title: Negative expressed emotion best discriminates families with bipolar disorder children.
abstract: BACKGROUND
  Children and adolescents with bipolar disorder (BD) live in family environments with high levels of expressed emotion (EE), conflict, and tension; as well as low maternal warmth and cohesion. These family characteristics have been evaluated in research settings using different scales. Nonetheless, empirically supported assessment instruments are not always feasible to be used in clinical settings. Our aim was to identify the best characteristics that discriminate BD families from control by building a classifier with the main characteristics found from different scales. We also built a classifier based on the adjective check-list scale (ACL) because this scale would be the most feasible one to be used in clinical setting.
  
  
  METHODS
  We evaluated 33 families of pediatric BD patients and 29 control families. Two self-report scales, ACL and the Family Environment Scale (FES), and a direct interview scale, the Psychosocial Schedule for School Age Children-Revised (PSS-R), were administered.
  
  
  RESULTS
  BD families presented lower positive EE and higher negative EE, less cohesion, organization, greater conflict and control; lower rate of intact family, higher maternal and paternal tension compared to control families. Both classifiers demonstrated high accuracy. The offspring's EE toward the mother was the family characteristic that best discriminated BD from control families.
  
  
  CONCLUSIONS
  Small sample size and cross-sectional design.
  
  
  CONCLUSIONS
  Families of BD children presented altered communication and functioning. The high accuracy of the ACL-based classifier highlights a feasible scale to be used in clinical settings. Further studies assessing prognosis associated with the patterns of communication in such families are needed.
authors.affiliation: Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Edmir G
authors.initials: EG
authors.lastname: Nader
authors.forename: Ana
authors.initials: A
authors.lastname: Kleinman
authors.forename: Bernardo Carramão
authors.initials: BC
authors.lastname: Gomes
authors.forename: Claudia
authors.initials: C
authors.lastname: Bruscagin
authors.forename: Bernardo
authors.initials: B
authors.lastname: dos Santos
authors.forename: Mark
authors.initials: M
authors.lastname: Nicoletti
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Caetano
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis*; D016022:Case-Control Studies; D002648:Child; D003142:Communication; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D019260:Expressed Emotion; D005190:Family / Q000523:psychology*; D005191:Family Characteristics; D005195:Family Relations; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009034:Mother-Child Relations / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results