Preventing the entrenchment of high expressed emotion in first episode psychosis: early developmental attachment pathways.
OBJECTIVE
As part of a strategy to consider the options for preventing the developmental entrenchment of expressed emotion (EE), we examine the early ontogeny of EE in a first-episode sample of individuals with psychosis and its links with the process of adaptation to change.


METHODS
The key relatives of 50 first-episode psychosis patients from two locations were interviewed soon after patient referral and again 9 months later using measures of expressed emotion and loss.


RESULTS
The developmental pathways of components of expressed emotion, particularly criticism and emotional over-involvement, were independent despite having a similar effect on outcome for patients. Initially, high levels of emotional over-involvement were reduced by follow up, with 37% resolving into high criticism. Overall expressed emotion status changed in 28.2% of key relatives (all parental), predominantly from high to low. High emotional over-involvement and low criticism are associated with significantly high levels of perceived loss in relatives. The metamorphosis of emotional over-involvement to criticism was linked to a reduction in perceived loss.


CONCLUSIONS
Expressed emotion is not a stable index in relatives of first-episode psychosis samples. Appraisals of loss by relatives may be driving high emotional over-involvement with implications for family intervention programs. Attachment theory may help to explain some of the processes underlying resistance to change in some of the high-EE behaviours measured by expressed emotion.
Patterson
P
P
Early Intervention Service, Northern Birmingham Mental Health Trust, Aston, UK. pjsp60@hotmail.com
Birchwood
M
M
Cochrane
R
R
D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology; D019260:Expressed Emotion; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D010553:Personality Development; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000517:prevention & control*; D012565:Schizophrenic Psychology