Anxiety Interacts With Expressed Emotion Criticism in the Prediction of Psychotic Symptom Exacerbation

Docherty, Nancy M.; St‐Hilaire, Annie; Aakre, Jennifer M.; Seghers, James P.; McCleery, Amanda; Divilbiss, Marielle

doi:10.1093/schbul/sbp123

Cited by 28 publications

(22 citation statements)

References 46 publications

(72 reference statements)

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“…Findings in the broader schizophrenia-spectrum literature also suggested that FIp improves levels of EE (Pharoah et al, 2010), however this included emotional over-involvement. Criticism from carers has been positively associated with increases in levels of anxiety in service users (Kuipers et al, 2006; Docherty et al, 2011). The reductions in criticism remains important given its predictive role in subsequent relapse (Bebbington and Kuipers, 1994) and adverse impact on patient well-being including at a neural level (Rylands et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

2017

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Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.

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Section: Discussionmentioning

confidence: 99%

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

2017

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“…Furthermore, high NEE in close relatives increases the likelihood of psychiatric relapse (Brown and Rutter 1966;Bebbington and Kuipers 1994). In patients with psychosis, a high level of relative criticism is related to longer hospital stay (Marom et al 2005) and high depression and anxiety in patients (Docherty et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Neural processing of criticism and positive comments from relatives in individuals with schizotypal personality traits

Premkumar

Williams

Lythgoe

et al. 2011

The World Journal of Biological Psychiatry

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Objectives . High negative expressed emotion by family members towards schizophrenia patients increases the risk of subsequent relapse. The study aimed to determine whether individuals with high schizotypy (HS) and low schizotypy (LS) would differ in activation of brain areas involved in cognitive control when listening to relative criticism. Methods . Twelve HS and 12 LS individuals listened to relative ' s critical, positive and neutral comments about them while undergoing functional MRI. Activation maps in the two groups during the comments were compared using SPM5. Results . The left superior frontal and middle frontal gyri and bilateral posterior cingulate cortex were activated during criticism, compared to neutral comments, across all participants. While there were no group differences in brain activity for criticism versus neutral comments, the HS group, who had lower current mood relative to the LS group, activated to a lesser extent the thalamus, insula, putamen and brain stem during positive, compared to neutral, comments. Conclusions . Listening to relative criticism in healthy individuals engages brain areas for cognitive control of negative emotion and self-referential processing. However, HS individuals may have an attenuated ability to respond to rewarding aspects of positive comments due to their lower current mood.

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“…However, CFI-data from relatives was not reported. In a longitudinal study, 27 relatively stable outpatients with schizophrenia or schizoaffective disorder filled in PCS and the single "most influential other" (MIO) person was interviewed with CFI [28]. Patient ratings on the perceived criticism item were significantly related to the high vs low CFI criticism ratings (p = 0.03).…”

Section: Comparison Of Feers With Alternative Studies Of Patient Percmentioning

confidence: 99%

How do Patients with Schizophrenia Perceive Relatives’ Levels of Expressed Emotions? A Brief Patient Rated Scale

Bjørge¹,

Notland²,

Boye³

et al. 2017

OJPsych

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Background: Patients' perspective on relatives' attitude and behaviour towards them (Expressed emotion-EE) may be an important addition to the current focus on relatives' perspective only, as measured by Camberwell Family Interview (CFI) or other methods. Based on the theory of EE, we have designed a brief, three-item questionnaire completed by patients, named Felt Expressed Emotion Rating Scale (FEERS). FEERS measures the patient's experience of criticism (Cri) and emotional over involvement (i.e. worry (Wo), and control (Con). Aims: To investigate the test-retest reliability of the FEERS and associations between the FEERS and the CFI and to which extent FEERS scores were modified by severity of psychotic symptoms, cognitive function, patient mood and amount of face-to-face contact with relatives. Methods:Forty-five patients with schizophrenia and related psychoses admitted to a psychiatric hospital and 67 relatives were included. Assessments included 221Wo correlated significantly with CFI-CC and CFI-positive comments, respectively. Among the relatives that the patient deemed "not at all critical" (low FEERS-Cri scores), 94% had low CFI-CC levels. Conclusions: The FEERS may be a brief, time-saving alternative for identifying relatives with low levels of criticism. However, illness severity, cognitive function and mood influence FEERS test-retest reliability and link to CFI.

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Anxiety Interacts With Expressed Emotion Criticism in the Prediction of Psychotic Symptom Exacerbation

Cited by 28 publications

References 46 publications

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

Neural processing of criticism and positive comments from relatives in individuals with schizotypal personality traits

How do Patients with Schizophrenia Perceive Relatives’ Levels of Expressed Emotions? A Brief Patient Rated Scale

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