Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-18T16:36:48.656Z Has data issue: false hasContentIssue false
  • English
  • Français

Differential predictors of critical comments and emotional over-involvement in first-episode psychosis

Published online by Cambridge University Press:  15 December 2008

M. Álvarez-Jiménez ,
J. F. Gleeson ,
S. M. Cotton ,
D. Wade ,
K. Crisp ,
M. B. H. Yap  and
P. D. McGorry
M. Álvarez-Jiménez*
Affiliation:
ORYGEN Youth Health Research Centre, Melbourne, Victoria, Australia ‘Marques de Valdecilla’ Public Foundation–Research Institute (FMV-IFIMAV), Santander, Spain
J. F. Gleeson
Affiliation:
Department of Psychology, The University of Melbourne and Northwestern Mental Health Program, Melbourne, Victoria, Australia
S. M. Cotton
Affiliation:
ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Victoria, Australia
D. Wade
Affiliation:
Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, The University of Melbourne, Victoria, Australia
K. Crisp
Affiliation:
ORYGEN Youth Health, Melbourne, Victoria, Australia
M. B. H. Yap
Affiliation:
ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Victoria, Australia
P. D. McGorry
Affiliation:
ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Victoria, Australia
*
*Address for correspondence: Dr M. Álvarez-Jiménez, ORYGEN Youth Health Research Centre, 35 Poplar Road, Parkville3054, Victoria, Melbourne, Australia. (Email: malvarez@unimelb.edu.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Little research has focused on delineating the specific predictors of emotional over-involvement (EOI) and critical comments (CC) in the early course of psychosis. The purpose of this study was to investigate the differential relationships of EOI and CC with relevant predictors in relatives of first-episode psychosis (FEP) patients.

Method

Baseline patient-related factors including psychotic symptoms, depression and duration of untreated psychosis (DUP) and carer attributes comprising CC, EOI, burden of care and carers' stress and depression were assessed in a cohort of 63 remitted FEP patients and their relatives. Carers were reassessed at 7 months follow-up.

Results

Baseline analysis showed that EOI was more strongly correlated with family stress compared with CC, whereas CC yielded a stronger association with DUP than EOI. Carers' CC at follow-up was not significantly predicted by either baseline family stress, burden of care or patient-related variables. Conversely, baseline EOI predicted both family stress and burden of care at 7 months follow-up. Finally, family burden of care at follow-up was a function of baseline EOI and patients' depressive symptoms.

Conclusions

This study provides preliminary support to the postulate that EOI and CC may be influenced by separate factors early in the course of psychosis and warrant future research and therapeutic interventions as separate constructs. Implications for family interventions in the early phase of psychosis and the prevention of CC and EOI are discussed.

