Psychophysiological Responses of Schizophrenic Patients to High and Low Expressed Emotion Relatives: A Follow-up Study

SummaryMeasurements of skin conductance response frequencies (SCRf) were obtained from 30 acutely ill schizophrenic patients during a standardised videotaped interview, conducted with the patient's key relative present. Significant differences in SCRf's were demonstrated between patients whose relatives had high and low Expressed Emotion (EE) respectively. Patients at high risk of relapse were allocated either to a control or an experimental group, the latter being offered a number of social interventions in order to reduce the relative's EE and/or contact with the patient. Follow-up measurements were obtained on 19 patients nine months after discharge. Although social intervention was highly successful in reducing relapse rates, its effects did not appear to be directly mediated via SCRf, which was found to be independently related to relapse.

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A Controlled Trial of Social Intervention in the Families of Schizophrenic Patients

The British Journal of Psychiatry ◽

10.1192/bjp.141.2.121 ◽

1982 ◽

Vol 141 (2) ◽

pp. 121-134 ◽

Cited By ~ 560

Author(s):

Julian Leff ◽

Liz Kuipers ◽

Ruth Berkowitz ◽

Rosemarie Eberlein-Vries ◽

David Sturgeon

Keyword(s):

Expressed Emotion ◽

Controlled Trial ◽

Therapeutic Interventions ◽

Social Intervention ◽

Control Group ◽

Social Interventions ◽

Schizophrenic Patients ◽

Experimental Group ◽

Risk Of Relapse

SummaryA study is reported of a controlled trial of social intervention in the families of schizophrenic patients at high risk of relapse. The patients were selected for being in high contact with high Expressed Emotion relatives. All patients were maintained on neuroleptic drugs. One half of the 24 families were randomly assigned to routine out-patient care, while the other half received a package of social interventions. This comprised a programme of education about schizophrenia, a group for the relatives, and family sessions for relatives and patients.The relapse rate in the control group was 50 per cent compared with nine per cent in the experimental group (P = 0.04). The stated aims of the therapeutic interventions were achieved in 73 per cent of experimental families. In these families, no patient relapsed. The results provide evidence for the causal role of relatives' expressed emotion (EE) in schizophrenic relapse, as well as for the therapeutic effectiveness of social intervention combined with drug treatment.

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An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings

Psychological Medicine ◽

10.1017/s0033291700027720 ◽

1994 ◽

Vol 24 (3) ◽

pp. 565-578 ◽

Cited By ~ 151

Author(s):

Jair De Jesus Mari ◽

David L. Streiner

Keyword(s):

Expressed Emotion ◽

Data Extraction ◽

Meta Analysis ◽

Control Group ◽

Family Interventions ◽

Medline Search ◽

Number Of Patients ◽

Schizophrenic Patients ◽

Experimental Group

SynopsisThe purpose of this overview is to appraise the studies on the efficacy and effectiveness of family interventions in decreasing relapse in schizophrenic patients. The studies were identified by means of a computerized MEDLINE search, and the scanning of review articles and the reference lists of the primary articles identified. More than 300 citations were reviewed, and the potentially relevant articles revealed six randomized controlled trials that were included in this meta-analysis. The criteria for selecting potential studies as well as for the meta-analysis were tested by means of an inter-rater reliability check that showed a good agreement between two independent raters (K = 0·83, and K = 0·82, respectively). There were independent assessments of the quality of the studies selected, and data extraction comprised a descriptive information of the study population, the types of interventions, and the relevant outcome measurements. The total number of patients included in the six trials was 350 (181 in the control group and 169 in the experimental group). Regarding the decrease of relapse in the experimental group, the pooled odds ratios and their 95% confidence intervals were: 0·30 (0·06, 0·71) for six months; 0·22 (0·09, 0·37) for nine months; and 0·17 (0·10, 0·35) for the 2-year follow-up. Two to five patients needed to be treated to avert one episode of relapse in a nine-month follow-up. The changes in Expressed Emotion status between experimental and control group combining nine months and one year follow-ups were shown to be marginally significant (P < 0·06), in favour of the experimental group. Emotional over-involvement was also marginally significant (P < 0·07), and there was no statistical difference in the distribution of criticism and hostility. In addition, the experimental group showed a significant increase with drug compliance and a reduction in hospitalization over time. These findings are discussed in light of the potential ingredients in the efficacy of family interventions by focusing on the limitations of using relapse as primary outcome in the assessment of efficacy trials with schizophrenic patients.

