1
|
Ferentinos P, Douki S, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1761-1773. [PMID: 38296844 DOI: 10.1007/s00127-023-02609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study systematically searched for differential correlates of criticism vs. emotional overinvolvement (EOI) towards patients with schizophrenia in families and halfway houses, which have only incidentally been reported in previous research. Identified patterns were compared across settings. METHODS We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the expressed emotion (EE) of 22 psychiatric nurses or 56 parents, respectively, through Five Minutes Speech Samples. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses. Each outpatient was rated by one or both parents. As EE ratings had a multilevel structure, weighted Spearman correlations of criticism and EOI with various patient- and caregiver-related characteristics were calculated and compared with Meng's z-test. RESULTS Criticism was weakly negatively correlated with EOI in nurses but negligibly in parents. Distinct patterns of significant differential correlates arose across settings. Outpatients' aggressive behavior and parents' related burden were mainly associated with higher criticism. Inpatients' symptoms (agitation/aggression, negative and other psychotic symptoms) and nurses' burnout (Depersonalization) were mainly associated with lower EOI. Inpatients' perceived criticism and outpatients' previous suicide attempts were equally associated with higher criticism and lower EOI (mirror correlations). Finally, various inpatient attributes (older age, chronicity, unemployment and smoking) triggered higher EOI only. Inpatients' age, psychopathology (esp. agitation/aggression and negative symptoms) and perceived criticism survived adjustment for multiple comparisons. CONCLUSION Our findings suggest setting-specific pathogenetic pathways of criticism and EOI and might help customize psychoeducational interventions to staff and families.
Collapse
Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
| | - Stamatina Douki
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Dimitra Dragoumi
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| |
Collapse
|
2
|
Ramanathan A, Miah SK, Nagularaj L, Sharif HS, Shaikh M. Perceived expressed emotion in individuals with a first episode of psychosis from a south Asian background. Early Interv Psychiatry 2024. [PMID: 38703089 DOI: 10.1111/eip.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
AIM To explore perceived expressed emotion in the south Asian context for individuals with a first episode of psychosis (FEP). METHOD Semi-structured interviews were conducted with 16 service users experiencing a FEP to understand their experience of expressed emotion (EE) from their caregivers. Interviews were analysed using inductive thematic analysis. RESULTS Four main categories were identified: connection and support, understanding and awareness, boundaries and independence and context and influence. Factors influencing perceived expressed emotion such as acceptance, acculturation, warmth and expressions of love, communication and family values were identified. Findings highlight south Asian's experiences of being cared for, and their perception of EE, including warmth and connection as a strength and resource. CONCLUSION The findings shed light on culturally specific EE within the context of FEP that can be considered when working with south Asian communities within early intervention services. Findings highlight the impact of navigating and negotiating bicultural identities and generational differences in EE in the British south Asian context.
Collapse
Affiliation(s)
- Amrita Ramanathan
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Syed K Miah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lidushi Nagularaj
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Madiha Shaikh
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- North East London NHS Foundation Trust, Rainham, UK
| |
Collapse
|
3
|
Vaswani-Bye A, McCain C, Blank JM, Tennison ME, Kopelovich SL. A Thematic Analysis Investigating the Inaugural Psychosis REACH Family Ambassador Peer Training Program. Neuropsychiatr Dis Treat 2024; 20:233-245. [PMID: 38348058 PMCID: PMC10860596 DOI: 10.2147/ndt.s432255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/15/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose Caregivers of loved ones with psychosis are tasked with navigating a barren care landscape for their loved ones and for themselves. The dearth of resources they face has a negative impact on outcomes for caregivers and their loved ones. The Psychosis REACH program, based on principles from Cognitive Behavioral Therapy for psychosis was developed as a community-based resource for families to address this care gap. A role for family peers called the Psychosis REACH Family Ambassadors (pRFAs) was developed to reinforce skill learning for caregivers by utilizing a task-sharing approach. This qualitative study sought to better understand pRFAs' experiences in the inaugural training cohort of this program. Patients and Methods Eleven pRFAs participated in semi-structured interviews with research coordinators via teleconference. Questions assessed the quality of the training, challenges and facilitators experienced in their role, and ways in which the program could be improved and expanded. Using thematic analysis, members of the research team coded interviews individually, discussed codes until consensus was reached, and iteratively developed themes based on codes that clustered based on meaning or content. Results This process identified 5 key themes: The development of hope and recovery, the development of solidarity networks, the challenges of navigating boundaries, preferred pedagogical strategies, and the need for more support. Conclusion Overall, the themes developed from this qualitative analysis demonstrate the value and feasibility of developing a caregiver peer network of pRFAs trained in recovery-oriented care and CBTp-informed skills to support other caregivers. Additionally, they highlight the challenges associated with being in the role of a pRFA and further efforts needed to align training content and learning management systems to the needs of pRFA trainees. These findings highlight the importance of expanding access to family peer training programs for the wellbeing of caregivers and loved ones with psychosis alike.
