Expressed emotion and social functioning in chronic schizophrenia

The aim of this study was to reveal the relationships between family expressed emotion (EE), family evaluations of social functioning, and the psychopathologic symptoms of patients with schizophrenia. We examined whether EE influenced the social functioning of patients with schizophrenia. Forty-four subjects with schizophrenia and 82 of their relatives participated in this study. The Five-Minute Speech Sample (FMSS) was conducted to evaluate EE, and subjects were divided into high-EE and low-EE groups. The Positive and Negative Symptom Scale (PANSS) was used to assess symptom severity. Social functioning was compared between the two groups using the Social Functioning Scale (SFS). No differences in symptom severity or social adjustment, as evaluated by a global assessment of functioning, were observed between the two groups. However, the high-EE relatives tended to evaluate the social functioning of the schizophrenia patient in their family as being rather low and showed a strong dissatisfaction with the patient's social withdrawal and level of independence (competence). Furthermore, low-EE relatives in high-EE families showed the same tendencies. The family members who were evaluated as low-EE relatives in a high-EE family were dissatisfied with the patient's social withdrawal, level of independence (competence), and also their interpersonal functioning. In the chronic stable phase of schizophrenia, the attention of the family members may be more directed towards changes in social functioning; thus, the EE may reflect a family's attitude towards improvements in the patient's social functioning.