Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T01:38:24.109Z Has data issue: false hasContentIssue false
  • English
  • Français

Expressed and Perceived Criticism, Family Warmth, and Symptoms in Schizophrenia

Published online by Cambridge University Press:  09 July 2013

Cristina Medina-Pradas ,
J. Blas Navarro ,
Esther Pousa ,
M. Isabel Montero  and
Jordi E. Obiols
Cristina Medina-Pradas*
Affiliation:
Universidad Autónoma de Barcelona (Spain)
J. Blas Navarro
Affiliation:
Universidad Autónoma de Barcelona (Spain)
Esther Pousa
Affiliation:
Corporación socio-sanitaria Parc Taulí (Spain).
M. Isabel Montero
Affiliation:
Universitat de Valencia (Spain)
Jordi E. Obiols
Affiliation:
Universidad Autónoma de Barcelona (Spain)
*
*Correspondence concerning this article should be addressed to Cristina Medina-Pradas. Departamento de Psicología Clínica y de la Salud. Universidad Autónoma de Barcelona. 08193. Barcelona (Spain). Phone: +34-935868528. Fax: +34-935812125. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Criticism directed by caregivers towards a family member with schizophrenia, both from the perspective of the patient and of the caregiver, predicts relapse, although both perspectives differ. This study aims to verify if the same applies to a Mediterranean sample, where criticism is not the main attitude of high expressed emotion families. The Camberwell Family Interview was applied to assess the family’s perspective, and the Perceived Criticism and the Family Emotional Involvement and Criticism Scales were used to assess the patients’ perspective, in 21 dyads. The association between both perspectives and psychotic symptoms was also examined. Results replicated those of previous studies in other countries, revealing that the perspectives on Criticism of patients and families do not match. The fact that family members also presented positive attitudes towards the patient did not cushion the patient’s perceived criticism. Thus, it seems that families considered to be critical may not be perceived as such by the patients. Furthermore, only the warmth from the family’s perspective correlated with the symptoms: positive affect proved to be more relevant than negative affect. Therefore, the patients’ subjective assessments and family warmth should be included in clinical and research proposals.

Keywords

expressed emotionperceptioncriticismwarmthschizophrenia
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 16 , 2013 , E45
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2013 

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.)

Footnotes

We are very grateful to all the persons who participated in the study and to the clinical team in Parc Taulí Hospital who provided access to their clients. This study was supported by a predoctoral fellowship to the first author (Science and Innovation Ministry I+D, Code BSO2003-05561/ PSCE). Special thanks go to Prof. Kuipers and Prof. López for their helpful comments on different stages of this project

