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PubMed1989

Expressed emotion and patient-relative interaction in families of recent onset schizophrenics.

This article examines the interaction patterns of relatives of young, recent onset schizophrenic patients classified as displaying either high or low expressed emotion (EE) by two measures, the original Camberwell interview method and a recently developed brief method. The former was administered during the hospitalization period and the latter was administered approximately 2 months later when the patient was in the community. Family interactions were coded with an observational coding system that permitted sequential patterns to be analyzed as a function of the EE status of the family. No relation between the Camberwell EE rating and interactional behavior was found. However, high EE-critical relatives, defined by the brief EE method, were more negative in direct interactions than low EE relatives or high EE relatives classified as emotionally overinvolved. Sequential analyses indicated that high EE-critical relatives showed extreme negative escalation patterns. Patients' reactions to high EE-critical relatives were characterized by self-justification and negative nonverbal behavior.

Adult↗
PubMed1996

Treatment, expressed emotion and relapse in recent onset schizophrenic disorders.

The effect of in-patient and individual orientated psychosocial intervention (IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate. Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may increase stress in low EE families, thus affecting relapse in their children.

Adolescent↗
PubMed1988

Examining for links between expressed emotion and EPI personality variables: can low EE be faked?

We investigated whether links exist between scores on the EPI personality measure (with its component neuroticism, extroversion and lie scales) and scores on the expressed emotion (EE) measures, the Camberwell Family Interview (CFI). CFI scale scores were not associated with scores on the EPI neuroticism and extroversion scales. By contrast, mothers who were designated "low EE" scored significantly higher on the EPI lie scale, suggesting that some may have "faked good" during EE family assessment. The capacity for response biases to influence the CFI and subsequent EE assignment is explored, and it is suggested that corrective strategies may be required to deal with such biases in predictive studies using the EE measure.

Emotions↗
PubMed1987

Appreciation of emotional expressions in the visual and auditory modality in normal and brain-damaged patients.

Right-handed patients with right-sided, left-sided or without brain lesions, were tested for their appreciation of pictures of faces and tape-recorded voices carrying emotional expressions. The right hemisphere group was impaired in relation to the left and normal group. On the auditory test the impaired right-sided group showed confusion of all emotional categories. On the visual test, the same patients evaluated all emotional qualities to be happy or neutral. It is suggested that different mechanisms explain these findings: one of defective perceptual analysis, prominent in the auditory test, and one of change of mood in an euphoric direction specific to patients suffering damage to the right hemisphere.

Adult↗
PubMed1991

Alternative measures of expressed emotion: a methodological and cautionary note.

Undergraduate raters listened to Camberwell Family Interviews that had been conducted with the spouses of depressed patients and then rated each relative with a rating-scale assessment of expressed emotion (EE). Students' ratings of relatives' criticism, hostility, emotional overinvolvement, and warmth were significantly correlated with trained raters' EE assessments obtained in the conventional manner. Despite this correspondence, further analyses revealed that undergraduates' assessments of relatives did not predict 9-month relapse rates in patients. These results highlight the importance of establishing both the concurrent and predictive validity of any alternative measure of EE. They also emphasize the dangers of assuming that significant correlates of EE are necessarily significant predictors of relapse.

Depressive Disorder↗
PubMed1997

Relation between premorbid personality and patterns of emotion expression in mid- to late-stage dementia.

Twenty-seven nursing home patients with mid- to late-stage dementia participated in a study of the relation between preillness personality, as indexed by attachment and emotion regulation style, and current emotional behavior. Preillness measures were completed by family members and current assessments of emotion were supplied by nursing home aides and family members; in addition, emotion was coded during a family visit using an objective coding system for facial emotion expressions. Attachment style was found to be related to the expression of positive affect, with securely attached individuals displaying more positive affect than avoidantly attached individuals. In addition, high ratings on premorbid hostility were associated with higher rates of negative affect and lower rates of positive affect. These findings indicate that premorbid aspects of personality show continuity over time, even in mid- to late-stage dementia.

Affective Symptoms↗
PubMed2000

Controllability perceptions and reactions to symptoms of schizophrenia: a within-family comparison of relatives with high and low expressed emotion.

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes.

Acute Disease↗
PubMed1980

The interaction of life events and relatives' expressed emotion in schizophrenia and depressive neurosis.

