The predictive validity of Expressed Emotions (EE) in schizophrenia. A 20-year prospective study

Cechnicki, Andrzej; Bielańska, Anna; Hanuszkiewicz, Igor; Daren, Artur

doi:10.1016/j.jpsychires.2012.10.004

Cited by 97 publications

(78 citation statements)

References 34 publications

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“…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.…”

Section: Introductionmentioning

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%

“…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.…”

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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: Introductionmentioning

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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“…Some studies showed an association between burnout and positive schizophrenia symptoms in male patients with female caregivers (10). Receiving inadequate professional support and situations negatively affecting the family's social support increase the psychological distress of the caregivers and impair their quality of life, in both developed and developing countries (11). The burnout rate in caregivers getting professional support for schizophrenia was lower than that of other caregivers (7,10,12).…”

Section: Introductionmentioning

confidence: 99%

Burnout in caregivers of patients with schizophrenia

Kokurcan¹,

Özpolat²,

Göğüş³

2015

Turk J Med Sci

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Background/aim: To evaluate the burnout of schizophrenia patients' caregivers and to determine the possible relationships between sociodemographic characteristics, symptomatology, perceived social support, and the burnout profile of the caregivers. Materials and methods:Subjects included in the study are 76 schizophrenia patients, diagnosed according to DSM-IV-TR criteria, and their caregivers. A sociodemographic form, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms were applied to evaluate the severity of the symptoms. The Maslach Burnout Inventory for Caregivers and the Multidimensional Scale of Perceived Social Support were applied to the caregivers of the patients. The collected data were analyzed via Student's t-test, one-way analysis of variance, and Pearson's correlation analysis. Results:The burnout profile of the caregivers was highly correlated with the perceived social support of the caregivers and was also correlated with negative symptoms of the patients. Lower perceived social support was related to all subscales of the Maslach Burnout Inventory. Conclusion:Perceived social support is a major factor for caregiver burnout and it was highly correlated with all subscales in our study. We think that having social support provides caregivers with better feelings and so they provide better help to the patients. Appropriate approaches should be taken to intervene in the social and clinical factors that may exacerbate the burnout process.

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“…A 20 year prospective study of EE in schizophrenia revealed that the level of EE in the family and its components including hostility, emotional over-involvement, and critical comments, are related to treatment outcomes in schizophrenia [19]. A high level of criticism and hostility is associated with a higher number of relapses and amplification of the positive symptoms in both, the short-term and long-term course of the illness.…”

Section: Discussionmentioning

confidence: 99%

Expressed emotion – a determinant of relapse in schizophrenia: a case report and literature review

Banerjee¹,

Retamero²

2014

J Psychiatry Brain Funct

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Expressed emotion (EE) pertains to care giver's attitude towards a person with a mental disorder. It is a characteristic of the family milieu that has been found to be one of the major psychosocial stressors and an important predictor of symptom relapse in a wide range of psychiatric disorders. Research on EE was initiated early in the 1950s, and the researchers observed that close emotional ties between families could lead to minimum stimulation and social withdrawal by a patient suffering from schizophrenia. They also observed that such patients were more likely to relapse when living with close relatives who had negative attitudes. The communication patterns in families with high EE relatives are usually characterized by intense and confronting verbal exchanges. The authors present the case of a young African American male with acute relapse of symptoms of schizophrenia in the background of a family with high EE.

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The predictive validity of Expressed Emotions (EE) in schizophrenia. A 20-year prospective study

Cited by 97 publications

References 34 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

Burnout in caregivers of patients with schizophrenia

Expressed emotion – a determinant of relapse in schizophrenia: a case report and literature review

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