April 12, 2004

Schizophrenia and Emotions

The latest British Journal of Psychiatry, (Issue (2004) 184: A15 ) reported that

Schizophrenia Intervention for Relapse and High Expressed Emotion

Researchers have found that costs for patients with schizophrenia who experienced relapse are up to 400% higher than for a non-relapse group. The authors suggest that implementing effective relapse prevention programmes, even if expensive, may reduce the overall financial cost of treatment as well as improving overall outcome. Raune et al (pp. 321?326) found that 43% of carers of patients with first-episode psychosis had high levels of expressed emotion.

(NOTE: Expressed Emotion is defined to include Critical attitudes: Statements of dislike, annoyance, or resentment with accompanying negative voice tone

Emotionally overinvolved attitudes: Statements indicating extreme overprotectiveness, overconcern, self-sacrifice, or exaggerated emotional responses regarding the patient.)

Although high expressed emotion was not associated with patient illness characteristics, it was linked to high levels of burden, avoidant coping styles and lower perceived patient interpersonal functioning. It is suggested that cognitive?behavioural approaches targeting carers? appraisals may be particularly important in reducing high expressed emotion in early intervention services.

Cognitive Therapy may Reduce Command Hallucinations

Cognitive therapy for command hallucinations administered to ?high-risk? patients resulted in large and significant reductions in compliance with voices. Using a case?control design v. treatment as usual, Trower et al (pp. 312?320) also observed improvements in the degree of conviction in the power of voices and the need to comply, and in the levels of distress and depression. Although a small study with the problems of the control condition, it suggests promising clinical results that are durable and definitely worthy of further study using a randomised controlled design.


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