Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-12-01T04:06:02.109Z Has data issue: false hasContentIssue false
  • English
  • Français

IV. Expressed Emotion and Relapse

Published online by Cambridge University Press:  29 January 2018

J. Fiona MacMillan ,
Aviva Gold ,
Timothy J. Crow ,
Anthony L. Johnson  and
Eve C. Johnstone
J. Fiona MacMillan
Affiliation:
Northwick Park Hospital and Clinical Research Centre; Department of Psychiatry, University of Birmingham
Aviva Gold
Affiliation:
Division of Psychiatry, Northwick Park Hospital and Clinical Research Centre
Timothy J. Crow
Affiliation:
Northwick Park Hospital and Clinical Research Centre
Anthony L. Johnson
Affiliation:
MRC Biostatistics Unit MRC Centre, Hills Road, Cambridge CB2 2QH
Eve C. Johnstone*
Affiliation:
Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA1 3UJ
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

The relatives of 82 patients in a study of first episodes of schizophrenia were interviewed within six weeks of the index admission; 77 patients were subsequently discharged, and were followed to relapse or readmission. Analysis of relapse-free survival time was used to examine whether the components of ‘expressed emotion’ predicted relapse or response to neuroleptic medication: ‘critical comments' by relatives was the only component present often enough to be used and was inversely related to ‘social contact’. When preadmission duration of illness, and neuroleptic medication following discharge (identified previously as significant predictors of outcome) were taken into account, neither ‘critical comments' nor ‘social contact’ were related to outcome nor to response to medication. The constellation of factors suggested as pathogenic was present only in a minority of cases: many patients lived alone and of those that were with families, most were not in high face-to-face contact with other members. The failure of the components of ‘expressed emotion’ to predict outcome or response to neuroleptic medication suggests that at best, such factors are weak predictors of liability to relapse. Their influence is unlikely to be comparable in magnitude to that of neuroleptic medication.

Type
Papers
Information
The British Journal of Psychiatry , Volume 148 , Issue 2 , February 1986 , pp. 133 - 143
Copyright
Copyright © 1986 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achte, K. A. (1967) On prognosis and rehabilitation in schizophrenic and paranoid psychoses. A comparative follow-up study of two series of patients admitted to hospital in 1950 and 1960 respectively. Acta Psychiatrica Scandinavica, 43, Suppl 196.Google Scholar
Astrup, C., Fossum, A. & Holmboe, R. (1962) Prognosis in functional psychoses. Springfield, Illinois: Thomas.Google ScholarPubMed
Baker, R. J. & Nelder, J. A. (1978) The GLIM System. Release 3 Generalised Linear Interactive Modelling. London. Royal Statistical Society.Google Scholar
Barrowclough, C. & Tarrier, N. (1984) “Psychosocial” interventions with families and their effects on the course of schizophrenia: a review. Psychological Medicine, 14, 629–642.Google Scholar
Bennett, D. H., Birley, J. L. T., Hailey, A. M. Q. & Wing, J. K. (1972) Non-residential services for the mentally ill. 1964–71. In Evaluating a Community Psychiatric Service. (Eds. Wing, J. K., Hailey, A. M.). London: Oxford University Press.Google Scholar
Bleuler, M. (1978a) The long term course of schizophrenic psychoses, pp. 631–636. The Nature of Schizophrenia, (eds. Wynne, L. C., Cromwell, R. L. & Matthysse, S.). New York: Wiley.Google Scholar
Cromwell (1978b) The schizophrenic disorders. Long Term Patient and Family Studies Translated by Clemens, Siegfried M. New Haven: Yale University Press.Google Scholar
