High level of expressed emotions in the family of people with schizophrenia: has a covert abrasive behaviours component been overlooked?

A Systematic Review Exploring the Relationship Between Family Factors and Symptom Severity, Relapse and Social or Occupational Functioning in First-Episode Psychosis

AIMS

Research on family functioning in psychosis has typically focused on specific family-related factors and their impact on symptomatology, finding strong associations between high expressed emotion and poor outcomes, especially in those with long-term illness. The objective of this review is to examine the impact of a broad range of family-related factors and their relationship with clinical, social, occupational and relational outcomes in first-episode psychosis (FEP).

METHOD

A systematic search of databases PsycInfo, Pubmed, Embase and CINHAL between 1990 and August 2023 was completed. In total, 1408 articles were screened, and study quality was assessed using the JBI critical appraisal checklists for analytical cross-sectional studies and cohort studies. A narrative synthesis approach was used to analyse the data.

RESULTS

Of the 1408 identified articles, 80 full-text articles were screened. Fifteen studies were included for data extraction. The objectives and scope of the selected studies varied considerably. Studies consisted of cross-sectional and prospective cohort designs. Participants consisted of FEP patients and family members, with the patient age range varying from 15.9 to 30.8 (MD = 24.5). Significant associations were identified between family factors (high EE, family environment and carer burden) and symptom and social outcomes.

DISCUSSION

While findings emphasised the significant impact of family factors on symptomatic and social outcomes, the literature had significant limitations due to the absence of underlying theoretical models and understanding of the dynamics of distress in families within FEP. Future research should seek to develop a model accounting for such processes.

Understanding the Dynamics: A Comprehensive Review of Family Therapy's Impact on Expressed Emotions in Schizophrenia Patients

This comprehensive review examines the impact of family therapy on expressed emotions (EE) within the context of psychiatric disorders. EE, characterized by high levels of criticism, hostility, or emotional over-involvement, have been consistently linked to poorer treatment outcomes and increased severity of psychiatric symptoms. The review explores various family therapy approaches and their effectiveness in reducing high EE levels in families of psychiatric patients. It synthesizes existing literature to highlight the mechanisms underlying the changes in EE, such as modifying communication patterns and enhancing family cohesion. Additionally, the review discusses the implications for clinical practice, emphasizing the importance of integrating family therapy into psychiatric treatment plans and providing psychoeducation to empower families to manage emotions effectively. Future research directions are also outlined, including investigating the long-term sustainability of changes brought about by family therapy and exploring cultural considerations in therapeutic approaches. Overall, the review underscores the pivotal role of family therapy in addressing EE and promoting recovery and resilience in psychiatric patients and their families.

Survey of High Expressed Emotions Experienced By Community Mental Health Service Users in Hong Kong During the COVID-19 Pandemic

Background

High expressed emotion (EE) experienced by people with mental illness is a known risk factor of relapse. With drastically increased time spent at home and limited health and social service provision during the COVID-19 pandemic, patients’ experience of high EE warranted attention.

Aims and Methods

The study aimed to investigate the experience of high EE among people with mental illness during the COVID-19 pandemic. We surveyed the service users of 2 community mental health centers, including participants with psychotic and nonpsychotic disorders.

Results

Valid responses from 303 participants indicated an overall high EE prevalence of 71.62%, much higher than previous findings, which range between 30% and 40%. People with other psychotic and nonpsychotic disorders showed a higher probability of experiencing high EE than people with schizophrenia. Participants reported a higher probability of experiencing high EE as a result of caregiving by other family relatives and friends than by parents.

Conclusion

Findings suggest a significantly elevated high EE prevalence among people suffering from mental illness in the community during the COVID-19 pandemic. It is worth further evaluating the long-term effects of high EE beyond the pandemic.