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PubMed2003

The family and compliance in schizophrenia: the influence of clinical variables, relatives' knowledge and expressed emotion.

BACKGROUND: . A variety of factors are related to compliance with medication in schizophrenia, but little attention has been paid to the role of families. Carers' knowledge or expressed emotion (EE) may be related to compliance. The aim of the present study was to evaluate the relevance of these two factors, as well as their relationships with other variables for the prediction of compliance. METHOD: A sample of patient-carer pairs (N = 79) involved in a family intervention for schizophrenia trial was recruited. Compliance, symptoms, social functioning and attitudes to their carers were assessed in patients. Carers' EE, knowledge and psychopathology were also evaluated. RESULTS: A number of factors were related to compliance, including carers' EE and patients' psychotic symptoms, which contributed independently to not taking medication. Carers' knowledge about schizophrenia and other groups of symptoms was not related to compliance. CONCLUSIONS: EE may be an important factor to account for in the understanding of patients' compliance and the direction of the relationship between EE and compliance should be the subject of further study.

Adolescent↗
PubMed2001

Longitudinal study of the stability of expressed emotion in families of schizophrenic patients: a 9-month follow-up.

The goal of this paper is to study attitude stability in schizophrenics' relatives, as reflected in the expressed emotion (EE) construct. For this purpose, the EE of 32 families of schizophrenic patients was assessed by means of the Camberwell Family Interview (CFI, Brown, Birley, & Wing, 1972; Vaughn & Leff, 1976b), both initially and at a 9-month follow-up. The results obtained indicate that EE is stable in fathers, whereas in mothers, high EE seems to be influenced by stressful situations, because, when assessed in crisis, EE was not stable, but in-between crises, it was. These results are discussed, as well as their relevance in family interventions aimed at reducing EE, where clinicians should take into account that mothers' EE may drop because of its instability, and not because of the intervention. On the other hand, clinicians should focus especially on fathers, because their high EE is constant, which is stressful to the patient during the follow-up.

Adolescent↗
PubMed2006

Assessing expressed emotion: comparing Camberwell Family Interview and Five-minute Speech Sample ratings for mothers of children with behaviour problems.

Little is known of the concordance between ratings of expressed emotion (EE) derived from the Camberwell Family Interview (CFI) and Five-minute Speech Sample (FMSS) for parents of children with behaviour problems. Concordance between CFI and FMSS ratings of EE was assessed prior to intervention and compared to parent-rated behaviour after intervention, at follow-up, 12 months later. Female primary caretakers of 75 children (3-10 years) showing behavioural difficulties were interviewed using FMSS and CFI. Interviews were coded independently by criterion-standard raters. Using CFI, 57 families were classified high EE, and 18 low EE. Using FMSS, 65 families were classified high EE and 10 low EE. 55/75 pairs of ratings (73%) were the same (high, n = 51: low, n = 4) and 20 mothers (27%) were allocated different EE status (Kappa = 0.14, n.s.). The FMSS ratings at initial interview appeared more closely related to behaviour rating at follow-up than CFI. Further investigation is required to establish comparability of CFI and FMSS results for carers of children.

Adult↗
PubMedDate not supplied

Evaluating expressed emotion and schizophrenia.

This article presents another review from the Network for Psychiatric Nursing Research (NPNR) National Journal Club (see Vol 8(15): 1010-12). The article reviewed was Willets and Leff's (1997) 'Expressed emotion and schizophrenia: the efficacy of a staff training programme'. The collated feedback comments from the regional journal clubs is based on the format proposed by Cormack (1991). The views expressed in this article are those of the journal club members and not necessarily those of the NPNR.

Attitude of Health Personnel↗
PubMed2001

Interpersonal control and expressed emotion in families of persons with schizophrenia: change over time.