Branchey, M. H., Branchey, L. B. & Richardson, M. A. (1981) Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients. American Journal of Psychiatry, 138, 608–612.Google ScholarPubMed
Brown, G. W. & Btrley, J. L. T. (1968) Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behaviour. 9, 203–214.Google Scholar
Brown, G. W., Monck, E. M., Carstairs, G. M. & Wing, J. K. (1962) Influence of family life on the course of schizophrenic illness. British Journal of Preventive and Social Medicine, 16, 55–68.Google Scholar
Brown, G. W. & Rutter, M. (1966) The measurement of family activities and relationships: a methodological study. Human Relations, 19, 241–263.Google Scholar
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241–258.Google Scholar
Carpenter, W. T., McGlashan, T. H. & Strauss, J. S. (1977) The treatment of acute schizophrenia without drugs: an investigation of some current assumptions. American Journal of Psychiatry, 134, 14–20.Google Scholar
Chapman, J. (1966) The early symptoms of schizophrenia. British Journal of Psychiatry, 112, 225–251.Google Scholar
Cooper, B. (1961) Social class and prognosis in schizophrenia,. British Journal of Preventive and Social Medicine, 15, 17–41.Google ScholarPubMed
Cox, D. R. (1972) Regression models and life tables. Journal of the Royal Statistical Society series B., 34, 187–220.Google Scholar
Crow, T. J., MacMillan, J. F., Johnson, A. L. & Johnstone, E. C. (1985) The Northwick Park study of first episodes of schizophrenia. 2. A randomised controlled trial of prophylactic neuroleptic treatment. British Journal of Psychiatry.CrossRefGoogle Scholar
Davis, J. M. (1975) Overview: Maintenance therapy in psychiatry. 1. Schizophrenia. American Journal of Psychiatry, 132, 1237–1245.Google Scholar
Davison, K. & Bagley, C. R. (1969) Schizophrenia-like psychoses associated with organic disorders of the central nervous system. In Current Problems in Neuropsychiatry (ed. Herrington, R. N.). Ashford: Headley Bros.Google Scholar
Dean, G., Walsh, D., Downing, H. & Shelley, E. (1981) First admissions of native-born and immigrants to psychiatric hospitals in South-East England in 1976. British Journal of Psychiatry. 139, 506–512.CrossRefGoogle Scholar
Everitt, B. S. (1977) The analysis of contingency tables. London: Chapman and Hall.Google Scholar
Falloon, I. R. H., Boyd, J. L., McGill, C. W., Razani, J., Moss, H. B. & Gilderman, A. M. (1982) Family management in the prevention of exacerbations of schizophrenia. New England Journal of Medicine, 306, 1437–1440.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Watt, S. C. & Sheppherd, M. (1978) A comparative controlled trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia. Psychological Medicine, 8, 59–70.CrossRefGoogle ScholarPubMed
Gillies, H. (1958) The clinical diagnosis of early schizophrenia. In Topics in Psychiatry (eds. Rodger, T. F., Mowbray, R. M. & Roy, J. R.) London: Cassell.Google Scholar
Goldstein, M. J., Roderick, E. H., Evans, J. R., May, P. R. A. & Steinberg, M. R. (1978) Drug and family therapy in the aftercare of acute schizophrenics. Archives of General Psychiatry, 35, 1169–1177.Google Scholar
Hirsch, S., Gaind, R., Rohde, P. D., Stevens, B. C. & Wing, J. K. (1973) Outpatient maintenance of chronic schizophrenic patients with long acting fluphenazine: double-blind placebo trial report to the Medical Research Council Committee on Clinical Trials in Psychiatry. British Medical Journal, 1, 633–637.Google Scholar
Hogarty, G. E. & Goldberg, S. C. and Collaborative Study Group (1973) Drugs and sociotherapy in the aftercare of schizophrenic patients. one year relapse rates. Archives of General Psychiatry, 28, 54–64.Google Scholar
Hogarty, G. E. & Goldberg, S. C., Schooler, N. R. Ulrich, R. F. & Collaborative Study Group (1974) Drug and sociotherapy in the aftercare of schizophrenic patients. 11—Two year relapse rates. Archives of General Psychiatry, 31, 603–608.Google Scholar
