Expressed emotion and psychiatric relapse a metaanalysis ronald l. Receive free email alerts when new articles cite this article sign up in the box at the. Phillips, veronica pearson, feifei li, minjie xu, lawrence yang. Expressed emotion of family members and psychiatric relapses of patients with a diagnosis of schizophrenia rev esc enferm usp 2018.
Patient attributes and expressed emotion as risk factors for. Guided by attributional literature on the prediction of distress and depression, the association between relatives distress and their explanations and beliefs concerning the illness is examined in the context of the expressed emotion status of the relative. This article investigates the level of distress in relatives at the time of an acute episode of illness in the schizophrenia sufferer. The influence of family expressed emotion on the course of schizophrenia in a sample of spanish patients. A study to assess the relationship between stigma and. The association between expressed emotion, illness severity and subjective burden. They can also influence the extent to which the person is able to recover. A longitudinal study was conducted comprising 53 inpatients sample diagnosed with schizophrenia and their 101 key carers.
An overview article pdf available in indian journal of psychological medicine 341. In international studies, however, the majority of families of persons with schizophrenia demonstrate low expressed emotion. Expressed emotion ee reflects the attitude of a close relative towards a schizophrenic family member. Expressed emotion ee is currently among the most thoroughly investigated psychosocial research constructs in psychiatry. The association between expressed emotion, illness severity and. Expressed emotion by the family of a patient with a disorder is characterized by having a critical, hostile, or. These attitudes do not arise as reactions to the form or severity of a relatives disorder, but they may relate to the length of time between initial onset of the disorder and first hospitalization. Research on schizophrenia has suggested an association between relapse of patients and high expressed emotion ee, defined as criticism, hostility, or emotional overinvolvement of at least one family member. The full text of this article hosted at is unavailable due to technical difficulties. Distress, expressed emotion, and attributions in relatives of. Sep 26, 2016 caregiver burden and expressed emotion were measured using burden assessment schedule bas and family emotional involvement and criticism scale feics respectively. Schizophrenia and expressed emotion schizophrenia and expressed emotion stirling, john 19940401 00. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Expressed emotion has been used as a construct in understanding the interaction between patients and their carers and families.
This study assessed the effect of expressed emotion ee among caregivers of schizophrenia. A considerable amount of data from western cultures suggests that high expressed emotion can lead to relapse. Diagnostic and statistical manual of mental disorders. Facial emotion recognition, sociooccupational functioning. The expressed emotion ee is considered to be an adverse family environment, which includes the quality of interaction patterns and nature of family relationships among the family caregivers and. A second weakness of the double bind theory is that there are ethical issues. Expressed emotions, burden and family functioning in. Expressed emotion of family members and psychiatric relapses. People with disorganized schizophrenia exhibit flat affect, which means that they show little or no emotions in their facial expressions, voice tone, or mannerisms.
Integrity of literature on expressed emotion and relapse. It is a psychological term specifically applied to psychiatric patients, and differs greatly from the daily use of the phrase emotion expression or another psychological concept family expressiveness. One study of expressed emotion in schizophrenia out patients. Toward specifying the nature of the relationship between. What are expressed emotions qualitative measure of the amount of emotion displayed family setting care takers relatives how do relatives of a psychological patient express their attitude towards them while they are not present.
Parents of 66 schizophrenic sydney patients were interviewed using the abbreviated camberwell family interview cfi. Expressed emotion among schizophrenic patients in lagos. Expressed emotion ee was examined, using the brief five minute speech sample measure, in families of 1 children with depressive disorders, 2 children with schizophrenia spectrum disorders, and 3 normal controls screened for the absence of psychiatric disorder. The aim of this study was to test the hypothesis that relatives designated as high ee would report higher subjective burden of care, and. Perceptions of efficacy, expressed emotion, and the course of. Article information, pdf download for expressed emotion and sociodemographic and clinical. May 15, 2014 family environmental variables are risk factors for recurrent courses of mood disorder in adolescents.
Psychosocial issues schizophrenia bulletin oxford academic. There are serious ethical concerns in blaming the family. Full text views reflects the number of pdf downloads, pdfs. Impact of expressed emotion on the course of schizophrenia. Are communication deviance and expressed emotion related to family history of psychiatric disorders in schizophrenia. Full text effect of caregivers expressed emotion on the. Recent developments in expressed emotion and schizophrenia volume 160 issue 5 david j. Parental expressed emotion and suicidal ideation in. Found that, through metaanlysis, expressed emotion in families usually correlated with relapse, especially with long lasting or chronic symptoms. Expressed emotion and the course of schizophrenia in pakistan.
