Expressed Emotion (EE) in families of individuals at risk of developing psychosis: A Systematic Review

Poster B84, Tuesday, October 9, 11:30 am - 1:00 pm, Essex Ballroom

Emma Izon1,2, Katherine Berry1, Heather Law2, Paul French1,2; 1Division of Psychology & Mental Health, The University of Manchester, Manchester, United Kingdom, 2Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom

The At-Risk Mental State (ARMS) for psychosis describes a state that confers a high but not inevitable risk for developing a psychotic disorder in the near future. The distressing experiences for individuals with an ARMS may impact on themselves; their sense of wellbeing, their psychosocial functioning as well as on their family. Understanding what variables may lead to poorer outcomes may help to further reduce transition rates. Expressed emotion (EE) looks at the environment and communication style of relatives to their family member and can be considered an important potential explanatory variable in the ARMS. Following PRISMA guidelines, a systematic review of EE in relatives of ARMS was conducted. We identified 15 studies investigating the relationship between EE in the ARMS population. Approximately one third of ARMS relatives had high-EE. The results suggest that greater levels of criticism and hostility are associated with higher levels of symptoms and poorer functioning. In contradiction to psychosis literature, the construct Emotional-Over-Involvement (EOI) was found to be an adaptive response, where family members’ worries of the individuals made no negative impact on symptoms. Environments that included warmth and positive remarks, combined with optimal family involvement were associated with improved functioning and reduced symptoms. Limitations of the quality of the studies includes small sample sizes, and over-represented samples of Caucasian, young males and middle-aged mothers. Although approximately half of the studies included were longitudinal, only two measured EE over time, therefore, future research should include larger studies measuring EE at more than one time point.

Topic Area: Ultra High Risk / Prodromal Research

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