title: Distress and negative experiences of the caregiving relationship in early psychosis: does social cognition play a role?
abstract: OBJECTIVE
  This study explored the relationship between individuals with early psychosis and first-degree relatives who were carers, to see whether negative and distressing experiences of the patient-carer relationship were associated with social cognition difficulties in both groups.
  
  
  METHODS
  The study had a cross-sectional correlational design. A total of 33 patients with early psychosis (within 3 years of first psychotic episode) and 24 first-degree relative carers (all parents) completed measures of mood, expressed emotion and negative experiences of caregiving. Social cognition measures of theory of mind and emotion recognition were also collected.
  
  
  RESULTS
  Patient perceptions of carer criticism were related to increased anxiety and depression. Carer negative experiences of caregiving were related to higher levels of expressed emotion, anxiety and depression. Both patients and carers showed impaired performance on social cognition tasks. However, patient social cognition was not related to perceptions of carer criticism or symptoms. Carer social cognition was not related to expressed emotion or carer burden.
  
  
  CONCLUSIONS
  Even in the early stages of psychosis, both patients and carers were reporting negative experiences of the caregiving relationship. These were related to higher levels of anxiety and depression. Social cognition difficulties were found in both early psychosis patients and first-degree relatives, but did not relate to caregiving relationships. The findings underscore the importance of providing targeted family interventions to individuals with early psychosis and their carers that address appraisals of the relationship and low mood.
authors.affiliation: Institute of Psychiatry, Kings College Hospital, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Tomlinson
authors.forename: Juliana
authors.initials: J
authors.lastname: Onwumere
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D017668:Age of Onset; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003071:Cognition; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology*; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000451:nursing / Q000523:psychology*; D021641:Recognition, Psychology; D056345:Theory of Mind; D055815:Young Adult
keywords: early intervention; expressed emotion; psychosis; relatives; social cognition