This study examined communication patterns in 62 families of persons with schizophrenia, comparing families with relatives who were low expressed emotion (EE) at the beginning and end of a 2-year study, those who were high EE at the beginning and end, and those whose EE status changed. Interaction was coded with the Relational Control Coding System and analyzed as a Markov process. Dialogues in the stable low-EE and stable high-EE families were rather similar initially, and both groups showed increasing flexibility at year 1. However, at year 2, low-EE dyads showed increasingly complex structure and flexibility in control, but high-EE dyads showed simpler structure and rigidly controlling patterns. When EE status changed, so did the structure of the dialogues and the patterning of control. Although earlier research found more "tightly joined" systems in families of high-EE relatives, it may be that over time, these family members distance from each other and so are less connected. It is also possible that relatives who remain high EE despite intervention are a subset of high-EE relatives who need more support or different therapeutic approaches to maintain change.

Adult↗
PubMed2002

Validity of a five-minute speech sample for the measurement of expressed emotion in the families of Japanese patients with mood disorders.

Both the Camberwell Family Interview (CFI) and the Five-Minute Speech Sample (FMSS) have been used to define expressed emotion (EE), but the validity of the FMSS relative to the CFI in mood disorders has not been evaluated. In our study, the FMSS and the CFI were performed on the same day in close family members of inpatients with mood disorders within 2 weeks after their admission. The ratings obtained from the CFI were then used to estimate the validity of the FMSS, which was defined by sensitivity and specificity on the basis of the overall evaluation of EE. Validity was also assessed by including borderline ratings of 'low EE' in the category of 'high EE.' Based on the overall evaluation, sensitivity and specificity were 66.7 and 96.8%, respectively. When borderline low EE was included in high EE, the sensitivity and specificity were 100 and 90.3%, respectively. The validity of definitions of EE by the FMSS relative to the CFI was high in mood disorders. Evaluation of EE by the FMSS, which is clinically applicable to patients with mood disorders, is feasible. The validity of this approach is enhanced when families defined as 'borderline low EE' are included in the high-EE category.

Adult↗
PubMed1997

Expressed emotion from the five-minute speech sample and relapse of out-patients with schizophrenia.

We investigated the relationship between 9-month relapse of 40 outpatients with schizophrenia and expressed emotion (EE) evaluated by the Five-Minute Speech Sample (FMSS). The results of this study suggest that the FMSS is suitable for use as a convenient instrument to measure EE, although it shows more false-positive results. Therefore borderline EE of the FMSS might have to be regarded as high EE.

Adult↗
PubMed2003

Making faces: testing the relation between child behavior problems and mothers' interpretations of child emotion expressions.

We examined the relations between preschool boys' behavior problems and mothers' interpretations of children's emotion expressions. A sample of 31 mothers of oppositional boys and 28 control mothers responded to standard stimuli depicting child emotional reactions to maternal control attempts; mothers were instructed to think of the stimuli as either (a) their own child or (b) an unfamiliar child. Mothers of oppositional boys were more likely to generate negative interpretations than were control mothers when thinking of their own children; however, this difference did not generalize to the explicitly unfamiliar child condition. Mothers of oppositional boys demonstrated negative and comparison mothers demonstrated positive interpretive tendencies toward their own children. Findings suggest that child emotion cues may trigger biased maternal cognitions even in the absence of child misbehavior.

Adult↗
PubMed1996

Emotion regulation in two-year-olds: strategies and emotional expression in four contexts.

A descriptive study of the modulation of negative emotion in the toddler period was conducted by examining expressions of negative emotion and the strategies used to reduce or change these expressions. 6 strategies were identified and evaluated in terms of their frequency of use in different situations, relations with emotional expressiveness, and cross-situational consistency. 37 2-year-olds were seen in 2 laboratory contexts (delay and separation) each with 2 variants. Emotion regulation strategies and emotional expressiveness were coded from videotapes of children's behavior in these 4 situations. Findings suggest that active engagement was most commonly used and most negatively associated with child distress. Use of strategies varied by context, and there was more cross-situational consistency in use of strategies that were more negatively or positively associated with distress within a given context than in use of particular strategies without consideration of their within-context significance.

Child Behavior↗
PubMed2006

Not all negative emotions are equal: the role of emotional expression in online support groups for women with breast cancer.

