Lithium Prophylaxis and Expressed Emotion

1989 ◽  
Vol 154 (3) ◽  
pp. 396-399 ◽  
Author(s):  
Stefan Priebe ◽  
Christiane Wildgrube ◽  
Bruno Müller-Oerlinghausen
Keyword(s):  
Expressed Emotion ◽  
Hospital Admissions ◽  
Lithium Treatment ◽  
Entire Period ◽  
Psychotic Symptoms ◽  
Course Of Illness ◽  
The Relationship

Expressed emotion (EE) in key relatives of 21 patients with bipolar affective or schizoaffective psychoses was assessed by the CFI. All patients had been on prophylactic lithium for at least three years and were without psychotic symptoms at interview. The relationship between relatives' EE status and patients' course of illness was studied both retrospectively and prospectively. Two critical remarks designated high EE. The relatives' EE status was not related to number of hospital admissions or to severity and length of recurrences if the entire period of lithium treatment is considered as a whole. However, patients living with high-EE relatives showed a significantly poorer response during the three years before interview, and an even poorer response in the nine-month follow-up.

Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

2008 ◽  
Vol 38 (8) ◽  
pp. 1141-1146 ◽  
Author(s):  
P. Whitty ◽  
M. Clarke ◽  
O. McTigue ◽  
S. Browne ◽  
M. Kamali ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
First Episode ◽  
Global Assessment Of Functioning ◽  
Methodological Issues ◽  
Course Of Illness ◽  
Dsm Iv ◽  
First Episode Schizophrenia ◽  
The Relationship ◽  
Positive And Negative Symptoms

BackgroundThe outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.MethodWe conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.ResultsThere were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=−3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=−2.77, p<0.01) significantly predicted a better outcome at follow-up.ConclusionsThe outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

Expressed emotion and early onset schizophrenia: a one year follow-up

1991 ◽  
Vol 21 (3) ◽  
pp. 675-685 ◽  
Author(s):  
John Stirling ◽  
Digby Tantam ◽  
Philip Thomas ◽  
David Newby ◽  
Linda Montague ◽  
...  
Keyword(s):  
Early Onset ◽  
Expressed Emotion ◽  
Acute Onset ◽  
Work Study ◽  
Early Onset Schizophrenia ◽  
Early Admission ◽  
Elapsed Time ◽  
One Year ◽  
The Relationship

SYNOPSISKey relatives of 33 first or early admission psychotic patients (mainly schizophrenics) were interviewed to determine household levels of expressed emotion (EE). The patients were followed up for 12 months from index admission, during which time 13 (39%) experienced psychotic relapse. There was no association between relapse rate and household EE, but correlations between individual components of EE and pre-morbid measures suggest that level of criticism may be related to less acute onset of index episode, greater elapsed time since first signs of illness, and poor adjustment in the realm of work/study. The results are discussed in the context of continuing uncertainties about the precise nature of the relationship between EE and relapse.

A Role for EMDR in the Treatment of Trauma in Patients Suffering From a Psychosis: Four Vignettes

2014 ◽  
Vol 8 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Richard Laugharne ◽  
Deborah Marshall ◽  
Jon Laugharne ◽  
Alan Hassard
Keyword(s):  
Hospital Admissions ◽  
Anxiety And Depression ◽  
Psychotic Symptoms ◽  
Ptsd Symptoms ◽  
Treatment Needs ◽  
Psychotic Illness ◽  
Functional Psychosis ◽  
History Of

Many patients with a functional psychosis are likely to have a history of trauma and symptoms of posttraumatic stress disorder (PTSD); some may be traumatized by their psychotic symptoms. We present a series of vignettes to describe eye movement desensitization and reprocessing (EMDR) treatment of 4 patients suffering from a functional psychotic illness who had a significant history of trauma. After receiving EMDR, each patient showed an improvement in their PTSD symptoms and reported an improvement in the quality of their lives. Follow-up at 3–6 years indicated that the treatment effects were maintained, with changes evident in elimination of trauma-related delusions, reduction in anxiety and depression, fewer hospital admissions, and overall improved quality of life. Because a history of trauma and PTSD symptoms are more frequent in patients with a psychosis, and trauma may be an etiological component of psychosis, EMDR treatment needs to be researched and explored as a treatment opportunity.