Hogarty, G. E., Ulrich, R. F., Mussare, F. & Aristigneta, N. (1976) Drug discontinuation among long term successfully maintained schizophrenic outpatients. Diseases of the Nervous System, 37, 494–500.Google Scholar
Hogarty, G. E., & Ulrich, R. F., (1977) Temporal effects of drugs and placebo in delaying relapse in schizophrenic outpatients. Archives of General Psychiatry, 34, 297–301.Google Scholar
Hogarty, G. E., Schooler, N. R., Ulrich, T., Mussare, F., Ferro, P. & Herron, E. (1979) Fluphenazine and social therapy in the aftercare of schizophrenic patients. Archives of General Psychiatry, 36, 1283–1294.Google Scholar
Huber, G., Gross, G. & Schluttler, R. (1975) A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatrica Scandinavica, 52, 49–57.Google Scholar
Jablensky, A., Schwartz, R. & Tomov, T. (1980) WHO Collaborative Study on impairments and disabilities associated with schizophrenic disorders. A preliminary communication. Objectives and methods. Acta Psychiatrica Scandinavica Suppl 285, 62, 152–163.Google Scholar
Johnstone, E. C., Crow, T. J., Johnson, A. L. & MacMillan, J. F. (1985) The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission. British Journal of Psychiatry.Google Scholar
Kane, J. M., Rifkin, A., Quitkin, F., Nayak, D. & Ramos-Lorenzi, J. (1982) Fluphenazine v.s. placebo in patients with remitted acute first episode schizophrenia. Archives of General Psychiatry, 39, 70–73.CrossRefGoogle Scholar
Kraepelin, E. (1919) Dementia Praecox and Paraphrenia. Translated by Mary Barclay, R. and Robertson, G. M.; facsimile edition, New York: Krieger; 1971.Google Scholar
Left, J. P. & Wing, J. K. (1971) Trial of maintenance therapy in schizophrenia. British Medical Journal, 3, 599–604.Google Scholar
Left, J. P. & Vaughn, C. (1980) The interaction of life events and relatives' expressed emotion in schizophrenia and depressive neurosis. British Journal of Psychiatry, 136, 146–153.Google Scholar
Left, J. P. & Vaughn, C. (1981) The role of maintenance therapy and relatives' expressed emotion in relapse of schizophrenics: a two-year follow-up. British Journal of Psychiatry, 139, 102–104.Google Scholar
Left, J. P., Kuipers, L., Berkowitz, R., Eberlein-Vries, R. & Sturgeon, D. (1982) A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.Google Scholar
Lewine, R. R. J. (1981) Sex differences in schizophrenia: Timing or subtypes. Psychological Bulletin, 90, 432–444.Google Scholar
Lindelius, R. (1970) A study of schizophrenia. A clinical prognostic and family investigation. Acta Psychiatrica Scandinavica (Suppl). 216.Google Scholar
MacMillan, J. F., Gold, A., Crow, T. J., Johnson, A. L. & Johnstone, E. C. (1985) The Northwick Park Study of first episodes of schizophrenia. 4. Expressed emotion and relapse. British Journal of Psychiatry, 148, 133–142.CrossRefGoogle Scholar
Markowe, M., Steinert, J. & Heyworth-Davis, F. (1967) Insulin and chlorpromazine in schizophrenia: a ten year comparative study. British Journal of Psychiatry, 113, 1101–1106.CrossRefGoogle Scholar
Marx, A. J., Test, M. A. & Stein, L. I. (1973) Extrahospital management of severe mental illness. Archives of General Psychiatry, 29, 505–511.Google Scholar
May, P. R. A., Tuma, A. H., Dixon, W. J., Yale, C., Thiele, D. A. & Kraude, W. H. (1981) Schizophrenia: a follow-up study of the results of five forms of treatment. Archives of General Psychiatry, 38, 776–784.Google Scholar
McClelland, H., Roth, M. & Neubauer, H. (1966) Some observations on a case material based on patients with certain common schizophrenic symptoms. Communication to the World Congress of Psychiatry, Madrid.Google Scholar
Noreik, K. & Odegard, O. (1966) Psychoses in Norwegians with a background of higher education. Acta Psychiatrica Scandinavica, 68, 458–475.Google Scholar
