Stress-Indicative Patterns of Non-Verbal Behaviour Their Role in Family Interaction

1992 ◽  
Vol 161 (S18) ◽  
pp. 103-113 ◽  
Author(s):  
Andreas Altorfer ◽  
Michael J. Goldstein ◽  
David J. Miklowitz ◽  
Keith H. Nuechterlein
Keyword(s):  
Mental Illness ◽  
Social Interaction ◽  
Hospital Admission ◽  
Expressed Emotion ◽  
Family Interaction ◽  
Short Term ◽  
Interpersonal Behaviour ◽  
Affective Attitudes ◽  
Verbal Behaviour ◽  
Schizophrenic Patients

Research in the field of interpersonal behaviour is widely recognised as an important key to understanding the nature of mental illness. In schizophrenic patients especially, deviant social interaction has been proved to be associated with pathological behaviour (see Bellack et al, 1989). Numerous studies have revealed that affective attitudes expressed towards the patient by a relative during hospital admission for an episode of schizophrenia (high expressed emotion (EE)) are predictive of the short-term course of the disorder (Leff & Vaughn, 1985; Jenkins et al, 1986; Nuechterlein et al, 1986; Mintz et al, 1987).

Relatives' expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients

1997 ◽  
Vol 170 (1) ◽  
pp. 58-61 ◽  
Author(s):  
Stephanie M. Woo ◽  
Michael J. Goldstein ◽  
Keith H. Nuechterlein
Keyword(s):  
Family Member ◽  
Hospital Discharge ◽  
Expressed Emotion ◽  
Rating Scale ◽  
Transactional Model ◽  
Schizophrenic Disorder ◽  
Family Attitudes ◽  
Affective Attitudes ◽  
Schizophrenic Patients ◽  
Anxious Behaviour

BackgroundPrevious research has generally found that variations in relatives' affective attitudes (expressed emotion; EE) towards a schizophrenic family member could not be accounted for by differences in the severity or form of the patient's symptomatology. These findings have been based on clinicians' ratings of psychopathology in patients.MethodTo approach the question from a different perspective, videotaped interactions between a patient and family members, obtained four to five weeks after hospital discharge, were coded for subclinical signs of psychopathology expressed by the patient. The Behavioral Subclinical Rating Scale (BSRS) was developed to compare subclinical levels of non-verbal and paralinguistic symptoms expressed by patients from both high- and low-EE families.ResultsHighly significant differences were found in the BSRS data. Patients from high-EE families showed more hostile and unusual behaviour with relatives than those from low-EE homes, who, in contrast, showed more anxious behaviour.ConclusionThese data suggest that a complex transactional model is necessary to understand how family attitudes evolve during the course of a relatives' schizophrenic disorder.

The Initial Onset of Schizophrenia and Family Expressed Emotion

1989 ◽  
Vol 154 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Lois Imber Mintz ◽  
Keith H. Nuechterlein ◽  
Michael J. Goldstein ◽  
Jim Mintz ◽  
Karen S. Snyder
Keyword(s):  
Hospital Admission ◽  
Expressed Emotion ◽  
Patient Treatment ◽  
First Episode ◽  
Parental Report ◽  
Illness Onset ◽  
Best Estimate ◽  
Duration Of Illness ◽  
Initial Onset ◽  
Schizophrenic Patients

The relationships between duration of schizophrenic illness before first hospital admission, expressed emotion in key relatives, and illness course have yielded conflicting reports. This study examined the issue from a methodological perspective in a sample of first-episode schizophrenic patients. A ‘best estimate’ of illness onset, based on a compilation of all sources, was compared with an estimate based on parental report. Parental estimates suggested that the children of high-EE parents had been ill for significantly longer, but this difference was not confirmed by the best estimate. In most cases, the ill children of high-EE parents were living at home before hospital admission and their parents' estimates of duration were quite accurate. In the few cases in which the child was living away from home, high-EE parents strikingly overestimated duration. Children of low-EE families were more likely to be living away from home, but this factor did not explain the consistent underestimates of duration made by their parents. Although duration of illness did not relate to EE, successful engagement in out-patient before in-patient treatment was more common among children from low-EE families.

The Influence of Hospitalization on the Verbal Behaviour of Chronic Schizophrenics

1963 ◽  
Vol 109 (460) ◽  
pp. 380-389 ◽  
Author(s):  
Ronald D. Wynne
Keyword(s):  
Length Of Stay ◽  
Old Age ◽  
Major Determinant ◽  
Short Term ◽  
Cross Sectional ◽  
Chronic Schizophrenics ◽  
Verbal Behaviour ◽  
Epileptic Patients ◽  
Schizophrenic Patients

After reviewing the literature pertaining to intellectual deterioration, Yates (1956) concluded that the major determinant of declining vocabulary in hospitalized persons, especially schizophrenic patients, was the length of stay in hospital. The studies on which Yates based his hypothesis were cross-sectional; that is, groups of patients admitted for relatively short periods of time were compared with patients admitted for longer periods. Two studies of schizophrenics showed that long-term patients did not perform as well as short-term patients on vocabulary subscales (Nelson, 1953; Rabin, King and Ehrmann, 1955). Similar decline was noted both in long-term epileptic patients (Capps, 1939) and in non-psychotic residents of old-age homes (Fox and Birren, 1949).