Collapse
Affiliation(s)
- Akansha Vaswani-Bye
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Chris McCain
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer M Blank
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Mackenzie E Tennison
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
4
|
Ferentinos P, Douki S, Yotsidi V, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Family in Crisis: Do Halfway Houses Perform Better Than Families with Expressed Emotion toward Patients with Schizophrenia? A Direct Adjusted Comparison. Healthcare (Basel) 2024; 12:375. [PMID: 38338260 PMCID: PMC10855104 DOI: 10.3390/healthcare12030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Expressed emotion (EE) toward patients with schizophrenia is typically reported to be lower in psychiatric halfway houses than in families. This is the first study directly comparing EE between these settings and investigating the pathways mediating EE differences. We included 40 inpatients in halfway houses and 40 outpatients living with their families and recorded 22 psychiatric nurses' and 56 parents' EE, respectively, through Five Minutes Speech Samples. Each inpatient was rated by 2-5 nurses and each outpatient by 1-2 parents. As EE ratings had a multilevel structure, generalized linear mixed models were fitted, adjusting for patient-related confounders and caregiver demographics. Mediatory effects were investigated in multilevel structural equation models. Outpatients were younger, less chronic, and better educated, with higher negative symptoms and perceived criticism than inpatients. Nurses were younger and better educated than parents. Before adjustment, EE rates were equally high across settings. After adjusting for patient-related confounders, emotional overinvolvement was significantly higher in parents. However, after also adjusting for caregiver demographics, only criticism was significantly higher in nurses. Patients' age, negative symptoms, and perceived criticism and caregivers' age and sex significantly mediated EE group differences. Our findings highlight pathways underlying EE differences between halfway houses and families and underscore the importance of staff and family psychoeducation.
Collapse
Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Stamatina Douki
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University of Social and Political Sciences, 176 71 Athens, Greece;
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, 15 451 Athens, Greece;
| | - Dimitra Dragoumi
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| |
Collapse
|
5
|
Heriot-Maitland C, Wykes T, Peters E. Trauma and Social Pathways to Psychosis, and Where the Two Paths Meet. Front Psychiatry 2021; 12:804971. [PMID: 35082703 PMCID: PMC8785245 DOI: 10.3389/fpsyt.2021.804971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/17/2021] [Indexed: 12/17/2022] Open
Abstract
The pathways from trauma-via dissociation-to psychosis have been thoroughly tested and evidenced, but what has received less attention has been the social pathways-via dissociation-to psychosis. Often social factors are more commonly linked to other influences, e.g., to appraisals and the creation of negative schema in cognitive models, or to unsupportive caregiving experiences where there is high "expressed emotion." However, evidence is now emerging that negative social rank experiences, such as being excluded or shamed, may themselves have dissociative properties, which poses intriguing questions as to how trauma pathways and social pathways might interact. This article reviews the state of knowledge in trauma and social pathways to psychosis and then considers the potential mechanisms and the relationships between them, specifically (i) dissociation, (ii) attachment, and (iii) social rank. Recommendations are suggested for future modeling and testing of three-way interactions (dissociation × attachment × social rank) in the pathway from trauma to psychosis.
Collapse
Affiliation(s)
- Charles Heriot-Maitland
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Institute of Health and Wellbeing, Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
6
|
Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial. Epidemiol Psychiatr Sci 2019; 29:e27. [PMID: 30968810 PMCID: PMC8061200 DOI: 10.1017/s2045796019000155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS First-episode psychosis (FEP) is a major life event and can have an adverse impact on the diagnosed individual and their families. The importance of intervening early and providing optimal treatments is widely acknowledged. In comparison to patient groups, literature is scarce on identifying treatment predictors and moderators of caregiver outcomes. This study aimed to identify pre-treatment characteristics predicting and/or moderating carer outcomes, based on data from a multi-element psychosocial intervention to FEP patients and carers (GET-UP PIANO trial). METHODS Carer demography, type of family relationship, patient contact hours, pre-treatment carer burden, patient perceptions of parental caregiving and expressed emotion (EE) were selected, a priori, as potential predictors/moderators of carer burden and emotional distress at 9 months post treatment. Outcomes were analysed separately in mixed-effects random regression models. RESULTS Analyses were performed on 260 carers. Only patient perceptions of early maternal criticism predicted reports of lower carer burden at follow-up. However, multiple imputation analysis failed to confirm this result. For treatment moderators: higher levels of carer burden at baseline yielded greater reductions in carer emotional distress at follow-up in the experimental group compared with treatment as usual (TAU). Higher levels of perceived EE moderated greater reductions in carer reports of tension in experimental group, compared with TAU, at follow-up. In younger caregivers (<51 years old), there were greater reductions in levels of worry during the baseline to follow-up period, within the experimental group compared with TAU. CONCLUSION The study failed to identify significant treatment predictors of FEP carer outcomes. However, our preliminary findings suggest that optimal treatment outcomes for carers at first episode might be moderated by younger carer age, and carers reporting higher baseline levels of burden, and where patients perceive higher levels of negative effect from caregivers.
