Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.
Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría 'Ramón de la Fuente Muñiz', Mexico City, Mexico.
PLoS One. 2020 Jun 15;15(6):e0234325. doi: 10.1371/journal.pone.0234325. eCollection 2020.
Mechanisms underlying the manifestation of relatives' expressed emotion (EE) in the early stages of psychosis are still not properly understood. The present study aimed to examine whether relatives' psychological distress and subjective appraisals of the illness predicted EE dimensions over-and-above patients' poor clinical and functional status. Baseline patient-related variables and relatives attributes comprising criticism, emotional over-involvement (EOI), psychological distress, and illness attributions were assessed in 91 early psychosis patients and their respective relatives. Relatives were reassessed regarding EE dimensions at a 6-month follow-up. Relatives' psychological distress and illness attributions predicted criticism and EOI over-and-above patients' illness characteristics at both time points. Relatives' increased levels of anxiety, attributions of blame toward the patients, an emotional negative representation about the disorder, and decreased levels of self-blame attributions predicted EE-criticism at baseline. Relatives' anxiety and negative emotional representation of the disorder were the only significant predictors of EE-criticism at follow-up, whereas anxiety, attributions of control by the relative and an emotional negative representation about the disorder predicted EE-EOI both at baseline and follow-up assessments. Understanding the components that comprise and maintain EE attitudes should guide early psychosis caregivers in family interventions, enhancing proper management of psychological distress and reduction of negative appraisals about the illness. The prevention of high-EE attitudes over time in a sensitive period such as early psychosis might be critical in shaping the health of caregivers and the outcome of the affected relatives.
亲属在精神病早期表现出的情绪表达（EE）的潜在机制仍未得到很好的理解。本研究旨在探讨亲属的心理困扰和对疾病的主观评价是否可以预测 EE 维度，而不仅仅是患者的临床和功能状况较差。在 91 名早期精神病患者及其各自的亲属中，评估了基线时与患者相关的变量和与亲属相关的属性，包括批评、情感过度卷入（EOI）、心理困扰和疾病归因。在 6 个月的随访时，亲属再次评估 EE 维度。亲属的心理困扰和疾病归因预测了在两个时间点上的批评和 EOI，超过了患者的疾病特征。亲属的焦虑水平增加、对患者的指责归因、对疾病的消极情绪表达以及自我指责归因的减少，预测了基线时的 EE-批评。亲属的焦虑和对疾病的消极情绪表达是随访时 EE-批评的唯一显著预测因素，而焦虑、亲属的控制归因和对疾病的消极情绪表达则预测了基线和随访时的 EE-EOI。了解构成和维持 EE 态度的组成部分应该指导早期精神病患者的家庭干预，加强对心理困扰的适当管理和减少对疾病的负面评价。在早期精神病等敏感时期，随着时间的推移预防高 EE 态度可能对塑造照顾者的健康和受影响亲属的结果至关重要。