The Schizophrenic as Soothsayer

1976 ◽  
Vol 39 (2) ◽  
pp. 635-642
Author(s):  
Arthur L. Sterne ◽  
Paul J. Martin ◽  
Joseph E. Moore ◽  
Ruth M. McNairy
Keyword(s):  
Hospital Admission ◽  
Therapeutic Response ◽  
Post Treatment ◽  
Response To Treatment ◽  
Objective Measures ◽  
Short Term ◽  
Outcome Relationship ◽  
Schizophrenic Patients ◽  
Pre Treatment

It is generally believed that patients' prognostic expectancies are linked to the outcome of treatment. It is also generally believed that the nature of the expectancy-outcome relationship is causative: patients' expectancies are viewed as causing or facilirating patients' responses to treatment. The study reported here tested both notions. The expectancies of hospitalized schizophrenic patients were tested by multiple regression for association with objective measures of the patients' pre- and post-treatment adjustment. Expectancy measures were closely correlated with patients' pre-treatment adjustment at hospital admission, were moderately correlated with patients' post-treatment adjustment at discharge, and were almost completely independent of post-treatment adjustment at 9-mo. follow-up. It is speculated that patients may base their prognostic expectancies partly on their pre-treatment adjustment, that patients' expectancies are associated with short-term measures of outcome, and that patients' expectancies predict but do not primarily cause or facilitate a therapeutic response to treatment for hospitalized schizophrenic patients. Finally, limitations of the findings and their generalizability are discussed.

Gender differences in family attitudes about schizophrenia

1996 ◽  
Vol 26 (4) ◽  
pp. 689-696 ◽  
Author(s):  
J. A. Davis ◽  
M. J. Goldstein ◽  
K. H. Nuechterlein
Keyword(s):  
Expressed Emotion ◽  
Rating Scale ◽  
Recent Onset ◽  
Distinct Subgroup ◽  
Female Patients ◽  
Patient Gender ◽  
Affective Attitudes ◽  
Schizophrenic Patients ◽  
Psychiatric Rating Scale ◽  
Harsh Criticism

SynopsisRecent studies have found that the expressed emotion (EE) status of relatives of female schizophrenics may not possess the prognostic value found previously for male schizophrenics. In the present study, relatives of 110 recent onset schizophrenic patients were assessed using the Camberwell Family Interview (CFI-EE), the Five Minute Speech Sample Method (FMSS-EE) and a measure of Affective Style (AS) to determine whether affective attitudes or behaviours varied by patient gender. Brief Psychiatric Rating Scale (BPRS) ratings made during in-patient and outpatient periods were examined to assess patient symptomatology. No differences were found by patient gender for CFI-EE, FMSS-EE, or subcomponents of the CFI-EE measure. However, when the subcomponents on the FMSS associated with a high EE critical rating were examined, males were found to be recipients of more harsh criticism than female patients. Similarly, for the AS measure, there was a distinct subgroup of male patients who received a level of criticism not seen in female patients. When the concordance across the two EE measures was examined, relatives of males were more consistent in their affective attitudes than relatives of female patients. Analysis of the BPRS data from the in-patient to the out-patient periods suggested variations by patient gender which may explain some of the differences in relatives' affective attitudes.

Expressed emotion and perceived family interaction in the key relatives of elderly patients with dementia

1987 ◽  
Vol 17 (4) ◽  
pp. 963-970 ◽  
Author(s):  
Jim Orford ◽  
Paul O'Reilly ◽  
Arnold Goonatilleke
Keyword(s):  
Elderly Patients ◽  
Psychiatric Disorder ◽  
Psychiatric Patient ◽  
Expressed Emotion ◽  
Psychiatric Patients ◽  
Family Interaction ◽  
Physical Disorder ◽  
Interpersonal Behaviour ◽  
Protective Behaviours

SynopsisFour groups of families were investigated using an interview designed to assess expressed emotion (EE) in relatives of psychiatric patients and a family interaction questionnaire (FIQ) based upon the Leary and Benjamin schemes for coding interpersonal behaviour. The families included 25 containing a psychiatric patient aged between 18 and 46, and three groups of 12 families each, all containing a patient over 60 (patients with dementia, a functional psychiatric disorder, or a chronic physical disorder respectively). In all cases data were obtained from key relatives.The FIQ clearly separated out the group of dementia relatives who reported the most dominant and protective behaviours and the highest levels of hostile-dominance and the lowest levels of affection. EE was not found to be so sensitive to interactions occurring in families with a member with dementia, and the possible reasons for this are discussed.

