(1/198) Expressed emotion and relapse in young schizophrenia outpatients.
High familial expressed emotion (EE) reliably predicts 9-month relapse rates in schizophrenia patients. Difficulties interpreting the EE-relapse finding arise, however, because EE is usually assessed during a hospital admission, yet relapse following discharge is predicted. Researchers in Scotland assessed EE in relatives while the patients were out of hospital; using conservative relapse criteria, they failed to find higher subsequent 6- and 12-month relapse rates among patients living in high-EE homes (McCreadie and Phillips 1988). Our goal was to determine the ability of EE to predict relapse in a sample of 69 schizophrenia outpatients using both conservative criteria (for 6-and 12-month rates) and standard relapse criteria (for 9- and 18-month rates). According to the conservative criteria, EE failed to predict 6- and 12-month relapse. According to the standard criteria, 9-month relapse rates were significantly greater among patients in high-EE households. In parental homes, relapse at both 9 months and 18 months was best predicted by fathers' critical comments and mothers' emotional overinvolvement. Relapse was not associated with medication compliance and the amount of contact with high-EE relatives. (+info)
(2/198) Schizophrenia patients are more emotionally active than is assumed based on their behavior.
Flat affect is a core symptom of schizophrenia. To date, researchers have focused primarily on emotional expression. Only recently has the emotional experience of patients with schizophrenia been studied in laboratory settings. The goal of this study is to assess emotional experience in the complex world of daily life. A structured time-sampling technique, the Experience Sampling Method, was used to collect data. Schizophrenia subjects (n = 58) were compared to 65 nonpatient controls. Patients were divided into blunted and nonblunted subgroups on the basis of Brief Psychiatric Rating Scale (BPRS) behavioral ratings of flat affect. Schizophrenia subjects experienced more intense and more variable negative emotions than controls. For the positive emotions, we found less intensity and less variability in the schizophrenia subjects. No difference in patterns of affect was found between the blunted and the nonblunted schizophrenia subgroups. Our findings suggest that patients with schizophrenia are more emotionally active than has been assumed based on behavioral observations. (+info)
(3/198) Hyperphagic short stature and Prader--Willi syndrome: a comparison of behavioural phenotypes, genotypes and indices of stress.
BACKGROUND: The clinical features of hyperphagic short stature (HSS) include short stature secondary to growth hormone insufficiency, excessive appetite (hyperphagia) and mild learning disabilities. Affected children characteristically live in conditions of high psychosocial stress. Symptoms resolve when the child is removed from the stressful environment. Family studies indicate a genetic predisposition. AIMS: To compare the behavioural and stress profiles of HSS with those of Prader--Willi syndrome (PWS), and to test the hypothesis that the genetic locus that predisposes to HSS co-inherits with the PWS locus at 15q11--13. METHOD: Twenty-five children with HSS, mean age 9.1 (s.d. 3.8) years, 28% female, were compared with 30 children with PWS, mean age 8.8 (s.d. 2.8) years, 33% female. RESULTS: The clinical profiles were largely similar across the conditions, but no evidence was found in HSS of co-inheritance of the PWS critical region. CONCLUSIONS: Hyperphagic short stature is one of the very few behavioural diseases associated with a pathognomonic physiological abnormality. Investigations of the suggested genetic dysregulation, which is so sensitive to environmental influences, may well be of importance in a broader context. (+info)
(4/198) Pathological laughter and crying: a link to the cerebellum.
Patients with pathological laughter and crying (PLC) are subject to relatively uncontrollable episodes of laughter, crying or both. The episodes occur either without an apparent triggering stimulus or following a stimulus that would not have led the subject to laugh or cry prior to the onset of the condition. PLC is a disorder of emotional expression rather than a primary disturbance of feelings, and is thus distinct from mood disorders in which laughter and crying are associated with feelings of happiness or sadness. The traditional and currently accepted view is that PLC is due to the damage of pathways that arise in the motor areas of the cerebral cortex and descend to the brainstem to inhibit a putative centre for laughter and crying. In that view, the lesions 'disinhibit' or 'release' the laughter and crying centre. The neuroanatomical findings in a recently studied patient with PLC, along with new knowledge on the neurobiology of emotion and feeling, gave us an opportunity to revisit the traditional view and propose an alternative. Here we suggest that the critical PLC lesions occur in the cerebro-ponto-cerebellar pathways and that, as a consequence, the cerebellar structures that automatically adjust the execution of laughter or crying to the cognitive and situational context of a potential stimulus, operate on the basis of incomplete information about that context, resulting in inadequate and even chaotic behaviour. (+info)
(5/198) Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment.
