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Biomedical subjects

L Kuipers

Publications and source records attributed to L Kuipers.

At least 37 records · Page 2Linked to original sources
PubMed1994

The clinical utility of expressed emotion in schizophrenia.

The measure expressed emotion (EE) has been developed over the course of the last 35 years, but it is only over the last decade that there has been an explosion of interest in it. It taps attitudes and behaviour in those who care for people with a range of psychiatric and physical conditions. It has been the basis for successful studies of psychosocial intervention in schizophrenia. However, several questions remain to be answered concerning EE. This article summarizes the results of an aggregate analysis of 25 studies of EE, which appears to be a robust predictor of relapse, in a range of locations and cultures, and in both sexes. Medication and family atmosphere exert effects on relapse that are completely independent. High contact with high-EE relatives increases relapse rates still further, while if anything contact with low-EE relatives is protective. We describe what is known about the relationship of EE with the behaviour of patients and carers. It is now clear that staff members can exhibit the same range of behaviours as the relatives of sufferers. Finally, we set out the implications for the routine management of people with longstanding schizophrenia.

Chronic Disease↗
PubMed1994

Cognitive behavioural therapy for drug-resistant psychosis.

A small controlled trial of cognitive behaviour therapy for drug-resistant psychosis is reported. The study was designed as a pilot study for a future larger and longer randomized controlled trial. The therapy was offered to patients with a diagnosis of schizophrenia or schizo-affective psychosis who presented unremitting positive symptoms. An average of 16 sessions were delivered over a six-month period. The results of this pilot study are promising. Rates of engagement in therapy were high. The treatment group also improved significantly on a number of key symptom measures when compared with the controls. These were reductions in delusional conviction, general symptomatology and depression scores. Future studies should offer therapy over a longer period, targeting social as well as symptom change, and considering factors which will enhance maintenance of improvement.

Activities of Daily Living↗
PubMed1993

Family work with patients suffering from schizophrenia: the impact of training on psychiatric nurses' attitude and knowledge.

The effectiveness of family work with patients suffering from schizophrenia is well established. However, so far working with families has been carried out by highly skilled research workers. It is argued that training should be carried out to disseminate skills so that family work can be carried out routinely in clinical settings. This paper reports the impact of two pilot studies on psychiatric nurses. It was found that the trainees gained in knowledge about schizophrenia and schizophrenia family work. Furthermore, their attitudes and beliefs about schizophrenia and schizophrenia family work changed in the desired direction. The results suggest that it is possible to teach psychiatric nurses an effective model of family work for patients with schizophrenia.

Adult↗
PubMed1992

Behavioural correlates of expressed emotion in staff-patient interactions.

Staff members working in community facilities for patients with long-standing mental illness were assessed using a modification of the Camberwell Family Interview designed to measure their attitudes towards their key patients. This enabled an evaluation of their levels of expressed emotion (EE). Staff members and their patients took part in a direct interaction task 2-4 weeks later. This was deliberately focused on low-conflict issues, and each interaction was audiotaped. The presence of the nuclear symptoms of schizophrenia in the mixed diagnosis sample was the only patient attribute associated with high-EE attitudes. Staff rated high in EE were more likely than low-EE staff to make negative statments during the interaction, and less likely to make supportive ones. Patients with low-EE keyworkers were more likely to volunteer statements of self-affirmation during the interaction. Low-EE staff tended to focus on positive aspects of the patient's life. During interviews and interactions, low-EE keyworkers did not dwell on their own negative feelings (if any) or on those expressed by the patient. This characteristic is probably a salient feature of successful therapeutic relations with clients suffering from long-term mental illness.

Adult↗
PubMed1992

Staff-patient relationships in the care of the long-term adult mentally ill. A content analysis of Expressed Emotion interviews.

Analysis of the content of 61 interviews with keyworkers supporting chronically disabled patients in long-term care settings revealed a range of EE ratings and associated characteristics. Low-EE interviews were prevalent (n = 46), a finding not unlikely given the experience and training of the staff group sampled. High-EE (n = 15) relationships were characterised by less tolerance, inappropriate expectations of patient progress and frustration in the key worker. Criticism in both high- and low-EE interviews was most frequently focused on socially embarrassing or difficult behaviour and, to a slightly lesser extent, the clinical poverty syndrome. It was rarely directed at positive symptomatology. High levels of criticism were significantly related to regarding the patient's difficulties as within their control and having negative rather than positive expectations of their ability to manage on their own. The factors identified by the EE interview that influence the nature of the staff-patient relationship are discussed, and the clinical implications of the findings briefly considered.

