Expressed emotions and relapse of psychosis: New vistas for an old concept

摘要

Substantial proportion (up to 80%) of patients with first episode psychosis experience remission with treatment (Lally et al., 2017). Yet, schizophrenia remains one of the leading causes of disability (Charlson et al., 2018). Relapse rates are as high as 80% (Lehman et al., 2010). Neurotoxic effects of relapse are well known (McGlashan, 2006); relapses also have serious psychological adverse effects (i.e., negative self-appraisal, shame, demoralization, depression -'psychotoxic' effects) as well as social consequences (i.e., break in education, work and relationships, stigma and exclusion - 'sociotoxic' effects). Together, these push patients down the spiral of poor outcome. As each relapse makes recovery harder to achieve, relapse prevention is an important intervention to limit disability. Among several factors that influence relapse, only a few are potentially modifiable. 'Expressed emotions' (EE) of family members are important among them. In this issue of Schizophrenia Research, O'Driscoll etal. (2019), report about the influence of EE on relapse of psychosis across several regions of the Globe through a systematic review and meta-analysis. They find about two-folds increase in the risk of relapse of patients exposed to high EE environment when compared to those exposed to low EE environments.