Keywords

Critical commentsemotional over-involvementexpressed emotionfirst-episode psychosis
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 1 , January 2010 , pp. 63 - 72
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, NC (1984). Scale for Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Bentler, PM, Bonett, DG (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin 88, 588–606.CrossRefGoogle Scholar
Bentsen, H, Boye, B, Munkvold, OG, Notland, TH, Lersbryggen, AB, Oskarsson, KH, Ulstein, I, Uren, G, Bjorge, H, Berg-Larsen, R, Lingjaerde, O, Malt, UF (1996). Emotional overinvolvement in parents of patients with schizophrenia or related psychosis: demographic and clinical predictors. British Journal of Psychiatry 169, 622–630.CrossRefGoogle ScholarPubMed
Bottonari, KA, Roberts, JE, Kelly, MA, Kashdan, TB, Ciesla, JA (2007). A prospective investigation of the impact of attachment style on stress generation among clinically depressed individuals. Behaviour Research and Therapy 45, 179–188.CrossRefGoogle ScholarPubMed
Bowlby, J (1980). Loss: Sadness and Depression. Basic Books: New York.Google Scholar
Bowlby, J (1988). A Secure Base: Clinical Applications of Attachment Theory. Routledge: London.Google Scholar
Browne, MW, Cudeck, R (1993). Alternative ways of assessing model fit. In Testing Structural Equation Models (ed. Bollen, K. A. and Long, J. S.), pp. 136–162. Sage: Thousand Oaks, CA.Google Scholar
Gleeson, J, Wade, D, Castle, D, Gee, D, Crisp, K, Pearce, T, Newman, B, Cotton, S, Alvarez-Jimenez, M, Gilbert, M, McGorry, M (2008). The EPISODE II trial of cognitive and family therapy for relapse prevention in early psychosis: rationale and sample characteristics. Journal of Mental Health 17, 19–32.CrossRefGoogle Scholar
Gleeson, JF, Jackson, HJ, Stavely, H, Burnett, P (1999). Family intervention in early psychosis. In The Recognition and Management of Early Psychosis (ed.McGorry, P. D. and Jackson, H. J.), pp. 376–405. Cambridge University Press: New York.Google Scholar
Goldberg, DP (1972). The Detection of Psychiatric Illness by Questionnaire: A Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness. Maudsley Monograph. Oxford University Press: London.Google Scholar
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising Axis-V for DSM-IV – a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google ScholarPubMed
Heikkila, J, Karlsson, H, Taiminen, T, Lauerma, H, Ilonen, T, Leinonen, KM, Wallenius, E, Virtanen, H, Heinimaa, M, Koponen, S, Jalo, P, Kaljonen, A, Salakangas, RK (2002). Expressed emotion is not associated with disorder severity in first-episode mental disorder. Psychiatry Research 111, 155–165.CrossRefGoogle Scholar
Hooley, JM (1998). Expressed emotion and locus of control. Journal of Nervous and Mental Disease 186, 374–378.CrossRefGoogle ScholarPubMed
Hooley, JM (2007). Expressed emotion and relapse of psychopathology. Annual Review of Clinical Psychology 3, 329–352.CrossRefGoogle ScholarPubMed
Hooley, JM, Campbell, C (2002). Control and controllability: beliefs and behaviour in high and low expressed emotion relatives. Psychological Medicine 32, 1091–1099.CrossRefGoogle ScholarPubMed
King, S, Dixon, MJ (1999). Expressed emotion and relapse in young schizophrenia outpatients. Schizophrenia Bulletin 25, 377–386.CrossRefGoogle ScholarPubMed
Kuipers, E, Bebbington, P, Dunn, G, Fowler, D, Freeman, D, Watson, P, Hardy, A, Garety, P (2006). Influence of carer expressed emotion and affect on relapse in non-affective psychosis. British Journal of Psychiatry 188, 173–179.CrossRefGoogle ScholarPubMed
Lenior, ME, Dingemans, PM, Schene, AH, Linszen, DH (2005). Predictors of the early 5-year course of schizophrenia: a path analysis. Schizophrenia Bulletin 31, 781–791.CrossRefGoogle ScholarPubMed
Linszen, D, Dingemans, P, Van der Does, JW, Nugter, A, Scholte, P, Lenior, R, Goldstein, MJ (1996). Treatment, expressed emotion and relapse in recent onset schizophrenic disorders. Psychological Medicine 26, 333–342.CrossRefGoogle ScholarPubMed
Lukoff, D, Liberman, RP, Nuechterlein, KH (1986). Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin 12, 578–593.CrossRefGoogle ScholarPubMed
Macmillan, JF, Crow, TJ, Johnson, AL, Johnstone, EC (1987). Expressed emotion and relapse in first episodes of schizophrenia. British Journal of Psychiatry 151, 320–323.CrossRefGoogle ScholarPubMed
Magana, AB, Goldstein, JM, Karno, M, Miklowitz, DJ, Jenkins, J, Falloon, IR (1986). A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Research 17, 203–212.CrossRefGoogle ScholarPubMed