The association between expressed emotion, illness. Researchers have found that costs for patients with schizophrenia who experienced relapse are up to 400% higher than for a nonrelapse group. The median relapse rate for individuals with schizophrenia in a high expressed emotion ee environment is 48%, compared to 21 % in a lowee environment. Background expressed emotion ee is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. Zigmund1 1acute psychiatry, special prison hospital, belgrade, serbia introduction the course of schizophrenia may vary as it depends on many factors. Expressed emotion ee, is a measure of the family environment that is based on how the relatives of a psychiatric patient spontaneously talk about the patient. It was identified that family interventions could modify expressed emotion resulting in a reduction in relapse rates and hospital admissions. Recent developments in expressed emotion and schizophrenia. The role of family expressed emotion and perceived social. Expressed emotion, family environment, family intervention and the psychiatric relapse of patients with severe mental disorders in iran. Higher expressed emotion within families was strongly correlated with relapse in patients with schizophrenia who returned to their family environment. Research on ee in relatives of people with schizophrenia has indicated that such an index. Sep, 2012 an appropriate understanding of the association between highexpressed emotion ee in family members of people with schizophrenia, patients and relatives correlates is needed to improve adaptation of psychoeducational interventions in diverse cultures. Low expressed emotion environments demonstrated a much lesser risk of relapse.
Although mental health professionals have shown much enthusiasm for the concept expressed emotion ee, little critical analysis of the concept has appeared in the literature. Informed consent was obtained from all patients after an explanation and resolution of doubts by the healthcare pro. There is another way to measure the amount of expressed emotion that is in a household, and it is taken from the point of view of the patient. Schizophrenia 2, suicidology and suicide prevention, treatment practice and obsessive.
Perceptions of efficacy, expressed emotion, and the course. In india, caregivers in the family play a vital role in providing care by attending to the physical and emotional needs of their ill relatives. Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. Patients and methods the descriptivecorrelation method was used in the current study. Original article expressed emotion and psychiatric relapse. Popular topics include the role of expressed emotion in the course of schizophrenia 58, family treatment 9, 25, correlative or streamlined meas ures of expressed emotion 2629, and vigorous pro. An appropriate understanding of the association between high expressed emotion ee in family members of people with schizophrenia, patients and relatives correlates is needed to improve adaptation of psychoeducational interventions in diverse cultures. Zigmund1 1acute psychiatry, special prison hospital, belgrade, serbia introduction the course of schizophrenia may vary as it depends on. Using preestablished criteria, 71% of the mothers, 58% of the fathers and 74% of the households were categorised as being of high expressed emotion ee status. Our study of the emotional atmosphere of the homes of schizophrenic patients in southern california has replicated british findings concerning the influence of the family environment on the course of schizophrenia. Schizophrenia intervention for relapse and high expressed emotion. Expressed emotion refers to a global index of particular emotions, attitudes and behaviours expressed by relatives of a family member diagnosed with schizophrenia.
Parental expressed emotion and affective style in an adolescent sample at risk for schizophrenia spectrum disorders. Knowledge and expressed emotions of caregivers towards. The interaction of life events and relatives expressed emotion in schizophrenia and depressive neurosis volume 6 issue 2 julian leff, christine vaughn. There are serious ethical concerns in blaming the family, particularly as there is little evidence upon which to base this. However, this doesnt just happen for schizophrenia. Dsmiiir diagnostic and statistical manual of mental disorders. Knowledge and expressed emotions of caregivers towards schizophrenia schizophrenia is a severe mental disorder affecting 35 of the general population at any given time in any society. The impact of caregivers expressed emotion and the. In numerous studies, schizophrenia patients who are in. Expressed emotion and relapse in young schizophrenia outpatients. In considering the importance of expanding the studies on the occurrence of psychiatric relapses over time and their link with ee, this study has the objective of assessing the relationship between psychiatric relapses of patients diagnosed with schizophrenia, levels of relatives expressed emotion. Familyexpressed emotion, childhoodonset depression, and. Tarrier n, barrowclough c, vaughn c, bamrah js, porceddu k, watts s, et al.
Consistent with the hypothesis of some specificity in the association between ee and the form of child disorder, rates of. Effect of caregivers expressed emotion on the care burden. Expressed emotion among employees of a clinic or other places in which people are in close proximity to patients with disorders also may put patients at a risk of relapse. Mean age of patient and caregivers of schizophrenia was 36. Expressed emotion by the family of a patient with a disorder is characterized by having a critical, hostile, or emotionally overinvolved relationship. It is, moreover, an accurate predictor of relapse in schizophrenic patients. Schizophrenia and expressed emotion, perspectives in. Schizophrenia 2, suicidology and suicide prevention, treatment practice and obsessivecompulsive disorder impact of expressed emotion on the course of schizophrenia g. Of particular relevance to schizophrenia is the level of expressed emotion yelling, shouting, fighting, or critical or hostile comments and stress that is in the living environment of the person with schizophrenia. The 1990 stirling award essay anthropology, expressed emotion, and schizophrenia janis hunterjenkins the question ofhow social response1 to schizophrenic illness2 varies across cultures has long been of interest to anthropologists carin.
