Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traits matter?

BACKGROUND

Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia.

OBJECTIVES

This study aimed at investigating the predictive role of relatives' EE index and components as well as personality traits in relapse among schizophrenia patients in Kuala Lumpur and Klang Valley, Malaysia.

METHODS

A total of 160 subjects consisting of 80 patients diagnosed with chronic schizophrenia and 80 relatives were recruited to participate in Phase 1 of the study. Only patient-participants were followed-up 6 months later for Phase 2 of the study in order to check for possible relapse. The Family Questionnaire (FQ) and the short scale Eysenck Personality Questionnaire-Revised (EPQ-R) were administered to measure relatives' EE and personality traits, respectively. Patients' were considered to relapse if they were readmitted into psychiatric wards 6 months post-hospital discharge.

RESULTS

The findings revealed that the odds for patients to relapse were increased by 8 times when relatives demonstrated high-EE level. Relatives' critical comments (CC) turned out to be the strongest predictor with the odds to relapse increased by 12% when they demonstrated an increase in CC level. Relatives' personality traits particularly the extraversion trait also turned out to be the significant direct predictor to patients' relapse. Our results showed that a unit decrease in extraversion trait score predicted the odds for patients to relapse by 23%.

DISCUSSIONS

Our findings supported the Western findings on the significant role of relatives' high-EE level particularly the CC scale on the course of schizophrenia. The novelty of the current finding was demonstrated in the significant role of relatives' extraversion trait that directly predicted patients' relapse. Results also indicated the feasibility of EE in predicting relapse among schizophrenia patients in Klang Valley, Malaysia.