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PubMed2005

Expressed emotion as predictor of relapse in patients with comorbid psychoses and substance use disorder.

OBJECTIVE: Expressed emotion (EE) and substance use disorder predict relapse in psychosis, but there is little research on EE in comorbid samples. The current study addressed this issue. METHOD: Sixty inpatients with a DSM-IV psychosis and substance use disorder were recruited and underwent diagnostic and substance use assessment. Key relatives were administered the Camberwell Family Interview. RESULTS: Patients were assessed on the initial symptoms and recent substance use, and 58 completed the assessment over the following 9 months. High EE was observed in 62% of households. Expressed emotion was the strongest predictor of relapse during follow-up and its predictive effect remained in participants with early psychosis. A multivariate prediction of a shorter time to relapse entered EE, substance use during follow-up and (surprisingly) an absence of childhood attention deficit hyperactivity disorder. CONCLUSIONS: Since high EE is a common and important risk factor for people with comorbid psychosis and substance misuse, approaches to address it should be considered by treating clinicians.

Adolescent↗
PubMed1997

Expressed-emotion development and course of schizophrenic illness: considerations based on results of a CFI replication.

This study examines the correlation between development of expressed emotion (EE) in relatives and course of illness of 99 DSM-III schizophrenic patients. Patients whose relatives were high EE at baseline and at the 2nd CFI approximately 20 months later had a poor prognosis at the very outset of the study and an unfavourable course of illness. They had a higher rehospitalisation rate, more symptoms, lower psychosocial assessment, and a poorer 2-year and even 8-year outcome. Patients from families with a fluctuating EE or a consistently low EE had better courses. Expressed emotion is therefore a valid predictor not only of symptomatic relapses, but also of other important aspects of schizophrenia. The connection between EE index and course of illness seems not to be simply reactive or causal, but complex and non-uniform.

Adult↗
PubMed1990

Maternal expressed emotion and parental affective disorder: risk for childhood depressive disorder, substance abuse, or conduct disorder.

Expressed emotion (EE) refers to a set of emotional aspects of speech for which ratings have been derived. Seven independent studies have established that higher EE ratings in the relatives of patients with schizophrenia predict higher rates of relapse in these patients and two studies have established an association of higher EE in spouses with relapse of depression in their mate. There are no previous studies of parental EE as a predictor of childhood affective disorder or other disorders not in the schizophrenia spectrum. In this study we investigated the relationship between the level of maternal EE and the incidence of DSM-III affective disorder (major depression or mania or dysthymia), substance abuse, or conduct disorder in 273 children. We found that a higher degree of maternal expressed emotion was associated with a three-fold increase in a child's risk (odds multiplier) for having at least one of the following diagnoses: depressive disorder (major depression or dysthymia), substance abuse, or conduct disorder. This increased risk acts in addition to the increased risk of child diagnosis associated with parental affective illness. Research and clinical implications are discussed.

Adolescent↗
PubMed2002

Acoustic patterns of infant vocalizations expressing emotions and communicative functions.

The present study aimed at identifying the acoustic pattern of vocalizations, produced by 7- to 11-month-old infants, that were interpreted by their mothers as expressing emotions or communicative functions. Participants were 6 healthy, first-born English infants, 3 boys and 3 girls, and their mothers. The acoustic analysis of the vocalizations was performed using a pattern recognition (PR) software system. A PR system not only calculates signal features, it also automatically detects patterns in the arrangement of such features. The following results were obtained: (a) the PR system distinguished vocalizations interpreted as emotions from vocalizations interpreted as communicative functions with an overall accuracy of 87.34%; (b) the classification accuracy of the PR system for vocalizations that convey emotions was 85.4% and for vocalizations that convey communicative functions was 89.5%; and (c) compared to vocalizations that express emotions, vocalizations that express communicative functions were shorter, displayed lower fundamental frequency values, and had greater overall intensity. These findings suggest that in the second half of the first year, infants possess a vocal repertoire that contributes to regulating cooperative interaction with their mothers, which is considered one of the major prerequisites for language acquisition.