Interactional Correlates of Expressed Emotion in the Families of Schizophrenics

1984 ◽  
Vol 144 (5) ◽  
pp. 482-487 ◽  
Author(s):  
David J. Miklowitz ◽  
Michael J. Goldstein ◽  
Ian R. H. Falloon ◽  
Jeri A. Doane
Keyword(s):  
Construct Validity ◽  
Expressed Emotion ◽  
Direct Interaction ◽  
Affective Communication ◽  
Verbal Behaviour ◽  
Schizophrenic Patients

SummaryMeasures of intrafamilial expressed emotion (EE) predict relapse in schizophrenic patients, but previous research has not investigated whether EE scores are representative of ongoing family transactions. Parents of 42 hospitalized schizophrenic patients were rated for level and type of EE. Following the patient's discharge, families participated in two 10-minute direct interaction tasks. Transcripts from these interactions were coded on dimensions of affective communication.High-EE parents exhibited more negatively charged emotional verbal behaviour in direct transaction with their schizophrenic offspring than did low-EE parents. Some parents rated high-EE were distinguished by their frequent usage of critical comments during the interactions, whereas high-EE overinvolved parents used more intrusive, invasive statements. These findings support the construct validity of expressed emotion.

Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia

1997 ◽  
Vol 171 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Christine Barrowclough ◽  
Michael Parle
Keyword(s):  
Expressed Emotion ◽  
Symptom Control ◽  
Well Being ◽  
Primary Appraisal ◽  
Coping Theory ◽  
Secondary Appraisal ◽  
Multivariate Relationships ◽  
Schizophrenic Patients ◽  
A Prospective Study ◽  
Appraisal Processes

BackgroundIt is argued that coping theory may be useful in attempting to understand how relatives adapt to the demands of living with a schizophrenia sufferer.MethodIn a prospective study, univariate and multivariate relationships were explored between appraisal variables (appraisal of symptom threat (primary appraisal) and perceived symptom control (secondary appraisal)) and (a) expressed emotion, and (b) psychological distress in relatives of schizophrenic patients. The profile of relatives who showed sustained distress over time was also examined.ResultsThe appraisal variables were found to be related to both the concurrent distress (GHQ scores), EE ratings of relatives at the time of the patients relapse and hospitalisation, as well as the subsequent GHQ scores of relatives when the patient was discharged back home. Relatives who showed sustained distress were likely to show high EE and have a longer caring history.ConclusionsThe study gives some support to the theory that appraisal processes underlie how relatives react to having a family member with schizophrenia, and may have implications both for identifying those at risk of poor adaptation, and for understanding strategies that improve well-being.

scholarly journals MyCare study: protocol for a controlled trial evaluating the effect of a community-based intervention on psychosocial, clinical outcomes and hospital admission rates for adults with severe mental illness

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040610
Author(s):  
Renée O'Donnell ◽  
Melissa Savaglio ◽  
Debra Fast ◽  
Ash Vincent ◽  
Dave Vicary ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Community Based ◽  
Admission Rates ◽  
Mental Health Support ◽  
Health Support

IntroductionPeople with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare into the community. MyCare is one such community-based mental health model of care. This paper describes the study protocol of a controlled trial examining the effect of MyCare on psychosocial and clinical outcomes and hospital admission and duration rates for adults with SMI.Methods and analysisThis is a multisite non-randomised controlled trial with a 3, 6 and 12-month follow-up period. The study participants will be adults (18–64 years of age) with SMI recruited from Hobart, Launceston and the North-West of Tasmania. The treatment group will include adults who receive both the MyCare intervention and standard mental health support; the control group will include adults who receive only standard mental health support. The primary outcome includes psychosocial and clinical functioning and the secondary outcome will examine hospital admission rates and duration of stay. Mixed-effects models will be used to examine outcome improvements between intake and follow-up. This trial will generate the evidence needed to evaluate the effect of a community mental health support programme delivered in Tasmania, Australia. If MyCare results in sustained positive outcomes for adults with SMI, it could potentially be scaled up more broadly across Australia, addressing the inequity and lack of comprehensive treatment that many individuals with SMI experience.Ethics and disseminationThis study has been approved by the Tasmanian Health and Medical Human Research Ethics Committee. The findings will be disseminated to participants and staff who delivered the intervention, submitted for publication in a peer-reviewed journal and shared at academic conferences.Trial registration numberACTRN12620000673943.

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