More recent findings about the interaction between ee and schizophrenic relapse and the. Effect of caregivers expressed emotion on the care burden and rehospitalization rate of schizophrenia xia wang,1 qiongni chen,2 min yang1 1xiangya school of nursing, 2nursing department, second xiangya hospital, central south university, changsha, hunan, peoples republic of china background. Expressed emotion and relapse personality research. Toward specifying the nature of the relationship between expressed emotion and schizophrenic relapse. The association between expressed emotion, illness severity. International journal of methods in psychiatric research volume 16, issue 1. Pdf expressed emotion ee is currently among the most thoroughly. Affect refers to a persons emotional responses, including the way emotions are expressed ex. Considering the lack of brief patients based questionnaires to measure how patients with schizophrenia perceive their interaction with relatives with emphasis on both critical comments and emotional over involvement, i. This article represents an effort to examine this issue in a statistically rigorous manner. An evaluation of the shortcuts the harvard community has made this article openly available. The search terms included expressed emotion, ee and schizophrenia, ee and severe mental disorder, ee and bipolar affective.
This suggests that there is a problem of the chicken and egg scenario in relation to expressed emotion causing schizophrenia. Method the retrospective study included 112 patients diagnosed with schizophrenia and their family members. Most studies support the hypothesis that high expressed emotion predicts relapse of schizophrenia. Although ee is an established predictor of negative outcomes for both people with longterm mental health difficulties and their family carers, its psychological underpinnings remain relatively poorly understood. The implications of expressed emotion in schizophrenia essays. Low expressed emotion is a different stress from high expressed emotion because it is less stress toward the patient. How do patients with schizophrenia perceive relatives. Although the effects of caregivers expressed emotion on the relapse of patients with schizophrenia have been studied widely, there is a relative paucity of research on how the patients perceived expressed emotion affects outcome in schizophrenia. Full text effect of caregivers expressed emotion on the care burden. The data on expressed emotion ee have been replicated more often than not, although the origins of high ee attitudes are not precisely understood.
International journal of health sciences and research. The implications of expressed emotion in schizophrenia. Expressed emotion, relapse rate and utilization of psychiatric inpatient care in schizophrenia. Attachment, mentalisation and expressed emotion in carers. As in the british studies, criticism and overinvolvement expressed by a key. Expressed emotion and the course of schizophrenia in. The interaction of life events and relatives expressed. The current study aimed to investigate the role of family expressed emotion and perceived social support in prediction of retrospective relapse of addiction among addicts. An overview anekal c amaresha 1, ganesan venkatasubramanian 2 1 department of psychiatry and psychiatric social work, national institute of mental health and neurosciences, bangalore, karnataka, india 2 department of psychiatric, national institute of mental health and neurosciences, bangalore, karnataka, india. The main aim of this study was to examine the relative impacts of patients perceived expressed emotion and the caregivers expressed emotion on the symptom severity of patients with schizophrenia. Mar 31, 2015 objective the study focused on the level of expressed emotion of family members of schizophrenia patients prior to and during their longterm hospitalization and how that affected the course of treatment. Distress, expressed emotion, and attributions in relatives. Jun, 2017 effect of caregivers expressed emotion on the care burden and rehospitalization rate of schizophrenia xia wang,1 qiongni chen,2 min yang1 1xiangya school of nursing, 2nursing department, second xiangya hospital, central south university, changsha, hunan, peoples republic of china background. British journal of social and clinical psychology, 15, 157165.
Placing families in dichotomous categories of high ee and low ee amounts to stereotyping. This study assessed the effect of expressed emotion ee among caregivers of schizophrenia patients. However, in recent years some prominent nonreplications of the eerelapse relationship have been published. Expressed emotion in the last 10 years alone, well over 100 englishlan guage journal articles on expressed emotion have ap peared. The present study examined the association between parental expressed emotion eecritical, hostile andor emotionally overinvolved attitudes toward a concurrently ill offspring and suicidal ideation in adolescents with bipolar disorder. Pdf fortytwo schizophrenic patients and their close relatives took part in an italian. Aim of the study is to evaluate the predictive power of expressed emotion in schizophrenia relapse in pakistan. Influence of ee has been found to be one of the robust predictors of relapse in schizophrenia.
Pdf expressed emotion and schizophrenia in italy researchgate. The aim of the study was to assess the relationship between stigma and expressed emotion among the primary care givers of persons with schizophrenia. The predictive utility of expressed emotion in schizophrenia. Quality of life in the care givers of schizophrenic patient. Expressed emotion ee is a measure of the family environment that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. Work carried out over the last decade has provided good evidence that the concept of ee is both valid and reliable. Family dynamic and expressed emotion ee of relatives are fundamental. Vaughn and leff 1976a found that schizophrenia patients who left the.