Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

Abstract

Objective: Assess the relationship between psychiatric relapses of patients with a diagnosis of schizophrenia, the levels of expressed emotion among their relatives and related factors. Method: Prospective study carried out at a mental health outpatient clinic and two Psychosocial Care Centers, with patients and relatives responding to the Family Questionnaire -Brazilian Portuguese Version, a form containing socio-demographic and clinical variables and a structured script to assess relapses. A logistic regression model was used for the analysis. Results: A total of 89 dyads participated in the study. Of the patients investigated, 31% presented relapses and, among the relatives, 68% presented elevated levels of expressed emotion. The relationship between expressed emotion and the relapses was not significant. The logistic regression analysis demonstrated that when there were a higher number of hospital admissions in the two years preceding the study, the chance of the patient relapsing in the 24-month period is 1.34. Conclusion: Expressed emotion was insufficient to predict relapses. Thus, a relapse should be understood as a multifactorial phenomenon. These results provide support for interventions and investigations on the multiple factors involved in the evolution of schizophrenia patients in follow-up at community-based health services. DESCRIPTORS INTRODUCTIONThe concept of Expressed Emotion (EE) has long been used to investigate the family environment of patients with mental disorders. EE reflects the extent to which family members close to a patient express critical, hostile and emotionally over-involved attitudes or warmth when talking about the patient (1) . The main components of EE are critical comments (CC), which are related to negative judgment of patient conduct; hostility (H), related to the negative concept of the patient as a person; and emotional overinvolvement (EOI), which refers to feelings or attitudes, to despair, to self-sacrifice and to overprotection of the patient on the part of the family members. It is worth highlighting that hostility overlaps with critical comments. The family may be classified as having high EE if the family member that spends most of the time with the patient presents one or more of these components (2)(3) . Studies show that EE is a strong predictor of psychiatric relapses in schizophrenic patients, in different social and cultural contexts (4)(5) . A meta-analysis identified 27 articles reporting EE and psychiatric relapses in schizophrenia patients. These studies confirmed that EE is a good predictor of schizophrenia relapses, especially in patients in the most chronic phase of the disease (6) . Recent prospective studies have shown that patients with schizophrenia living with families with high levels of EE have higher chances of suffering relapses when compared to those that live in family settings with low EE (7)(8) .Relapses are defined by the exacerbation of symptoms related to the diagnosis of schizophrenia in patients with a stable condition (7)...

A relação entre emoção expressa e variáveis sociodemográficas, estresse precoce e sintomas de estresse em cuidadores informais de pessoas com transtornos mentais

“…No Brazilian studies were found that investigated caregivers' EE in moments of patient psychiatric crisis. However, Zanetti et al (2018b), in a recent study conducted in Brazil with 89 relatives of people with schizophrenia found a high EE of 49% and 52% in the CC and EOD components, respectively.…”

“…EE is a relevant measure because several studies showed that people with mental disorders from families with high EE have a worse prognosis of the disease and more episodes of psychiatric acute than those from families with low EE (AHMAD et al, 2017;ZANETTI et al, 2018b).…”

Convívio sociofamiliar do paciente com esquizofrenia

“…Um agravante são os comentários críticos, que estão relacionados à avaliação negativa da conduta do paciente; a hostilidade, a avaliação negativa do paciente como pessoa; e o super envolvimento emocional, que se refere aos sentimentos ou atitudes, à desesperança, ao auto sacrifício e à superproteção do paciente por parte dos familiares (Zanetti, 2019).…”

Por uma retórica do extraordinário: loucura, cultura e experiência

“…8 Atribui-se o surgimento da metodologia de EE ao contexto de desenvolvimento da Psiquiatria Social e Comunitária, nos anos 1950/1960, principalmente aos desdobramentos do trabalho do psiquiatra George W. Brown. É apontada como uma metodologia eficaz para reconhecer o que se chama de atmosfera emocional que circunda pacientes ditos esquizofrênicos (WEARDEN et al, 2000;ZANETTI et al, 2018;SANTOS et al, 2005). Amaresha e Venkatasubramanian (2012) informam que ela emergiu do próprio processo de desinstitucionalização que se seguiu ao surgimento da clorpromazina, processo que foi, apesar do "sucesso" da medicação, sucedido pela readmissão de muitos sujeitos a contextos institucionais devido a recaídas e reincidência de sintomas.…”