PubMed · 9990247
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1999. Relapse and expressed emotion.. https://pubmed.ncbi.nlm.nih.gov/9990247/
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The experience of stress is commonly implicated in the onset and maintenance of psychotic disorders such as schizophrenia. Previous studies that have addressed this relationship have had mixed results and serious methodological flaws associated with study design are common. One central limitation is the over-reliance on the experience of life events as a measure of the experience of stress. Research in the general stress literature suggest that attention also needs to be paid to the experience of other types of stressful events (such as 'hassles') as well as qualitative appraisals of events to fully understand the relationship between stressful experiences and mental health problems such as psychosis. Investigation of the experiences of stress by young people who are identified as being at heightened risk of developing a psychotic disorder would also result in a more complete understanding of the relationship between the experience of stress and the onset of psychotic disorder.
BACKGROUND: People with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families are now widely used. OBJECTIVES: To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared to standard care. SEARCH STRATEGY: We updated previous searches by searching The Cochrane Schizophrenia Group's Register (November 2002 and June 2005), searched references of all new included studies for further trial citations, and contacted authors of trials. SELECTION CRITERIA: We selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care. DATA COLLECTION AND ANALYSIS: We independently extracted data and calculated fixed effects relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). MAIN RESULTS: This 2005-6 update adds data of 15 additional trials (1765 participants, 43% of the total 4124). Family intervention may decrease the frequency of relapse (n=857, 16 RCTs, RR 0.71 CI 0.6 to 0.8, NNT 8 CI 6 to 11), although some small but negative studies may not have been identified by the search. Family intervention may also reduce hospital admission (8 RCTs, n=481, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13)--and this finding is a change to the previous equivocal data reported in 2002. Family intervention may also encourage compliance with medication (n=369, 7 RCTs, RR 0.74 CI 0.6 to 0.9, NNT 7 CI 4 to 19) but does not obviously affect the tendency of individuals/families to drop out of care (n=481, 6 RCTs, RR 0.86 CI 0.5 to 1.4). It may improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide. AUTHORS' CONCLUSIONS: Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are applicable to routine care.
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