Family factors in schizophrenic relapse. Replication in California of British research on expressed emotion

Our study of the emotional atmosphere of the homes of schizophrenic patients in southern California has replicated British findings concerning the influence of the family environment on the course of schizophrenia. As in the British studies, criticism and overinvolvement expressed by a key relative about the patient at the time of the key admission proved to be the best single predictor of symptomatic relapse in the nine months after discharge from the hospital. Replicating the British results, the association between relatives' expressed emotion and relapse was independent of all other variables investigated. Cross-cultural results concerning the prophylactic effects of medication suggest that clinicians should look to the emotional atmosphere in the home for explanations of medication failures.