The aim of this study was to assess patterns and correlates of family variables in 31 adolescents treated for their first episode of a schizophrenia spectrum disorder (early-onset schizophrenia [EOS]). Expressed emotion, perceived criticism, and rearing style were assessed. Potential correlates were patient psychopathology, premorbid adjustment, illness duration, quality of life (QoL), sociodemographic variables, patient and caregiver "illness concept," and caregiver personality traits and support. Families were rated as critical more frequently by patients than raters (55% vs. 13%). Perceived criticism was associated with worse QoL in relationship with parents and peers. An adverse rearing style was associated with a negative illness concept in patients, particularly with less trust in their physician. Future research should examine perceived criticism as a predictor of relapse and indicator of adolescents with EOS who need extended support and treatment. Rearing style should be carefully observed because of its link with patients' illness concept and, potentially, to service engagement and medication adherence.Key Words: Family, psychosis, adolescents, expressed emotion, perceived criticism, parental bonding (J Nerv Ment Dis 2014;202: 00-00) E arly-onset schizophrenia spectrum disorders (age of onset < 18 years; henceforth EOS) are associated with many negative outcomes, including worse premorbid functioning, longer duration of untreated psychosis (DUP), a higher number of negative symptoms at initial presentation, and lower response rates to and more side effects with antipsychotic treatment (Meng et al., 2006;Schimmelmann et al., 2007Schimmelmann et al., , 2013a. Furthermore, EOS seems to have distinguishable prodromal features (Fux et al., 2013;Schimmelmann et al., 2011Schimmelmann et al., , 2013b. These findings highlight the importance of identifying malleable prognostic factors in EOS.In adults with schizophrenia, family environment and, to a certain degree, rearing style (i.e., parental bonding; Parker et al., 1988) are important predictors of treatment course. In particular, a link has been established between an adverse family climate (defined as high expressed emotion [HEE] status) and a markedly increased relapse rate and higher risk for a chronic course of illness (Butzlaff and Hooley, 1998;Cechnicki et al., 2013). Although both an EE status and rearing style describe a possibly stressful or supportive environment of patients within their families, both measures seem to be associated only weakly and, therefore, represent separate paradigms of family environment (Parker et al., 1988). Family interventions have proven to effectively decrease the frequency of relapse, hospital admissions, and medication nonadherence as well as to reduce HEE (Pharoah et al., 2010). However, studies looking at firstepisode psychosis have been more ambiguous in their recommendations, and some have questioned the long-term efficacy or even reported potential harmful effects of family interventions with families ...