Collapse
|
7
|
Ng SM, Yeung CH, Gao S. A concise self-report scale can identify high expressed emotions and predict higher relapse risk in schizophrenia. Compr Psychiatry 2019; 89:1-6. [PMID: 30550992 DOI: 10.1016/j.comppsych.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Although high expressed emotions (EE) is one of the most significant predictors for schizophrenic relapse, the assessment of EE is often impeded by the demanding Camberwell Family Interview (CFI) that is required to be conducted by specifically trained staff. To enable a more efficient assessment of EE, we developed the 12-item Concise Chinese Level of Expressed Emotion Scale (CCLEES) and reported its predictive and concurrent validity in this study. METHODS A one-year prospective study design was adopted. Totally 101 participants diagnosed with schizophrenia were recruited from the department of psychiatry of a major acute hospital in Hong Kong. CCLEES was administered and subsequent relapse information was collected from all participants. At baseline, 10 family members of the participants were also administered CFI. RESULTS Participants who scored above the optimal cut-off point (Score 13 on Criticism, and/or 13 on Hostility, and/or 15 on Emotional Over-involvement) showed a 6.3 times elevated 12-month schizophrenic relapse rate compared to those who scored below cut-off. The CCLEES also demonstrated excellent correspondence with CFI, the widely-recognized golden benchmark of EE assessment. CONCLUSIONS The results support the CCLEES as a brief and psychometrically sound self-report measurement for EE in Chinese people with schizophrenia.
Collapse
Affiliation(s)
- Siu-Man Ng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.
| | - Chi-Hung Yeung
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.
| | - Siyu Gao
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.
| |
Collapse
|
8
|
Müller H, de Millas W, Gaebel W, Herrlich J, Hasan A, Janssen B, Juckel G, Karow A, Kircher T, Kiszkenow-Bäker S, Klingberg S, Klosterkötter J, Krüger-Özgürdal S, Lambert M, Lautenschlager M, Maier W, Michel TM, Mehl S, Müller BW, Pützfeld V, Rausch F, Riedel M, Sartory G, Schneider F, Wagner M, Wiedemann G, Wittorf A, Wobrock T, Wölwer W, Zink M, Bechdolf A. Negative schemata about the self and others and paranoid ideation in at-risk states and those with persisting positive symptoms. Early Interv Psychiatry 2018; 12:1157-1165. [PMID: 28524542 DOI: 10.1111/eip.12433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/13/2016] [Accepted: 01/19/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The objective of this study is to test the conflicting theories concerning the association of negative self and other schemata and paranoid ideation. METHODS A risk-based approach, including risk stratification, is used to gain insight into the association of the negative self and other schemata that may be shared by individuals or differentiate between individuals at clinical high risk (CHR) for a first-episode psychosis and those with full-blown psychosis. The dataset includes a sample of individuals at CHR (n = 137) and a sample of individuals with persisting positive symptoms (PPS, n = 211). The CHR sample was subdivided according to a prognostic index yielding 4 CHR sub-classes with increasing risk for transition to psychosis. RESULTS Negative beliefs about the self were associated with paranoid ideation in CHR and a lower risk state. In the highest risk state and full-blown psychosis, there is an association with negative beliefs about others. CONCLUSION These findings are in line with theories suggesting a switch from a predominantly activated negative self-schema to a malevolent others-schema in association with paranoid ideation along the risk-continuum. However, due to methodological limitations these results should be replicated by future studies.
Collapse
Affiliation(s)
- Hendrik Müller
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Walter de Millas
- Department of Psychiatry and Psychotherapy, Charité University Medicine Campus Mitte, Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Jutta Herrlich
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Birgit Janssen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Stefanie Kiszkenow-Bäker
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
| | | | - Seza Krüger-Özgürdal
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Lautenschlager
- Department of Psychiatry and Psychotherapy, Charité University Medicine Campus Mitte, Berlin, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Tanja Maria Michel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Stefanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Bernhard W Müller
- Department for Psychiatry and Psychotherapy, LVR-Clinic Essen, Faculty of Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Franziska Rausch
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gudrun Sartory
- Department of Clinical Psychology, University of Wuppertal, Wuppertal, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Georg Wiedemann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Goettingen, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic am Urban and Vivantes Clinic im Friedrichshain, Academic Hospital Charité, Berlin, Germany
| |
Collapse
|
9
|
Sensitivity to criticism and praise predicts schizotypy in the non-clinical population: The role of affect and perceived expressed emotion. Eur Psychiatry 2018; 55:109-115. [PMID: 30469009 DOI: 10.1016/j.eurpsy.2018.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Schizotypy represents a cluster of personality traits consisting of magical beliefs, perceptual aberrations, disorganisation, and anhedonia. Schizotypy denotes a vulnerability for psychosis, one reason being psychosocial stress. High expressed emotion (EE), a rating of high criticism, hostility, and emotional over-involvement from a close relative, denotes psychosocial stress and vulnerability to psychosis, and is associated with schizotypy. This study aimed to decipher the relationship of schizotypy to perceived criticism and perceived praise in terms of affect and perceived EE. METHODS Ninety-eight healthy participants listened to short audio-clips containing criticism, praise, and neutral comments from a stranger, and evaluated them in terms of the comments' arousal and personal relevance. Participants also answered self-report questionnaires of schizotypy, depression, mood, and perceived EE. Correlational analyses tested the relationship between schizotypy and the evaluations of criticism and praise. Mediation analyses then tested whether depression, positive mood, and perceived EE explained these relationships. RESULTS Greater relevance of standard criticism correlated with higher positive schizotypy. This association was fully mediated by high depression and perceived irritability from a close relative. Lower relevance of standard praise correlated with higher cognitive disorganisation (another schizotypal trait). This relationship was partially mediated by low positive mood and high perceived intrusiveness from a close relative. CONCLUSION Greater perceived criticism and lower perceived praise predict schizotypy in the healthy population. Affect and interpersonal sensitivity towards a close relative explain these relationships, such that depression increases perceived criticism, and positive mood increases perceived praise. Perceived EE defines the interpersonal nature of schizotypy.
