Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

The results are reported of a two-year follow-up of a trial of family sessions in the home (including patients) (12 families) versus a relatives' group (excluding patients) (11 families). Subjects were patients with schizophrenia living in high face-to-face contact with high-EE relatives. Patients were maintained on neuroleptic drugs for two years where possible. Relatives' critical comments and hostility were significantly lowered by nine months, but no significant changes occurred subsequently. Relatives' overinvolvement reduced steadily throughout the trial, and reduction in relatives' EE, either alone or in combination with reduced face-to-face contact, appeared to be associated with a lower relapse rate. The relapse rates for patients in the family-therapy and relatives'-group streams were 33% and 36% at two years. When these data were combined with the results of a previous trial, it was found that patients in families assigned to any form of social intervention had a two-year relapse rate of 40%, significantly lower than the 75% relapse rate for patients whose families were offered no help. We therefore recommend that relatives' groups are established in conjunction with some family sessions in the home for patients at high risk of relapse.

Although symptoms of Post‐Traumatic Stress Disorder are expected to persist for many years, there is often no systematic assessment of Vietnam veterans' combat experiences. A study of 43 help‐seeking Vietnam veterans revealed that a reliable assessment of war trauma, the Combat Exposure Scale, could be constructed from dichotomous questions about seven stressful events. Scale scores related significantly to current diagnosis of PTSD and intensity of symptoms. The Guttman scaling technique resulted in an ordering of events that provides clinically relevant information about the nature of trauma in the Vietnam War.

The degree to which expressed emotion (EE) attitudes in key relatives reflect ongoing transactional processes in families is a topic of controversy. The associations between EE attitudes, as measured during an acute hospitalization (using the Camberwell Family Interview) and during the aftercare period (using 5-minute speech samples), and interactional behavior in parents of recent-onset schizophrenics (this article) and in patients themselves (second article), were investigated. In the first study, EE attitudes manifested by parents during the aftercare period were stronger correlates of their interactional behaviors during the aftercare period than were EE attitudes measured during the inpatient period, despite the frequent correspondence between the two EE measures. The pattern of attitudes shown between the inpatient and outpatient periods also predicted transactional styles in parents during the outpatient period, findings not accounted for by clinical attributes of patients. When high-EE attitudes persist during the aftercare period and are reflected in transactional behaviors, the risk for subsequent patient relapse may be enhanced.