Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-17T07:25:06.328Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of carer expressed emotion and affect on relapse in non-affective psychosis

Published online by Cambridge University Press:  02 January 2018

E. Kuipers ,
P. Bebbington ,
G. Dunn ,
D. Fowler ,
D. Freeman ,
P. Watson ,
A. Hardy  and
P. Garety
E. Kuipers*
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London
P. Bebbington
Affiliation:
Department of Mental Health Sciences, Royal Free and University College London Medical School, London
G. Dunn
Affiliation:
Biostatistics Group, Division of Epidemiology and Health Sciences, University of Manchester, Manchester
D. Fowler
Affiliation:
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich
D. Freeman
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
P. Watson
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
A. Hardy
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
P. Garety
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
*
Professor E. Kuipers, Department of Psychology PO Box 77, Institute of Psychiatry, King's College London, London SE5 8AF, UK. E-mail: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes.

Aims

To investigate the relationships between carer expressed emotion, patients' symptoms and carer characteristics during a recent relapse of psychosis.

Method

A total of 86 patients and carers were investigated in a cross-sectional design.

Results

Patients whose carers showed high expressed emotion had significantly higher levels of anxiety and depression, but not more psychotic symptoms or lower self-esteem. Linear regression showed that carers' critical comments predicted anxiety in patients. Critical comments were related to low carer self-esteem and avoidant coping strategies. Low carer self-esteem was also related to carer depression, stress and carer ‘burden’, and to low patient self-esteem.

Conclusions

Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of psychosis.

Type
Papers
Information
The British Journal of Psychiatry , Volume 188 , Issue 2 , February 2006 , pp. 173 - 179
Copyright
Copyright © 2006 The Royal College of Psychiatrists 

Footnotes

Declaration of Interest

None. Funding detailed in Acknowledgements.

References

Addington, D., Addington, J. & Maticka-lyndale, E. (1993) Assessing depression in schizophrenia: The Calgary Depression Scale. British Journal of Psychiatry, 163 (suppl. 22), 39–44.CrossRefGoogle Scholar
Anderson, C. M., Rei ss, D. J. & Hogarty, G. E. (1986) Schizophrenia and the Family. New York: Guilford Publications.Google Scholar
Barrowclough, C. & Larrier, N. (1992) Families of Schizophrenic Patients: Cognitive Behavioural Intervention. London: Chapman & Hall.Google Scholar
Barrowclough, C. & Hooley, J. M. (2003) Attributions and expressed emotion: a review. Clinical Psychology Review, 23, 849–880.Google Scholar
Barrowclough, C., Larrier, N., Lewis, S., et al (1999) Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. British Journal of Psychiatry, 174, 505–511.Google Scholar
Barrowclough, C., Larrier, N., Humphreys, L., et al (2003) Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology. Journal of Abnormal Psychology, 112, 92–99.Google Scholar
Bebbington, P. & Kuipers, L. (1994) The predictive utility of EE in schizophrenia: an aggregate analysis. Psychological Medicine, 24, 707–718.CrossRefGoogle ScholarPubMed
Beck, A. T., Epstein, N., Brown, G., et al (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A. & Brown, G. K. (1996) BDI-II Manual. San Antonio: The Psychological Corporation.Google Scholar
Birchwood, M., Iqbal, Z., Chadwick, P., et al (2000) Cognitive approach to depression and suicidal thinking in psychosis. I. Ontogeny of post-psychotic depression. British Journal of Psychiatry, 177, 516–528.CrossRefGoogle ScholarPubMed
Butzlaff, R. L. & Hooley, J. M. (1998) Expressed emotion and psychiatric relapse: a meta-analysis. Archives of General Psychiatry, 55, 547–552.Google Scholar
Carver, C. S. & Scheier, M. F. (1994) Situational coping dispositions in a stress transaction. Journal of Personality and Social Psychology, 66, 184–195.Google Scholar
Carver, C. S., Scheier, M. F. & Weintraub, J. K. (1989) Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.Google Scholar
Department of Health (1999) National Service Framework – Mental Health. London: Department of Health.Google Scholar
Falloon, I. R. H., Boyd, J. L. & McGill, C. W. (1984) Family Care of Schizophrenia. New York: Guilford Press.Google Scholar
Freeman, D. & Garety, P. A. (2003) Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research Therapy, 41, 923–947.Google Scholar
Garety, P., Kuipers, E., Fowler, D., et al (2001) A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189–195.Google Scholar
Goldberg, D. P. & Williams, P. (1988) A User's Guide to the General Health Questionnaire. Windsor: NFER Nelson.Google Scholar
Kay, S. R. (1991) Positive and Negative Syndromes in Schizophrenia: Assessment and Research. New York: Brunner Mazel.Google Scholar
Kuipers, E., Leff, J. & Lam, D. (2002) Family Work for Schizophrenia: a Practical Guide (2nd edn). London: Gaskell Press.Google Scholar
Leff, J. & Vaughn, C. E. (1985) Expressed Emotion in Families. London: Guilford Press.Google Scholar
Marriott, A., Donaldson, C., Larrier, N., et al (2000) Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. British Journal of Psychiatry, 176, 557–562.Google Scholar
Marwaha, S. & Johnson, S. (2004) Schizophrenia and employment. A review. Social Psychiatry and Psychiatric Epidemiology, 39, 337–349.Google Scholar
National Collaborating Centre for Mental Health (2003) Schizophrenia. Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. London & Leicester: Royal College of Psychiatrists & British Psychological Society.Google Scholar
Raune, D., Kuipers, E. & Bebbington, P. E. (2004) Expressed emotion at first episode psychosis: investigating a carer appraisal model. British Journal of Psychiatry, 184, 321–326.CrossRefGoogle ScholarPubMed
Rosenberg, M. (1965) Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press.Google Scholar
Sturgeon, D., Kuipers, L., Berkowitz, R., et al (1981) Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives. British Journal of Psychiatry, 138, 40–45.CrossRefGoogle ScholarPubMed
Szmukler, G. I., Burgess, P., Herrman, H., et al (1996) Caring for relatives with serious mental illness: the development of experience of caregiving inventory. Social Psychiatry and Psychiatric Epidemiology, 31, 137–148.CrossRefGoogle ScholarPubMed
Szmukler, G., Kuipers, E., Joyce, J., et al (2003) An exploratory randomised controlled trial of a support programme for carers of patients with a psychosis. Social Psychiatry and Psychiatric Epidemiology, 38, 411–418.Google Scholar
Tarrier, N., Vaughn, C. E., Laden, M. H., et al (1979) Bodily reactions to people and events in schizophrenia. Archives of General Psychiatry, 36, 311–315.Google Scholar
Turnbull, G. & Bebbington, P. (2001) Anxiety and the schizophrenic process: clinical and epidemiological evidence. Social Psychiatry and Psychiatric Epidemiology, 36, 235–243.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
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.