RESUMO
Expressed Emotion (EE) strongly predicts relapse in mental disorders, but there remains a need to develop and refine brief, self-report measures. This article describes two studies testing the validity of a self-report measure of criticism or burden, the Family Attitude Scale (FAS), in relatives of patients with psychosis. Study 1 had 54 families of patients with psychosis and a substance use disorder, while Study 2 had 61 families of patients at an early psychotic episode. In Study 1, a consensus FAS was obtained; in Study 2 separate parental scores were used. The FAS was positively associated with EE, and with relationship negativity. Associations with negative caregiving experiences or stress were restricted to maternal or consensual FAS ratings. FAS scores predicted relapse in both studies, although prediction at the optimal cutoff (>or=60) only reached statistical significance in Study 2, and time to relapse was only predicted by the FAS in Study 1. Prediction of relapse from the CFI was stronger, and the FAS did not add to that prediction. Results supported the utility of the FAS, but confirmed the pre-eminence of the CFI as a household-related predictor of relapse.
Assuntos
Emoções Manifestas , Saúde da Família , Família/psicologia , Transtornos Psicóticos/diagnóstico , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Cuidadores/psicologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Inventário de Personalidade/estatística & dados numéricos , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Psicometria , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Recidiva , Reprodutibilidade dos Testes , Psicologia do Esquizofrênico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Expressed emotion (EE) and substance use disorder predict relapse in psychosis, but there is little research on EE in comorbid samples. The current study addressed this issue. METHOD: Sixty inpatients with a DSM-IV psychosis and substance use disorder were recruited and underwent diagnostic and substance use assessment. Key relatives were administered the Camberwell Family Interview. RESULTS: Patients were assessed on the initial symptoms and recent substance use, and 58 completed the assessment over the following 9 months. High EE was observed in 62% of households. Expressed emotion was the strongest predictor of relapse during follow-up and its predictive effect remained in participants with early psychosis. A multivariate prediction of a shorter time to relapse entered EE, substance use during follow-up and (surprisingly) an absence of childhood attention deficit hyperactivity disorder. CONCLUSIONS: Since high EE is a common and important risk factor for people with comorbid psychosis and substance misuse, approaches to address it should be considered by treating clinicians.
