title: Expressed emotion as an adaptation to loss: prospective study in first-episode psychosis.
abstract: BACKGROUND
  The factors influencing the development of expressed emotion (EE) are still unclear. Understanding the carer and patient appraisals operating during the initial adaptation to psychosis may help to clarify the early ontogenesis of EE.
  
  
  METHODS
  Fifty patients and key carers were followed-up over 9 months and their appraisals of loss and burden were measured in relation to the evolution of high emotional overinvolvement (EOI) and critical (CC) relationships.
  
  
  RESULTS
  The appraisal of loss was linked to high EOI but not high CC relationships at baseline. Loss reduced by 9-month follow-up in those changing from high EOI to high CC or low EE. Subjective burden of carers was linked to loss but not to EE status. Patients' and relatives' appraisals of loss were strongly correlated, particularly in high EOI relationships. Longer duration of untreated psychosis was associated with high CC.
  
  
  CONCLUSIONS
  The results are consistent with Bowlby's attachment theory, where EOI and coercive criticism may be understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.
authors.affiliation: ED:IT, Early Intervention Service, 97 Church Lane, Aston, Birmingham B6 5UG, UK. patterpj@bham.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Patterson
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.forename: Ray
authors.initials: R
authors.lastname: Cochrane
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D019260:Expressed Emotion; D005192:Family Health; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000523:psychology*