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Schulze Mönking H, Hornung WP, Stricker K, Buchkremer G. Expressed emotion in an 8 year follow-up. Eur Psychiatry 2020; 12:105-10. [DOI: 10.1016/s0924-9338(97)80197-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/1996] [Accepted: 12/05/1996] [Indexed: 10/18/2022] Open
Abstract
SummaryThis study addresses the questions if and for which patients expressed emotion (EE) has a predictive validity in an 8 year follow-up study and if this is dependent on the residential form, especially on patients and relatives living together. Eight years after a baseline examination (Camberwell Family Interviews [CFI], global assessment scale [GAS], symptom score) 69 of 99 patients were reexamined. The number and duration of rehospitalizations as well as the symptom and GAS scores were recorded. These was no difference between outcome of high and low EE patients with a duration of illness of less than 4.5 years and for those living with partners. Patients from high EE parents with a longer duration of illness (> 4.5 years) at the outset of the study were significantly more often and longer in hospital. They had significantly higher symptom and GAS scores at the outset of the study and after 8 years. The EE effect was equal in the first and second 4 years of the follow-up and was independent from patients and parents living together. The results emphasize the significance of the EE index as a long-term predictor for the course of schizophrenic illness. The independence of the prediction from living together is an argument against a simple causal interpretation of the connection between EE and the course of schizophrenia.
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Huguelet P, Binyet-Vogel S, Gonzalez C, Favre S, McQuillan A. Follow-up study of 67 first episode schizophrenic patients and their involvement in religious activities. Eur Psychiatry 2020; 12:279-83. [DOI: 10.1016/s0924-9338(97)84786-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/1996] [Accepted: 11/03/1996] [Indexed: 10/17/2022] Open
Abstract
SummaryWe studied the characteristics of religious practice in a cohort of 67 first admission schizophrenic patients over 5 years. Thirty percent of these patients were involved in religious activities, either with an established religion or in a marginal group. They were mostly women, who had a good premorbid psychosocial adaptation and tended not to be substance abusers. Their social adaptation was improved at year 5. They were as compliant with their ambulatory treatment as the other patients. However, when controlling for the inclusion characteristics, a similar outcome was shown between the group of practicing patients and the nonpracticing group. Religious activity may not be by itself the cause of this favorable outcome, as it is probable that only the patients who are less symptomatic and relatively well adapted could actually join a religious movement. The fact that many schizophrenic patients find an occupation and relationships in religious activities that they would not find elsewhere should encourage the psychiatric community target its occupational goals.
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O'Driscoll C, Sener SB, Angmark A, Shaikh M. Caregiving processes and expressed emotion in psychosis, a cross-cultural, meta-analytic review. Schizophr Res 2019; 208:8-15. [PMID: 31028000 DOI: 10.1016/j.schres.2019.03.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 11/19/2022]
Abstract
The construct of Expressed Emotion (EE) is a reliable predictor of relapse in psychotic disorders globally. However, cultural differences in the level and manifestation of EE have been reported. This review was conducted in line with PRISMA guidelines to demonstrate the distribution of EE and its domains cross-culturally as well as its relationship with relapse in psychosis. Ninety-six studies reported global EE scores and/or separate EE domains amongst caregivers of a family member with psychosis and used the Camberwell Family Interview (CFI) to measure EE. In the meta-analysis (k = 34, n = 1982), exposure to high EE was indicative of a 95% increased likelihood of relapse compared to low EE. However, no significant effect of geographical region on global EE scores (high/low) or EE domains was found. Several adjustments to the scoring of the CFI were highlighted based on cultural norms, particularly relevant to the domains of emotional over-involvement, warmth and criticism. Although this made meaningful quantitative comparisons across studies difficult, it nonetheless highlighted cultural considerations that need to be taken into account when interpreting EE and understanding its relationship to clinical outcomes. There is not a universal normative EE experience, with cultural variation in the scoring and interpretation of EE existing as evidenced by adjusted cut off scores and conceptualisation of EE constructs. Thus, it is important for clinical practitioners to have an awareness of different cultural norms in relation to caregiving and care receiving behaviours, which can inform adaptations to clinical interventions in multicultural settings.
