Karen S. Snyder

Ethnicity, Expressed Emotion, Attributions, and Course of Schizophrenia: Family Warmth Matters

The authors examined the role of family factors and the course of schizophrenia by carrying out additional assessments and analyses in 2 previously published studies of Mexican American and Anglo American patients and families. The authors found partial support for an attributional model of relapse for families who are low in emotional overinvolvement. Attributions of control, criticism, and warmth together marginally predicted relapse. The data also indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. These findings suggest that the sociocultural context shapes the pathways by which family processes are related to the course of illness. Moreover, the warmth findings suggest that families may contribute to preventing relapse.

The vulnerability/stress model of schizophrenic relapse: a longitudinal study

A tentative model for conceptualizing the interplay of vulnerability factors, stressors, and protective factors in the course of schizophrenia is discussed. A study of the initial years after a first schizophrenic episode is testing the predictive role of key factors. During an initial 1‐year period of depot antipsychotic medication, independent life events and expressed emotion were found to predict the likelihood of psychotic relapse. Initial analyses indicate that independent life events play less of a role in relapse prediction during a medication‐free period. These results suggest that maintenance antipsychotic medication raises the threshold for return of psychotic symptoms, such that relapses are less likely unless major environmental stressors occur. A low expressed emotion environment may be a protective factor.

Expressed emotion, attributions, and schizophrenia symptom dimensions

Using a sample of 40 Anglo American family members of schizophrenic patients, the present study replicates and lends cross-cultural support for an attribution-affect model of expressed emotion (EE). Consistent with attribution theory, the authors found that highly critical relatives (high-EE) viewed the illness and associated symptoms as residing more within the patients personal control as compared with less critical relatives (low-EE). A content analysis classified the types of behaviors and symptoms most frequently criticized by relatives. Symptoms reflecting behavioral deficits (e.g., poor hygiene) were found to be criticized more often than symptoms reflecting behavioral excesses (e.g., hallucinations). In line with an attribution-affect framework, relatives may be less tolerant of behavioral deficits because they are viewed as intentional, whereas behavioral excesses are easily recognized as core symptoms of mental illness.

Do Recent-Onset Schizophrenia Patients Experience a “Social Network Crisis”?

Abstract It has been proposed that the onset of schizophrenia creates a social network crisis, resulting in a dramatic deterioration of social resources during the period immediately following a first hospitalization from essentially normal pre—hospitalization levels. To evaluate this proposal, recent onset patients (n = 89) completed comprehensive assessments that examined their social networks in the 12 months prior to first hospitalization and, in a subset of patients (n = 34), at a 15—month follow—up. Cross—sectional relationships to social functioning and symptoms were examined at both time points. Compared to existing research, at the initial assessment patients were characterized by several network disturbances, including small network size, a high proportion of family members, and highly dense interconnections among network members; these disturbances generally remained moderately to highly stable at follow—up. Smaller social networks were related to poor current and premorbid social functioning and aspects of clinical functioning, particularly at the 15—month follow—up assessment. Thus, this first repeated assessment of social network characteristics in the early course of schizophrenia does not support the social network crisis concept. Instead, results suggest that functionally relevant social network disturbances often exist by the time of first hospitalization in schizophrenia.

Controllability perceptions and reactions to symptoms of schizophrenia : A within-family comparison of relatives with high and low expressed emotion

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes.

The Relationship of Residential Care-home Operators’ Expressed Emotion and Schizophrenic Residents’ Symptoms and Quality of Life

The relationship of Expressed Emotion (EE) and schizophrenic relapse has been studied repeatedly in homes where schizophrenic persons live with family members, but rarely studied in residential-care settings where they live with nonfamilial caregivers. Actually, all caregivers who live and interact with mentally ill people might be expected to exhibit attitudes classifiable by EE criteria; yet, despite the prominent role of special residences in the care of schizophrenic persons [1], few investigators have focused on EE attitudes of nonfamilial caregivers. Three studies have investigated EE in nonfamilial environments. Herzog [2] reported that 65% of staff on a psychiatric ward had highEE attitudes toward one or more patients. The attitudes varied with patient diagnosis and behavioral agitation. Heinssen and colleagues found that 22% of patients on an inpatient unit - primarily those rated as hostile, uncooperative, or impulsive - were discussed by staff in

Expressed Emotion, Appraisal and Coping by Patients with Recent-onset Schizophrenia: A Pilot Investigation

This pilot study sought to follow up on indications that patients from households with high levels of expressed emotion (EE) differ from those from households with low levels of EE in ways not assessed in typical symptom rating profiles. We examined how patients appraised and coped with a prominent societal stressor. Soon after the start of the Gulf War, 22 patients with recent-onset schizophrenia living in Los Angeles appraised the stressor and completed a coping questionnaire. Results indicated that patients from high-EE homes were likely to use emotion-based confrontational methods to cope with the crisis, while patients from low-EE environments were likely to use avoidance and denial. Patients from high-EE homes thus coped with this non-familial, societal stressor in a way similar to the way in which they have been observed to cope with family conflict: they more readily expressed their anger and frustration than patients from low-EE homes. These pilot data suggest that increased attention should be d...

Factores familiares en la recaída de pacientes esquizofrénicos

ResumenNuestro estudio de la atmosfera emocional de los hogares de los pacientes esquizofrenicos en California del Sur ha replicado los descubrimientos britanicos en relacion con la influencia del ambiente familiar sobre el curso de la esquizofrenia. Como en los estudios britanicos, las criticas y la implicacion emocional excesiva de un familiar clave para el paciente en el momento de su ingreso constituyen el mejor predictor aislado de recaida sintomatica en los nueve meses posteriores al alta hospitalaria. Al igual que en los resultados britanicos, la asociacion entre la emocion expresada de los familiares y la recaida fue independiente de todas las demas variables investigadas. Los resultados transculturales sobre los efectos preventivos de la medicacion sugieren que los clinicos deben considerar la atmosfera emocional del hogar, a la hora de explicar los fracasos de la medicacion.