Schizophrenia Bulletin Advance Access originally published online on February 16, 2005
Schizophrenia Bulletin 2005 31(3):751-758; doi:10.1093/schbul/sbi016
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Expressed Emotion: Relevance to Rehospitalization in Schizophrenia Over 7 Years
Senior Psychologist, Anxiety Disorders Unit, Geha Mental Health Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
former Head of Geha Mental Health Center, Rabin Medical Center; and Clinical Professor of Psychiatry at the Sackler Faculty of Medicine, Tel Aviv University
Professor of Psychiatry and Head of the Department of Psychiatry, University of Cambridge, Cambridge, U.K
Head of the Research Department, Geha Mental Health Center, Rabin Medical Center; Head of the Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Campus; and Professor of Psychiatry at Sackler Faculty of Medicine, Tel Aviv University
Director of the Outpatient Department, Geha Mental Health Center, Rabin Medical Center; and Senior Lecturer of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University
Send reprint requests to Dr. S. Marom, Geha Mental Health Center, P.O. Box 102, Petah Tikva 49100, Israel; e-mail: smarom{at}clalit.org.il .
Expressed emotion (EE) is an established factor in short-term relapse in schizophrenia. However, data on its long-term predictive ability are scarce. We extended our short-term investigation over 7 years' followup. The study population consisted of 108 patients, 93 with schizophrenia and 15 with schizoaffective disorder. EE of the key relatives was rated with the Five Minute Speech Sample (FMSS). Patient households were categorized by EE and its two components: criticism (CR) and emotional overinvolvement (EOI). High CR was associated with earlier first and second readmissions (Breslow p = 0.002 and 0.04, respectively). High CR was associated with a higher rate of readmissions (p = 0.01) and a longer hospital stay (p = 0.02) compared with low CR. Both compliance with pharmacotherapy and the interaction of high-CR x poor compliance were additional contributors to time to first readmission. This study is the first to demonstrate the prolonged predictive validity of EE. Our results support the value of CR as a prognostic indicator of the course of schizophrenia. The FMSS appears to have predictive power in respect to psychiatric hospitalization. Therapies aimed at lowering high EE seem warranted as a long-term preventive approach.
Keywords: Expressed emotion (EE) / long-term course / family relatives / hospitalizations
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