Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 3/2014

01-03-2014 | Original Paper

Positive affect in the family environment protects against relapse in first-episode psychosis

Authors: Gary Lee, Christine Barrowclough, Fiona Lobban

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2014

Login to get access

Abstract

Purpose

To evaluate the contribution of positive affect in the family environment to relapse in first episode psychosis.

Method

65 service users with a first episode of psychosis were recruited into the current study along with their key relatives. Relatives were interviewed and rated using the Expressed Emotion (EE) measure of warmth, whilst service users completed questionnaires about the positive and negative affects that they perceived from the family environment. Associations between these measures and relapse were examined in a one-year prospective design.

Results

Service users were less likely to relapse within 6 and 12-month follow-up periods when their relatives were rated high on EE warmth, or when they perceived more positive affect from the family. The relationships between service users’ perceived positive affect and relapse were preserved after controlling for baseline symptoms, substance use and employment status. Service users’ perceptions of positive affect and EE ratings of warmth appeared to be stronger predictors of relapse outcome than criticism and other EE variables.

Conclusions

Positive family environments may protect against relapse in first episode psychosis. Psychosocial interventions should aim to foster and maintain positive affect in families during the early stages of illness. Further research is needed to understand the mechanisms linking positive affect and outcomes for people recovering from psychosis.
Footnotes
1
The criteria for relapse meant that service users did not need to be experiencing an active relapse at the two end-points of the study to be classified as such.
 
2
A criterion of p < 0.1 was set for removal of predictors from initial models.
.
 
3
It was deemed more appropriate to control for the PANSS total score, rather than individual PANSS subscales to reduce the number of predictors in the regression analyses.
 
