title: Expressed emotion at first-episode psychosis: investigating a carer appraisal model.
abstract: BACKGROUND
  Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient-carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode.
  
  
  OBJECTIVE
  To investigate the utility of a carer appraisal model of EE in first-episode psychosis.
  
  
  METHODS
  We compared high- and low-EE carers of people who had first-episode psychosis (n=46).
  
  
  RESULTS
  High EE in carers was associated with higher avoidant coping, higher subjective burden and lower perceived patient interpersonal functioning. Patient illness factors and carers' distress levels were not associated with EE.
  
  
  CONCLUSIONS
  Even at the first episode, carers' psychological appraisal, not patient illness factors, is influential in determining high EE. Carers' appraisal of their situation should be a primary target to lower or prevent high EE in early intervention for psychosis.
authors.affiliation: Department of Adult Clinical Psychology, Ealing Locality, John Connelly Wing, West London Mental Health Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Raune
authors.forename: E
authors.initials: E
authors.lastname: Kuipers
authors.forename: P E
authors.initials: PE
authors.lastname: Bebbington
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D019260:Expressed Emotion; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D011594:Psychometrics; D011618:Psychotic Disorders / Q000451:nursing / Q000523:psychology*