The Community Management of Schizophrenia

1988 ◽  
Vol 153 (4) ◽  
pp. 532-542 ◽  
Author(s):  
Nicholas Tarrier ◽  
Christine Barrowclough ◽  
Christine Vaughn ◽  
J. S. Bamrah ◽  
Kathleen Porceddu ◽  
...  
Keyword(s):  
Expressed Emotion ◽  
Psychiatric Services ◽  
Community Management ◽  
Behavioural Intervention ◽  
Partial Support ◽  
Routine Treatment ◽  
Treatment Groups ◽  
Schizophrenic Patients ◽  
Relapse Rates

Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication.

Expressed emotion and relapse rates in schizophrenic patients

1992 ◽  
Vol 6 (2) ◽  
pp. 172-173
Author(s):  
R. Cohen ◽  
T. Niedermeier ◽  
H. Watzl
Keyword(s):  
Expressed Emotion ◽  
Schizophrenic Patients ◽  
Relapse Rates

Family Management Programmes for Schizophrenic Patients

1989 ◽  
Vol 155 (S5) ◽  
pp. 112-116 ◽  
Author(s):  
Kurt Hahlweg ◽  
Eli Feinstein ◽  
Ursula Müller ◽  
Matthias Dose
Keyword(s):  
Expressed Emotion ◽  
Causal Role ◽  
Family Management ◽  
New Techniques ◽  
Schizophrenic Psychosis ◽  
Schizophrenic Patients ◽  
Family Variables ◽  
Relationship Of ◽  
The Relationship

Hypotheses on the relationship of schizophrenia and family variables have changed considerably over the last 15 years: whereas speculations on the causal role of familial interaction for the onset of schizophrenic psychosis previously dominated the field of psychological theorising and psychotherapy (Bateson et al, 1956), it was not possible to confirm these theories empirically. In accordance with the research on Expressed Emotion (EE), a shift in emphasis to the influence of family variables on the further course of the illness has taken place. As a consequence, promising new techniques have been developed for the prevention or postponement of relapse.

Emotional family atmosphere and relapse: investigations on the role of relapse definition, duration of illness and resignation of relatives

1995 ◽  
Vol 10 (2) ◽  
pp. 85-91 ◽  
Author(s):  
H Schulze Mönking ◽  
G Buchkremer
Keyword(s):  
Predictive Value ◽  
Expressed Emotion ◽  
Intervention Study ◽  
Prospective Design ◽  
Therapeutic Consequences ◽  
Hospitalization Rates ◽  
Duration Of Illness ◽  
Definition Of ◽  
Relapse Rates

SummaryAn analysis of existing studies on the expressed emotion (EE) concept shows that the predictive validity of the EE index depends on the definition of relapse. Whilst symptomatic relapses are recorded in patients from high-EE families, about 3 times as often as in patients from low-EE families, a comparison of hospitalization rates reveals a difference of only approximately 1.5 times. In the Münster Families Study, a prospective intervention study to evaluate the therapeutic impact of relatives' groups, the predictive value of the familial emotional atmosphere could be measured in a prospective design. Ninety-nine DSMIII Schizophrenics, 72 male, 27 female, mean age 27 (SD 6.6), mean duration of illness 5.5 (SD 4.3) were followed up. In the first eighteen months patients from high-EE- families had a risk of rehospitalisation approximately 1.5 (p < 0.05). Further analysis showed that relapse rates among patients from high-EE and low-EE families were roughly the same for patients with a duration of illness of less than 4.5 years but were significantly different after a longer duration (p = 0.019). Besides a high EE rating, resignation of relatives was also a significant (p = 0.000) predictor of rehospitalisation for high and — even more — low EE families. Possible causes of these findings and therapeutic consequences are discussed.