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Affiliation(s)
- Ciarán O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.
| | | | | | - Madiha Shaikh
- Research Department of Clinical, Educational and Health Psychology, University College London, UK; Research & Development Department, North East London NHS Foundation Trust, UK
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Koutra K, Triliva S, Roumeliotaki T, Basta M, Simos P, Lionis C, Vgontzas AN. Impaired family functioning in psychosis and its relevance to relapse: a two-year follow-up study. Compr Psychiatry 2015; 62:1-12. [PMID: 26343461 DOI: 10.1016/j.comppsych.2015.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/12/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate whether dysfunctional family functioning contributes to relapse over a two-year follow-up period in patients experiencing their first episode of psychosis (FEP) and chronic patients with psychosis. METHODS The sample consisted of 100 remitted patients (50 FEP and 50 chronic) diagnosed with schizophrenia (82%) or bipolar disorder with most recent episode manic severe with psychotic features (18%) recruited from the Inpatient Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece, and their family caregivers. Family functioning was assessed in terms of cohesion and flexibility (FACES-IV), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Relapse was defined as patient rehospitalisation due to acute psychotic exacerbation, while number, length, and type of hospitalisations were also evaluated. RESULTS Dysfunctional family functioning in terms of cohesion and flexibility was not found to be a significant risk factor for relapse in psychosis. High expressed emotion, as indexed primarily by increased levels of criticism rather than emotional over-involvement, was associated with increased risk of relapse and shorter time to relapse (HR=0.48, 95% CI: 0.24, 0.98, p=0.043). Similarly, high levels of family burden were related to shorter time to relapse (HR=0.47, 95% CI: 0.23, 0.95, p=0.037), whereas there was no significant difference in survival curves based on caregivers' psychological distress. No significant interaction effect of illness chronicity was observed in the aforementioned associations. CONCLUSION These findings highlight caregivers' criticism and burden of care as long-term predictors of the course of psychosis from the early stages of the illness and later on. In contrast, unbalanced levels of cohesion and flexibility in the family, as well as caregivers' high emotional over-involvement and psychological distress do not appear to be factors that contribute to patient relapse. Family psychoeducational interventions focusing at ameliorating caregivers' negativity toward the patient, and easing the burden of care should be considered as means in reducing relapse.
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Affiliation(s)
- Katerina Koutra
- Department of Psychiatry and Behavioural Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece; Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Sofia Triliva
- Department of Psychology, University of Crete, Rethymnon, Greece
| | - Theano Roumeliotaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Maria Basta
- Department of Psychiatry and Behavioural Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Panagiotis Simos
- Department of Psychiatry and Behavioural Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros N Vgontzas
- Department of Psychiatry and Behavioural Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
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Koutra K, Triliva S, Roumeliotaki T, Stefanakis Z, Basta M, Lionis C, Vgontzas AN. Family functioning in families of first-episode psychosis patients as compared to chronic mentally ill patients and healthy controls. Psychiatry Res 2014; 219:486-96. [PMID: 25024058 DOI: 10.1016/j.psychres.2014.06.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/03/2014] [Accepted: 06/23/2014] [Indexed: 01/29/2023]
Abstract
The present study aimed to investigate possible differences in family environment among patients experiencing their First Episode of Psychosis (FEP), chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50 FEP and 50 chronic patients, as well as 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients. Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility, high criticism and burden appeared to be the outcome of psychosis and not risk factors triggering the onset of the illness. Furthermore, emotional over-involvement both in terms of positive (i.e. concern) and negative behaviors (i.e. overprotection) is prevalent in Greek families. Psychoeducational interventions from the early stages of the illness should be considered to promote caregivers' awareness regarding the patients' illness, which in turn, may ameliorate dysfunctional family interactions.
