title: The predictive validity of expressed emotions (EE) in schizophrenia. A 20-year prospective study.
abstract: BACKGROUND
  The level of expressed emotions in the family (EE) and components thereof (emotional over-involvement EOI, and critical comments CC) have been found to be related to treatment outcomes in psychotic patients. One point of interest is the dynamic of various outcomes in relation to initial EE, CC and EOI levels.
  
  
  METHODS
  43 individuals with diagnosis of schizophrenia were assessed at 1, 3, 7, 12 and 20-year follow-ups. The EE indicator was evaluated during the index hospitalization. Outcome indicators included: number of relapses, number and duration of in-patient rehospitalizations, and severity of psychopathological symptoms.
  
  
  RESULTS
  1) A high EE indicator was associated with a higher number of relapses in every follow-up and differences between the groups with low and high EE indicators proved significant after 3, 7, 12 and 20 years of the illness. 2) A high EE indicator was associated with a higher number of rehospitalizations after 3 and 7 years, and showed as a clear trend after 12 and 20 years. 3) A high level of CC was associated with a higher number of relapses. 4) The severity of positive symptoms increased only in the group with high CC. 5) The negative syndrome was not associated with EE, EOI or CC.
  
  
  CONCLUSIONS
  The EE indicator may be considered a valid prolonged predictor of relapses and rehospitalizations. A high level of CC was associated with a higher number of relapses and intensification of the positive syndrome in both the short-term and long-term course of the illness.
authors.affiliation: Community Psychiatry Unit, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, 2/8 Sikorskiego sq., 31-115 Cracow, Poland. mzcechni@cyf-kr.edu.pl
authors.forename: Andrzej
authors.initials: A
authors.lastname: Cechnicki
authors.forename: Anna
authors.initials: A
authors.lastname: Bielańska
authors.forename: Igor
authors.initials: I
authors.lastname: Hanuszkiewicz
authors.forename: Artur
authors.initials: A
authors.lastname: Daren
mesh_terms: D000328:Adult; D019260:Expressed Emotion / Q000502:physiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000150:complications* / Q000628:therapy; D012565:Schizophrenic Psychology; D013997:Time Factors; D016896:Treatment Outcome