Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T16:56:16.611Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  16 April 2020

H Schulze Mönking  and
G Buchkremer
H Schulze Mönking
Affiliation:
St. Rochus Hospital, Postfach 120, D-48283Telgte, Germany
G Buchkremer
Affiliation:
Psychiatric Department, Tübingen University, D-72076Tübingen, Germany
Get access

Summary

An 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.

Keywords

expressed emotionrelapserelapse definition/duration of illnessresignation
Type
Original article
Information
European Psychiatry , Volume 10 , Issue 2 , 1995 , pp. 85 - 91
Copyright
Copyright © Elsevier, Paris 1995

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

AMDP, Das AMDP-SystemArbeitsgemeinschaft für Methodik und Dokumentation in der PsychiatrieManual zur Dokumentation psychiatrischer Befunde 1981 SpringerGoogle Scholar
Barrelet, LFerrero, FSzigethy, LGiddey, CPellizzer, GExpressed emotion and first-admission schizophrenia: Nine-months follow-up in a French cultural environment. Br J Psychiatry 1990; 156: 357–6210.1192/bjp.156.3.357CrossRefGoogle Scholar
Boonen, MBockhorn, MSchizophreniebehandlung in der Familie. Psychiatr Prax 1992; 19: 76–80Google Scholar
Brown, GWMonck, EMCarstairs, GMWing, JKInfluence of family life on the course of schizophrenic illness. Br J Prev Soc Med 1962; 16: 55–68Google Scholar
Brown, GWBirley, JLTWing, JKThe influence of family life on the course of schizophrenic disorders: A replication. Br J Psychiatry 1972; 121: 241–5810.1192/bjp.121.3.241CrossRefGoogle ScholarPubMed
Buchkremer, GRezidiv-Prophylaxe bei schizophrenen Patienten Unpublished professorial thesis submitted to Münster University,1984aGoogle Scholar
Buchkremer, GTherapeutische Angehorigenarbeit bei rtickfallgefahrdeten schizophrenen Patienten. Project application, BMFT (funding no 01 2X024/7), 1984bGoogle Scholar
Buchkremer, GSchulze Mönking, HLewandowski, LWittgen, CGoldstein, MJHand, IHahlweg, K eds. Treatment of schizophrenia. Family assessment and intervention. Berlin: Springer, 1986;79–8410.1007/978-3-642-95496-2_7CrossRefGoogle Scholar
Buchkremer, GStricker, KHolle, RKuhs, HThe predictability of relapses in schizophrenic patients. Eur Arch Psychiatry Neural Sci 1991; 240: 292–30010.1007/BF02189543CrossRefGoogle ScholarPubMed
Buchkremer, GSchulze Mönking, HHolle, RHornung, WPThe impact of therapeutic relatives' groups on the course of illness of schizophrenic patients. Eur Psychiatry 1995; 10: 17–2710.1016/0767-399X(96)80071-XCrossRefGoogle ScholarPubMed
Dulz, BHand, IShort-term relapse in young schizophrenics: can it be predicted and affected by family (CFI), patient, and treatment variables? An experimental study. In: Goldstein, MJHand, IHahlweg, K eds. Treatment of schizophrenia. Family assessment and intervention. Berlin: Springer, 1986; 59–7510.1007/978-3-642-95496-2_6CrossRefGoogle Scholar
Glynn, SMRandolph, ETEth, SPatient psychopathology and expressed emotion in schizophrenia. Br J Psychiatry 1990; 157: 877–80CrossRefGoogle Scholar
Goldstein, JMKreisman, DGender, family environment and schizophrenia. Psychol Med 1988; 18: 861–7210.1017/S0033291700009806CrossRefGoogle Scholar
Hahlweg, GKFeinstein, EMüller, UDose, MFamily management programmes for schizophrenic patients. Prevention of relapse and modification of family communication patterns. Br J Psychiatry 155suppl 5 1989 112–610.1192/S0007125000296086CrossRefGoogle Scholar
Hell, DAngehörigenarbeit und Schizophrenieverlauf. Nervenarzt 1988; 59: 66–72Google Scholar
Hogarty, GEAnderson, CMReiss, DJet al.the, EPICSSchizophrenia Research Group Family psycho-education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia I: one year effects of a controlled study on relapse and expressed emotion. Arch Gen Psychiatry 1986; 43: 633–42CrossRefGoogle Scholar
Karno, MJenkins, JHde la Selva, ASantana, FTelles, CLopez, SMintz, JExpressed emotion and schizophrenic outcome among Mexican-American families. J Nerv Ment Dis 1987; 175: 143–5110.1097/00005053-198703000-00004CrossRefGoogle ScholarPubMed
Kavanaugh, DJRecent developments in expressed emotion and schizophrenia. Br J Psychiatry 1992; 160: 601–2010.1192/bjp.160.5.601CrossRefGoogle Scholar
Koenigsberg, HWHandley, RExpressed emotion: from predic tive index to clinical construct. Am J Psychiatry 1986; 143: 1361–73Google Scholar
Leff, JPVaughn, CEThe role of maintenance therapy and relatives' expressed emotion in relapse of schizophrenia: a two-year follow-up. Br J Psychiatry 1981; 139: 102–4CrossRefGoogle ScholarPubMed