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Affiliation(s)
- Katerina Koutra
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion 71003, Crete, Greece; Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Sofia Triliva
- Department of Psychology, University of Crete, Rethymnon, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Zacharias Stefanakis
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion 71003, Crete, Greece
| | - Maria Basta
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion 71003, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros N Vgontzas
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion 71003, Crete, Greece
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Koutra K, Vgontzas AN, Lionis C, Triliva S. Family functioning in first-episode psychosis: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1023-36. [PMID: 24407976 DOI: 10.1007/s00127-013-0816-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Katerina Koutra
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece,
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Vasconcelos E Sa D, Wearden A, Barrowclough C. Expressed emotion, types of behavioural control and controllability attributions in relatives of people with recent-onset psychosis. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1377-88. [PMID: 23407901 DOI: 10.1007/s00127-013-0659-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE High expressed emotion (high-EE), as compared with low-EE, relatives of patients with long-term psychosis may behave in a more controlling manner towards patients. Furthermore, higher levels of behavioural control have been associated with higher relapse rates. We investigated in a recent-onset sample, the extent to which high-EE relatives engage in controlling behaviours and attribute the patient's illness to factors within patient's control. Furthermore, we examined whether criticism/hostility and emotional overinvolvement (EOI) were, respectively, associated with two types of behavioural control (termed 'direct influencing' and 'buffering'). We also investigated if controlling behaviours or attributions were better relapse predictors than EE. METHOD Measures of EE, controllability attributions and behavioural control and its subtypes ('direct influencing' and 'buffering') were derived from Camberwell Family Interviews with 80 relatives of recent-onset psychosis patients. 'Direct influencing' attempts denote any behaviour intending to coerce the patient; while 'buffering' attempts refer to any behaviour aiming to take control or do things for the patient. RESULTS High-EE relatives perceived patients as having more control over their illness and were more inclined to attempt to control patients' behaviour than low-EE relatives. Furthermore, high-EE-critical relatives used more direct influencing attempts, and high-EE-EOI relatives used more buffering attempts, but behavioural control was not associated with relapse in this recent-onset sample. CONCLUSIONS These findings may help us to understand the development of EE in recent-onset psychosis families. Acknowledging and integrating relatives' attributional and behavioural patterns in designing and delivering clinical and familial early interventions should prove beneficial in meeting the needs of this specific population.
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Affiliation(s)
- Debora Vasconcelos E Sa
- School of Psychological Sciences & Manchester Centre for Health Psychology, The University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.
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Meneghelli A, Alpi A, Pafumi N, Patelli G, Preti A, Cocchi A. Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: results from the Programma2000 (Milan, Italy). Psychiatry Res 2011; 189:331-8. [PMID: 21529969 DOI: 10.1016/j.psychres.2011.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Anna Meneghelli
- Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milano, Dipartimento di Salute Mentale: Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000
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Healey F, Tan VLM, Chong SA. Cross-cultural validation of expressed emotion in caregivers of Chinese patients with first episode psychosis in Singapore: a qualitative study. Int J Soc Psychiatry 2006; 52:199-213. [PMID: 16875192 DOI: 10.1177/0020764006067199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The concept of Expressed Emotion (EE; Brown et al., 1972), a measure of criticism, over-involvement and hostility in families, has been shown to be a robust predictor of relapse in schizophrenia (Parker & Hadzi-Pavlovic, 1990). Recent criticism of using Western instruments in Asian countries has led to more stringent procedures for validation of scales. AIMS The first aim was to establish that the concept of Expressed Emotion exists in Singapore. The second aim was to examine the Level of Expressed Emotion (LEE; Cole & Kazarian, 1988, Gerlsma & Hale, 1997) scale to ascertain the conceptual and construct operationalisation of this instrument in this culture. METHODS This was a qualitative study. The concept of EE was examined using a Singaporean population; 10 patient-caregiver pairs were recruited and interviewed using a semi-structured interview format. Regarding the LEE, small focus-group interviews were conducted with a cross-section of Singaporeans to gain their views on the concepts in the scale and the relevance of the items in this culture. RESULTS The interviews were analysed in light of attitudes found to discriminate between high and low EE families (Leff & Vaughn, 1985). A clear distinction between high and low EE groups was found. With regard to the LEE, the data from the focus groups, for the most part, supported the cross-cultural conceptual and operational equivalence of the scale and suggestions for additional items were made. CONCLUSION There is support for the existence of EE among families in Singapore, and the LEE was found, for the most part, to be applicable in Singapore, with the addition of several emic items.
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Affiliation(s)
- Frances Healey
- Department of Psychology, National University of Singapore.
