care institutions.

Influence of patient caregivers on course of patient illness: "expressed emotion" and alternative measures

The influence of the quality of care that patients receive during the course of their illness has been the subject of special scrutiny in the area of mental health. The concept of "expressed emotion" (EE) evolved in an effort to understand the impact of family and social environment on the vulnerability to relapse of schizophrenic patients. A semistructured interview, the Camberwell Family Interview, was developed to assess expressed emotion. This article examines the historical context, generalizability, methodological strengths and limitations of the construct of EE and the Camberwell Family Interview, as well as the nature and effects of treatment intervention programs designed to neutralize adverse effects of patient caretaker attitudes.