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December 1984, Vol 41, No. 12 >
Article | December 1984

Family Factors in Schizophrenic Relapse: Title and subTitle BreakReplication in California of British Research on Expressed Emotion

Christine E. Vaughn, PhD; Karen Sorensen Snyder, MA; Simon Jones, MD; William B. Freeman, MA; Ian R. H. Falloon, MD
[+] Author Affiliations

Accepted for publication Feb 21, 1984.

Reprint requests to 760 Westwood Plaza, NPI, Box 18, Los Angeles, CA 90024 (Ms Snyder).


Arch Gen Psychiatry. 1984;41(12):1169-1177. doi:10.1001/archpsyc.1984.01790230055009
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• Our study of the emotional atmosphere of the homes of schizophrenic patients in southern California has replicated British findings concerning the influence of the family environment on the course of schizophrenia. As in the British studies, criticism and overinvolvement expressed by a key relative about the patient at the time of the key admission proved to be the best single predictor of symptomatic relapse in the nine months after discharge from the hospital. Replicating the British results, the association between relatives' expressed emotion and relapse was independent of all other variables investigated. Cross-cultural results concerning the prophylactic effects of medication suggest that clinicians should look to the emotional atmosphere in the home for explanations of medication failures.

REFERENCES

1 +
Leff JP:  Schizophrenia and sensitivity to the family environment . Schizophr Bull 1976;;2:566-574.
2 +
Brown GW, Carstairs GM, Topping GG:  The post-hospital adjustment of chronic mental patients . Lancet 1958;;2:685-689.
3 +
Brown GW:  Experiences of discharged chronic schizophrenic mental hospital patients in various types of living group . Milbank Mem Fund Q 1959;;37:105-131.
4 +
Brown GW, Monck EM, Carstairs GM, Wing JK:  Influence of family life on the course of schizophrenic illness . Br J Prev Soc Med 1962;;16:55-68.
5 +
Brown GW, Birley JLT, Wing JK:  Influence of family life on the course of schizophrenic disorders: A replication . Br J Psychiatry 1972;;121:241-258.
6 +
Vaughn CE, Leff JP:  The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients . Br J Psychiatry 1976;;129:125-137.
7 +
Leff JP, Vaughn CE:  The role of maintenance therapy and relatives' expressed emotion in relapse of schizophrenia: A two-year follow-up . Br J Psychiatry 1981;;139:102-104.
8 +
Tarrier N, Vaughn C, Lader MH, Leff JP:  Bodily reactions to people and events in schizophrenia . Arch Gen Psychiatry 1979;;36:311-315.
9 +
Sturgeon D, Kuipers L, Berkowitz R, Turpin G, Leff J:  Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives . Br J Psychiatry 1981;;138:40-45.
10 +
Wing JK, Cooper JE, Sartorius N: The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego System . Cambridge, England, Cambridge University Press, 1974;.
11 +
Krawiecka M, Goldberg D, Vaughan M:  A standardized psychiatric assessment scale for rating chronic psychotic patients . Acta Psychiatr Scand 1977;;55:299-308.
12 +
Vaughn CE, Leff JP:  The measurement of expressed emotion in the families of psychiatric patients . Br J Soc Clin Psychol 1976;;15:157-165.
13 +
Brown GW, Rutter M:  The measurement of family activities and relationships: A methodological study . Hum Relations 1966;;19:241-263.
14 +
Rutter M, Brown GW:  The reliability and validity of measures of family life and relationships in families containing a psychiatric patient . Soc Psychiatry 1966;;1:38-53.
15 +
Kuipers L:  Expressed emotion: A review . Br J Soc Clin Psychol 1979;;18:237-243.
16 +
Leff JP, Vaughn CE:  The interaction of life events and relatives' expressed emotion in schizophrenia and depressive neurosis . Br J try 1980;;136:146-153.
17 +
Anderson CM, Hogarty GE, Reiss DJ:  Family treatment of adult schizophrenic patients: A psychoeducational approach . Schizophr Bull 1980;;6:490-505.
18 +
Falloon IRH, Liberman RP, Lillie FJ, Vaughn CE:  Family therapy of schizophrenics with high risk of relapse . Fam Process 1981;;20:211-221.
19 +
Falloon IRH, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AH:  Family management in the prevention of exacerbations of schizophrenia: A controlled study . N Engl J Med 1982;;306:1437-1440.
20 +
Leff J, Kuipers L, Berkowitz R, Eberlein-Vries R, Sturgeon D:  A controlled trial of social intervention in the families of schizophrenic patients . Br J Psychiatry 1982;;141:121-134.
21 +
Liberman RP, Wallace CJ, Vaughn CE, Snyder KS, Rust C:  Social and family factors in the course of schizophrenia: Towards an interpersonal problem-solving therapy for schizophrenics and their families , in Strauss JS, Bowers M, Downey TW, et al (eds): The Psychotherapy of Schizophrenia . New York, Plenum Publishing Corp, 1980;, pp 21-54.
22 +
Johnson DAW:  The duration of maintenance therapy in chronic schizophrenia . Acta Psychiatr Scand 1976;;53:298-301.
23 +
Falloon I, Watt DC, Shepherd M:  A comparative controlled trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia . Psychol Med 1978;;8:59-70.
24 +
Hogarty GE, Schooler NR, Ulrich R, Mussare F, Ferro P, Herron E:  Fluphenazine and social therapy in the aftercare of schizophrenic patients: Relapse analyses of a two-year controlled study of fluphenazine decanoate and fluphenazine hydrochloride . Arch Gen Psychiatry 1979;;36:1283-1294.