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

1984 ◽  
Vol 145 (1) ◽  
pp. 62-69 ◽  
Author(s):  
David Sturgeon ◽  
Graham Turpin ◽  
Liz Kuipers ◽  
Ruth Berkowitz ◽  
Julian Leff
Keyword(s):  
Skin Conductance Response ◽  
Expressed Emotion ◽  
Social Intervention ◽  
Psychophysiological Responses ◽  
Social Interventions ◽  
Follow Up Study ◽  
Schizophrenic Patients ◽  
Experimental Group ◽  
Relapse Rates

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.

The Salford Family Intervention Project: Relapse Rates of Schizophrenia at Five and Eight Years

1994 ◽  
Vol 165 (6) ◽  
pp. 829-832 ◽  
Author(s):  
Nicholas Tarrier ◽  
Christine Barrowclough ◽  
Kathleen Porceddu ◽  
Elizabeth Fitzpatrick
Keyword(s):  
Predictive Power ◽  
Expressed Emotion ◽  
Intervention Group ◽  
Family Intervention ◽  
Control Group ◽  
Long Term Effects ◽  
The Family ◽  
Schizophrenic Patients ◽  
Relapse Rates

BackgroundThis study assessed the long-term effects of family intervention on schizophrenic relapse.MethodForty schizophrenic patients who had participated in a family intervention trial and who had not experienced relapse at two years after discharge from the index admission were traced through case notes and hospital records. The percentage of patients experiencing a relapse was estimated for patients in the family intervention group, the high-EE control group, and the low-EE control group, at five years and eight years after discharge.ResultsThere were significantly fewer relapses in the family intervention group than in the high-EE control group at both five years and eight years. The number of relapses in the low-EE control group was lower than in the high-EE control group, but this just failed to reach significance.ConclusionsThe benefit of family intervention and the predictive power of EE are sustained over eight years. Expressed emotion (EE) has remained a remarkably robust predictor of relapse in schizophrenia. Kavanagh (1992) cited 20 out of 23 prospective studies that showed patients who returned to live with high-EE relatives had higher relapse rates over 9–12 months after discharge than did patients returning to live with low-EE relatives. Seventeen of these studies reported this difference to be significant.British Journal of Psychiatry (1994),165, 829–832

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

1982 ◽  
Vol 141 (2) ◽  
pp. 121-134 ◽  
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.

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.

The Role of the Occupational Therapist in a Community Mental Health Centre in Greece

1986 ◽  
Vol 49 (12) ◽  
pp. 389-391 ◽  
Author(s):  
I Tsipra ◽  
P Voutsina ◽  
E Charitaki ◽  
V Tomaras ◽  
A Kapsali ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Health Centre ◽  
Occupational Therapist ◽  
Community Mental Health Centre ◽  
Rehabilitation Unit ◽  
Care Programme ◽  
Mental Health Centre ◽  
Schizophrenic Patients

This article deals with a developing rehabilitation unit for mentally ill people, mostly chronic schizophrenic patients, which has been integrated into the Community Mental Health Centre of two Athenian boroughs. The unit includes a day care programme, a vocational training workshop and a social therapeutic club. All these programmes have been developed for the first time in Greece at a certain community level. The authors describe the rationale and the structure of the rehabilitation unit and the role of the occupational therapist.

The role of psychiatrist on prescription of psychotropic drugs in schizophrenic patients in a psychiatric brief hospitalization unit

2007 ◽  
Vol 22 ◽  
pp. S121
Author(s):  
I. Lerma-Carrillo ◽  
F. Mora Minguez ◽  
S. de Pablo ◽  
M. Leonor ◽  
F. Pascual ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Schizophrenic Patients

scholarly journals The Role of the Family in the Course and Treatment of Bipolar Disorder

2007 ◽  
Vol 16 (4) ◽  
pp. 192-196 ◽  
Author(s):  
David J. Miklowitz
Keyword(s):  
Bipolar Disorder ◽  
Expressed Emotion ◽  
Psychosocial Interventions ◽  
Developmental Pathways ◽  
Psychosocial Stressors ◽  
At Risk Children ◽  
The Family ◽  
Initial Onset ◽  
Patterns Of Interaction

Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.

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