Literature
1.
Nuechterlein KH, Dawson ME (1984) A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 10:300–312PubMedCrossRef
2.
Butzlaff R, Hooley J (1998) Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 55:547–552PubMedCrossRef
3.
Alvarez-Jimenez M, Priede A, Hetrick S, Bendall S, Killackey E, Parker A et al (2012) Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res 139:116–128PubMedCrossRef
4.
Kuipers E, Lam D, Leff J (2002) Family work for schizophrenia: a practical guide. Gaskell Press, London
5.
Barrowclough C, Tarrier N, Lewis S, Sellwood W, Mainwaring J, Quinn J et al (1999) Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. Br J Psychiatry 174:505–511PubMedCrossRef
6.
7.
Lopez S, Hipke K, Polo A, Jenkins J, Karno M, Vaughn C (2004) Ethnicity, expressed emotion, attributions, and course of schizophrenia: family warmth matters. J Abnorm Psychol 113:428–439PubMedCrossRef
8.
Ivanovic M, Vuletic Z, Bebbington P (2004) Expressed emotion in the families of patients with schizophrenia and its influence on the course of illness. Soc Psychiatry Psychiatr Epidemiol 29:61–65
9.
Leff J, Vaughn C (1985) Expressed emotion in families. Guilford Press, New York
10.
Greenberg JS, Knudsen KJ, Aschbrenner KA (2006) Prosocial family processes and the quality of life of persons with schizophrenia. Psychiatr Serv 57:1771–1777PubMedCentralPubMedCrossRef
11.
O’Brien M, Gordon J, Bearden C, Lopez S, Kopelowicz A, Cannon T (2006) Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis. Schizophr Res 81:269–275PubMedCrossRef
12.
Bertrando P, Beltz J, Bressi C, Clerici M, Farma T, Invernizzi G et al (1992) Expressed emotion and schizophrenia in Italy: a study of an urban-population. Br J Psychiatry 161:223–229PubMedCrossRef
13.
Schlosser DA, Zinberg JL, Loewy RL, Casey-Cannon S, O’Brien MP, Bearden CE et al (2010) Predicting the longitudinal effects of the family environment on prodromal symptoms and functioning in patients at-risk for psychosis. Schizophr Res 118:69–75PubMedCentralPubMedCrossRef
14.
Gonzalez-Pinto A, Ruiz de Azua S, Ibanez B, Otero-Cuesta S, Castro-Fornieles J, Graell-Berna M et al (2011) Can positive family factors be protective against the development of psychosis? Psychiat Res 186:28–33CrossRef
15.
Leff J, Wig N, Bedi H, Menon D, Kuipers L, Korten A et al (1990) Relatives Expressed Emotion and the course of schizophrenia in Chandigarh: a 2-year follow-up of a 1st-contact sample. Brit J Psychiat 156:351–356PubMedCrossRef
16.
King S, Dixon M (1999) Expressed emotion and relapse in young schizophrenia outpatients. Schizophr Bull 25:377–386PubMedCrossRef
17.
Fridgen G, Aston J, Gschwandtner U, Pflueger M, Zimmermann R, Studerus E, et al (2012) Help-seeking and pathways to care in the early stages of psychosis. Soc Psychiatr Psychiatr Epidemiol 48:1033–1043. doi:10.​1007/​s00127-012-0628-0
18.
Norman R, Malla A, Manchanda R, Harricharan R, Takhar J, Northcott S (2005) Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophr Res 80:227–234PubMedCrossRef
19.
Addington J, Jones B, Ko T, Addington D (2001) Family intervention in early psychosis. Psychiatr Rehabil Skills 5:272–286CrossRef
20.
Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E (2010) Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Brit J Psychiat 197:350–356PubMedCentralPubMedCrossRef
21.
Vaughn C, Leff J (1976) Measurement of expressed emotion in families of psychiatric-patients. Br J Soc Clin Psychol 15:157–165PubMedCrossRef
22.
Tompson M, Goldstein M, Lebell M, Mintz L, Marder S, Mintz J (1995) Schizophrenic-patients perceptions of their relatives attitudes. Psychiatry Res 57:155–167PubMedCrossRef
23.
Lebell MB, Marder SR, Mintz J, Mintz LI, Tompson M, Wirshing W et al (1993) Patients’ perceptions of family emotional climate and outcome in schizophrenia. Br J Psychiatry 162:751–754PubMedCrossRef
24.
Barrowclough C, Gooding P, Hartley S, Lee G, Lobban F (2013) Factors associated with distress in relatives experiencing recent onset psychosis in a family member. J Nerv Ment Dis (in press)
25.
Leff J, Vaughn C (1985) Expressed emotion in families. Guilford Press, New York
26.
Parker G, Tupling H, Brown L (1979) A parental bonding instrument. Br J Med Psychol 52:1–10CrossRef
27.
Hooley J, Teasdale J (1989) Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism. J Abnorm Psychol 98:229–235PubMedCrossRef
28.
Kay S, Fiszbein A, Opler L (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276PubMedCrossRef
29.
Barrowclough C, Haddock G, Wykes T, Beardmore R, Conrod P, Craig T et al (2010) Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. BMJ 341:c6325. doi:10.​1136/​bmj.​c6325 PubMedCentralPubMedCrossRef
30.
Barrowclough C, Tarrier N, Lewis S, Sellwood W, Mainwaring J, Quinn J, Hamlin C (1999) Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. Br J Psychiatry 174:505–511PubMedCrossRef
31.
Vasconcelos e Sa, D., Wearden, A., & Barrowclough, C. (2013). Expressed emotion, types of behavioural control and controllability attributions in relatives of people with recent-onset psychosis. Soc Psychiatry Psychiatr Epidemiol 48:1377–1388. doi:10.​1007/​s00127-013-0659-1
32.
Stirling J, Tantam P, Thomas D, Newby L, Montague N, Ring S, Rowe S (1991) Expressed emotion and early onset schizophrenia: a 1-year follow-up. Psychol Med 21:675–685PubMedCrossRef
33.
Bentsen H, Munkvold O, Notland T, Boye B, Oskarsson K, Uren G et al (1998) Relatives’ emotional warmth towards patients with schizophrenia or related psychoses: demographic and clinical predictors. Acta Psychiatr Scand 97:86–92PubMedCrossRef
34.
Tempier R, Balbuena L, Lepnurm M, & Craig TK (2013) Perceived emotional support in remission: results from an 18-month follow-up of patients with early episode psychosis. Soc Psychiatry Psychiatr Epidemiol. doi:10.​1007/​s00127-013-0701-3
35.
Halford W, Steindl S, Varghese F, Schweitzer R (1999) Observed family interaction and outcome in patients with first-admission psychoses. Behav Ther 30:555–580CrossRef
36.
Addington J, Burnett P. Working with families in the early stages of psychosis (2004) In: Gleeson JF, McGorry PD (eds) Psychological interventions in early psychosis: a treatment handbook. Wiley and Sons, Chichester pp 9–116
37.
Fadden G, Smith J. Family work in early psychosis (2009) In: Lobban F, Barrowclough C (ed) A casebook of family interventions for psychosis. Wiley and Sons, Chichester, pp 23–46
38.
39.
40.
Lobban F, Postlethwaite A, Glentworth D, Pinfold V, Wainwright L, Dunn G et al (2013) A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis. Clin Psychol Rev 33:372–382. doi:10.​1016/​j.​cpr.​2012.​12.​004 PubMedCrossRef
Metadata
Title
Positive affect in the family environment protects against relapse in first-episode psychosis
Authors
Gary Lee
Christine Barrowclough
Fiona Lobban
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 3/2014
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-013-0768-x

Other articles of this Issue 3/2014

Social Psychiatry and Psychiatric Epidemiology 3/2014 Go to the issue

Original Paper

Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse

Original Paper

Use transition between illegal drugs among Brazilian university students

Original Paper

Traumatic events and their relative PTSD burden in Northern Ireland: a consideration of the impact of the ‘Troubles’

Original Paper

Neighborhood disadvantage in context: the influence of urbanicity on the association between neighborhood disadvantage and adolescent emotional disorders

Original Paper

Validation of the Orbach & Mikulincer Mental Pain Scale (OMMP) on a drug addicted population

Original Paper

A two-stage epidemiologic study on prevalence of eating disorders in female university students in Wuhan, China