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Paths to Relapse: Possible Transactional Processes Connecting Patient Illness Onset, Expressed Emotion, and Psychotic Relapse

Published online by Cambridge University Press:  06 August 2018

Keith H. Nuechterlein ,
Karen S. Snyder  and
Jim Mintz
Keith H. Nuechterlein*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 300 UCLA Medical Plaza, Room 2251, Los Angeles, California 90024-6968, USA
Karen S. Snyder
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
Jim Mintz
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, West Los Angeles Veterans Administration Medical Center, Brentwood Division, Clinical Research Center for Schizophrenia (B117), Wilshire and Sawtelle Blvds., Los Angeles, California 90073, USA
*
Correspondence
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Extract

A vulnerability/stress framework for schizophrenia is one means by which the strong evidence for genetic and other biological factors in schizophrenia can be combined in a useful way with persistent evidence that stressful environments may play a role in precipitating psychotic episodes (Gottesman & Shields, 1972; Zubin & Spring, 1977; Nuechterlein & Dawson, 1984; Nuechterlein, 1987; Ciompi, 1989). Within a large longitudinal study of the early course of schizophrenia, we have been attempting to examine several possible ways in which both psychobiological vulnerability factors in the patient (Dawson & Nuechterlein, 1987; Nuechterlein et al, 1991) and external environmental stressors (Ventura et al, 1989) individually and jointly influence the course of schizophrenia. At the Second International Symposium on Schizophrenia in Bern, we focused on two promising mediating factors in schizophrenia — those involving persistent information-processing abnormalities and stress-triggered autonomic arousal (Nuechterlein et al, 1989). We focus here on recent analyses that relate to current controversies in the literature on interpersonal attitudes that are typically called expressed emotion (EE) — socio-environmental attributes that have been statistically associated with psychotic relapse in schizophrenia.

