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Patients' Perceptions of Family Emotional Climate and Outcome in Schizophrenia

  • Malca B. Lebell (a1), Stephen R. Marder (a2), Jim Mintz (a3), Lois I. Mintz (a4), Martha Tompson (a5), William Wirshing (a6), Kathleen Johnston-Cronk (a7) and Joanne McKenzie (a1)...


Thirty-nine chronic schizophrenic male out-patients and their relatives were interviewed separately to assess their perceptions of their current relationships. Two simple 5-point rating scales predicted the risk of psychotic exacerbation during a one-year follow-up: patients' perceptions of the relatives' attitudes towards them, and patients' own attitudes towards the relatives. Survival analysis of data in a 2 × 2 factorial - combining degree of contact with the key relatives and the patients' perceptions of their relatives - found that patients in frequent contact with a positively perceived relative had significantly better survival rates without psychotic exacerbation. Patients' perceptions of their relatives may help identify patients at risk of exacerbation of their illness.


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West Los Angeles VA Medical Center, Brentwood Division, 11301 Wilshire Boulevard, Building 210, Room 15, Los Angeles, CA 90073, USA


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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.
Baker, B., Helmes, E. & Kazarian, S. S. (1984) Past and present perceived attitudes of schizophrenics in relation to rehospitalisation. British Journal of Psychiatry, 144, 263269.
Baker, B., Kazarian, S. S., Helmes, E., et al (1987) Perceived attitudes of schizophrenic inpatients in relation to rehospitalization. Journal of Consulting and Clinical Psychology, 55, 775777.
Brown, G. W. (1959) Experiences of discharged chronic schizophrenic mental hospital patients in various types of living group. Millbank Memorial Fund Quarterly, 37, 105131.
Brown, G. W., Birley, J. L. T. & Wino, J. K. (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241258.
Brown, G. W., Monck, E. M., Carstairs, G. M., et al (1962) The influence of family life on the course of schizophrenic illness. British Journal of Preventative Social Medicine, 16, 5568.
Hooley, J. M. & Teasdale, J. D. (1989) Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism. Journal of Abnormal Psychology, 94, 229235.
Karno, M., Jenkins, J. H., de la Selva, A., et al (1987) Expressed emotion and schizophrenic outcome among Mexican-American families. Journal of Nervous and Mental Disease, 175, 143151.
Kreisman, D. E., Simmons, S. J. & Joy, V. D. (1979) Rejecting the patient: preliminary validation of a self-report scale. Schizophrenia Bulletin, 5, 220222.
Leff, J., Wig, N. N., Ghosh, A., et al (1987) III. Influence of relatives' expressed emotion on the course of schizophrenia in Chandigarh. British Journal of Psychiatry, 151, 166173.
Marder, S. R., Van Putten, T., Mintz, J., et al (1984) Costs and benefits of two doses of fluphenazine. Archives of General Psychiatry, 41, 10251029.
Marder, S. R., Van Putten, T., Mintz, J., et al (1987) Low- and conventional-dose maintenance therapy with fluphenazine decanoate: two-year outcome. Archives of General Psychiatry, 44, 518521.
Moos, R. H. & Moos, B. S. (1981) Family Environment Scale Manual. Palo Alto, California: Consulting Psychologists Press.
Overall, J. & Gorham, D. (1962) The Brief Psychiatric Rating Scale (BPRS). Psychological Reports, 10, 799812.
Parker, G., Tupling, M. & Brown, L. B. (1979) A parental bonding instrument. British Journal of Medical Psychology, 52, 110.
Parker, G., Fairley, M., Greenwood, J., et al (1982) Parental representations of schizophrenics and their association with onset and course of schizophrenia. British Journal of Psychiatry, 141, 573581.
Parker, G., & Mater, R. (1986) Predicting schizophrenic relapse: a comparison of two measures. Australian and New Zealand Journal of Psychiatry, 20, 8286.
Schnur, D. B., Friedman, S., Dorman, M., et al (1986) Assessing the family environment of schizophrenic patients with multiple hospital admissions. Hospital and Community Psychiatry, 37, 249252.
Spanier, G. (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 1528.
Spiegel, D. & Wissler, T. (1986) Family environment as a predictor of psychiatric rehospitalization. American Journal of Psychiatry, 143, 5660.
Vaughn, C. E. & Leff, J. P. (1976a) The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125137.
Vaughn, C. E. & Leff, J. P. (1976b) The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157165.
Warner, R. & Atkinson, M. (1988) The relationship between schizophrenic patients' perceptions of their parents and the course of their illness. British Journal of Psychiatry, 153, 344353.
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego System. London: Cambridge University Press.


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Patients' Perceptions of Family Emotional Climate and Outcome in Schizophrenia

  • Malca B. Lebell (a1), Stephen R. Marder (a2), Jim Mintz (a3), Lois I. Mintz (a4), Martha Tompson (a5), William Wirshing (a6), Kathleen Johnston-Cronk (a7) and Joanne McKenzie (a1)...
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