Predicting relapse risk from patients' perceptions of family functioning in early psychosis: A three-year...

This study examines the predictive capacity of the Spanish adaptation of the Influential Relationships Questionnaire (IRQ) in the clinical course of patients with first-episode psychosis. A total of 119 patients diagnosed with psychotic disorders (ICD-10 F20-F31), aged 18 to 35 years and living with one or both parents, were recruited from a Community Mental Health Unit and followed for three years. During initial evaluations, patients completed the short version of the IRQ, in addition to routine clinical assessments. Outcome variables included the number of relapses, hospital admissions, and time to relapse/admission, obtained from clinical records and follow-up databases. The criticism dimension of the IRQ showed the strongest predictive power, with significant and moderate-to-strong correlations with all outcome measures, particularly when referred to fathers. Care was negatively correlated with relapses and admissions, suggesting a protective effect, although with smaller effect sizes. Overinvolvement showed weak and inconsistent associations, while restriction was not significantly related to outcomes. Regression analyses confirmed the explanatory capacity of criticism, accounting for up to 23% of the variance in admissions in the paternal subgroup. Patients in the highest-criticism tertile showed markedly higher rates of relapse and admission compared to those in the lowest tertile. These findings confirm the predictive validity of the Spanish adaptation of the IRQ and highlight the importance of perceived criticism as a key dimension in the family emotional climate of first-episode psychosis. The results underscore the clinical relevance of incorporating the assessment of perceived criticism into routine practice and of including parents, particularly fathers, in therapeutic interventions.