Controlled intervention studies carried out in families of schizophrenia patients have been shown to have a positive impact in relapse prevention, but it remains to be seen whether different forms of family intervention affect outcomes other than relapse and hospital readmission in different ways. This study compared the outcome profile of relevant clinical variables after two different family intervention strategies for schizophrenia patients in public health care in a Spanish sample. We conducted a randomized controlled study comparing (1) a relatives group (RG) and (2) a single-family behavioral family therapy (BFT), both offered as standard treatment in one catchment area in Valencia. All randomized patients were included in the main analysis, and all cases remained in the therapy group to which they were originally assigned regardless of whether they suffered a relapse. The relapse rate at 12 months for the 87 cases studied was not significantly different in the two groups, but the two approaches did affect outcomes other than relapse and rehospitalization (such as social functioning, dose of antipsychotic medication, "delusions" and "thought disorder") in different ways. The BFT approach offered more advantages than the RG approach. The results suggest that these approaches should always be implemented in a clinical environment in a Mediterranean setting. (+info)
(6/198) Interpersonal control and expressed emotion in families of persons with schizophrenia: change over time.
This study examined communication patterns in 62 families of persons with schizophrenia, comparing families with relatives who were low expressed emotion (EE) at the beginning and end of a 2-year study, those who were high EE at the beginning and end, and those whose EE status changed. Interaction was coded with the Relational Control Coding System and analyzed as a Markov process. Dialogues in the stable low-EE and stable high-EE families were rather similar initially, and both groups showed increasing flexibility at year 1. However, at year 2, low-EE dyads showed increasingly complex structure and flexibility in control, but high-EE dyads showed simpler structure and rigidly controlling patterns. When EE status changed, so did the structure of the dialogues and the patterning of control. Although earlier research found more "tightly joined" systems in families of high-EE relatives, it may be that over time, these family members distance from each other and so are less connected. It is also possible that relatives who remain high EE despite intervention are a subset of high-EE relatives who need more support or different therapeutic approaches to maintain change. (+info)
(7/198) Processing emotional facial expressions: the role of anxiety and awareness.
In this paper, the role of self-reported anxiety and degree of conscious awareness as determinants of the selective processing of affective facial expressions is investigated. In two experiments, an attentional bias toward fearful facial expressions was observed, although this bias was apparent only for those reporting high levels of trait anxiety and only when the emotional face was presented in the left visual field. This pattern was especially strong when the participants were unaware of the presence of the facial stimuli. In Experiment 3, a patient with right-hemisphere brain damage and visual extinction was presented with photographs of faces and fruits on unilateral and bilateral trials. On bilateral trials, it was found that faces produced less extinction than did fruits. Moreover, faces portraying a fearful or a happy expression tended to produce less extinction than did neutral expressions. This suggests that emotional facial expressions may be less dependent on attention to achieve awareness. The implications of these results for understanding the relations between attention, emotion, and anxiety are discussed. (+info)
(8/198) Stigma and expressed emotion: a study of people with schizophrenia and their family members in China.
BACKGROUND: The most damaging effect of stigma is the internalisation of others' negative valuations. AIMS: To explore the factors that mediate patients' emotional and cognitive responses to stigma. METHOD: Based on responses to 10 open-ended questions about stigma appended to the Chinese version of the Camberwell Family Interview, trained coders rated the effect of stigma on both patients and family members in 1491 interviews conducted with 952 family members of 608 patients with schizophrenia at 5 sites around China from 1990 to 2000. RESULTS: Family members reported that stigma had had a moderate to severe effect on the lives of patients over the previous 3 months in 60% of the interviews, and on the lives of other family members in 26% of the interviews. The effect of stigma on patients and family members was significantly greater if the respondent had a high level of expressed emotion, if the patient had more severe positive symptoms, if the respondent was highly educated and if the family lived in a highly urbanised area. CONCLUSIONS: Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives. (+info)