Adult↗
PubMed1991

Abstract art and emotion: expressive form and the sense of wholeness.

This paper limits itself to abstract art the better to concentrate on the relation between the emotionally expressive power of esthetic form--apart from its narrative content--and emotional responsiveness. The emotionally expressive power of art--not to be confused with the artist's own emotions--has to do with the way sensuous esthetic forms highlight the rhythmic changes of tension and release inherent in ordinary perceptual experience. Tension and release are useful terms in thinking about how the perception of an esthetic structure is transformed (transduced) into feelingful psychological meanings, and contributes to the subjective sense of wholeness. The sense of wholeness may be illusory and/or authentic depending on the mix of elements in the individual's responsiveness. It comes about through a unified organization of tension and release, as embodied in expressive forms such as rhythm and rhyme, resonating with tension and release evoked in the observer's associations to such psychological issues as separation and reunion. Having stirred the viewer's emotional responsiveness, the art work provides a reliable "container" for the objectification of latent emotions.

Art↗
PubMed2002

The validity and reliability of the measurement of the concept 'expressed emotion' in the family members and nurses of Hong Kong patients with schizophrenia.

This study aimed to test the validity and reliability of three measures of expressed emotion in a sample of family members and nurses of Hong Kong Chinese people with schizophrenia. Little research has been done in Hong Kong in relation to family expressed emotion (EE) and schizophrenia so the present study set out to pilot some measures that could become reliable and valid measures for future clinical studies. The Adjective Check List (ACL) and the Family Attitude Scale (FAS) were compared to EE ratings obtained after a brief interview. The ratings were made based on the conceptual framework of the Camberwell Family Interview, which includes the dimensions of criticism, hostility and emotional over-involvement. Twenty-one family members and their primary nurses participated in the study which revealed that 13 of the family members and 10 of the primary nurses were rated as high EE, either in terms of criticism, emotional over-involvement or both, based on the interview. The differences in the mean FAS scores between the high EE groups and the low EE group was large but not statistically significant, and there was a significant correlation between the FAS and the brief interview. The ACL revealed some interesting results in terms of the way relatives and nurses see themselves responding to the person with schizophrenia and vice versa. Recommendations for future studies and family education strategies are made.

Adult↗
PubMed2005

Ambivalence over emotional expression in patients with gastrointestinal cancer and their caregivers: associations with patient pain and quality of life.

This study examined the role of patient and caregiver ambivalence over emotional expression (AEE) in pain and quality of life (QOL) in a sample of 78 patients with gastrointestinal (GI) cancer. Measures of ambivalence over emotional expression as well as ratings of patient pain and pain behavior were collected from patients and caregivers. Measures of pain catastrophizing, perceptions of social support, and QOL were obtained from patients. Data analyses revealed that patients high in AEE engaged in more catastrophizing and reported higher levels of pain behaviors and poorer QOL. In addition, patients whose caregivers were high in AEE engaged in more catastrophizing, had higher levels of pain and pain behavior, and reported lower emotional well-being. Patient catastrophizing mediated the effects of both patient and caregiver AEE on some patient outcomes. Taken together, these findings suggest that emotional regulation in both patients and their caregivers may be an important factor in understanding cancer patients' experience of and coping with symptoms such as pain.

Adaptation, Psychological↗
PubMedDate not supplied

Mothers, fathers, and infants: the role of person familiarity and parental involvement in infants' perception of emotion expressions.

The roles of person familiarity and parental involvement in 3.5-month-old infants' sensitivity to the dynamic emotion expressions of others were explored. In the home, parental facial/vocal expressions (happy, sad, angry) were videotaped, and measures of parent-infant involvement were obtained. In the laboratory, 32 infants alternately viewed their mother and father and an unfamiliar woman and man portraying expressions in an intermodal preference task. Infants looked differentially at mothers' expressions but not at those of fathers or unfamiliar adults. Examination of parent-child involvement patterns revealed significant relations with infants' sensitivity to expressions. Results suggest that person familiarity may facilitate infants' developing understanding of others' emotion expressions, and that individual differences in family dynamics may be relevant to infants' patterns of responding.