Type
Stressors
Information
The British Journal of Psychiatry , Volume 161 , Issue S18: Onset and Course of Schizophrenic Disorders: Dynamic Interactions between Relevant Factors , October 1992 , pp. 88 - 96
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Bebbington, P. & Kuipers, L. (1989) Social influences on schizophrenia. In Schizophrenia: The Major Issues (eds P. Bebbington & P. McGuffin), pp. 201–225. Oxford: Heinemann.Google Scholar
Brown, G. W., Monck, E. M., Carstairs, G. M., et al (1962) Influence of family life on the course of schizophrenic illness. British Journal of Preventative and Social Medicine, 16, 55–68.Google Scholar
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241–258.Google Scholar
Ciompi, L. (1989) The dynamics of complex biological-psychosocial systems: four fundamental psycho-biological mediators in the long-term evolution of schizophrenia. British Journal of Psychiatry, 155 (suppl. 5), 15–21.CrossRefGoogle Scholar
Dawson, M. E. & Nuechterlein, K. H. (1987) The role of autonomic dysfunctions within a vulnerability/stress model of schizophrenic disorders. In Psychopathology: An Interactional Perspective (eds D. Magnusson & A. Öhman), pp. 41–51. Orlando, Florida: Academic Press.Google Scholar
Falloon, I. R. H., Boyd, J. L., McGill, C. W., et al (1982) Family management in the prevention of exacerbations of schizophreia: a controlled study. New England Journal of Medicine, 306, 1437–1440.Google Scholar
Glynn, S. M., Randolph, E. T., Eth, S., et al (1990) Patient psychopathology and expressed emotion in schizophrenia. British Journal of Psychiatry, 157, 877–880.CrossRefGoogle ScholarPubMed
Goldstein, M. J., Rodnick, E. H., Evans, J. R., et al (1978) Drug and family therapy in the aftercare treatment of acute schizophrenia. Archives of General Psychiatry, 35, 169–177.CrossRefGoogle Scholar
Gottesman, I. I. & Shields, J. (1972) Schizophrenia and Genetics: A Twin Study Vantage Point. New York: Academic Press.Google Scholar
Hogarty, G. I., Anderson, C. M., Reiss, D. J., et al, and the Environmental/Personal Indicators in the Course of Schizophrenia Research Group (1986) Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia: I. One-year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry, 43, 633–642.CrossRefGoogle Scholar
Hooley, J. M., Orley, J. & Teasdale, J. D. (1986) Levels of expressed emotion and relapse in depressed patients. British Journal of Psychiatry, 148, 642–647.Google Scholar
Kanter, J., Lamb, H. R. & Loeper, C. (1987) Expressed emotion in families: a critical review. Hospital and Community Psychiatry, 38, 374–380.Google Scholar
Karno, M., Jenkins, J. H., de la Selva, A., et al (1987) Expressed emotion and schizophrenic outcome among Mexican-American families. Journal of Nervous and Mental Disease, 175, 143–151.Google Scholar
Leff, J. P., Kuipers, L., Berkowitz, R., et al (1982) A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.Google Scholar
Leff, J. P. & Vaughn, C. (1981) The role of maintenance therapy and relatives’ expressed emotion in relapse of schizophrenia: a two-year follow up. British Journal of Psychiatry, 139, 102–104.Google Scholar
Leff, J. P. & Vaughn, C. (1985) Expressed Emotion in Families. New York: Guilford Press.Google Scholar
Leff, J. P., Wig, N. N., Ghosh, A., et al. (1987) Expressed emotion and schizophrenia in North India. III. Influence of relatives’ expressed emotion on the course of schizophrenia in Chandigarh. British Journal of Psychiatry, 151, 166–173.Google Scholar
Lefley, H. P. (1989) Family burden and family stigma in major mental illness. American Psychologist, 44, 556–560.Google Scholar
Liberman, R. P. (1986) Coping and competence as protective factors in the vulnerability-stress model of schizophrenia. In Treatment of Schizophrenia: Family Assessment and Intervention (eds Goldstein, M. J., Hand, I. & Hahlweg, K.). Berlin: Springer.Google Scholar
Loehlin, J. C. (1987) Latent Variable Models. Hillsdale, New Jersey: Erlbaum.Google Scholar
Lukoff, D., Nuechterlein, K. H. & Ventura, J. (1986) Manual for Expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin, 12, 594–602.Google Scholar
Macmillan, J. F., Gold, A., Crown, T. J., et al (1986). The Northwick Park Study of First Episodes of Schizophrenia. IV. Expressed emotion and relapse. British Journal of Psychiatry, 148, 133–143.Google Scholar
Miklowitz, D. J., Goldstein, M. J., Doane, J. A., et al (1989) Is expressed emotion an index of a transactional process? I. Relative's affective style. Family Process, 28, 153–167.Google Scholar
Miklowitz, D. J., Goldstein, M. J., & Falloon, I. R. H. (1983) Premorbid and symptomatic characteristics of schizophrenics from families with high and low levels of expressed emotion. Journal of Abnormal Psychology, 92, 359–367.Google Scholar
Miklowitz, D. J., Goldstein, M. J., Nuechterlein, K. H., et al (1988) Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225–231.Google Scholar
Mintz, L. I., Nuechterlein, K. H., Goldstein, M. J., et al (1989) The initial onset of schizophrenia and family expressed emotion: some methodological considerations. British Journal of Psychiatry, 154, 212–217.CrossRefGoogle ScholarPubMed
Moline, R. A., Singh, S., Morris, A., et al (1985) Family expressed emotion and relapse in schizophrenia in 24 urban American patients. American Journal of Psychiatry, 142, 1078–1081.Google Scholar
Nuechterlein, K. H. (1987) Vulnerability models for schizophrenia: state of the art. In Search for the Causes of Schizophrenia (eds H. Häfner, W. F. Gattaz & W. Janzarik), pp. 297–316. Heidelberg: Springer.Google Scholar
Nuechterlein, K. H. & Dawson, M. E. (1984) A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin, 10, 300–312.Google Scholar
Nuechterlein, K. H., Edell, W. S., Norris, M., et al (1986a) Attentional vulnerability indicators, thought disorder, and negative symptoms. Schizophrenia Bulletin, 12, 408–426.Google Scholar
Nuechterlein, K. H., Snyder, K. S., Dawson, M. E., et al (1986b) Expressed emotion, fixed-dose fluphenazine decanoate maintenance, and relapse in recent-onset schizophrenia. Psychopharmacology Bulletin, 22, 633–639.Google ScholarPubMed
Nuechterlein, K. H., Goldstein, M. J., Ventura, J., et al (1989) Patient-environment relationships in schizophrenia: information processing, communication deviance, autonomic arousal, and stressful life events. British Journal of Psychiatry, 155 (suppl. 5), 84–89.CrossRefGoogle Scholar
Nuechterlein, K. H., Dawson, M. E., Ventura, J., et al (1991) Testing vulnerability models: stability of potential vulnerability indicators across clinical state. In Search for the Causes of Schizophrenia, Vol. II (eds H. Häfner & W. F. Gattaz), pp. 177–191. Heidelberg: Springer.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799–812.Google Scholar
Parker, G., Johnston, P. & Hayward, L. (1988) Parental “expressed emotion” as a predictor of schizophrenic relapse. Archives of General Psychiatry, 45, 806–813.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.Google Scholar
Strauss, J. S. & Carpenter, W. T. Jr. (1974) The prediction of outcome in schizophrenia: II. Relationships between predictor and outcome variables. Archives of General Psychiatry, 31, 37–42.Google Scholar
Strauss, J. S. & Carpenter, W. T. Jr. (1977) Prediction of outcome in schizophrenia: III. Five year outcome and its predictors. Archives of General Psychiatry, 34, 159–163.Google Scholar
Tarrier, N. (1989) Electrodermal activity, expressed emotion and outcome in schizophrenia. British Journal of Psychiatry, 155 (suppl. 5), 51–56.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., et al (1988) The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry, 153, 532–542.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976a) The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125–137.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976b) The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157–165.CrossRefGoogle ScholarPubMed
Vaughn, C. E., Snyder, K. S., Jones, S., et al (1984) Family factors in schizophrenic relapse: a California replication of the British research on expressed emotion. Archives of General Psychiatry, 41, 1169–1177.Google Scholar
Ventura, J., Nuechterlein, K. H., Lukoff, D., et al (1989) A prospective study of stressful life events and schizophrenic relapse. Journal of Abnormal Psychology, 98, 407–411.Google Scholar
Watt, N. (1974) Amherst Modification of the Hollingshead Two-Factor Index of Social Position. Unpublished. Available from N. Watt, University of Denver, Denver, Colorado.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and CATEGO programs. London: Cambridge University Press.Google Scholar
Zubin, J. & Spring, B. (1977) Vulnerability – a new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.CrossRefGoogle Scholar
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