Expressed Emotion and Schizophrenia in North India An Essay-Review (original) (raw)
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British Journal of Psychiatry, 1992
A sample of 60 Spanish schizophrenic patients was studied to ascertain the relationship between their relatives' expressed emotion (EE) and relapse at follow-up. The relatives' EE and patients' relapse were operationalised following Leff & Vaughn's criteria. At nine months a significant association was not found between the relatives' EE and relapse, but this association became significant on reclassifying the relatives' EE scores after decreasing to four points the cut-off point for critical comments. At 24 months no association was found between EE and relapse. There was a tendency for patients who interrupted their medication or who did not work to relapse more frequently, particularly among the high-EE group.
Social psychiatry and psychiatric epidemiology, 1994
This paper presents the results of a study carried on an urban population in Belgrade investigating the connections between relapse in schizophrenia and the expressed emotion (EE) status of families where at least one of the patient's parents was a member of the household. The overall rate of high EE was just under 50%, in the middle of the range of values reported in studies carried out elsewhere. Relapse was found to be 10 times more frequent in patients whose families were rated high in EE. The sample consisted of 30 patients with hebephrenic schizophrenia and 30 with paranoid schizophrenia. The results suggested that these subtypes may be associated with different attributes of EE. Criticism was more frequent in families of patients with paranoid schizophrenia, while emotional overinvolvement was more frequent in families having a hebephrenic offspring. The different components of EE, suitably combined, may differentiate between the two subtypes of schizophrenia in terms of ...
Family Process, 1989
This study focused on the development of and changes in the interaction within a family after the onset of schizophrenia in a family member. Special attention is given to the possible effects of various treatments on the interaction. Our method was a circular interview of all family members in a joint session 8 years after the onset of schizophrenia. We observed that changes in family interaction usually had taken place during the first year of the illness. Thereafter, family conditions and interactions seem to have remained relatively unchanged. On the other hand, in addition to actual family-centered therapy, all other treatment modesindividual therapy, medication, hospitalizationseemed to have acted as systemic interventions on the family level. Our observation that family interactions and models of therapy often had a surprisingly strong resemblance led us to consider the idea of their coevolution over the years and the possible significance of this. This article aims at calling the reader's attention to the manifold influences that the onset of schizophrenia and its various treatments seem to have had on family systems. The opportunity to study family interaction several years after the onset of schizophrenia in a family member came about when the decision was made to continue the study of Alanen and his colleagues (2, 3) in the Mental Health District of Turku on 100 successive cases of schizophrenic psychoses in 1976-77. The patients had undergone a thorough examination that included their registration, a followup of various symptoms, study and followup of their life situation, work situation, and relationships within their family and with significant others. The patients had been studied at the onset of their psychosis and at 2-and 5-year followups. The patient sample included 53 men and 47 women. The diagnostic spectrum was relatively broad: 56 typical schizophrenia, 10 schizophreniform psychoses, 14 schizoaffective psychoses, and 20 borderline schizophrenia (3). From the beginning, the treatment was psychotherapeutic, with an emphasis mostly on individual therapy, although family therapy and a therapeutic ward milieu were also available (3). The 2-and 5-year followup studies had been family-oriented only to the extent that attempts were made to meet with all family members separately; previously, no conjoint interviews had been arranged. In our own study, we chose to interview family members as a unit because we wanted to evaluate family interaction, including changes and the factors responsible for the changes (see 6). Prior to our study, neither of us had met these patients or families; we had not participated in the first study nor in the 2-and 5-year followups. We had, however, access to all the material from the previous studies. Our starting point was the idea of the family as a system whose members have a circular interaction with and influence on each other. The changes both inside and outside the system are variously reflected in all interactional relationships within the system (4). One such change is, of course, the mental illness of a family member. We therefore hypothesized that the illness and the treatments affected not only the life and relationships of the patient but also the life and relationships of the whole family.
1996
A case series to study factors related to family expectation regarding schizophrenic patients was conducted in an outpatient setting in the city of S. Paulo, Brazil. Patients diagnosed as presenting schizophrenia by the ICD 9th Edition and having had the disease for more than four years were included in the study. Family Expectation was measured by the difference between the Katz Adjustment Scale (R2 and R3) scores based on the relative's expectation and the socially expected activities of the patient (Discrepancy Score), and social adjustment was given by the DSM-III-R Global Assessment Scale (GAS). Outcome assessments were made independently, and 44 patients comprised the sample (25 males and 19 females). The Discrepancy mean score was twice as high for males as for females (p < 0.02), and there was an inverse relationship between the discrepancy score and social adjustment (r =-0.46, p < 0.001). Moreover, sex and social adjustment exerted independent effects on the discrepancy score when age, age at onset and number of psychiatric admissions were controlled by means of a multiple regression technique. There was an interaction between sex and social adjustment, the inverse relationship between social adjustment and discrepancy score being more pronounced for males. These findings are discussed in the light of the potential association between the family environment, gender and social adjustment of schizophrenic patients, and the need for further research, i.e. ethnographic accounts of interactions between patient and relatives sharing households particularly in less developed countries. Schizophrenia. Social adjustment. Family, psychology. Resumo Foi realizado estudo de corte transversal para estudar fatores associados às expectativas familiares com familiares ambulatoriais esquizofrênicos pela Classificação Internacional de Doenças, 9ª edição e que tivessem mais de 4 anos de duração da doença foram incluídos no estudo. A expectativa familiar 206 Rev. Saúde Pública, 30 (3), 1996 Social adjustment of schizophrenic patients Shirakawa, I. et al.
Background: The international pilot study of schizophrenia found that the prognosis of schizophrenia is better in developing countries than developed. Based on this finding it was hypothesized that joint family is better as far as expressed emotion and its effect is concerned. The scientific research on this issue has yielded inconclusive results. So, this study made an attempt to find out whether expressed emotion is different in nuclear and joint families and whether it has any relationship with the attitude of the relative towards mental illness. Method: It is a prospective cross-sectional hospital based study conducted at CIP, Ranchi. 60 key relatives of persons with schizophrenia each from nuclear and joint families respectively were selected purposively for the study. Opinions about mental illness scale and attitude questionnaire were administered to assess attitude and expressed emotion. Results: Significant difference was observed in the area of expressed emotion in key rela...