[Update on "expressed emotions"]. / Le point sur les "expressed emotions".

The present article is meant to sum up the current state of scientific knowledge with regard to the concept of "Emotional Expression" and its very implementation in the clinical and therapeutical field which are well-known in anglo-saxon countries but very little applied and known in France. "Emotional Expression" (EE), which came out of research and studies undertaken by Brown (1959) and later on, Vaughn and Leff (1976), defines interaction between a schizophrenic patient and his close environment according to 3 criterium: judgmental comments and criticism, hostility, emotional over-involvement. Family surroundings are characterized by strong EE or weak EE according to the frequency and the quantity of the measures during a typical standard family-interview: the Camberwell Family Interview (CFI). A strong EE is considered as being a non-specific factor. "Emotional Expression" proves to be a predictable indication for relapse in terms of psychiatric affluence (positive symptoms), hospitalization rate and psycho-social adjustment process. The possibilities of forecasting do not concern specifically schizophrenia as the relation between family climate and relapse can be observed in other mental pathology as well. The psycho-educational approach which is induced by this research trend is based on a concept of a partnership between the patients's family and the patient. The purpose in fact is to bring about changes within the relationship of the patient and his environment so as to reduce judgmental criticism, hostility and emotional over-involvement (information programs concerning etiology, therapeutical strategies in view of improving understanding of the illness and to reorganize proper family relationship). The advantage of such a concept which is well-known lies in the fact that it helps to find out those family surroundings with strong EE who represent factors of relapse for psychiatric patients and to suggest therefore therapeutical treatment, the purpose of which should be defined together with all those concerned namely, the patient, the family, the therapeutist so as to intervene during the evolution of the illness. The literary bibliographical review which we have made lead us to find the existence of a wide field of research with results showing clearly the predictable aspects of EE in the illness process. In this way, new approaches in the "intake" of schizophrenic patients and their families are clearly defined.

[What is the meaning of "stabilization" in schizophrenic patients?]. / Que recouvre le terme "stabilisation" des patients schizophrènes?

UNLABELLED: The notion of stabilization in schizophrenia has been investigated, in France, through a survey of 875 psychiatrists. This survey, which has been conducted on the 9th, 10th and 11th of December 1997, looked into the clinical, therapeutic and socio-demographic variables, and the means of patient management, which are used by psychiatrists to ascertain that their patients are stabilized. The data was collected by each psychiatrist by way of a questionnaire administered to his or her next three patients, either at the hospital or in private practice (2,464 questionnaires were completed). RESULTS: 65% of the patients seen during this survey were considered stabilized by their psychiatrist (n = 1,597). The most common clinical presentation was of the paranoïd type. An insiduous onset of disease seems to be correlated with an absence of stabilization. Stabilization appears to be estimated at a given time rather than over a time period, since over half the patients who were considered stabilized had suffered at least one relapse over the last 2 years, and had been rehospitalized an average of 2.4 times over that period. In terms of drug therapy, they received 1.4 neuroleptic drugs, which does not differ markedly from the 1.5 neuroleptics administered to patients who were considered non stabilized. Co-prescriptions of anticholinergic medications, benzodiazepines and antidepressants were very common in these patients considered stabilized (49.9%, 39.8% and 24.8% respectively), which is similar to that observed in their non-stabilized counterparts (47.6%, 45%, 8% and 26.4%, respectively). Patient follow-up remained above an average of 1 patient visit per month (an average of 8.9 visit over the last 6 months), despite the fact that patients were considered stabilized. Two primary criteria were used by psychiatrists to determine that a patient was stabilized: treatment compliance and the absence of positive symptoms. However, 43% of the patients which were considered stabilized still presented with positive symptoms. Negative symptoms were also very prevalent in these patients (65%), as well as concomitant depressive signs (36%) and anxiety (64%). CONCLUSION: Even though the concept of stabilization remains difficult to define, it appears that schizophrenic patients are considered by their psychiatrist as stabilized on the grounds of good treatment compliance and decreased positive symptoms. Therefore, even in these so-called stabilized patients, enhancements are still possible, as symptoms remain present.