Leff, JPKuipers, LBerkowitz, REberlein-Fries, RSturgeon, DA controlled trial of social intervention in the families of schizophrenic patients. Br J Psychiatry 1982; 141: 121–3410.1192/bjp.141.2.121CrossRefGoogle ScholarPubMed
Leff, JPKuipers, LBerkowitz, RSturgeon, DA controlled trial of social intervention in the families of schizophrenic patients: two years follow up. Br J Psychiatry 1985; 146: 594–600CrossRefGoogle Scholar
Leff, JPWig, NNGhosh, ABedi, HMenon, KKuipers, LKorten, AErnberg, GDay, RSartorius, NJablensky, AExpressed emotion schizophrenia in North India III Influence of the relatives' expressed emotion on the course of schizophrenia in Chandigarh. Br J Psychiatry 1987; 151: 166–7310.1192/bjp.151.2.166CrossRefGoogle ScholarPubMed
Leff, JPWig, NNGhosh, ABedi, HMenon, KKuipers, LKorten, AErnberg, GDay, RSartorius, NJablensky, ARelatives' expressed emotion and the course of schizophrenia in Chandigarh: a two-year follow-up of a firstontact sample. Br J Psychiatry 1990; 156: 351–6CrossRefGoogle ScholarPubMed
MacMillan, FJGold, ACrow, TWJohnson, ALJohnstone, ECThe Northwick Park study of first episodes of schizophrenia IV: expressed emotion and relapse. Br J Psychiatry 1986; 148: 133–4310.1192/bjp.148.2.133CrossRefGoogle Scholar
McCreadie, RGPhillips, KThe Nithdale schizophrenia survey VII Does relatives' high expressed emotion predict relapse?. Br J Psychiatry 1988; 152: 477–8110.1192/bjp.152.4.477CrossRefGoogle ScholarPubMed
Moline, RASingh, SMorris, AMeltzer, HYFamily expressed emotion and relapse in schizophrenia in 24 urban American patients. Am J Psychiatry 1985; 142: 1078–81Google ScholarPubMed
Nuechterlein, KHSnyder, KSDawson, MERappe, SGitlin, MFogelson, DExpressed emotion, fixed-dose fluphenazine decanoate maintenance, and relapse in recent-onset schizophrenia. Psychopharmacol Bull 1986; 22: 633–9Google ScholarPubMed
Parker, GJohnston, PHay ward, LParental expressed emotion' as a predictor of schizophrenic relapse. Arch Gen Psychiatry 1988; 45: 806–13CrossRefGoogle ScholarPubMed
Schulze Mönking, HDas Konzept der Expressed Emotions (EE) in der Arbeit mit Angehörigen schizophrener Patienten. In: Steinberg, R eds. Schizophrenie 17. Psychiatrie-Symposion, Pfalzklinik Landeck Klingenmünster. Klingenmünster Tilia-Verlag Mensch und Medizin 1991; 130–40Google Scholar
Schulze Mönking, HAngehörigen-Selbsthilfegruppen in der Schizophreniebehandlung — Gründung, Entwicklung und therapeutische Effizient. Regensburg: S Roderer Verlag, 1993Google Scholar
Smith, JBirchwood, MRelatives patients as partners in the management of schizophrenia The development of a service model. Br J Psychiatry 1990; 156: 654–60CrossRefGoogle ScholarPubMed
Spitzer, JEndicott, JEFleiss, LThe Global Assessment Scale A procedure for measuring overall severity of psychiatric disturbances. Arch Gen Psychiatry 1976; 33: 766–71Google Scholar
Tarrier, NBarrowclough, CVaughn, CEBamrah, JSPorceddu, KWatts, SFreeman, HThe community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. Br J Psychiatry 1988; 153: 532–42CrossRefGoogle ScholarPubMed
Tarrier, NBarrowclough, CVaughn, CEBamrah, JSPorceddu, KWatts, SFreeman, HCommunity management of schizophrenia: a two-year follow-up of a behavioural inter-vention with families. Br J Psychiatry 1989; 154: 625–8CrossRefGoogle Scholar
Vaughan, KDoyle, MMcConaghy, NBlaszczynski, AFox, ATarrier, NThe relationship between relatives' expressed emotion and schizophrenic relapse: an Australian replication. Soc Psychiatry 1992; 27: 10–5Google Scholar
Vaughan, KDoyle, MMcConaghy, NBlaszczynski, AFox, ATarrier, NThe Sydney intervention trial: a controlled trial of relatives' counselling to reduce schizophrenic relapse. Soc Psychiatry 1992; 27: 16–21Google ScholarPubMed
Vaughn, CEPatterns of emotional response in the families of schizophrenic patientsGoldstein, MJHand, IHahlweg, KTreatment of Schizophrenia. Family assessment and intervention Berlin: Springer, 1986; 79–84Google Scholar
Vaughn, CELeff, JPThe influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 1976; 129: 125–37CrossRefGoogle ScholarPubMed
Vaughn, CELeff, JPThe measurement of expressed emotion in the families of psychiatric patients. Br J Clin Psychol 1976; 15: 157–6510.1111/j.2044-8260.1976.tb00021.xCrossRefGoogle ScholarPubMed
Vaughn, CESnyder, KSJones, SFreeman, WFalloon, IRHFamily factors in schizophrenic relapse: replication in California of British research on expressed emotion. Arch Gen Psychiatry 1984; 41: 1169–7710.1001/archpsyc.1984.01790230055009CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.