In order to find out whether the level of Expressed Emotion represents only the emotional engagement of the closest relative, or whether it corresponds to a special sort of relationship between relative and patient, 17 parents of schizophrenic patients were examined with the Camberwell Family Interview and rated as high or low EE. They were also questioned in a semi-structured interview about interactions between themselves and the patient. Transcripts of these reported interactions were analysed and described with an interpersonal instrument (SASB). The comparison of the data from CFI and SASB shows that EE-measures of the parents correlate strongly with certain features of the relationship. High EE relationships have a more negative emotional climate, a conflict-prone structure and especially rigid patterns of interaction. In addition, there were significant correlations between SASB-variables and two subscores of the CFI (criticism and emotional overinvolvement). These results add to the validity of the EE-concept and suggest that EE-measures of relatives correspond with certain qualities of the patient-relative relationship.
As the course of schizophrenia shows a large variability, a prognosis of outcome is extremely difficult. The search for valid predictors shows that there exist numerous predictors with variable predictive significance for distinct outcome criteria and also for different phases of the illness. The indications in the literature are accordingly variable or even inconsistent. The following statements seem us to be proved: A good premorbid social adjustment, a harmonious premorbid personality, and an acute onset of the illness predict a better course, whereas an insidious onset and a development of marked negative symptoms correspond to a poorer outcome. A combination of several factors improves the predictive significance. The importance of the following indicators remains questionable: Genetic loading, neuropathological findings, positive symptoms, and age at onset of the illness. Equally open are these questions: How are the various indicators interrelated and for what span of time have they a predictive power? Psychosocial indicators have more predictive significance than the so far known biological variables. Probably the difficulties in finding valid predictors are not only related to unsolved methodological problems, but above all to intrinsic characteristics of the illness itself.
Although family therapy (or family psychotherapy) originated from schizophrenia research and therapy, it seems to be labouring particularly under the difficulties presented by schizophrenia; in the author's opinion this is due to an epistemological error. A promising new approach has emerged in recent years, once again originating from schizophrenia research, namely, "family education" or co-operation with closest relatives of the patient. The present article compares family therapy and family education, describes an updated and valid model of schizophrenia, and derives from this a preventive-rehabilitative approach.
Our considerations are based upon a new concept of schizophrenia and upon our clinical experience which has been controlled in two catamnestic studies. The new concept contains the notion of vulnerability, saying that there is no specific process underlying mental illness but there is a variety of interacting organic and psychosocial factors causing a special vulnerability leading towards psychotic break down in situations of stress. An optimal treatment should therefore consist of preventing relapse and at the same time of a soft promoting of social learning; thus an optimal treatment is a rehabilitation. Clinical experience and catamnestic studies show that mentally ill patients can be reintegrated into occupation and independent living even after a long history of illness and hospitalization. But we also find a severe ongoing handicap concerning social relations and quality of life, a strong indicator for the fact that rehabilitation has to continue even after a successful reintegration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.