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A Controlled Trial of Social Intervention in the Families of Schizophrenic Patients: Two Year Follow-up

The British Journal of Psychiatry ◽

10.1192/bjp.146.6.594 ◽

1985 ◽

Vol 146 (6) ◽

pp. 594-600 ◽

Cited By ~ 247

Author(s):

Julian Leff ◽

Liz Kuipers ◽

Ruth Berkowitz ◽

David Sturgeon

Keyword(s):

Relapse Rate ◽

Antipsychotic Medication ◽

Expressed Emotion ◽

Controlled Trial ◽

Social Contact ◽

Social Intervention ◽

Face To Face ◽

The Social ◽

Schizophrenic Patients

SummaryThe two-year follow-up results are reported of a trial of social intervention in families of schizophrenic patients in high social contact with high-expressed emotion (EE) relatives. For those patients who remained on antipsychotic medication throughout the two years, the social intervention significantly reduced the relapse rate. In those experimental families where relatives' EE and/or face-to-face contact was lowered, the relapse rate was 14%, compared with 78% for control patients on regular medication (P = 0.02).

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Expressed emotion and relapse rates in schizophrenic patients

Schizophrenia Research ◽

10.1016/0920-9964(92)90280-i ◽

1992 ◽

Vol 6 (2) ◽

pp. 172-173

Author(s):

R. Cohen ◽

T. Niedermeier ◽

H. Watzl

Keyword(s):

Expressed Emotion ◽

Schizophrenic Patients ◽

Relapse Rates

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A Trial of Family Therapy v. a Relatives Group for Schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.154.1.58 ◽

1989 ◽

Vol 154 (1) ◽

pp. 58-66 ◽

Cited By ~ 169

Author(s):

Julian Leff ◽

Ruth Berkowitz ◽

Naomi Shavit ◽

Angus Strachan ◽

Ilana Glass ◽

...

Keyword(s):

Family Therapy ◽

Relapse Rate ◽

Expressed Emotion ◽

Cost Effective ◽

Or Education ◽

Face To Face ◽

Social Interventions ◽

The Family ◽

Schizophrenic Patients ◽

Therapy Sessions

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

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The Expectation of Outcome from Maintenance Therapy in Chronic Schizophrenic Patients

The British Journal of Psychiatry ◽

10.1192/bjp.128.3.246 ◽

1976 ◽

Vol 128 (3) ◽

pp. 246-250 ◽

Cited By ~ 37

Author(s):

D. A. W. Johnson

Keyword(s):

Maintenance Therapy ◽

Patient Population ◽

Significant Proportion ◽

Community Services ◽

Neuroleptic Drugs ◽

Follow Up Study ◽

High Incidence ◽

Schizophrenic Patients ◽

Long Acting

SummaryThe results from a prospective follow-up study of a group of schizophrenic patients suggest that a significant proportion (41 per cent) are likely to relapse during a two-year period despite the prescription of long-acting injectable neuroleptic drugs. Some will relapse because of a failure of the regime, but others (32–37 per cent) because the pharmacological protection of these drugs would appear to be less effective in certain patients. Even with the major advantages of the long-acting injectable neuroleptics over oral medication, the schizophrenic patient population remains a group with a high incidence of psychiatric and social morbidity which continues to require the full resources of both the hospital and community services.

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Relapse rates following antipsychotic discontinuation in the maintenance phase after first-episode of schizophrenia: Results of a long-term follow-up study

Schizophrenia Research ◽

10.1016/j.schres.2019.10.015 ◽

2020 ◽

Vol 225 ◽

pp. 31-38

Author(s):

Alp Üçok ◽

İlayda Arjen Kara

Keyword(s):

Maintenance Phase ◽

First Episode ◽

Follow Up Study ◽

Long Term Follow Up ◽

Relapse Rates ◽

First Episode Of Schizophrenia

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Course and Prediction of Caregiver Burden: Results of a 2-year Follow-up Study

European Psychiatry ◽

10.1016/s0924-9338(09)70467-5 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

A. Moeller-Leimkuehler ◽

M. Obermeier

Keyword(s):

Stress Response ◽

Expressed Emotion ◽

Satisfaction With Life ◽

Well Being ◽

Subjective Burden ◽

Linear Modeling ◽

Global Satisfaction ◽

Follow Up Study ◽

Time Invariant

Objective:The aim of the study was to identify the best predictors of the course of burden during a 2-year follow-up period. The study is part of the Munich 5-year follow-up study in relatives of first admitted patients with schizophrenia or depression.Method:A cohort of 60 key relatives was assessed based on a transactional stress model concerning objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. The stressors were defined as patients' illness variables, and the potential predictors included different dispositions and resources of the relatives. Effects were analyzed by regression models. In a first step, the main predictors of burden were identified at each assessment. In a second step, the resulting predictors were included in a Generalized Linear Modeling procedure.Results:Caregivers' burden improved significantly, but well-being and self-rated symptoms remained elevated. In the final regression model, expressed emotion, neuroticism, generalized negative stress response and life stressors resulted as the best predictors of burden. The effects were rather time invariant than time dependent.Conclusion:In order to effectively work on long-standing unfavourable patterns of stress response, family interventions should be long-term and targeted to vulnerable caregivers who could be identified by virtue of their personality traits.

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