Nyman, A. K. & Jonsson, (1983) Differential evaluation of outcome in schizophrenia. Acta Psychiatrica Scandinavica, 68, 458–475.Google Scholar
Peto, R., Pike, M. C., Armitage, R., Breslow, W. E., Cox, O. R., Howard, J. V., Mantel, W., McPherson, K., Peto, J. & Smith, P. G. (1976) Design and Analysis of randomised clinical trials requiring prolonged observation of each patient. I–Introduction and design. British Journal of cancer, 34, 585–612.Google Scholar
Peto, R., Pike, M. C., Armitage, R., Breslow, W. E., Cox, O. R., Howard, J. V., Mantel, W., McPherson, K., Peto, J. & Smith, P. G. (1977) Design and Analysis of randomised clinical trials requiring prolonged observation of each patient. II. Analysis and examples. British Journal of Cancer, 35, 1–39.Google Scholar
Rappaport, M., Hopkins, H. K., Hall, K., Belleza, T. & Silverman, J. (1978) Are there schizophrenics for whom drugs may be unnecessary or contra-indicated? International Pharmacopsychiatry, 13, 100–111.Google Scholar
Rifkin, A., Quitkin, F., Rabiner, C. J. & Klein, D. F. (1977) Fluphenazine decanoate, fluphenazine hydrochloride given orally and placebo in the treatment of remitted schizophrenics. I. Relapse rates after one year. Archives of General Psychiatry, 34, 43–37.Google ScholarPubMed
Schofield, W., Hathaway, S. R., Hastings, D. W. & Bell, D. M. (1954) Prognostic factors of schizophrenia. Journal of Consulting Psychology, 18, 155–166.CrossRefGoogle ScholarPubMed
Simpson, G. M. & May, P. R. A. (1982) Schizophrenic disorders in Treatment of Mental Disorders edited by Greist, J. H., Jefferson, J. W., Spitzer, R. L. New York: Oxford University Press.Google Scholar
Small, I. F., Small, J. G., Fjeld, S. P. & Hayden, M. P. (1966) Organic cognates of acute psychiatric illness. American Journal of Psychiatry, 122, 790–797.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1977) Research Diagnostic Criteria for a Selected Group of Functional Disorders, ed. 3. New York: Biometrics Research Division, New York State Psychiatric Institute.Google Scholar
Stephens, J. H. (1978) Long-term prognosis and follow-up in schizophrenia. Schizophrenia Bulletin. 4, 25–47.Google Scholar
Strang, J. S., Falloon, I. R. H., Moss, H. B., Razani, J. & Boyd, J. L. (1981) The effects of family therapy on treatment compliance in schizophrenia. Psychopharmacology Bulletin, 17, 87–88.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1974) The prediction of outcome in schizophrenia II. Relationships between predictor and outcome variables. Archives of General Psychiatry, 31, 37–42.Google Scholar
Taylor, P. J. & Gunn, J. (1984) Violence and psychosis. 1. Risk of violence among psychotic men. British Medical Journal. 288, 1945–1949.CrossRefGoogle ScholarPubMed
Tsuang, M. T. & Winokur, G. (1975) The Iowa 500: Fieldwork in a 35-year follow-up of depression, mania and schizophrenia. Canadian Psychiatric Journal, 20, 359–365.Google Scholar
Vaillant, G. E. (1962) An historical review of the remitting schizophrenias. American Journal of Psychiatry, 120, 367–375.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125–137.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976) The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157–165.Google Scholar
Weller, M. (1984) Violence and mental illness. British Medical Journal, 289, 2–3.Google Scholar
Weissman, M., Sholomskas, D. & John, K. (1981) The assessment of social adjustment. Archives of General Psychiatry, 38, 1250–1258.Google Scholar
Wilkinson, D. G. (1982) The suicide rate in schizophrenia. British Journal of Psychiatry, 140, 138–141.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The description and classification of psychiatric symptoms: an instruction manual for the PSE and Catego systems. Cambridge University Press. Cambridge.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.