A history of life events in the three months before onset of illness was taken in a group of schizophrenic and a group of depressed neurotic in-patients. The Expressed Emotion (EE) of the patients' key relatives was measured. There was no difference between the schizophrenic and depressed patients in the rate of events in the three month period before onset or in the proportion of undesirable events. However, the two groups exhibited significantly different patterns of interaction between life events and relatives' EE. Schizophrenic patients living with high EE relatives had a low rate of life events compared with those living with low EE relatives, whereas depressives living with high criticism relatives had a high rate of events compared with those living with low criticism relatives. The implications of these findings are discussed in relation to schizophrenic and depressive patients' differential vulnerability to environmental stress.

Adjustment Disorders↗
PubMed1987

The Nithsdale Schizophrenia Survey. VI. Relatives' expressed emotion: prevalence, patterns, and clinical assessment.

A review of all known schizophrenics (n = 142) in Nithsdale, Scotland, found 50% were living with relatives or friends. Of these, 32% had high contact with a relative showing high expressed emotion (EE); put another way, 87% of all Nithsdale schizophrenics were not living in a high contact/high EE family. Parents were more critical than spouses, and more showed emotional over-involvement. A retrospective review showed a trend, not of statistical significance, towards a higher admission rate to in-patient care in patients from high EE homes. Of relatives believed by a consultant psychiatrist to be neither critical nor hostile, 80% fell into the low EE category, but only 44% thought hostile or critical belonged to the high EE category; that is, the clinician had a wider view of high EE than the Camberwell Family Interview. Relative's scores on a short patient-rejection scale were higher in high EE than in low EE relatives, but the wide scatter of scores suggested the scale could not be used to identify an individual relative with high EE.

Adult↗
PubMed1992

The influence of family expressed emotion on the course of schizophrenia in a sample of Spanish patients. A two-year follow-up study.

A sample of 60 Spanish schizophrenic patients was studied to ascertain the relationship between their relatives' expressed emotion (EE) and relapse at follow-up. The relatives' EE and patients' relapse were operationalised following Leff & Vaughn's criteria. At nine months a significant association was not found between the relatives' EE and relapse, but this association became significant on reclassifying the relatives' EE scores after decreasing to four points the cut-off point for critical comments. At 24 months no association was found between EE and relapse. There was a tendency for patients who interrupted their medication or who did not work to relapse more frequently, particularly among the high-EE group.

Adult↗
PubMedDate not supplied

[The connection of visual evoked potentials with the subjective differences between emotional expressions of the "schematic face"].

Human cortical visual potentials (VEP) were studied to obtain electrophysiological data concerning face discrimination and to compare them with the direct estimates of differences between faces obtained in the previous publications. The present schematic faces varied in curvature of a mouth and/or declination of eyebrows. These features determined the emotional expression of the schematic faces. We recorded the VEP as the response to the instant replacement of one schematic face (referent stimulus) by an other one (test stimulus) rather then to presentation of a single stimulus. Thus we recorded direct electrophysiological differences between schematic faces. A characteristic feature of this approach was the application of the set of functionally connected test stimuli with monotonously increasing values of differences between the referent and test stimuli. In a result of analysis the complex of components P120-N180-P230 in sites O1, O2, P3, P4, T5, T6 was described. Interpeaks amplitudes of the components shows high correlations with subjective differences between the same pairs of stimuli as well as with physical (configurative) differences between stimuli measured as the angles of lines, defining curvature of a mouth and a declination of eyebrows. The highest correlation with subjective estimates of emotional differences between faces was shown by interpeaks amplitudes N180-P230 in sites O1 and P3. In the some time the interpeaks amplitudes P120-N180 in sites O1 and T5 reflected highest correlation between configurative measures and subjective estimates of stimuli differences.

Electroencephalography↗
PubMed2000

Expressed emotion in the families of young people with epilepsy.

The parents of 41 young people with epilepsy who were living in the same household as the patients were interviewed using the Camberwell Family Interview, and ratings of expressed emotion (EE) carried out according to standard criteria. The presence of any seizures in the 6 months prior to interview was found to be a predictor of EE (p= 0. 0017). Absolute seizure frequency, as well as presence or absence of seizures was also found to vary with the EE score. Fathers may exhibit high EE by critical comments, mothers by emotional over involvement. Although it is unclear whether high EE is the result of seizures, or whether high EE makes seizures more likely to occur, an intervention study aimed at assessing the effect of lowering parental EE levels on young people's seizure frequency might be worth pursuing.

Adolescent↗
PubMed1993

Relatives' awareness of their own expressed emotion as measured by a self-report adjective checklist.

