Familjens emotionella klimat, recidivrisken och psykosocial intervention vid schizofrena störningar

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Abstract
Orhagen T, d'Elia G. The emotional atmosphere in the family (Expressed Emotion), relapse rate, and psychosocial intervention in schizophrenia. Several empirical studies have identified elements in the family emotional atmosphere (Expressed Emotion, EE) which seem to be related to an increased rate of relapses in schizophrenia. In this article an overview of empirical research in the field is presented. Expressed Emotion is an empirical index that comprises ratings of five variables: critical remarks, hostility, emotional overinvolvement, warmth, and positive remarks. Ratings are obtained from a semistructured interview, the Camberwell Family Interview (CFI), conducted with key relatives. Twelve prospective studies in different countries have found an association between a high index of critical remarks, hostility, or emotional overinvolvement, or a combination of these, and a higher risk of relapse. However, several studies could not replicate these findings. Research in EE indicates three possible ways of reducing relapse rate: providing continuous pharmacologic support, reducing the face-to-face contact with high-EE relatives, and lowering a high EE level in the family. Thus, psychoeducational programmes for families seem to add a prophylactic effect to the pharmacologic maintenance treatment and possibly improve the quality of life of family members. In connection with a study of a psychoeducational programme for relatives of mainly chronic schizophrenic patients in the county of Ostergotland, a Swedish version of the CFI has been used. Preliminary results show satisfactory interrater reliability of the EE ratings. In its present form the CFI is not easily applicable in clinical routine and remains a research tool.