References

APA (2002). DSM-IV-TR: Manual diagnóstico y estadístico de los trastornos mentales. [Diagnostic and Statistical Manual of Mental Disorders] . Barcelona, Spain: Masson.Google Scholar
Bachmann, S., Bottmer, C., Jacob, S., & Schröder, J. (2006). Perceived criticism in schizophrenia: A comparison of instruments for the assessment of the patient’s perspective and its relation to relatives’ expressed emotion. Psychiatry Research, 142, 167–175. http://dx.doi.org/10.1016/j.psychres.2005.10.001 Google Scholar
Baker, B., Kazarin, S. S., Helmes, E., Ruckman, M., & Tower, N. (1987). Perceived attitudes of schizophrenic inpatients in relation to rehospitalization. Journal of Consulting and Clinical Psychology, 55, 775–777. http://dx.doi.org/10.1037/0022-006X.55.5.775 Google Scholar
Bebbington, P., & Kuipers, L. (1994). The predictive utility of expressed emotion in schizophrenia: An aggregate analysis. Psychological Medicine, 24, 707–718. http://dx.doi.org/10.1017/S0033291700027860 Google Scholar
Bellack, A. S., Mueser, K. T., Wade, J., Sayers, S., & Morrison, R. L. (1992). The ability of schizophrenics to perceive and cope with negative affect. British Journal of Psychiatry, 160, 473–480. http://dx.doi.org/10.1192/bjp.160.4.473 CrossRefGoogle ScholarPubMed
Benjamini, Y., & Yekutieli, D. (2001). The control of the false discovery rate in multiple testing under dependency. The Annals of Statistics, 29, 1165–1188.Google Scholar
Bentsen, H., Munkvold, O. G., Notland, T. H., Boye, B., Oskarsson, K. H., Uren, G., … Malt, U. F. (1998). Relatives’ emotional warmth towards patients with schizophrenia or related psychoses: Demographic and clinical predictors. Acta Psychiatrica Scandinavica, 97, 86–92. http://dx.doi.org/10.1111/j.1600-0447.1998.tb09968.x Google Scholar
Bentsen, H., Notland, T. H., Boye, B., Munkvold, O. G., Bjorge, H., Lersbryggen, A. B., … Malt, U. F. (1998). Criticism and hostility in relatives of patients with schizophrenia or related psychoses: Demographic and clinical predictors. Acta Psychiatrica Scandinavica, 97, 76–85. http://dx.doi.org/10.1111/j.1600-0447.1998.tb09967.x Google Scholar
Bertrando, P, Beltz, J., Bressi, C., Clerici, M., Farma, T., Invernizzi, G., & Cazzullo, C. L. (1992). Expressed emotion and schizophrenia in Italy. A study of an urban population. British Journal of Psychiatry, 161, 223–229. http://dx.doi.org/10.1192/bjp.161.2.223 CrossRefGoogle ScholarPubMed
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. http://dx.doi.org/10.1192/bjp.121.3.241 CrossRefGoogle ScholarPubMed
Brüne, M. (2005). “Theory of Mind” in schizophrenia: A review of the literature. Schizophrenia Bulletin, 31, 21–42. http://dx.doi.org/10.1093/schbul/sbi002 Google Scholar
Butzlaff, R. L., & Hooley, J. M. (1998). Expressed emotion and psychiatric relapse. A meta-analysis. Archives of General Psychiatry, 55, 547–552. http://dx.doi.org/10.1001/archpsyc.55.6.547 CrossRefGoogle ScholarPubMed
Cutting, L. P., Aakre, J. M., & Docherty, N. M. (2006). Schizophrenic patients’ perceptions of stress, expressed emotion, and sensitivity to criticism. Schizophrenia Bulletin, 32, 743–750. http://dx.doi.org/10.1093/schbul/sbl001 Google Scholar
Fredickson, B. L. (2001). The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. American Psychologist, 56, 218–226.Google Scholar
Heikkilä, J., Karlsson, H., Taiminen, T., Lauerma, H., Ilonen, T., Leinonen, K. M., … Salakangas, R. K. R. (2002). Expressed emotion is not associated with disorder severity in first-episode mental disorder. Psychiatry Research, 111, 155–165. http://dx.doi.org/10.1016/S0165-1781(02)00134-8 Google Scholar
Hooley, J. (2007). Expressed emotion and relapse of psychopathology. Annual Review of Clinical Pychology, 3, 329–352. http://dx.doi.org/10.1146/annurev.clinpsy.2.022305.095236 Google Scholar
