Outcome studies in schizophrenia research consistently show the importance of family variables in predicting patient relapse. The concept of expressed emotion (EE) is clinically relevant, though concerns remain about its precise meaning. The history of the EE studies is reviewed in the light of other family research, and an alternative model of family emotional environment is proposed. A number of clinical implications are considered.
References
1.
BrownG, CarstairsJ, ToingJ.The post hospital adjustment of chronic mental patients. Lancet1958;2:685–689.
2.
BrownG, MonckC, CarstairsG, WingJ.The influence of family life on the course of schizophrenic illness. British Journal of Preventative Social Medicine1962;16:55–58.
3.
WynneL, SingerM.Thought disorder and family relations of schizophrenics 1: A research study. Archives of General Psychiatry1963;9:191–198.
4.
BrownG, RutterM.The measurement of family activities and relationships. Human Relations1966; 19:241–263.
5.
RutterM, BrownG.The reliability and validity of measures of family life and relationships in families containing a psychiatric patient. Social Psychiatry; 1:36–53.
6.
BrownG, BirleyWing J.Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry1972;121:241–258.
7.
VaughnC, LeffJ.The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic, depressed and neurotic patients. British Journal of Psychiatry1976;129:125–137.
8.
KuipersL.Expressed emotion: A review. British Journal of Social and Clinical Psychology1979;18:237–243.
9.
VaughnC, SnyderK, JonesS.Patterns of emotional response in relating to schizophrenic patients. Schizophrenic Bulletin1981;7:1.
10.
LeffJ, KuipersL, BerkowitzR, VaughanC, SturgeonD.Life events, relatives expressed emotion, and maintenance neuroleptics in schizophrenic relapse. Psychological Medicine1983; 13:799–806.
11.
LeffJ, KuipersL, BerkowitzR, Eberlein-FriesA, SturgeonD.A controlled study of social intervention in the families of schizophrenic patients. British Journal of Psychiatry1983; 141:121–134.
12.
VaughnC, SnyderK, JonesS, Family factors in schizophrenic relapse: a replication in California of British research on expressed emotion. Archives of General Psychiatry1984;41:1169–1177.
13.
ParkerG, Johnson. Parenting and schizophrenia: An Australian study of expressed emotion. Australian and New Zealand Journal of Psychiatry1987;21:60–66.
14.
KottgenC, SonnichsenI, MollenhauerK, Families' high expressed emotion and relapsed in young schizophrenic patients: results of the Camberwell family intervention study. II International Journal of Family Psychiatry1984;5:71–82.
15.
MacMillanJF, GoldA, CrowTJ, JohnsonA, JohnstoneE.The Northwick Park study of first episodes of schizophrenia IV. Expressed emotion and relapse. British Journal of Psychiatry1986;148:133–143.
16.
McCredieR, PhillipsK.The Nithsdale Schizophrenia Survey: VII. Does relatives' high expressed emotion predict relapse?British Journal of Psychiatry; 152:477–481.
17.
ParkerG, JohnstonP, HaywardL.Prediction of schizophrenic relapse using the parental bonding instrument. Australian and New Zealand Journal of Psychiatry1988;22:283–292.
18.
ParkerG, JohnstonP, HaywardL.Parental “expressed emotion” as a predictor of schizophrenic relapse. Archives of General Psychiatry1988;45:806–813.
19.
GoldsteinM.New directions in interventions with families of schizophrenics. Hossey-Bass Inc.San Francisco1981.
20.
GoldsteinM.Interventions with families and the course of schizophrenia. Department of Psychology, University of California in Los Angeles1984.
21.
HogartyG, AndersonC, ReissD, Family Psychoeducation, social skills training and maintenance chemotherapy in the aftercare of schizophrenia. One year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry1986;43:633–642.
22.
StrachanA.Family Intervention for Rehabilitation of Schizophrenia. Toward Protection and Coping Schizophrenia Bulletin1986;4:678–698.
23.
KoensigbergH, HandleyR.Expressed Emotion: From predictive index to clinical construct. American Journal of Psychiatry1986:143:11:1361–1373.
24.
HooleyJ.Expressed emotion: A critical overview. Clinical Psychology Review1985;5:119–139.
25.
ReissD, WyattR.Family and biologic variables in the same etiological studies of schizophrenia: A proposal. Schizophrenia Bulletin1975;14:64–81.
26.
FreemanH, SimmonsO.The mental patient comes home. John Wiley and Sons, New York/London1963.
27.
BlandR.Families caring for a schizophrenic family member at home. Unpublished Ph.D. Thersis, University of Queensland1987.
28.
SpiegelD, WisslerT.Family environment and rehospitalization. American Journal of Psychiatry1986;143:56–60.
29.
BlandR.Family support and education programme. University of Queensland; Department of Social Work, Occasional Paper 1986.
30.
BrownG, Birley, WingJ.Schizophrenia and social care. Oxford University Press, London1966.
31.
CreerC, WingJ.Schizophrenia at home. National Schizophrenia Fellowship, Surbiton, Surrey1974.
32.
HatfieldA.Psychological costs of schizophrenia to the family. Social Work1978;23:5.
33.
BernheimK, LewineR, BealeC.The caring family. Random Books, New York1982.
34.
FaddenG, BebbingtonP, KuipersL.The burden of care: the impact of functional psychiatric illness on the patient's family. British Journal of Psychiatry1987;150:285–292.
35.
HatfieldA, SpaniolL, ZippleA.Expressed emotion: A family perspective. Schizophrenia Bulletin1987; 13:221–225.
36.
HatfieldA.Coping with mental illness in the family: A family guide. Maryland Department of Health and Mental Hygiene, and NAMI, Arlington1985.
37.
BlandR.Social work with the family of the schizophrenic patient. Australian Social Work Journal1987;40:25–30.
38.
BernheimK.Supportive family counselling. Schizophrenia Bulletin1982;8:634–641.