How Do Patients with Schizophrenia Perceive Relatives’ Levels of Expressed Emotions?

Expressed emotion (EE) is a measure of the family environment that is based on how the relatives of a psychiatric patient spontaneously talk about the patient. Currently, interventions based on reducing high EE are considered integral to the psychosocial component of treatments for schizophrenia. And patients’ perspective on relatives’ attitude and behavior towards them (expressed emotions) may be an important addition to the current focus on relatives’ perspective only, as measured by Camberwell Family Interview (CFI) or other methods. Based on the theory of EE, the authors designed a brief, three-item questionnaire completed by patients, named Felt Expressed Emotion Rating Scale (FEERS) and aimed to investigate the test-retest reliability of the FEERS and associations between the FEERS and the CFI and to which extent FEERS scores were modified by severity of psychotic symptoms, cognitive function, patient mood and amount of face-to-face contact with relatives. 

In this study, forty-five patients (18 - 39 years old) with schizophrenia and related psychoses admitted to a psychiatric hospital and 67 relatives were included. Assessments included FEERS, CFI and Positive and Negative Syndrome Scale (PANSS). The results indicated that FEERS-Cri test-retest intra-class correlation (ICC_1,1) was 0.71 among patients with low total PANSS scores, low cognitive impairment (0.59) and depression (0.63). For low levels of cognitive impairment, the ICCs of the FEERS-Wo and the FEERS-Con were 0.62 and 0.83, respectively. The FEERS-Cri and FEERSHowWo correlated significantly with CFI-CC and CFI-positive comments, respectively. Among the relatives that the patient deemed “not at all critical” (low FEERS-Cri scores), 94% had low CFI-CC levels.

In conclusion, the FEERS may be an efficient screening instrument for identifying how patients perceive relatives attitude and behavior, especially in patients with less severe psychosis, less depression and less impaired cognitive function. FEERS may also be a brief and valid instrument to rule out high levels of EE in families. Those capacities may have important treatment implications.

Article by Heidi Bjørge, et al, from Norway.

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