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Expressed emotion and relapse.

J F MacMillan, A Gold, T J Crow

    The British Journal of Psychiatry : the Journal of Mental Science
    |February 1, 1986
    PubMed
    Summary
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    Expressed emotion components like critical comments did not predict relapse in schizophrenia patients. Neuroleptic medication significantly impacts outcomes more than family expressed emotion factors.

    Area of Science:

    • Psychiatry
    • Clinical Psychology
    • Neuroscience

    Background:

    • 'Expressed emotion' (EE) in relatives is a proposed predictor of relapse in schizophrenia.
    • Specific EE components, such as critical comments, have been investigated for their impact on patient outcomes.

    Purpose of the Study:

    • To investigate if components of 'expressed emotion' predict relapse or response to neuroleptic medication in first-episode schizophrenia patients.
    • To assess the predictive power of 'critical comments' and 'social contact' in relation to relapse and medication response.

    Main Methods:

    • Interviewed relatives of 82 first-episode schizophrenia patients within six weeks of admission.
    • Analyzed relapse-free survival time for 77 discharged patients.
    • Examined the relationship between EE components, preadmission illness duration, and neuroleptic medication with patient outcomes.

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    Main Results:

    • 'Critical comments' by relatives was the only EE component frequent enough for analysis and was inversely related to 'social contact'.
    • Neither 'critical comments' nor 'social contact' predicted relapse or medication response when controlling for illness duration and medication.
    • The pathogenic EE constellation was present in a minority; many patients lived alone or had low family contact.

    Conclusions:

    • Components of 'expressed emotion' appear to be weak predictors of schizophrenia relapse liability.
    • The influence of 'expressed emotion' on relapse is likely less significant than that of neuroleptic medication.
    • Clinical outcomes in schizophrenia are more strongly associated with medication adherence than with family expressed emotion.