Forty-two schizophrenic patients and their close relatives took part in an Italian replication study of expressed emotion (EE). The patients were selected from the psychiatric ward of a general hospital in Milan and were subsequently followed up for nine months. All patients attended a community service clinic as out-patients, and all but one were prescribed neuroleptics for the duration of the study. Relatives were assigned to the high-EE group if they scored 4 or 5 on the emotional overinvolvement (EOI) scale, or showed hostility, or made six or more critical comments. On this basis, 18 (42%) families were rated as low EE and 24 (57%) as high EE. At follow-up, the admission rate for the 9-month period was significantly higher for the high-EE group (P less than 0.05). Furthermore, significantly fewer patients were readmitted from families showing high warmth (P less than 0.05). The presence of high warmth appeared to be associated with a lower admission rate, even in high-EE families.

This article presents the results of a pilot study carried out on families of people with a diagnosis of schizophrenia (high‐frequency users of psychiatric services) using a standardized version of systemic family intervention based on the Milan Approach (‘Circular Interview’). We used expressed emotion (EE) to compare and assess two homogeneous samples of families, a treatment group (n = 10) and a control group (n = 8). We found that families participating in circular interviews showed a reduction in criticism, while 30% of their members with a diagnosis of schizophrenia relapsed. Families not receiving treatment showed no changes in EE levels, while 62.5% of their members with a diagnosis of schizophrenia relapsed. Although the difference in relapse rates is not statistically significant, these results justify further studies on the use of nondirective systemic intervention with families of people with a diagnosis of schizophrenia.

Family interactive patterns were investigated in the relatives of 20 mentally retarded patients institutionalised in two centres in Northern Italy. Expressed emotion (EE) was used as evaluation instrument. The results show a surprisingly high rate (45%) of high EE, even in relatives of patients who did not live inside the family. High EE was positively correlated to the presence of behavioral disorders in the patients, as already shown for children with conduct disorders. Treatment implications are discussed; there is an opportunity for the implementation of a family psychoeducational approach, aimed both at managing the behavioural consequences of the disorder and at enhancing rehabilitation programmes.

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