Abstract
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 effeet of warmth was higher for fathers than for mothers. Marital conflict was significantly related to relapse, mainly because it was associated with high EE. Within the high EE group marital conflict did not predict relapse, whereas it was predictive in the low EE group. This implies that it was a source of some stress, but the effect was minor in comparison with that of high EE, emerging only in a low EE environment. Patient aggression showed only a non-significant trent towards association with relapse and with EE.
Similar content being viewed by others
References
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn revised. American Psychiatric Association, Washington, DC
Barrowclough C, Johnston M, Tarrier N (1994) Attributions, expressed emotion, and patient relapse: an attributional model of relatives' response to schizophrenic illness. Behav Ther (in press)
Bebbington PE, Kuipers L (1994) The predictive utility of Expressed Emotion in schizophrenia: an aggregate analysis. Psychol Med (in press)
Brown GW (1959) Experiences of discharged chronic schizophrenic mental hospital patients in various types of living group. Millbank Memorial Fund Q 37: 105–31
Brown GW, Monck EM, Carstairs GM, Wing JK (1962) Influence of family life on the course of schizophrenic illness. Br J Prev Soc Med 16: 55–68
Brown GW, Birley JLT, Wing JK (1972) Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 121: 241–258
Hooley MJ (1987) The nature and origins of expressed emotion: understanding major mental disorder. Family Process, New York, pp 176–194
Karno M, Jenkins JH, de la Selva A, Santata F, Telles C, Lopex S, Mintx J (1987) Expressed Emotion and schizophrenic outcome among Mexican-American families. J Nerv Ment Dis 175: 143–151
Kavanagh DJ (1992) Recent developments in expressed emotion and schizophrenia. Br J Psychiatry 160: 601–620
Leff JP, Kuipers L, Berkcwitz R, Eberlein-Fries R, Sturgeon D (1982) A controlled trial of social intervention in schizophrenic families. Br J Psychiatry 141: 121–134
Leff J, Vaughn C (1985) Expressed emotion in families: its significance for mental illness. Guilford, New York
Leff JP, Wig NN, Ghosh A, Bedi H, Menon DK, Kuipers L et al. (1987) Expressed emotion and schizophrenia in North India. III. Influence of relatives' expressed emotion on the course of schizophrenia in Chandigarh. Br J Psychiatry 151: 156–173
MacMillan JF, Gold A, Crow TJ, Johnson AL, Johnstone EC (1986) The Northwick Park Study of first episodes of schizophrenia. IV. Expressed Emotion and relapse. Br J Psychiatry 148: 133–143
Mavreas VG, Tomaras V, Karydi V, Economon M, Stefanis C (1992) Expressed Emotion in families of chronic schizophrenics and its association with clinical measures. Soc Psychiatry Psychiatr Epidemiol 27: 4–9
Miklowitz DJ, Goldstein MJ, Faloon IRH (1983) Premorbid and symptomatic characteristics of schizophrenics from families with high and low levels of Expressed Emotion. J Abnorm Psychol 3: 359–367
Nuechterlein KH, Snyder KS, Dawson ME, Rappe S, Gitlin M, Fogelson D (1986) Expressed Emotion, fixed-dose fluphenazine decanoate maintenance, and relapse in recent onset schizophrenia. Psychopharmacol Bull 22: 633–639
Parker G, Johnson P (1987) Parenting and schizophrenia: an Australian study of expressed emotion. Aust N Z J Psychiatry 21: 60–66
Vaughn C, Leff JP (1976) The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 129: 125–137
Vaughn C, Snyder KS, Jones S, Freeman WB, Falloon IRH (1984) Family factors in schizophrenic relapse. Arch Gen Psychiatry 41: 1169–1177
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ivanović, M., Vuletić, Z. & Bebbington, P. Expressed emotion in the families of patients with schizophrenia and its influence on the course of illness. Soc Psychiatry Psychiatr Epidemiol 29, 61–65 (1994). https://doi.org/10.1007/BF00805622
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00805622