Adult↗
PubMed1977

Control of emotional expression in pseudobulbar palsy. A personal experience.

This report is based on the recorded experience of a patient with lability of emotional expression and other features of the syndrome of pseudobulbar palsy. We describe severe emotional overflow despite an underlying affective tone that is normal. In this context, emotional lability is a misnomer. "Hyperactive emotional reflexes" would be a more appropriate descriptive term, as the underlying mood appears normal, and only the degree of emotional expression is pathological.

Bulbar Palsy, Progressive↗
PubMed1997

Family treatment, expressed emotion and relapse in recent onset schizophrenia.

A controlled longitudinal treatment study was carried out to investigate the effect of a behavioral family treatment on Expressed Emotion (EE) and to examine the correspondence between EE changes and relapse rates. Subjects were 52 patients with recent onset schizophrenia or related disorders and their parents. After completion of inpatient treatment they were randomly allocated to individual treatment or individual treatment plus family treatment. The family treatment consisted of education and training in communication and problem-solving skills. Expressed Emotion was measured with the Five-Minute Speech Sample (FMSS). The findings show that family treatment did not have a significant positive effect on EE level. The dichotomous FMSS/EE did not systematically change and these findings were comparable with the results of prior EE research. A scoring system that included all subscores of the FMSS was somewhat more sensitive to changes. In the individual treatment condition relapse rates tended to co-occur with a change in FMSS/EE level, irrespective of the direction of this change.

Adolescent↗
PubMedDate not supplied

[Family expressed emotion. From research to therapeutic intervention].

The Expressed Emotion (EE) index is today one of the most important tools to evaluate the effect of family environment on the course of schizophrenia. The A. critically examine many experimental researches, performed on the EE index during the past 15 years, reporting the results of the first Italian replication study. The psychoeducational family interventions (originated by the EE research) are then considered, with particular attention to the treatment conceived by the team of the Association for the Research on Schizophrenia (A.R.S.). In the final section of the paper, the A. propose an extension of the EE research to families with chronic organic pathologies, reporting some preliminary results.

Emotions↗
PubMed1999

Development of procedures for rating posed emotional expressions across facial, prosodic, and lexical channels.

A number of rating systems are available to evaluate emotional communication in a single modality. The main purpose of this study was to develop procedures to train human raters to evaluate posed expressions of emotion across three different channels of communication, i.e., facial, prosodic/intonational, and lexical/verbal. These procedures were used to evaluate posed emotional expressions produced by individuals with unilateral brain lesions from stroke. Posers in this preliminary report were two right brain-damaged, two left brain-damaged, and two normal control right-handed adults who were matched on demographic and neurological factors. Eight emotional expressions, both positive and negative, were produced in three channels and rated for intensity, pleasantness, and category accuracy. 15 normal adults served as raters, five per channel. The rating procedures were comparable across channels, with analogous properties, and yielded substantial interrater agreement. In this small sample of posers, it was observed that the expressions of the right brain-damaged group were rated as the least accurate and those of the left brain-damaged group as the most intense. When patterns of individual performance across the channels were examined, performance was quiet consistent for the normal controls yet variable for the right brain-damaged persons. These observations are in keeping with the notion that patients with right hemisphere pathology have difficulty in emotional communication. In summary, these findings suggest that comparison of emotional expressions across multiple channels is feasible.

Adult↗
PubMed1984

Asymmetry of the face at rest: size, area and emotional expression.

In a sample of 53 right-handed, young adult males, asymmetry was examined in the size of 11 facial regions, in total area, and in emotional expression of the face at rest. In the complete sample no evidence was obtained of consistent asymmetry in size of facial regions, in facial area, or in emotional expression. There was, however, an interaction between family history of sinistrality and sighting dominance in facial asymmetry for the pleasantness/unpleasantness of facial expression. The findings suggest that previously established asymmetries in phasic emotional displays are not an outcome of expressive or morphological asymmetries of the face at rest.

