Expressed Emotion and Schizophrenia in Italy

1992 ◽  
Vol 161 (2) ◽  
pp. 223-229 ◽  
Author(s):  
P. Bertrando ◽  
J. Beltz ◽  
C. Bressi ◽  
M. Clerici ◽  
T. Farma ◽  
...  

Forty-two schizophrenic patients and their close relatives took part in an Italian replication study of expressed emotion (EE). The patients were selected from the psychiatric ward of a general hospital in Milan and were subsequently followed up for nine months. All patients attended a community service clinic as out-patients, and all but one were prescribed neuroleptics for the duration of the study. Relatives were assigned to the high-EE group if they scored 4 or 5 on the emotional overinvolvement (EOI) scale, or showed hostility, or made six or more critical comments. On this basis, 18 (42%) families were rated as low EE and 24 (57%) as high EE. At follow-up, the admission rate for the 9-month period was significantly higher for the high-EE group (P<0.05). Furthermore, significantly fewer patients were readmitted from families showing high warmth (P<0.05). The presence of high warmth appeared to be associated with a lower admission rate, even in high-EE families.

1970 ◽  
Vol 19 (1-2) ◽  
pp. 315-317 ◽  
Author(s):  
Erik Essen-Möller

In 1941, I published a psychiatric study of 69 same-sexed pairs of twins. The index cases were derived from 8596 consecutive admissions to three mental hospitals and one psychiatric unit of a general hospital in South Sweden, every patient being checked for twin birth in the official birth registers. There was no pair with more than one index case. Upon examination, 21 pairs were considered more or less certainly MZ, and 48 DZ. The degree of certainty of the zygosity diagnosis was expressed by a special formula (Essen-Möller, 1941b).Of the 21 index cases, 7 (N. 1-7 of the monograph) were at that time judged schizophrenic. The later course revaled that one more index case (N. 12) was a schizophrenic and should have been included into this diagnostic group, which I shall have to concentrate upon in this brief presentation.Out of the 8 cotwins of the schizophrenic index cases, 5 had presented symptoms of mental disorder up to the time of my investigation, which took place almost thirty years ago. This corresponds so far to a concordance rate of 62%. However, all of the cotwin disorders were relatively mild and transient in nature and consisted mainly of depressive or anxiety states. Even if some of the disordered cotwins had spent some time in a nursing home or in a psychiatric ward of a general hospital, none of them had been admitted to a mental hospital. And, although several of the clinical pictures contained some single trait suggestive of schizophrenia — such as ideas of reference (N. 2 and 7) or hallucinations (N. 5) — in no case a proper diagnosis of schizophrenia could be made. The cotwin who came closest to this diagnosis was a man aged 35 (N. 1), who gave much thought to telepathic phenomena and the like; yet, he was comparatively open-minded and accessible to discussion of his ideas, and he had never been incapacitated by them. Thus, at the time of the first investigation, the correct rate of concordance for schizophrenia in fact was zero. This finding was the more striking as the two other samples published up to that time, those of Luxenburger (1928) and Rosanoff (1934), showed rates of concordance at about 70%, although Luxenburger (1934) later corrected his figure to 33%, for diagnostic reasons. Personally, I was inclined to attribute my zero finding to chance, the number of pairs being small, and also to the relatively short time of observation.


1992 ◽  
Vol 161 (2) ◽  
pp. 217-222 ◽  
Author(s):  
I. Montero ◽  
M. Gómez-Beneyto ◽  
I. Ruiz ◽  
E. Puche ◽  
A. Adam

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.


1969 ◽  
Vol 43 (1-4) ◽  
pp. 525-534 ◽  
Author(s):  
David A. Soskis ◽  
Martin Harrow ◽  
Thomas P. Detre

1990 ◽  
Vol 156 (3) ◽  
pp. 351-356 ◽  
Author(s):  
J. Leff ◽  
N. N. Wig ◽  
H. Bedi ◽  
D. K. Menon ◽  
L. Kuipers ◽  
...  

A two-year follow-up was conducted of a subsample of the Chandigarh cohort of first-contact schizophrenic patients from the WHO Determinants of Outcome project. The patients were those living with family members who had been interviewed initially to determine their levels of expressed emotion (EE). The interview was repeated for 74% of the relatives at one-year follow-up. A dramatic reduction had occurred in each of the EE components and in the global index. No rural relative was rated as high EE at follow-up. Of the patients included in the one-year follow-up, 86% were followed for two years. In contrast to the one-year findings, the global EE index at initial interview did not predict relapse of schizophrenia over the subsequent two years. However, there was a significant association between initial hostility and subsequent relapse. The better outcome of this cohort of schizophrenic patients compared with samples from the West is partly attributable to tolerance and acceptance by family members.


1994 ◽  
Vol 24 (3) ◽  
pp. 565-578 ◽  
Author(s):  
Jair De Jesus Mari ◽  
David L. Streiner

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.


2005 ◽  
Vol 14 (4) ◽  
pp. 227-234 ◽  
Author(s):  
Andrea Gaddini ◽  
Francesco Franco ◽  
Domenico Di Lallo ◽  
Lilia Biscaglia

SUMMARYAim – To determine the rates of psychiatric hospitalisation and to evaluate the predictors of readmissions in a cohort of 887 schizophrenic patients at their “first” psychiatric admission. Methods – Data were collected using the hospital dis-charge database of the Lazio region, Italy. The cohort included patients admitted to a psychiatric ward in 1999, with a main diagnosis of schizophrenia and no prior psychiatric hospitalisation during the 5 years preceding the index admission. Psychiatric read-missions were considered up to year 2004. Kaplan-Meier survival curves and logistic procedures were performed to estimate the cumulative readmission incidence and ORs of readmissions for potential confounders. Results – During the 4-year follow-up, 44.3% of the patients were readmitted at least once. An active treatment among community psychiatric facilities at the time of index admission predicted a higher readmission risk. However, for those who experienced their first admission in a private ward read-mission risk was consistently higher, whether or not having had such a treatment. Conclusions – Risk of readmission in a psychiatric ward appears to be related to the level of integration with mental health community facilities, while length of stay is strongly affected by service system variables. Possible uses of medical information systems in this field are described.Declaration of Interest: none.


2010 ◽  
Vol 25 ◽  
pp. 704
Author(s):  
E. Marini ◽  
N. Kouroumalos ◽  
D. Tassakopoulou ◽  
N. Marketos ◽  
D. Sakkas

1985 ◽  
Vol 146 (6) ◽  
pp. 594-600 ◽  
Author(s):  
Julian Leff ◽  
Liz Kuipers ◽  
Ruth Berkowitz ◽  
David Sturgeon

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).


1984 ◽  
Vol 145 (1) ◽  
pp. 62-69 ◽  
Author(s):  
David Sturgeon ◽  
Graham Turpin ◽  
Liz Kuipers ◽  
Ruth Berkowitz ◽  
Julian Leff

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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