The family and compliance in schizophrenia: the influence of clinical variables, relatives' knowledge and expressed emotion

2002 ◽  
Vol 33 (1) ◽  
pp. 91-96 ◽  
Author(s):  
W. SELLWOOD ◽  
N. TARRIER ◽  
J. QUINN ◽  
C. BARROWCLOUGH
Keyword(s):  
Social Functioning ◽  
Expressed Emotion ◽  
Family Intervention ◽  
Psychotic Symptoms ◽  
Number Of Factors ◽  
The Family ◽  
Two Factors ◽  
The Subject ◽  
The Relationship

Background. A variety of factors are related to compliance with medication in schizophrenia, but little attention has been paid to the role of families. Carers' knowledge or expressed emotion (EE) may be related to compliance. The aim of the present study was to evaluate the relevance of these two factors, as well as their relationships with other variables for the prediction of compliance.Method. A sample of patient–carer pairs (N=79) involved in a family intervention for schizophrenia trial was recruited. Compliance, symptoms, social functioning and attitudes to their carers were assessed in patients. Carers' EE, knowledge and psychopathology were also evaluated.Results. A number of factors were related to compliance, including carers' EE and patients' psychotic symptoms, which contributed independently to not taking medication. Carers' knowledge about schizophrenia and other groups of symptoms was not related to compliance.Conclusions. EE may be an important factor to account for in the understanding of patients' compliance and the direction of the relationship between EE and compliance should be the subject of further study.

What Courses and Outcomes are Possible in Schizophrenia?

Schizophrenia ◽  
2019 ◽  
Author(s):  
Stephen J. Glatt ◽  
Stephen V. Faraone ◽  
Ming T. Tsuang
Keyword(s):  
Social Functioning ◽  
Acute Onset ◽  
Psychotic Symptoms ◽  
Course Of Illness ◽  
Good Outcome ◽  
Complex Picture ◽  
Episodic Course ◽  
Number Of Individuals

Kraepelin described one of the core features of schizophrenia to be its progres­sively worsening course with little chance of recovery. In contrast, mood dis­orders were thought to have an episodic course with good functioning between bouts of mania and depression, and a relatively good outcome. The ensuing dec­ades of research have painted a more complex picture of the course and outcome of schizophrenia. Most notably, in contrast to Kraepelin’s bleak outlook, a fair number of individuals can more or less successfully recover from schizophrenia. Dr Manfred Bleuler, son of Dr Eugen Bleuler, reported a 20- year follow-up of over 200 individuals with schizophrenia excluding those who had either died or shown little psychiatric stability over the previous 5 years. Bleuler noted that one in five patients had recovered to normal levels of social functioning and were free of psychotic symptoms. Furthermore, one in three patients had a relatively good outcome. Thus, while patients still experienced hallucinations and delu­sions, they showed only mild problems in social functioning and very few visible behavioural problems. These results are quite remarkable given that the study was completed prior to the discovery of antipsychotic medications.Dr Luc Ciompi was able to follow nearly 300 patients for as long as 50 years after hospitalization. Using Bleuler’s categories of outcome, Ciompi found 27% of the patients to be fully recovered, 22% to have mild symptoms, 24% to have moderately severe symptoms, and 18% to have severe symptoms. Nine per cent of the sample had an uncertain outcome. A progressively worsening, gradual, and serious onset was seen in about half of the affected individuals, while a sudden or acute onset of illness with little or no problems in premorbid func­tioning was found for the rest of the sample. About half of the individuals with schizophrenia had a continuous course of illness, and the remainder had an episodic course. In addition, an episodic course was more likely among patients with acute onset. Acute onset and episodic course were both associated with better long- term outcome.A study performed by Dr Ming Tsuang and team, known as the Iowa 500 study, followed 186 individuals with schizophrenia, 86 with bipolar disorder, and 212 with major depressive disorder for 35– 40 years.

The Influence of Family Expressed Emotion on the Course of Schizophrenia in a Sample of Spanish Patients

1992 ◽  
Vol 161 (2) ◽  
pp. 217-222 ◽  
Author(s):  
I. Montero ◽  
M. Gómez-Beneyto ◽  
I. Ruiz ◽  
E. Puche ◽  
A. Adam
Keyword(s):  
Expressed Emotion ◽  
Schizophrenic Patients ◽  
The Relationship

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.

Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects

2003 ◽  
Vol 18 (3) ◽  
pp. 133-136 ◽  
Author(s):  
F. Sorbara ◽  
F. Liraud ◽  
F. Assens ◽  
F. Abalan ◽  
H. Verdoux
Keyword(s):  
Substance Use ◽  
Substance Misuse ◽  
Alcohol Misuse ◽  
Psychotic Symptoms ◽  
Sources Of Information ◽  
Social Outcome ◽  
Course Of Illness ◽  
Increased Risk ◽  
The Impact

AbstractObjectiveTo examine the impact of alcohol and substance use on the early course of psychosis.Methods: First-admitted subjects with psychosis (n = 58) were assessed at 6-month intervals over a 2-year follow-up. Information on substance and alcohol misuse and clinical and social outcome was collected using multiple sources of information.ResultsAfter adjustment for potential confounding factors, subjects with persistent substance misuse over the follow-up were at increased risk of readmission (OR = 3.1; 95%CI = 1.0-9.4; P = 0.05), of presenting with psychotic symptoms (OR = 4.3; 95%CI = 1.0-18.1; P = 0.04), and with a non-continuous course of illness (OR = 11; 95%CI = 1-122; P = 0.05). No significant association was found between substance misuse and social outcome, or between alcohol misuse and clinical and social outcome.ConclusionsPersistent substance misuse after a first admission for psychosis has a deleterious impact on clinical outcome. Early identification and treatment of substance use is essential in the care of subjects with incipient psychosis.

Tobacco and anti-psychotics side effects

2017 ◽  
Vol 41 (S1) ◽  
pp. S753-S753
Author(s):  
I. González González ◽  
A. Hernández Dorta
Keyword(s):  
Side Effects ◽  
Hospital Admissions ◽  
Tobacco Consumption ◽  
Psychotic Symptoms ◽  
Blood Levels ◽  
Potent Inducer ◽  
Tobacco Treatment ◽  
Cyp 1A2 ◽  
Competing Interest ◽  
The Relationship

IntroductionIt's known that, patients with schizophrenia smoke more tobacco than general population, and that tobacco is a potent inducer of cythocrome P450 isoenzyme 1A2 (CYP 1A2). In addition, clozapine and quetiapine, drugs frequently used in the treatment of schizophrenia, are CYP1A2 substrates. So, tobacco smoking may reduce blood levels of clozapine and quetiapine.ObjectiveTo revisit the influence of changes in tobacco consumption in clozapine and quetiapine side effects.MethodsCase report.ResultsA 48-year-old male diagnosed of schizophrenia following DSM IV-TR criteria. He required five hospital admissions from 2008 to 2013 because of psychotic episodes. Since 2013, he was asymptomathic receiving clozapine, 600 mg/day, and quetiapine, 1200 mg/day. Recently, he came to the emergency service due to sudden extreme sedation, thinking impairment, sialorrhea, and walking disability. The patient denied treatment abuse and his family confirmed this statement. When asked about toxics he referred progressive tobacco reduction in the last 3 months (from 60 to 20 cigarettes/day). Bearing in mind the relationship between clozapine and quetiapine metabolism and tobacco, treatment was slowly reduced until the doses of clozapine 500 mg/day and quetiapine 400 mg/day. One week after admission, side effects disappeared, psychotic symptoms were not detected, and the patient was discharged.ConclusionsInquiring about changes in tobacco consumption may be useful when anti-psychotics side effects appear suddenly without an alternative explanation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Expressed emotion and schizophrenia: the ontogeny of EE during an 18-month follow-up

1993 ◽  
Vol 23 (3) ◽  
pp. 771-778 ◽  
Author(s):  
J. Stirling ◽  
D. Tantam ◽  
P. Thomas ◽  
D. Newby ◽  
L. Montague ◽  
...  
Keyword(s):  
Expressed Emotion ◽  
Psychiatric Morbidity ◽  
Index Admission ◽  
Initial Assessment ◽  
Early Admission ◽  
Psychiatric Status ◽  
The Relationship ◽  
Interim Period

SynopsisKey relatives of 30 first or early admission psychotic patients (mainly with a diagnosis of schizophrenia) were interviewed (for a second time) 18 months after participating in an initial assessment of expressed emotion (EE). The patients were followed up throughout the interim period, during which time 17 experienced a psychotic relapse. Although there continued to be a negligible association between initial EE rating (established during the index admission) and relapse, a significant association between EE rating at 18 months and psychiatric status of the patient during the follow-up period emerged. Results are discussed in the context of recent interactional theories of the relationship between household EE and psychiatric morbidity.

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