Relatives' ratings of their affective attitudes toward a schizophrenic family member (N = 54) on a self-report adjective checklist were compared with two methods for rating expressed emotion (EE)--the original Camberwell Family Interview (CFI-EE) and a Five-Minute Speech Sample method (FMSS-EE). Eighty-four relatives were included in the sample. Results indicate that, in general, the relatives in the present sample perceive in themselves attitudes toward the patient that parallel those assessed by outside raters. A higher rate of correspondence was found between adjective ratings and concurrent FMSS-EE status than with prior CFI-EE status. Relatives classified as high-EE, critical by either method, were more readily discriminable in their adjective ratings from those rated low-EE than were relatives rated high-EE on the basis of emotional overinvolvement.

Adult↗
PubMed1999

Gender differences in emotional expressivity and self-regulation during early infancy.

Eighty-one 6-month-old infants and their mothers were videotaped in Tronick's face-to-face still-face paradigm to evaluate gender differences in infant and maternal emotional expressivity and regulation. Male infants had greater difficulty than female infants in maintaining affective regulation during each episode, including the still face. Mother-son dyads had higher synchrony scores than mother-daughter dyads but took longer in repairing interactive errors. In addition, maternal affect, matching, rate of change between matching and mismatching states, and synchrony in the play preceding the still face differentially mediated male and female infants' responses to the still face and reunion play. The developmental implications of these gender differences are discussed.

Adult↗
PubMed1988

The Nithsdale Schizophrenia Survey. VII. Does relatives' high expressed emotion predict relapse?

A review of all known schizophrenic people living in Nithsdale in South-West Scotland identified long-stay in-patients, patients living on their own and those living with relatives showing low or high expressed emotion (EE). A prospective 12-month follow-up identified relapsing patients, defined as those readmitted to hospital with exacerbation of schizophrenic symptoms or a fresh episode of illness, or, if not readmitted, with a significant increase in antipsychotic medication. There was no difference in relapse rates in patients living on their own, with low-EE, or with high-EE relatives. Amount of contact with high-EE relatives did not affect relapse rates. The different results obtained from the Nithsdale group compared with one from Camberwell are discussed.

Emotions↗
PubMed1994

Expressed emotion in the families of patients with schizophrenia and its influence on the course of illness.

This paper presents the results of a study carried on an urban population in Belgrade investigating the connections between relapse in schizophrenia and the expressed emotion (EE) status of families where at least one of the patient's parents was a member of the household. The overall rate of high EE was just under 50%, in the middle of the range of values reported in studies carried out elsewhere. Relapse was found to be 10 times more frequent in patients whose families were rated high in EE. The sample consisted of 30 patients with hebephrenic schizophrenia and 30 with paranoid schizophrenia. The results suggested that these subtypes may be associated with different attributes of EE. Criticism was more frequent in families of patients with paranoid schizophrenia, while emotional overinvolvement was more frequent in families having a hebephrenic offspring. The different components of EE, suitably combined, may differentiate between the two subtypes of schizophrenia in terms of relapse rate. The relative odds for high criticism were similar for both subtypes, but for maternal overinvolvement (EOI) the odds were 10.5 for hebephrenic as against 2.3 for paranoid schizophrenia. Thus, EOI was more common in the families of those with hebephrenia and also led more frequently to relapse. There was also an inverse relationship between relapse rate and warmth, whether paternal or maternal. This was significant in both subtypes, and indicated that the threshold for the positive effect of warmth was higher for fathers than for mothers. Marital conflict was significantly related to relapse, mainly because it was associated with high EE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Parenting and schizophrenia: an Australian study of expressed emotion.

Parents of 66 schizophrenic Sydney patients were interviewed using the abbreviated Camberwell Family Interview (CFI). Using pre-established criteria, 71% of the mothers, 58% of the fathers and 74% of the households were categorised as being of high expressed emotion (EE) status. Comparison is made with published data on the CFI and on EE categorisation for similar groups studied in England, the United States and India. The Sydney families were described as 'vocal, ambitious and aggressive', and EE scale scores more resembled the Los Angeles families than the British families originally studied. A number of factors influencing high EE categorisation (e.g., family intactness, socio-demographic variables) are noted.

Adolescent↗
PubMed1995

[The role of expressed emotions in schizophrenia].

In a decade dedicated to the brain, one particular line of research has been demonstrating the value of considering psychosocial factors in the course of schizophrenia. The purpose of this article is to briefly describe the concept of "expressed emotion" which has been shown repeatedly to predict relapse in a variety of severe mental disorders. We will, as well, describe a research program undertaken at the Douglas Hospital Research Centre which has been developed to deepen our understanding of the association between the family and outcome in schizophrenia. Selected results will be presented that highlight the complexity of the family process in mental illness.

Adult↗