Collapse
|
10
|
Haidl T, Rosen M, Schultze-Lutter F, Nieman D, Eggers S, Heinimaa M, Juckel G, Heinz A, Morrison A, Linszen D, Salokangas R, Klosterkötter J, Birchwood M, Patterson P, Ruhrmann S. Expressed emotion as a predictor of the first psychotic episode - Results of the European prediction of psychosis study. Schizophr Res 2018; 199:346-352. [PMID: 29661524 DOI: 10.1016/j.schres.2018.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the impact of expressed emotion (EE) on the risk of developing the first psychotic episode (FEP). METHOD The European Prediction of Psychosis Study (EPOS) investigated 245 patients who were at clinical high risk (CHR) of psychosis. The predictive value of EE alone and as a part of the multivariate EPOS model was evaluated. RESULTS "Perceived irritability", a domain of the Level of Expressed Emotion Scale (LEE), was found to be predictive for the First Psychotic Episode (FEP), even as an individual variable. Furthermore, it was selected in the multivariate EPOS prediction model, thereby replacing two of the original predictor variables. This led to an improved revised version that enabled the identification of three significantly different risk classes with a hazard rate of up to 0.911. CONCLUSIONS CHR subjects who perceive the most important person in their individual social environment to be limited in their stress coping skills had a higher risk of conversion to the first psychotic episode. The importance of this risk factor was further demonstrated by an improvement of risk estimation in the original EPOS predictor model. Perceiving a reference person as stress-prone and thus potentially unreliable might amplify self-experienced uncertainty and anxiety, which are often associated with the prodromal phase. Such an enforcement of stress-related processes could promote a conversion to psychosis.
Collapse
Affiliation(s)
- Theresa Haidl
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Effingerstrasse 14a, 3011 Bern, Switzerland; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Dorien Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Susanne Eggers
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Kiinamyllynkatu 4-8, Rakennus 11B, 20520 Turku, Finland
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Alexandrinenstraße 1, 344791 Bochum, Germany
| | - Andreas Heinz
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Anthony Morrison
- School of Psychological Sciences, University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Don Linszen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam-Zuidoost, Netherlands; Department of Psychiatry and Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
| | - Raimo Salokangas
- Department of Psychiatry, University of Turku, Kiinamyllynkatu 4-8, Rakennus 11B, 20520 Turku, Finland
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Paul Patterson
- Birmingham Children's Hospital, Steelhouse Ln, Birmingham B4 6NH, Birmingham, United Kingdom
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany.
| | | |
Collapse
|
11
|
Villalobos BT, Ullman J, Krick TW, Alcántara D, Kopelowicz A, López SR. Caregiver criticism, help-giving, and the burden of schizophrenia among Mexican American families. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:273-285. [PMID: 28464243 DOI: 10.1111/bjc.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study tested an attribution model of help-giving in family caregivers of persons with schizophrenia as it relates to caregivers' reported burden. We hypothesized (a) that caregivers' attributions of their ill relatives' responsibility for their symptoms would be associated with more negative and less positive affective reactions, (b) that affective reactions would be related to perceptions of administered support, and (c) that support would in turn predict greater burden. METHODS We examined 60 family caregivers of Mexican origin living in Southern California. Mexican Americans were chosen because of their high degree of contact with their ill relative, thereby facilitating the examination of help-giving and burden. Contrary to past studies, caregivers' attributions and affective stance were assessed independently, the former based on self-report and the latter based on codes drawn from the Camberwell Family Interview. Caregiver burden was assessed at baseline and one year later. RESULTS Path analyses showed partial support for the attribution model of help-giving. Specifically, attributions of responsibility negatively predicted caregiver's warmth, which in turn predicted more administered support. Contrary to hypotheses, attributions were not associated with caregiver criticism, and criticism was positively related to administered support. In addition, caregiver support was not related to burden at either baseline or a year later. Criticism was a significant predictor of burden at follow-up through burden at baseline. CONCLUSION The emotional stance of caregivers predicts burden independent of the help they provide. Caregiver criticism not only predicts negative patient outcomes but can predict negative caregiver outcomes as well. PRACTITIONER POINTS Positive clinical implications In family treatment, it is important to address caregiver criticism not only because of its relationship to poor clinical outcomes of ill relatives but also because of its relationship to greater caregiver burden. Integrating a balanced rationale for family interventions - to improve ill relatives' and caregivers' outcomes - may promote further engagement of both parties as some caregivers may be additionally motivated to improve their own well-being, and some ill relatives may appreciate more equitably distributing the treatment focus. Limitations The caregiver sample was in general low in criticism; therefore, the findings may not be generalizable to families with a higher degree of criticism. There was a 35% sample attrition at the one-year follow-up.