Adult↗
PubMedDate not supplied

Cognitive functioning and expressed emotion among patients with first-episode severe psychiatric disorders.

Expressed emotion (EE) in families is able to predict the clinical outcome of patients with schizophrenia and mood disorders. However, the origins of EE and its interactions with the patient's clinical characteristics are not clear. In this respect, cognitive functioning of schizophrenic and mood-disorder patients has yielded contradictory results. In this cross-sectional study, we examined a sample of 42 consecutive first-episode patients with schizophrenia-related psychoses and severe mood disorders. Forty-two relatives were interviewed with the Five-Minute Speech Sample method. The relationships between EE and 3 clusters of patient-related variables (sociodemography, performance in cognitive tests, and psychopathology) were analyzed with stepwise regression analysis. With the exception of premorbid adjustment in childhood, only the cognitive variables were significantly associated with EE after controlling for the effect of the other variables. High EE was significantly associated with good performance in cognitive tests. Our results favor the attribution hypothesis of EE instead of the hypothesis that patient psychopathology would explain EE. Good cognitive functioning may lead to higher EE scores because of the higher expectations by the relatives.

Adult↗
PubMed1993

Diagnostic specificity of a brief measure of expressed emotion: a community study of children.

The association between expressed emotion (EE) and psychiatric disorders was investigated in a community survey of 108 preadolescent children. Results indicated that the two components of EE, critical comments and emotional overinvolvement, identified non-overlapping subsets of families and displayed diagnostic specificity. Significantly higher rates of disruptive behavior diagnoses were observed in children of parents who expressed high levels of criticism, while children of parents who expressed high levels of emotional overinvolvement were significantly more likely to have an anxiety disorder when compared to the remaining sample. Findings support the utility of this brief measure of EE in epidemiologic samples.

Child↗
PubMed2000

Attitudes towards emotional expression: factor structure, convergent validity and associations with personality.

The aim of the present study was to investigate the structure of the Attitudes towards Emotional Expression scale (AEE), its convergent validity with the Ambivalence over Emotional Expressiveness Questionnaire (AEQ), and its association with the Big 5 personality dimensions. The AEE was found to consist of four clearly identifiable factors, which loaded together on a higher order single factor. Higher scores on the AEE were associated with higher scores on the AEQ. Regression of scores on the AEE onto the Big 5 personality dimensions showed that scores on the AEE were associated with agreeableness, extraversion, and openness to experience.

Adolescent↗
PubMed1998

Facial asymmetry during emotional expression: gender, valence, and measurement technique.

The purpose of the current study was to examine 49 extant experiments of facial asymmetry during emotional expression in normal adult males and females in regard to gender, valence, and measurement technique. When facial asymmetry was evaluated by trained judges or muscle quantification, facial expressions were left-sided, a finding implicating the right cerebral hemisphere in emotional expression. However, when self-report experiential methods were utilized, the valence hypothesis received some support. Although there was some indication in single-gender studies of greater facial lateralization for males than for females, studies involving both males and females yielded no systematic asymmetry patterns as a function of gender.

Adult↗
PubMed1992

The relationship between relative's Expressed Emotion and schizophrenic relapse: an Australian replication.

We report a predictive study, carried out in Sydney Australia, investigating the association between the Expressed Emotion (EE) status of the household to which the patient is discharged and schizophrenic relapse. Expressed Emotion was not related to illness severity either at admission or discharge, but was related to variables reflecting chronicity and employment history. There was a significant association between returning to a high EE household and both re-hospitalisation and relapse. The significant association between EE and relapse held only for: patients not on medication, males, and those patients in high contact with their relatives. A discriminant function analysis found that decline in occupational status and the number of critical comments expressed by the relative were the strongest predictors of relapse. The results presented here are consistent with the majority of published reports on EE and relapse and contradict the negative findings of a recently published but smaller study also carried out in Sydney.

Adult↗