Hooley, J., & Gotlib, I. H. (2000). A diathesis-stress conceptualization of expressed emotions and clinical outcome. Applied & Preventive Psychology, 9, 135–151. http://dx.doi.org/10.1016/S0962-1849(05)80001-0 CrossRefGoogle Scholar
Hooley, J. M., & Teasdale, J. D. (1989). Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism. Journal of Abnormal Psychology, 98, 229–235. http://dx.doi.org/10.1037/0021-843X.98.3.229 CrossRefGoogle ScholarPubMed
Kavanagh, D. J. (1992). Recent developments in expressed emotion and schizophrenia. British Journal of Psychiatry, 160, 601–620. http://dx.doi.org/10.1192/bjp.160.5.601 Google Scholar
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276. http://dx.doi.org/10.1093/schbul/13.2.261 Google Scholar
Kazarian, S. S., Malla, A. K., Cole, J. D., & Baker, B. (1990). Comparisons of two expressed emotion scales with the Camberwell Family Interview. Journal of Clinical Psychology, 46, 306–309. http://dx.doi.org/10.1002/1097-4679(199005)46:3<306::AID-JCLP2270460310>3.0.CO;2–2 3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Keefe, J. P., López, S. R., Tiznado, D., Medina-Pradas, C., & Mendoza, E. (2012). Towards a dyadic view of expressed emotion. Manuscript submitted for publication.Google Scholar
Kuipers, E., Bebbington, P., Dunn, G., Fowler, D., Freeman, D., Watson, P., …Garety, P. (2006). Influence of carer expressed emotion and affect on relapse in non-affective psychosis. British Journal of Psychiatry, 188, 173–179. http://dx.doi.org/10.1192/bjp.bp.104.007294 Google Scholar
Lazarus, R. S. (1993). From psychological stress to the emotions: A history of changing outlooks. Annual Review of Psychology, 44, 1–21. http://dx.doi.org/10.1146/annurev.psych.44.1.1 Google Scholar
Lazarus, R., & Folkman, S. (1984). Stress, appraisal and coping. New York, NY: Springer.Google Scholar
Lebell, M. B., Marder, S. R., Mintz, J., Mintz, L. I., Tompson, M., Wirshing, W., … McKenzie, J. (1993). Patients’ perceptions of family emotional climate and outcome in schizophrenia. British Journal of Psychiatry, 162, 751–754. http://dx.doi.org/10.1192/bjp.162.6.751 Google Scholar
Leff, J., & Vaughn, C. (1985). Expressed emotion in families. New York, NY: Guilford.Google Scholar
López, S. R., Hipke, N. K., Polo, A. J., Jenkins, J. H., Karno, M., Vaughn, C., & Snyder, K. S. (2004). Ethnicity, expressed emotion, attributions, and course of schizophrenia: Family warmth matters. Journal of Abnormal Psychology, 113, 428–439. http://dx.doi.org/10.1037/0021-843X.113.3.428 Google Scholar
Medina-Pradas, C., Navarro, J. B., López, S. R., Grau, A., & Obiols, J. E. (2011). Further development of a scale for patients’ perceptions of carer’s expressed emotion and its evaluation in a sample with eating disorders. Psychiatry Research, 190, 291–296.CrossRefGoogle Scholar
Miklowitz, D. J., Goldstein, M. J., & Falloon, I. R. (1983). Premorbid and symptomatic characteristics of schizophrenics from families with high and low levels of expressed emotion. Journal of Abnormal Psychology, 92, 359–367. http://dx.doi.org/10.1037//0021-843X.92.3.359 Google Scholar
Montero, I., & Ruiz, I. (1992). La Entrevista Familiar Camberwell (CFI). [The Camberwell Family Interview (CFI)]. Revista de la Asociación Española de Neuropsiquiatría, 12, 27–30.Google Scholar
Nuechterlein, K. H., Dawson, M. E., Gitlin, M., Ventura, J., Goldstein, M. J., Snyder, K. S., ... Mintz, J. (1992). Developmental processes in schizophrenic disorders: Longitudinal studies of vulnerability and stress. Schizophrenia Bulletin, 18, 387–425. http://dx.doi.org/10.1093/schbul/18.3.387 Google Scholar
Nuechterlein, K. H., Snyder, K. S., & Mintz, J. (1992). Paths to relapse: Possible transactional processes connecting patient illness onset, expressed emotion, and psychotic relapse. British Journal of Psychiatry, 161, 88–96.Google Scholar