Collapse
Affiliation(s)
| | - Jodie Ullman
- California State University, San Bernardino, California, USA
| | | | | | | | - Steven R López
- University of Southern California, Los Angeles, California, USA
| |
Collapse
|
12
|
Onwumere J, Kuipers E. Caregiving roles: when will they be routinely recognized and supported? J Ment Health 2017; 26:95-97. [DOI: 10.1080/09638237.2017.1301649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Juliana Onwumere
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Elizabeth Kuipers
- Psychology Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
13
|
Sadath A, Muralidhar D, Varambally S, Gangadhar BN, Jose JP. Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis. Asian J Psychiatr 2017; 25:163-168. [PMID: 28262142 DOI: 10.1016/j.ajp.2016.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 08/26/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caring for a person with first episode psychosis (FEP) is a challenging and distressing task for the carers. The carers' stress in the early stage of psychosis can increase their expressed emotion (EE) while social support is hypothesized to decrease EE. However, the influence of stress and social support on carers' EE is not well understood in FEP. AIM To examine how the stress and social support shape expressed emotion in the carers of FEP. METHODS Seventy one carers of the patients with non-affective FEP were recruited from the inpatient psychiatry ward of a tertiary mental health care center in South India. The family questionnaire, perceived stress scale and multidimensional scale of perceived social support were used to measure their EE, stress and social support respectively. RESULTS Carers experienced high level of perceived stress, EE and poor social support. Perceived stress significantly increased EE (β=0.834; p<0.001) and social support did not significantly influence EE (β=-0.065; p>0.05). Perceived stress predicted 76 percent of the variance on EE (Adjusted R2=0.761). CONCLUSION The results emphasize high level of stress and EE in carers of patients with FEP that implies the need for appropriate psychosocial interventions to manage their stress.
Collapse
Affiliation(s)
- Anvar Sadath
- Institute of Mental Health and Neurosciences, Kozhikode, Kerala 673 008, India.
| | - D Muralidhar
- Department of Psychiatric Social Work, National Institute of Mental Health & Neuro-Sciences, Bangalore, 560 029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health& Neuro-Sciences, Bangalore, 560 029, India
| | - B N Gangadhar
- Department of Psychiatry, National Institute of Mental Health& Neuro-Sciences, Bangalore, 560 029, India
| | | |
Collapse
|
14
|
Abstract
The family environment can play either a detrimental or a protective role in symptom severity for people with schizophrenia. The current study examined both patient and caregiver perspectives of the family environment in an ethnically diverse sample of 221 patients with schizophrenia. We hypothesized that environments characterized by high levels of perceived caregiver criticism, low perceived caregiver warmth, and low family cohesion (from both the patient and caregiver perspective) would predict greater symptom severity. As expected, results demonstrated that lower patient ratings of family cohesion and caregiver warmth were associated with greater symptom severity. However, once put into a hierarchical regression analysis, only patient ratings of family cohesion remained significant. Ethnic patterns were also examined and revealed that family cohesion may be particularly protective for ethnic minorities. Study implications are discussed.
Collapse
|
15
|
Haselden M, Piscitelli S, Drapalski A, Medoff D, Glynn SM, Cohen AN, Dixon LB. Relationship between symptoms and family relationships in Veterans with serious mental illness. ACTA ACUST UNITED AC 2016. [DOI: 10.1682/jrrd.2015.08.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Amy Drapalski
- Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Shirley M. Glynn
- VA Desert Pacific Healthcare Network (VISN 22) MIRECC, Los Angeles, CA
| | - Amy N. Cohen
- VA Desert Pacific Healthcare Network (VISN 22) MIRECC, Los Angeles, CA
| | | |
Collapse
|
16
|
Gerlsma C, de Ruiter NMP, Kingma W. Mood dependence of perceived criticism: a significant null finding. Psychiatry Res 2014; 220:1102-5. [PMID: 25242433 DOI: 10.1016/j.psychres.2014.08.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
Five decades of research have shown that the quality of one׳s interactions with significant others, as captured in the expressed emotion (EE) concept, affects the course of various psychiatric and medical complaints. The key EE-component, interpersonal criticism, is increasingly assessed with the single-item Perceived Criticism Measure (PCM). The measure is highly practical and has shown good concurrent and predictive validity. Because the PCM relies on respondents׳ memories, ratings may be subject to mood bias. In this study we examined to what extent PCM-ratings are mood dependent. College students (N=150) provided data on mood and PCM before and after the induction of either a positive or negative mood. Although the mood induction was highly successful, PCM-ratings remained stable and appeared unaffected by changes in mood. This finding contradicts the robust mood-congruency-effect finding that the valence of one's mood enhances the recollection of similarly valenced memories. This apparent stability bolsters the PCM's construct validity and makes it less likely that high PCM-ratings simply reflect the negatively biased perceptions of distressed individuals.
