Expressed emotion in the families of patients with schizophrenia and its influence on the course of illness

Abstract

This paper presents the results of a study carried on an urban population in Belgrade investigating the connections between relapse in schizophrenia and the expressed emotion (EE) status of families where at least one of the patient's parents was a member of the household. The overall rate of high EE was just under 50%, in the middle of the range of values reported in studies carried out elsewhere. Relapse was found to be 10 times more frequent in patients whose families were rated high in EE. The sample consisted of 30 patients with hebephrenic schizophrenia and 30 with paranoid schizophrenia. The results suggested that these subtypes may be associated with different attributes of EE. Criticism was more frequent in families of patients with paranoid schizophrenia, while emotional overinvolvement was more frequent in families having a hebephrenic offspring. The different components of EE, suitably combined, may differentiate between the two subtypes of schizophrenia in terms of relapse rate. The relative odds for high criticism were similar for both subtypes, but for maternal overinvolvement (EOI) the odds were 10.5 for hebephrenic as against 2.3 for paranoid schizophrenia. Thus, EOI was more common in the families of those with hebephrenia and also led more frequently to relapse. There was also an inverse relationship between relapse rate and warmth, whether paternal or maternal. This was significant in both subtypes, and indicated that the threshold for the positive effect of warmth was higher for fathers than for mothers. Marital conflict was significantly related to relapse, mainly because it was associated with high EE.(ABSTRACT TRUNCATED AT 250 WORDS)