Adult↗
PubMed1992

Expressed Emotion in community care staff. A comparison of patient outcome in a nine month follow-up of two hostels.

Expressed Emotion was measured in the staff of two similar hostels for the long term mentally ill in an Inner London Borough (Hostel A and Hostel B). Patients in the two hostels showed similar levels of disturbance as measured by the PSE and symptom and behaviour profile scores. Staff from Hostel B displayed higher levels of EE, and were more critical, and these attitudes generalised easily into hostility and rejection. Those from Hostel A showed lower EE with warmth and positive attitudes towards clients. At 9 month follow up, Hostel A and B had similar levels of relapse requiring hospital admission. However Hostel B had a 64% discharge rate compared with 12.5% for Hostel A. These results are discussed with reference to the literature.

Adult↗
PubMed1992

Social networks and support in long-term psychiatric patients.

This paper describes quantitative and qualitative aspects of social support in a sample of 40 long-term schizophrenic day patients attending a rehabilitation unit. The influence of symptomatology and experience of life stressors on network and support characteristics was also investigated. The primary networks of these patients were found to be small, comprising on average 7 members, of whom only 3 were seen regularly. Despite this, subjects rated their perceived support as adequate. The secondary networks were of the order of 32. It emerged that greater prevalence of negative symptoms was significantly associated with lower ideal levels of support and this group of patients was significantly less likely to seek support in the event of a life stressor. This may be a protective mechanism to insulate the person from the effects of stressful relationships but at the same time means that they are isolated from potential supports. The clinical implications are discussed in terms of offering optimum support for this marginalized group.

Adolescent↗
PubMed1992

Expressed emotion research in Europe.

The results of increased research into Expressed Emotion (EE) in Europe over the past five years reinforce the significance of the measure, show that it is not culturally specific and can be used with different carers including staff, and across different languages. This continuing and productive research is reviewed and new questions and issues are identified. In addition, outcome studies in schizophrenia, research in other conditions; intervention studies, methodological issues and theoretical aspects are focused on.

Attitude to Health↗
PubMed1992

Psychosocial family intervention in schizophrenia: a review of empirical studies.

"This paper reviews the recent empirical studies on psychosocial family intervention in schizophrenia. Six family educational intervention studies and five more intensive family work studies with 2-year follow-up have been included. A series of questions is asked relating to the effects of such interventions, the efficacy of the different educational models, the active ingredients of these multi-component treatment packages, and the contribution of this new generation of studies to our understanding of the mechanisms through which these interventions work. Suggestions for further research are made. Finally, from the published manuals, the common components of these diverse, multi-component treatment packages of different family-intervention studies are identified."

Behavior Therapy↗
PubMed1992

Expressed emotion in staff working with the long-term adult mentally ill.

Staff-patient relationships in long-term settings were examined in 35 staff and 61 patients. Measures were also taken of the staff's general health, their coping style in relation to work events, and job satisfaction. A range of ratings of EE was evident in staff descriptions of patients under their care. Strain and criticism in the relationship were not associated with identified stressors in the workplace, or the general health of the carer. When patients were grouped according to high-EE and low-EE interviews, there were no significant differences in their symptoms. Criticism was associated with other patient characteristics, including aggressive and attention-seeking behaviour, underactivity, and limited social interaction. The findings have implications for staff training and for the maintenance of optimal staff-patient relationships in services supporting severely disabled patients.

Adaptation, Psychological↗
PubMed1990

Relatives' expressed emotion and the course of schizophrenia in Chandigarh. A two-year follow-up of a first-contact sample.

A two-year follow-up was conducted of a subsample of the Chandigarh cohort of first-contact schizophrenic patients from the WHO Determinants of Outcome project. The patients were those living with family members who had been interviewed initially to determine their levels of expressed emotion (EE). The interview was repeated for 74% of the relatives at one-year follow-up. A dramatic reduction had occurred in each of the EE components and in the global index. No rural relative was rated as high EE at follow-up. Of the patients included in the one-year follow-up, 86% were followed for two years. In contrast to the one-year findings, the global EE index at initial interview did not predict relapse of schizophrenia over the subsequent two years. However, there was a significant association between initial hostility and subsequent relapse. The better outcome of this cohort of schizophrenic patients compared with samples from the West is partly attributable to tolerance and acceptance by family members.

Attitude to Health↗