Collapse
Affiliation(s)
- Coby Gerlsma
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands.
| | | | | |
Collapse
|
17
|
Jolley S, Ferner H, Bebbington P, Garety P, Dunn G, Freeman D, Fowler D, Kuipers E. Delusional belief flexibility and informal caregiving relationships in psychosis: a potential cognitive route for the protective effect of social support. Epidemiol Psychiatr Sci 2014; 23:389-97. [PMID: 24160466 PMCID: PMC7192175 DOI: 10.1017/s2045796013000553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/25/2013] [Accepted: 08/29/2013] [Indexed: 11/07/2022] Open
Abstract
Aims. For people with psychosis, contact with informal caregivers is an important source of social support, associated with recovery, and with better outcomes following individual cognitive therapy (CBTp). In this study, we tested whether increased flexibility in delusional thinking, an established predictor of positive outcome following CBTp, was a possible mechanism underlying this effect. Methods. 219 participants with delusions (mean age 38 years; 71% male; 75% White) were grouped according to the presence of a caregiver (37% with a caregiver) and caregiver level of expressed emotion (High/Low EE, 64% Low). Delusional belief flexibility was compared between groups, controlling for interpersonal functioning, severity of psychotic symptoms, and other hypothesised outcome predictors. Results. Participants with caregivers were nearly three times more likely than those without to show flexibility (OR = 2.7, 95% CI 1.5 to 5.0, p = 0.001), and five times more likely if the caregiving relationship was Low EE (OR = 5.0, 95% CI 2.0-13.0, p = 0.001). ORs remained consistent irrespective of controlling for interpersonal functioning and other predictors of outcome. Conclusions. This is the first evidence that having supportive caregiving relationships is associated with a specific cognitive attribute in people with psychosis, suggesting a potential cognitive mechanism by which outcomes following CBTp, and perhaps more generally, are improved by social support.
Collapse
Affiliation(s)
- S. Jolley
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| | - H. Ferner
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| | - P. Bebbington
- Department of Mental Health Sciences, UCL, London, UK
| | - P. Garety
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| | - G. Dunn
- Health Sciences Research Group, School of Community Based Medicine, University of Manchester, UK
| | - D. Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - D. Fowler
- School of Medicine, Health Policy and Practice, University of East Anglia, UK
| | - E. Kuipers
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| |
Collapse
|
18
|
Patterns and correlates of expressed emotion, perceived criticism, and rearing style in first admitted early-onset schizophrenia spectrum disorders. J Nerv Ment Dis 2014; 202:783-7. [PMID: 25259947 DOI: 10.1097/nmd.0000000000000209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess patterns and correlates of family variables in 31 adolescents treated for their first episode of a schizophrenia spectrum disorder (early-onset schizophrenia [EOS]). Expressed emotion, perceived criticism, and rearing style were assessed. Potential correlates were patient psychopathology, premorbid adjustment, illness duration, quality of life (QoL), sociodemographic variables, patient and caregiver "illness concept," and caregiver personality traits and support. Families were rated as critical more frequently by patients than raters (55% vs. 13%). Perceived criticism was associated with worse QoL in relationship with parents and peers. An adverse rearing style was associated with a negative illness concept in patients, particularly with less trust in their physician. Future research should examine perceived criticism as a predictor of relapse and indicator of adolescents with EOS who need extended support and treatment. Rearing style should be carefully observed because of its link with patients' illness concept and, potentially, to service engagement and medication adherence.
Collapse
|
19
|
Tomlinson E, Onwumere J, Kuipers E. Distress and negative experiences of the caregiving relationship in early psychosis: does social cognition play a role? Early Interv Psychiatry 2014; 8:253-60. [PMID: 23489370 DOI: 10.1111/eip.12040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 12/28/2012] [Indexed: 12/01/2022]
Abstract
AIM This study explored the relationship between individuals with early psychosis and first-degree relatives who were carers, to see whether negative and distressing experiences of the patient-carer relationship were associated with social cognition difficulties in both groups. METHOD The study had a cross-sectional correlational design. A total of 33 patients with early psychosis (within 3 years of first psychotic episode) and 24 first-degree relative carers (all parents) completed measures of mood, expressed emotion and negative experiences of caregiving. Social cognition measures of theory of mind and emotion recognition were also collected. RESULTS Patient perceptions of carer criticism were related to increased anxiety and depression. Carer negative experiences of caregiving were related to higher levels of expressed emotion, anxiety and depression. Both patients and carers showed impaired performance on social cognition tasks. However, patient social cognition was not related to perceptions of carer criticism or symptoms. Carer social cognition was not related to expressed emotion or carer burden. CONCLUSION Even in the early stages of psychosis, both patients and carers were reporting negative experiences of the caregiving relationship. These were related to higher levels of anxiety and depression. Social cognition difficulties were found in both early psychosis patients and first-degree relatives, but did not relate to caregiving relationships. The findings underscore the importance of providing targeted family interventions to individuals with early psychosis and their carers that address appraisals of the relationship and low mood.