The repression/suppression of negative emotions has long been considered detrimental for breast cancer (BC) patients, leading to poor coping, progression of symptoms, and general lower quality of life. Therapies have focused on encouraging the expression of negative emotions. While group therapies have proven to be successful for BC patients, no study has looked at the role of expressing negative emotions during the therapeutic interaction. We examined written expressed emotions by women participating in a common form of psychosocial support, Internet based bulletin boards (BBs). Fifty-two new members to BC BBs were studied. They completed measures of quality of life and depression. After 6 months the measures were again assessed and messages during that time were collected and analyzed for emotional content. For the 52 women, results showed that greater expression of anger was associated with higher quality of life and lower depression, while the expression of fear and anxiety was associated with lower quality of life and higher depression. The expression of sadness was unrelated to change scores. Our results serve to challenge the commonly held belief that the expression of all negative emotions are beneficial for BC patients. Instead, expressing specific negative emotions are beneficial, while others are not.

Affect↗
PubMed1997

Family climate and expressed emotion in the course of alcoholism.

Family-based predictors of relapse were examined in 100 alcoholics who participated in a 12-week treatment program with 6-month and 18-month followups. "Expressed Emotion" (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self-reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6-month followup and 30% at 18-month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: "Critical Comments," "Emotional Overinvolvement," and "Warmth." A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the "survival function" of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.

Adult↗
PubMed2003

Brief measure of expressed emotion: internal consistency and stability over time.

The study examined three methodological aspects of expressed emotion (EE) as assessed in the course of PACE (Psychosocial Assessment of Childhood Experiences) interviews with a parent. In a sample of 87 children, aged 6 13 years, enrolled in a prospective study examining the role of stress on the course of asthma, EE was assessed at three time points, 9 months apart. A high degree of agreement was found among the three concurrent measures of negative and positive EE (kappas from 0.74 to 0.97, and from 0.45 to 0.88, respectively; p < or = 0.0001 in all instances). The temporal stability of all measures was lower, although statistically significant in all but 2 instances (kappas from 0.19 to 0.59, and from 0.11 to 0.39, respectively). The temporal stability across measures, as well as across interviewers and over time, was broadly similar (kappas from 0.21 to 0.56 for negative EE, and from 0.09 to 0.38 for positive EE, with all but three of the 36 statistically significant). The findings provide support for the underlying assumptions of the PACE-EE and show the utility of measures based on just very brief periods of non-directive interviewing, making them practical in a wide range of studies with EE just one of a larger set of measures.

Adolescent↗
PubMed1994

The predictive utility of expressed emotion in schizophrenia: an aggregate analysis.

We analysed aggregate data from 25 studies linking Expressed Emotion (EE) and schizophrenia. We had access to original data sets from 17 studies, and used published data from the remainder. This provided us with 1346 cases from around the world. The association of EE with relapse was overwhelming, and was maintained whatever the geographical location. The predictive capacity of EE was virtually identical in men and women. While high contact with a high EE relative increased the risk of relapse, the opposite was true in low EE households. Medication and EE were independently related to relapse, and thus EE status has no bearing on the decision to prescribe. Our findings were confirmed using log-linear analysis.

Cross-Cultural Comparison↗
PubMed2002

Familial expressed emotion: outcome and course of Israeli patients with schizophrenia.

We investigated the validity of expressed emotion (EE) in Israel. The study sample consisted of 108 patients with schizophrenia and 15 with schizoaffective disorder, and their key relatives. EE was rated with the Five Minute Speech Sample (FMSS). Patient households were categorized by EE and its two components: criticism and emotional overinvolvement. Patients were rated with the Brief Psychiatric Rating Scale (BPRS) at admission, at discharge, and 6 months after discharge. Readmissions were determined over a 9-month period. High EE and particularly high criticism were significantly associated with poorer outcome (higher rate of and earlier readmissions, and higher BPRS score at followup) and worse illness course (higher annual number of prior psychiatric hospital admissions). Odds ratios between high EE and high criticism and readmission were 2.6 and 3.5, respectively. The strongest predictor of earlier readmission was the interaction of high criticism x poor compliance with medication. The results converge to further confirm the notion that familial EE is a valid crosscultural predictor of the clinical course of schizophrenia. Moreover, EE has predictive power in very chronic samples. Criticism appears to be the crucial EE component linked with short-term outcome. Treatment aimed at reducing high criticism is warranted. The FMSS appears to have predictive validity.