Marom, S, Munitz, H, Jones, PB, Weizman, A, Hermesh, H (2005). Expressed emotion: relevance to rehospitalization in schizophrenia over 7 years. Schizophrenia Bulletin 31, 751–758.CrossRefGoogle ScholarPubMed
May, K, Hittner, JB (1997). Tests for comparing dependent correlations revisited: a Monte Carlo study. Journal of Experimental Education 65, 257–269.CrossRefGoogle Scholar
Moller-Leimkuhler, AM (2005). Burden of relatives and predictors of burden. Baseline results from the Munich 5-year-follow-up study on relatives of first hospitalized patients with schizophrenia or depression. European Archives of Psychiatry and Clinical Neuroscience 255, 223–231.CrossRefGoogle ScholarPubMed
Montgomery, SM (1979). Depressive symptoms in acute schizophrenia. Progress in Neuro-Psychopharmacology 3, 429–433.CrossRefGoogle ScholarPubMed
Nagelkerke, N (1991). A note on general definition of the coefficient of determination. Biometrika 78, 791–792.CrossRefGoogle Scholar
Patterson, P, Birchwood, M, Cochrane, R (2005). Expressed emotion as an adaptation to loss: prospective study in first-episode psychosis. British Journal of Psychiatry (Suppl.) 48, s59–s64.CrossRefGoogle ScholarPubMed
Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Orbach, G, Morgan, C (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine 32, 763–782.CrossRefGoogle ScholarPubMed
Raune, D, Kuipers, E, Bebbington, PE (2004). Expressed emotion at first-episode psychosis: investigating a carer appraisal model. British Journal of Psychiatry 184, 321–326.CrossRefGoogle ScholarPubMed
Roick, C, Heider, D, Bebbington, PE, Angermeyer, MC, Azorin, JM, Brugha, TS, Kilian, R, Johnson, S, Toumi, M, Kornfeld, A (2007). Burden on caregivers of people with schizophrenia: comparison between Germany and Britain. British Journal of Psychiatry 190, 333–338.CrossRefGoogle ScholarPubMed
Roick, C, Heider, D, Toumi, M, Angermeyer, MC (2006). The impact of caregivers' characteristics, patients' conditions and regional differences on family burden in schizophrenia: a longitudinal analysis. Acta Psychiatrica Scandinavica 114, 363–374.CrossRefGoogle ScholarPubMed
Scazufca, M, Kuipers, E (1996). Links between expressed emotion and burden of care in relatives of patients with schizophrenia. British Journal of Psychiatry 168, 580–587.CrossRefGoogle ScholarPubMed
Scazufca, M, Kuipers, E (1998). Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning. Psychological Medicine 28, 453–461.CrossRefGoogle ScholarPubMed
Sergi, MJ, Rassovsky, Y, Nuechterlein, KH, Green, MF (2006). Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. American Journal of Psychiatry 163, 448–454.CrossRefGoogle ScholarPubMed
Szmukler, GI, Burgess, P, Herrman, H, Benson, A, Colusa, S, Bloch, S (1996). Caring for relatives with serious mental illness: the development of the experience of caregiving inventory. Social Psychiatry and Psychiatric Epidemiology 31, 137–148.CrossRefGoogle ScholarPubMed
van Os, J, Marcelis, M, Germeys, I, Graven, S, Delespaul, P (2001). High expressed emotion: marker for a caring family? Comprehensive Psychiatry 42, 504–507.CrossRefGoogle ScholarPubMed
Vaughn, CE, Leff, JP (1976). 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, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, CE, Snyder, KS, Freeman, W, Jones, S, Falloon, IR, Liberman, RP (1982). Family factors in schizophrenic relapse: a replication. Schizophrenia Bulletin 8, 425–426.CrossRefGoogle ScholarPubMed
Weisman, AG, Nuechterlein, KH, Goldstein, MJ, Snyder, KS (1998). Expressed emotion, attributions, and schizophrenia symptom dimensions. Journal of Abnormal Psychology 107, 355–359.CrossRefGoogle ScholarPubMed
West, M, Rose, MS, Sheldon, A (1993). Anxious attachment as a determinant of adult psychopathology. Journal of Nervous and Mental Disease 181, 422–427.CrossRefGoogle ScholarPubMed
West, M, Rose, MS, Verhoef, MJ, Spreng, S, Bobey, M (1998). Anxious attachment and self-reported depressive symptomatology in women. Canadian Journal of Psychiatry 43, 294–297.CrossRefGoogle ScholarPubMed
Wiedemann, G, Rayki, O, Feinstein, E, Hahlweg, K (2002). The Family Questionnaire: development and validation of a new self-report scale for assessing expressed emotion. Psychiatry Research 109, 265–279.CrossRefGoogle ScholarPubMed
Wuerker, AK, Haas, GL, Bellack, AS (2001). Interpersonal control and expressed emotion in families of persons with schizophrenia: change over time. Schizophrenia Bulletin 27, 671–685.CrossRefGoogle ScholarPubMed
Wynne, LC (1981). Current concepts about schizophrenics and family relationships. Journal of Nervous and Mental Disease 169, 82–89.CrossRefGoogle ScholarPubMed