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Heikkilä J, Karlsson H, Taiminen T, Lauerma H, Ilonen T, Leinonen KM, Wallenius E, Virtanen H, Heinimaa M, Koponen S, Jalo P, Kaljonen A, Salakangas RKR. Expressed emotion is not associated with disorder severity in first-episode mental disorder. Psychiatry Res 2002; 111:155-65. [PMID: 12374633 DOI: 10.1016/s0165-1781(02)00134-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A family atmosphere characterized by expressed emotion (EE) is a robust predictor of clinical outcome of patients with schizophrenia and mood disorders. However, there is ongoing discussion as to whether EE is more a cause of clinical outcome or a parental reaction to disorder severity. This cross-sectional study examines a sample of 42 consecutive first-episode patients from a defined geographical area with severe mental disorders (schizophrenia-related disorders, psychotic mood disorders, and non-psychotic mood disorders). Their 42 relatives were interviewed, and the relationships between EE variables derived with the five-minute speech sample method (FMSS) and the patients' demographic, premorbid and clinical measures were analyzed. A high EE score was found in 40% of the relatives. High EE was associated with the interviewed relative's not being a spouse and the patient's being young and unmarried. It was not associated with premorbid characteristics, symptom dimensions or the diagnostic group of the patient. These results do not support the hypothesis that EE is a reaction to the clinical features of the patient. Instead, demographic factors may partly mediate the effect of EE on prognosis.
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Affiliation(s)
- Jyrki Heikkilä
- Department of Psychiatry, University of Turku and Turku City Mental Health Center, Kunnallissairaalantie 20, rakennus 9, FIN 20700 Turku, Finland.
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Wearden AJ, Tarrier N, Barrowclough C, Zastowny TR, Rahill AA. A review of expressed emotion research in health care. Clin Psychol Rev 2000; 20:633-66. [PMID: 10860170 DOI: 10.1016/s0272-7358(99)00008-2] [Citation(s) in RCA: 200] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Much research has been carried out on the impact of family relationships on the development and course of different illness. Research on Expressed Emotion (EE) developed out of studies of the impact of family members on patients with schizophrenia, and has provided us with a robust measure of relatives' emotional attitudes towards patients, which has now been applied in the study of numerous psychiatric and medical illnesses. This review outlines the history of EE research in schizophrenia, and discusses the evidence for the association between family EE and the course of schizophrenic illness. Some of the factors which might moderate the association between EE and illness course are outlined and the issues of the meaning and development of EE are discussed in the light of recent theoretical advances. The application of the EE methodology in other psychiatric and medical conditions is then reviewed and conclusions are drawn about the extent to which EE predicts illness course in conditions other than schizophrenia. Consideration is given to the ways in which the application of the paradigm to a variety of illnesses or conditions with different features can enhance our understanding of the EE construct.
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Affiliation(s)
- A J Wearden
- Department of Clinical Psychology, University of Manchester, Withington Hospital, UK.
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Abstract
The purpose of this study was to identify the psychiatric and social factors associated with multiple admissions, especially for psychotic patients. Demographic and diagnostic information (based on the DSM-III-R) was collected on a computerized database for all patients admitted to the only psychiatric hospital in Geneva, Switzerland. Patients who had had at least three admissions over a period of 1 year were compared with a control group drawn from the total clinic population. In 1994, a total of 1575 patients were hospitalized, and 18% of these patients were readmitted for the third or more time. The principal diagnoses were psychotic disorders (25%), affective disorders (35%) and substance-related disorders (24%). The predictors of multiple admissions for psychotic patients were a comorbidity of substance-related disorder, longer duration of illness, female sex, younger age and poorer psychosocial adjustment during the past year. These results highlight the usefulness of a computerized psychiatric database. Indeed, early identification of the types of psychiatric patient who are likely to be readmitted is necessary to enable the planning and implementation of specific programmes of ambulatory care to prevent rehospitalization.
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Affiliation(s)
- S Vogel
- Psychiatric Clinic, University Hospitals of Geneva, Switzerland
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Schulze Mönking H, Hornung WP, Stricker K, Buchkremer G. Expressed-emotion development and course of schizophrenic illness: considerations based on results of a CFI replication. Eur Arch Psychiatry Clin Neurosci 1997; 247:31-4. [PMID: 9088803 DOI: 10.1007/bf02916250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study examines the correlation between development of expressed emotion (EE) in relatives and course of illness of 99 DSM-III schizophrenic patients. Patients whose relatives were high EE at baseline and at the 2nd CFI approximately 20 months later had a poor prognosis at the very outset of the study and an unfavourable course of illness. They had a higher rehospitalisation rate, more symptoms, lower psychosocial assessment, and a poorer 2-year and even 8-year outcome. Patients from families with a fluctuating EE or a consistently low EE had better courses. Expressed emotion is therefore a valid predictor not only of symptomatic relapses, but also of other important aspects of schizophrenia. The connection between EE index and course of illness seems not to be simply reactive or causal, but complex and non-uniform.
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