Adult↗
PubMed1992

Expressed emotion in depressed patients and their partners.

This study was designed to assess the expressed emotion (EE) status in the spouses of depressed patients and the patients themselves, to relate the EE status to the severity of depression as measured by the Beck Depression Inventory (BDI), and to compare the prevalence of high EE between the target and control group. Seventeen depressed patients and their spouses, and 20 control couples participated in the study. The Five-Minute Speech Sample was used to assess the EE status. High EE was significantly more common in spouses of depressed patients and the patients themselves than in controls. There was a significant relationship between the EE status of the patients and their spouses. High EE in the patient and in the spouse corresponded significantly with a high BDI score of the patient. These findings underline the importance that in EE research the patients' EE status as well as their present mental health state must also be taken into account.

Adult↗
PubMed1994

The relationship between psychosocial and cognitive functioning in schizophrenic patients and expressed emotion and communication deviance in their parents.

The relationship between the family variables of expressed emotion (EE) and communication deviance (CD) and patient attributes of cognitive functions and clinical symptoms were examined. Eleven schizophrenic patients and their parents were evaluated at the beginning and the end of a 2-year treatment programme. The test battery for the patients included the Global Assessment Scale (GAS), Brief Psychiatric Rating Scale and a cognitive test battery. Parents' CD was evaluated with the Communication Conflict Situation and their EE level with Camberwell Family Interview. A significant correlation between patients' GAS score and mother's criticism score was found. The cognitive variable of backward masking was the measure that most consistently showed a close relationship to parent's EE level. The masking measure also differentiated significantly between parents who improved and parents who did not improve on EE during the 2-year treatment period. An empirical basis for a link between patients' cognitive functioning and parents' style of communication was not found.

Adolescent↗
PubMed1998

Language development and emotional expression.

The relation of language and emotion in development is most often thought about in terms of how language describes emotional experiences with words that name different feelings. However, children typically do not begin to use these words until language development is well underway, at approximately 2 years of age. Given the relatively small number of words for naming feelings and emotions, and the redundancy between emotion words and the expressions they name, understanding how emotion and language are related in early development requires looking beyond just acquisition of specific emotion words.

Child Development↗
PubMed1999

Maternal expressed emotion and adjustment in children with epilepsy.

Epilepsy in childhood may alter family relationships but the relevance of these changes for the increased rates of psychopathology has been little investigated. This study uses maternal expressed emotion (EE) to examine family relationships of children with epilepsy and the association with high risk for psychiatric disorder. EE was assessed using the Camberwell Family Interview carried out with the mothers of 22 schoolchildren with chronic epilepsy who were attending a general hospital outpatient clinic. Sixteen of these children had similarly aged healthy siblings who served as controls. High risk for psychiatric disorder in the children and mothers was assessed using behavioural, mood, and self-esteem questionnaires completed by mothers, teachers, and children. It was found that mothers showed significantly more emotional overinvolvement and a trend for more hostility towards their children with epilepsy than towards sibling controls. For the 22 children with epilepsy, maternal emotional overinvolvement was not associated with child behavioural deviance. High levels of criticism and, to a lesser extent, hostility did show associations with child behavioural deviance, and the strongest links were between maternal criticism and maternal rated antisocial and overactive behaviour in the child. Fewer positive comments by mothers towards the children were associated with child emotional symptoms and lower self-esteem in a number of areas. This study suggests that further research could consider the appropriateness of psychological intervention for families in which mothers are critical and hostile and whose children show antisocial behaviour.

Adaptation, Psychological↗