title: Family functioning in first-episode psychosis: a systematic review of the literature.
abstract: OBJECTIVE
  The influential role of family in the outcome of chronic schizophrenia is well documented. However, there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP), a point in time when most of the changes in family dynamics are observed. The aim of this article is to present a review of the literature focusing on the family environment of FEP patients.
  
  
  METHODS
  We carried out a computerized literature search on MEDLINE and PsycINFO (1990-2013), and a manual search of references of pertinent articles. In total, 27 studies investigating expressed emotion (EE) and family burden (FB) in FEP were identified and fulfilled the inclusion criteria.
  
  
  RESULTS
  Similar to chronic patients, a high prevalence of high-EE in carers of FEP patients was reported. High-EE status appears to be independent of the patient's illness-related characteristics, but dependent of relatives' attributions. In contrast to chronic patients, low levels of FB and psychological distress among family members of FEP patients were observed indicating that in the early stages of the illness family involvement is not yet associated with significant disruption in their lives. Studies assessing FB in chronic patients have found a well-established link of FB with patient's illness-related factors, but in FEP patients the families' appraisal of FB is more closely associated with their coping mechanisms.
  
  
  CONCLUSIONS
  Further studies evaluating family functioning in terms of cohesion and adaptability will shed light on the intrafamilial relationships in FEP patients which may be associated with the long-term outcome of this chronic illness.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece, koutra.k@gmail.com.
authors.forename: Katerina
authors.initials: K
authors.lastname: Koutra
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Vgontzas
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Sofia
authors.initials: S
authors.lastname: Triliva
mesh_terms: D019260:Expressed Emotion; D005190:Family / Q000523:psychology*; D006801:Humans; D011618:Psychotic Disorders / Q000523:psychology*; D013315:Stress, Psychological