Expressed Emotion in Relatives of Chinese Patients with First-Episode Psychosis in Hong Kong

Abstract Objective: To evaluate the expressed emotion in a group of caregivers of young adults with first-episode psychosis. Participants and Methods: This cross-sectional study was done to examine the relationships between expressed emotion and the clinical characteristics of caregivers supporting patients attending a first-episode psychosis clinic in the Hong Kong Special Administrative Region. The caregivers' expressed emotions and the patients' perceptions of those expressed emotions were evaluated using the Level of Expressed Emotion questionnaire. Expressed emotion profiles were correlated with psychiatric symptomatology according to the Positive and Negative Syndrome Scale. Results: One hundred and thirty nine caregiver-patient pairs completed and returned all the questionnaires. Higher caregiver-rated expressed emotion was associated with the caregiver being the father, unemployed, and patients being of young age. The total Positive and Negative Syndrome Scale score was positively correlated with both the caregiver-rated (Spearman's rho [r] = 0.28, p = 0.001) and patient-rated (r = 0.38, p Conclusions: Expressed emotion in the caregivers looking after young adults with psychosis was modulated by different clinical parameters. At an early stage of the illness, special attention should be paid to the caregiving experience of family members who play an instrumental role in the health care plan. Key words: Caregivers/psychology; Expressed emotion; Psychotic disorders Introduction With the introduction of the early intervention programme for psychotic young adults (EASY), caregivers are expected to actively participate in the care of these patients. While caregivers handle the impact of having a family member newly diagnosed with a psychiatric disorder, their perception of the caregiving experience and the family burden imposed is likely to affect their expressed emotion (EE). Expressed emotion describes the quality of a relative's relationship with a particular person. This is an empirical construct that has been defined in terms of 3 components including the expression of hostility, emotional over-involvement, and the number of critical comments directed towards the patient. Expressed emotion is measured in a semi-structured interview, the Camberwell Family Interview, based on the number of critical comments, the absence or presence of hostility, and emotional over-involvement. (1) To understand the complex interactions between EE, family coping, and the course of illness, further research on the actual behaviour of relatives with different levels and styles of EE has been done. It was found that relatives with high EE exhibited more negatively charged verbal behaviour than those with low EE. Within the former group, members of the 'critical' subgroup were distinguished by their frequent use of critical comments whereas the 'over-involved' subgroup used more intrusive, invasive statements. (2) Two common patterns of interpersonal control patterning were identified in these high EE families. The first was the competition for 'who's in charge' between the patient and the caregiver, with both insisting on exerting control. The other showed the caregiver playing the controlling role regardless of the response of the patient. (3) The caregivers of patients with better social functioning are more likely to adopt the 'Ignore / Accept' coping style and experience greater perceived control and a lesser burden. (4) Caregivers' beliefs about the causes of the patients' symptoms and negative behaviours also contribute to the difference in EE. Relatives with high EE made more attributions about the illness than those with low EE. The caregivers with high criticism / hostility perceived the causes of problems as more personally related to the patient. (5,6) Studies performed over the years have shown that EE is a robust predictor of relapse in schizophrenic patients. …