Influence of patient caregivers on course of patient illness: “Expressed emotion” and alternative measures

Abstract

The influence of the quality of care that patients receive during the course of their illness has been the subject of special scrutiny in the area of mental health. The concept of "expressed emotion" (EE) evolved in an effort to understand the impact of family and social environment on the vulnerability to relapse of schizophrenic patients. A semistructured interview, the Camberwell Family Interview, was developed to assess expressed emotion. This article examines the historical context, generalizability, methodological strengths and limitations of the construct of EE and the Camberwell Family Interview, as well as the nature and effects of treatment intervention programs designed to neutralize adverse effects of patient caretaker attitudes.The quality of the care to which patients are exposed has long been recognized in medicine as a factor that influences the course of their illness. Brown and his colleagues (Brown, Carstairs, 8z Topping, 1958) coined the term "expressed emotion" in an effort to measure the impact of family and social life on the vulnerability to relapse of schizophrenic patients. The concept that family interactions or communication patterns influence the development of psychopathology or the recurrence of psychiatric disorders, in particular, schizophrenia, is not new. Early psychoanalytic theory emphasized disturbances in the mother-child relationship and the role of the "schizophrenogenic" mother in the pathogenesis of the schizophrenic process (Fromm-Reichmann, 1948). Later studies (Bateson, 1973;Sullivan, 1974;Wynne, Singer, & Barko, 1977) focused on the impact of disruptions in familial communication on the onset of schizophrenia.

Family Responses and Multifamily Behavioral Treatment for Obsessive‐Compulsive Disorder

“…Initially, research on EE presented a one-sided focus that emphasized critical comments and EOI of the relative toward the patient. Descriptively, EE became synonomous with negative, critical interactions because these factors appeared to be related to relapse (Gottschalk & Keatinge, 1993). Unidirectional models suggest that patients' behaviors cause relatives' high EE or relatives' high EE causes patients' psychopathology.…”

Expressed emotion and burnout: the experience of staff caring for men with learning disability and psychosis in a medium secure setting

“…The possibility of high staff EE predicting relapse and prognosis has been suggested (Gamble & Brennan 2000). Living in a high EE setting is a chronic stressor that can impact on relapse (Gottschalk & Keating 1993, Lebell et al . 1993).…”

Η Επίδραση Του Συνθετικού Μοντέλου Ψυχοθεραπείας Στις Ενδοοικογενειακές Σχέσεις Ασθενών Με Σχιζοφρένεια Παρανοϊκού Τύπου Και Σχιζοσυναισθηματική Διαταραχή

“…Εξαιτίας της αδυναμίας της έννοιας του εκφραζόμενου συναισθήματος να συμβάλει σε ένα αιτιολογικό μοντέλο μεταξύ των οικογενειακών παραγόντων και της πορείας της σχιζοφρένειας, η έρευνα στράφηκε στην μελέτη εναλλακτικών εννοιών (Gottschalk & Keatinge, 1993). Η έννοια που είχε την μεγαλύτερη επίδραση ήταν αυτή της διπλοσύνδεσης, η οποία αφορά στην μεταβίβαση αντιφατικών μηνυμάτων, σε πραγματικό και επικοινωνιακό επίπεδο, στο οποίο βρίσκονται και αλληλεπιδρούν δύο άτομα με μία στενή και συμπληρωματική σχέση (το ένα μέλος εξαρτάται από το άλλο) (Bateson et al, 1956).…”

“…Οι Vaughn & Leff (1976b) ανέπτυξαν μία σύντομη μορφή της συνέντευξης αυτής (The Camberwell Family Interview Schedule -the abbreviated form). Οι Gottschalk & Keatinge (1993) υποστήριξαν ότι, μολονότι η Οικογενειακή Συνέντευξη του Camberwell είναι το πιο διαδεδομένο εργαλείο για τη μέτρηση του εκφραζόμενου συναισθήματος και έχει καλές ψυχομετρικές ιδιότητες, είναι ιδιαίτερα χρονοβόρο.…”