Collapse
Affiliation(s)
- Eleanor Tomlinson
- Institute of Psychiatry, Kings College Hospital, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
20
|
Onwumere J, Grice S, Garety P, Bebbington P, Dunn G, Freeman D, Fowler D, Kuipers E. Caregiver reports of patient-initiated violence in psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:376-84. [PMID: 25007421 PMCID: PMC4086313 DOI: 10.1177/070674371405900705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. METHOD Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. RESULTS One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. CONCLUSIONS Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.
Collapse
Affiliation(s)
- Juliana Onwumere
- Lecturer in Clinical Psychology, Institute of Psychiatry, King’s College London, London, England
| | - Sarah Grice
- Clinical Psychologist, Institute of Psychiatry, King’s College London, London, England
| | - Philippa Garety
- Professor of Clinical Psychology, Institute of Psychiatry, King’s College London, London, England; Professor of Clinical Psychology, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, Institute of Psychiatry, King’s College London, London, England
| | - Paul Bebbington
- Emeritus Professor of Social and Community Psychiatry, Mental Health Science Unit, University College London, London, England
| | - Graham Dunn
- Professor of Biomedical Statistics, Centre for Biostatistics, University of Manchester, Manchester, England
| | - Daniel Freeman
- Professor of Clinical Psychology, Department of Psychiatry, University of Oxford, Oxford, England
| | - David Fowler
- Professor of Social Psychiatry, Department of Psychiatry, University of East Anglia, Norfolk, England
| | - Elizabeth Kuipers
- Professor of Clinical Psychology, Institute of Psychiatry, King’s College London, London, England; Professor of Clinical Psychology, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, Institute of Psychiatry, King’s College London, London, England
| |
Collapse
|
21
|
Boydell J, Onwumere J, Dutta R, Bhavsar V, Hill N, Morgan C, Dazzan P, Morgan K, Pararajan M, Kuipers E, Jones P, Murray R, Fearon P. Caregiving in first-episode psychosis: social characteristics associated with perceived 'burden' and associations with compulsory treatment. Early Interv Psychiatry 2014; 8:122-9. [PMID: 23458284 DOI: 10.1111/eip.12041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 01/06/2013] [Indexed: 01/03/2023]
Abstract
AIMS High incidence of psychosis and compulsory treatment within black and minority ethnic (BME) groups in the UK remain a concern. Psychosis has an impact on families and family involvement is important in predicting compulsory treatment. We therefore aimed to report the levels and predictors of caregiver burden in first-episode psychosis, in white British, and BME groups of carers, and investigate their relevance to compulsory treatment. METHODS A total of 124 caregivers were interviewed soon after the onset of psychosis using the General Health Questionnaire, GHQ-28, the Experience of Caregiving Inventory, the Personal and Psychiatric History Schedule, and the MRC Sociodemographic Schedule. RESULTS The overall level of distress as measured by GHQ-28 was high (mean 50, SD 11.4). Feelings of carer burden were also high (mean total negative score 72.5, SD 34.8), increased in men, and with carer age. Neither ethnicity nor social class nor social support was associated with distress or burden. Compulsory treatment was predicted by carer burden (as indicated by carer reports of 'problems with services' (OR 1.08; 95% CI 1.01, 1.15; P = 0.023)); this was particularly evident in the black Caribbean group of carers (OR 1.28; 95% CI 1.04, 1.57; P = 0.02) CONCLUSION: Carers of adults with first-episode psychosis experience considerable psychological distress and feelings of burden. There was a specific association between carer burden, specifically in terms of experience of services, and compulsory admission of service users, particularly in the black Caribbean group. Better ways of liaising with carers and targeted efforts to reduce carer burden at illness onset are needed.
Collapse
Affiliation(s)
- Jane Boydell
- King's College London, Institute of Psychiatry, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sündermann O, Onwumere J, Kane F, Morgan C, Kuipers E. Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety. Soc Psychiatry Psychiatr Epidemiol 2014; 49:359-66. [PMID: 23955376 PMCID: PMC4081600 DOI: 10.1007/s00127-013-0754-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/31/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate social support and network features in people with first-episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia. METHOD Thirty-eight people with first-episode psychosis were recruited for a cross-sectional study. Self-report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted. RESULTS One-third of the sample (34%) had no confidant [95% CI (18.4, 50.0%)]. The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (0.35 < rs < 0.60). The association between loneliness and paranoia was mediated through anxiety (ab = 0.43, z = 3.5; p < 0.001). CONCLUSIONS Even at first episode, a large proportion of people with psychosis have poor perceived support, no confidant and report several lonely days a week. Patients without a confidant appear to be more susceptible to feeling lonely and anxious. Anxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated.
