Expressed Emotion: Relevance to Rehospitalization in Schizophrenia Over 7 Years

Marom, Sofi; Munitz, Hanan; Jones, Peter B.; Weizman, Abraham; Hermesh, Haggai

doi:10.1093/schbul/sbi016

Cited by 74 publications

(65 citation statements)

References 29 publications

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“…This instrument was adapted and validated for the Brazilian context in 2013 and contains 20 items, divided into two domains -CC (10 items -2, 4,6,8,10,12,14,16,18,20) and EOI (10 items -1, 3,5,7,9,11,13,15,17,19). The items in the two domains reflect different situations that the family members use to cope with their daily problems.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, relapse detection and prevention are fundamental to better prognosis (9) . The international literature shows that there is an association between the occurrence of relapses in schizophrenia patients at different stages of the disease and the presence of EE among relatives (4,11) . Prospective studies assessed the presence of EE in family members and relapses of schizophrenia patients for a period varying from 1 to 20 years.…”

Section: Introductionmentioning

confidence: 99%

“…Prospective studies assessed the presence of EE in family members and relapses of schizophrenia patients for a period varying from 1 to 20 years. They demonstrated that there is an association between these two variables, even after more than three years of follow-up (4,11) . However, there are gaps in studies on the association between EE and relapses in Brazil.…”

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confidence: 99%

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

Zanetti

Vedana

Gherardi‐Donato

et al. 2018

Rev. esc. enferm. USP

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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)...

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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

Zanetti

Vedana

Gherardi‐Donato

et al. 2018

Rev. esc. enferm. USP

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“…Furthermore, high NEE in close relatives increases the likelihood of psychiatric relapse (Brown and Rutter 1966;Bebbington and Kuipers 1994). In patients with psychosis, a high level of relative criticism is related to longer hospital stay (Marom et al 2005) and high depression and anxiety in patients (Docherty et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Neural processing of criticism and positive comments from relatives in individuals with schizotypal personality traits

Premkumar

Williams

Lythgoe

et al. 2011

The World Journal of Biological Psychiatry

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Objectives . High negative expressed emotion by family members towards schizophrenia patients increases the risk of subsequent relapse. The study aimed to determine whether individuals with high schizotypy (HS) and low schizotypy (LS) would differ in activation of brain areas involved in cognitive control when listening to relative criticism. Methods . Twelve HS and 12 LS individuals listened to relative ' s critical, positive and neutral comments about them while undergoing functional MRI. Activation maps in the two groups during the comments were compared using SPM5. Results . The left superior frontal and middle frontal gyri and bilateral posterior cingulate cortex were activated during criticism, compared to neutral comments, across all participants. While there were no group differences in brain activity for criticism versus neutral comments, the HS group, who had lower current mood relative to the LS group, activated to a lesser extent the thalamus, insula, putamen and brain stem during positive, compared to neutral, comments. Conclusions . Listening to relative criticism in healthy individuals engages brain areas for cognitive control of negative emotion and self-referential processing. However, HS individuals may have an attenuated ability to respond to rewarding aspects of positive comments due to their lower current mood.

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“…EE has been well established as a predictor of relapses (Kavanagh, 1992;King, 2000;Cechnicki et al, 2010), rehospitalizations (Schulz- Monking et al, 1997;Marom et al, 2005), and severity of positive symptoms in schizophrenia (Woo et al, 2004). Among its components, perceived criticism has been singled out as playing a particularly important role in these associations (Cechnicki et al, 2014;Docherty et al, 2011;Hooley, 2007).…”

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confidence: 99%

Expressed Emotion and Hallucination Proneness: The Mediating Role of Metacognitive Beliefs

Barahmand¹,

Sheikhahmad²

2016

Int J Life Sci

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Article InformationThis study was designed to examine the mediating role of meta-cognitions in the relationship between perceived expressed emotions and hallucination proneness in a non-clinical sample. The study sample (n = 432 university students) was selected through a stratified cluster sampling procedure and measures of perceived expressed emotions, metacognitive beliefs and hallucination proneness were administered. Two dimensions of expressed emotion, perceived irritability and perceived intrusion, and two metacognitive beliefs, beliefs about uncontrollability and danger and beliefs about cognitive confidence were found to be associated with hallucination proneness. However, only negative beliefs about uncontrollability of thoughts mediated the relationship between perceived intrusiveness and hallucination proneness. Findings imply the experience of real or perceived parental intrusiveness may activate negative beliefs about thoughts concerning uncontrollability and danger, which in turn, leads to hallucinatory experiences as a coping strategy and contributes to the persistence of real or perceived career intrusiveness.

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Expressed Emotion: Relevance to Rehospitalization in Schizophrenia Over 7 Years

Cited by 74 publications

References 29 publications

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

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

Neural processing of criticism and positive comments from relatives in individuals with schizotypal personality traits

Expressed Emotion and Hallucination Proneness: The Mediating Role of Metacognitive Beliefs

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