Critical comments made to schizophrenic patients by their families in Japan

Critical comments (CCs) are one of the components of expressed emotion (EE), an excess of which is related to relapse. Therefore, CCs could be a target of family psychoeducation. We examined the nature of CCs for clues to family therapy. We classified CCs expressed in the Camberwell Family Interview (CFI) into nine categories: (1) positive symptoms, (2) negative symptoms, (3) compliance with medical care, (4) life problems, (5) socially inappropriate behavior, (6) aggression, (7) rejection, (8) premorbid personality, and (9) other. Positive symptoms were the most frequently commented on (34%). Negative symptoms were not so frequently commented on (11%), as expected. In comparing high-EE and low-EE relatives or relapsers and nonrelapsers, there were no significant differences in the distribution of the nine CC categories. We conclude that positive symptoms should be a main topic of family psychoeducation in such cases.