Collapse
Affiliation(s)
- Oliver Sündermann
- South London Maudsely NHS Foundation Trust, Anxiety Disorders Residential Unit, Bethlem Royal Hospital, Monks Orchard Road, London, BR3 3BX, UK,
| | | | | | | | | |
Collapse
|
23
|
|
24
|
Medina-Pradas C, Navarro JB, López SR, Grau A, Obiols JE. Further development of a scale of perceived expressed emotion and its evaluation in a sample of patients with eating disorders. Psychiatry Res 2011; 190:291-6. [PMID: 21737145 DOI: 10.1016/j.psychres.2011.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 04/07/2011] [Accepted: 06/13/2011] [Indexed: 11/17/2022]
Abstract
High expressed emotion (EE) as measured by the Camberwell Family Interview (CFI) predicts the course of eating disorders (ED). Despite its important contribution to the field, the CFI has two major limitations; it is time-consuming and it does not consider the patient's perspective. Obtaining the patient's view may help shed light on the dyadic nature of caregiver's EE and the patient's illness course. The objectives of our study of 77 patients with ED were to develop further a brief measure to assess the patients' perceptions of their caregivers' EE, the patient version of the Brief Dyadic Scale of Expressed Emotion (BDSEE), and to evaluate its psychometric properties. Three clearly separate factors were identified: perceived criticism, perceived emotional overinvolvement, and perceived warmth. The BDSEE also demonstrated good levels of reliability and construct validity. The BDSEE subscales are significantly related to other measures of the perceived family emotional climate and to the CFI, the gold standard in the field of EE. The clinical implications of the ED patients' perceptions of their caregivers' EE are discussed. Findings support the utility of the expanded BDSEE for both research and clinical practise in assessing the perspective of patients with ED.
Collapse
Affiliation(s)
- Cristina Medina-Pradas
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Spain.
| | | | | | | | | |
Collapse
|
25
|
Meneghelli A, Alpi A, Pafumi N, Patelli G, Preti A, Cocchi A. Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: results from the Programma2000 (Milan, Italy). Psychiatry Res 2011; 189:331-8. [PMID: 21529969 DOI: 10.1016/j.psychres.2011.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
Expressed emotion (EE) was examined in a large sample of families of patients with either first-episode psychosis (FEP) within the schizophrenia spectrum, or who met the criteria for ultra high-risk (UHR) of psychosis. The aim of our study was to determine the patterns and relationship of EE with the duration of untreated illness (DUI) or of untreated psychosis (DUP), as well as with illness severity. The sample used in our study included 77 FEP and 66 UHR families. The Camberwell Family Interview was used to assess EE. In both samples, about one-third of patients' families were classified as high EE, with emotional over-involvement (EOI) being the most frequent reason for a family to be classified as high EE. In FEP, higher EE correlated with longer DUI, and higher paternal EOI with longer DUP. DUI, however, was not found to correlate to EE in UHR patients. Severity of illness at the initial assessment did not relate to EE in either FEP or UHR families. Families of FEP and UHR patients were not found to differ in terms of the prevalence of a high EE rating, or of any of its subcomponents. The results of this study only partially support the hypothesis that high EE develops as a reaction to patient status. Patients from families with high EE could possibly benefit from interventions that are targeted at improving their resilience when dealing with problematic family environments.
Collapse
Affiliation(s)
- Anna Meneghelli
- Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milano, Dipartimento di Salute Mentale: Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000
| | | | | | | | | | | |
Collapse
|
26
|
Expressed and perceived emotion over time: does the patients' view matter for the caregivers' burden? Eur Arch Psychiatry Clin Neurosci 2011; 261:349-55. [PMID: 21174110 DOI: 10.1007/s00406-010-0178-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
While the impact of mentally ill patients' perceptions of their key relatives' expressed emotion is well examined with regard to relapse, there is a paucity of evidence concerning the impact on their key relatives' burden. The present study aims to evaluate the relative prognostic value of expressed and perceived emotion on caregivers' stress outcome within a 3-year follow-up period. Yearly follow-up data of the key relatives of 16 first-hospitalized schizophrenic and 34 depressed patients were available including expressed and perceived emotion and different dimensions of caregivers' stress outcome: objective and subjective burden, well-being, psychological symptoms and subjective quality of life. Multiple linear regression analyses were computed to assess the relative impact of expressed and perceived emotion. All dimensions of burden were significantly and consistently correlated with caregivers' expressed emotion and patients' perceived criticism on the bivariate level. On the multivariate level, however, expressed criticism appeared to be the most relevant predictor, followed by perceived resignation. Data indicate that the impact of the patients' perceived criticism on caregivers' stress outcome is limited. More attention should be paid to patients' perceived resignation which may be an unidentified stress contributor for caregivers so far.
Collapse
|
27
|
Abstract
BACKGROUND There is a long history of research into the attributes of carers of people with psychosis, but few interventions target their distress or their difficulties. AIMS To describe an empirically based model of the relationships of those caring for people with psychosis to inform clinical and theoretical advances. METHOD We developed a model of informal carer relationships in psychosis, based on an integration of the literature elaborating the concept of expressed emotion. The model accounts for divergent outcomes of three relationship types: positive, overinvolved and critical/hostile relationships. RESULTS Good evidence supports a number of hypotheses concerning the origin and maintenance of these relationship outcomes, which relate to specific differences in carer attributions, illness perceptions, coping behaviour, social support, distress, depression and low self-esteem predicted by our model. We propose that interventions aimed at modifying the specific maintenance factors involved in the different styles of relationships will optimise therapeutic change both for service users with psychosis and for their carers. CONCLUSIONS Family work in psychosis, which improves relationships through problem-solving, reduces service user relapse. It is now time to consider theory-based interventions focused on improving carer outcomes.
Collapse
|