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1 +
Leff JP:  Schizophrenia and sensitivity to the family environment . Schizophr Bull 1976;;2:566-574.
2 +
Brown GW, Carstairs GM, Topping GG:  The post-hospital adjustment of chronic mental patients . Lancet 1958;;2:685-689.
3 +
Brown GW:  Experiences of discharged chronic schizophrenic mental hospital patients in various types of living group . Milbank Mem Fund Q 1959;;37:105-131.
4 +
Brown GW, Monck EM, Carstairs GM, Wing JK:  Influence of family life on the course of schizophrenic illness . Br J Prev Soc Med 1962;;16:55-68.
5 +
Brown GW, Birley JLT, Wing JK:  Influence of family life on the course of schizophrenic disorders: A replication . Br J Psychiatry 1972;;121:241-258.
6 +
Vaughn CE, Leff JP:  The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients . Br J Psychiatry 1976;;129:125-137.
7 +
Leff JP, Vaughn CE:  The role of maintenance therapy and relatives' expressed emotion in relapse of schizophrenia: A two-year follow-up . Br J Psychiatry 1981;;139:102-104.
8 +
Tarrier N, Vaughn C, Lader MH, Leff JP:  Bodily reactions to people and events in schizophrenia . Arch Gen Psychiatry 1979;;36:311-315.
9 +
Sturgeon D, Kuipers L, Berkowitz R, Turpin G, Leff J:  Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives . Br J Psychiatry 1981;;138:40-45.
10 +
Wing JK, Cooper JE, Sartorius N: The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego System . Cambridge, England, Cambridge University Press, 1974;.
11 +
Krawiecka M, Goldberg D, Vaughan M:  A standardized psychiatric assessment scale for rating chronic psychotic patients . Acta Psychiatr Scand 1977;;55:299-308.
12 +
Vaughn CE, Leff JP:  The measurement of expressed emotion in the families of psychiatric patients . Br J Soc Clin Psychol 1976;;15:157-165.
13 +
Brown GW, Rutter M:  The measurement of family activities and relationships: A methodological study . Hum Relations 1966;;19:241-263.
14 +
Rutter M, Brown GW:  The reliability and validity of measures of family life and relationships in families containing a psychiatric patient . Soc Psychiatry 1966;;1:38-53.
15 +
Kuipers L:  Expressed emotion: A review . Br J Soc Clin Psychol 1979;;18:237-243.
16 +
Leff JP, Vaughn CE:  The interaction of life events and relatives' expressed emotion in schizophrenia and depressive neurosis . Br J try 1980;;136:146-153.
17 +
Anderson CM, Hogarty GE, Reiss DJ:  Family treatment of adult schizophrenic patients: A psychoeducational approach . Schizophr Bull 1980;;6:490-505.
18 +
Falloon IRH, Liberman RP, Lillie FJ, Vaughn CE:  Family therapy of schizophrenics with high risk of relapse . Fam Process 1981;;20:211-221.
19 +
Falloon IRH, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AH:  Family management in the prevention of exacerbations of schizophrenia: A controlled study . N Engl J Med 1982;;306:1437-1440.
20 +
Leff J, Kuipers L, Berkowitz R, Eberlein-Vries R, Sturgeon D:  A controlled trial of social intervention in the families of schizophrenic patients . Br J Psychiatry 1982;;141:121-134.
21 +
Liberman RP, Wallace CJ, Vaughn CE, Snyder KS, Rust C:  Social and family factors in the course of schizophrenia: Towards an interpersonal problem-solving therapy for schizophrenics and their families , in Strauss JS, Bowers M, Downey TW, et al (eds): The Psychotherapy of Schizophrenia . New York, Plenum Publishing Corp, 1980;, pp 21-54.
22 +
Johnson DAW:  The duration of maintenance therapy in chronic schizophrenia . Acta Psychiatr Scand 1976;;53:298-301.
23 +
Falloon I, Watt DC, Shepherd M:  A comparative controlled trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia . Psychol Med 1978;;8:59-70.
24 +
Hogarty GE, Schooler NR, Ulrich R, Mussare F, Ferro P, Herron E:  Fluphenazine and social therapy in the aftercare of schizophrenic patients: Relapse analyses of a two-year controlled study of fluphenazine decanoate and fluphenazine hydrochloride . Arch Gen Psychiatry 1979;;36:1283-1294.

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