Peralta, V., & Cuesta, M. J. (1994). Validación de la escala de los síndromes positivo y negativo (PANSS) en una muestra de esquizofrénicos españoles. [Validation of positive and negative symptom scale (PANSS) in a sample of Spanish schizophrenic patients]. Actas Luso-Españolas de Neurología y Psiquiatría, 22, 171–177.Google Scholar
Renshaw, K. D. (2008). The predictive, convergent, and discriminant validity of perceived criticism: A review. Clinical Psychology Review, 28, 521–534. http://dx.doi.org/10.1016/j.cpr.2007.09.002 CrossRefGoogle ScholarPubMed
Restrepo, N., Hernández, D. L., Cardona, L. J., Arango, A. M., González, D., Puerta, A., ... Molina, B. M. (2004). Validación de la Escala de Envolvimiento Emocional y Criticismo Familiar (FEICS) en la población clínica psiquiátrica colombiana. [Validation of the Family Emotional Involvement and Criticism Scale (FEICS) in Colombian Psychiatric Clinical Population]. Revista Colombiana de Psiquiatría, 33, 143–162.Google Scholar
Scazufca, M., Kuipers, E., & Menezes, P. R. (2001). Perception of negative emotions in close relatives by patients with schizophrenia. British Journal of Clinical Psychology, 40, 167–175. http://dx.doi.org/10.1348/014466501163616 Google Scholar
Shields, C., Franks, P., Harp, J., Campbell, T., & McDaniel, S. (1994). Family Emotional and Criticism Scale (FEICS) II. Reliability and validity studies. Journal of Family Systems Medicine, 12, 361–377. http://dx.doi.org/10.1037/h0089289 Google Scholar
Shields, C. G., Franks, P., Harp, J. J., McDaniel, S. H., & Campbell, T. L. (1992). Development of the Family Emotional Involvement and Criticism Scale (FEICS): A self-report scale to measure expressed emotion. Journal of Marital and Family Therapy, 18, 395–407.Google Scholar
Taylor, T. M., & Meeks, S. (1996). Can perceived criticism predict outcomes among older outpatients? A comparison of depression and schizophrenia. Journal of Clinical Geropsychology, 2, 23–36.Google Scholar
Tompson, M. C., Goldstein, M. J., Lebell, M. B., Mintz, L. I., Marder, S. R., & Mintz, J. (1995). Schizophrenic patients’ perceptions of their relatives’ attitudes. Psychiatry Research, 57, 155–167. http://dx.doi.org/10.1016/0165-1781(95)02598-Q Google Scholar
Trémeau, F. (2006). A review of emotion deficits in schizophrenia. Dialogues in Clinical Neurosciences, 8, 59–70,Google Scholar
Vaughn, C. E., & Leff, J. (1976). The measurement of expressed emotion of families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157–165. http://dx.doi.org/10.1111/j.2044-8260.1976.tb00021.x Google Scholar
Vaughn, C. E., Snyder, K. S., Jones, S., Freeman, W. B., & Falloon, I. R. (1984). Family factors in schizophrenic relapse: Replication in California of British research on expressed emotion. Archives of General Psychiatry, 41, 1169–1177. http://dx.doi.org/10.1001/archpsyc.1984.01790230055009 Google Scholar
Warner, R., & Atkinson, M. (1988). The relationship between schizophrenic patients’ perceptions of their parents and the course of their illness. British Journal of Psychiatry, 153, 344–353. http://dx.doi.org/10.1192/bjp.153.3.344 Google Scholar
Weisman, A. G., Rosales, G. A., Kymalainen, J. A., & Armesto, J. C. (2006). Ethnicity, expressed emotion, and schizophrenia patients’ perceptions of their family members’ criticism. The Journal of Nervous and Mental Diseases, 194, 644–649. http://dx.doi.org/10.1097/01.nmd.0000235504.39284.f1 Google Scholar
White, J. D., Strong, J. E., & Chambless, D. L. (1998). Validity of the perceived criticism measure in an undergraduate sample. Psychological Reports, 83, 83–97. http://dx.doi.org/10.2466/pr0.1998.83.1.83 Google Scholar
Zubin, J., & Spring, B. (1977). Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126. http://dx.doi.org/10.1037//0021-843X.86.2.103 Google Scholar