EXPRESSED EMOTION AND RELAPSE OF SCHIZOPHRENIA IN HONG KONG

Abstract

ABSTRACT Objective: We examined the cross cultural relevance of expressed emotion in predicting relapse of schizophrenia in Hong Kong. Methods: A longitudinal prospective study was conducted. Thirty three patients with a Diagnostic and Statistical Manual of Disease IV diagnosis of schizophrenia were recruited. The Camberwell Family Interview was conducted with key relatives to evaluate the expressed emotion status. The patients were followed up for 9 months after their index discharge by a psychiatrist who was blind to the expressed emotion status. The psychiatrist evaluated the mental state of the patients with the Brief Psychiatric Rating Scale. Content analysis was also conducted on the critical comments of the relatives. Results: The relapse rate in the high expressed emotion group was 60.0% (p Conclusion: The predictive validity of expressed emotion construct for schizophrenic relapse is applicable to Hong Kong Chinese people. Key words: Content analysis, Expressed emotion, Prospective study, Relapse, Schizophrenia INTRODUCTION Butzlaff and Hooley concluded in their meta-analysis that expressed emotion (EE) in predicting relapse is a well-defined factor and there is no point in conducting any more study on relationship between EE and relapse. (1) However, EE has been found to be culturally dependent. (2) As Kuipers has suggested, EE could be seen as an assessment of the quality of the relationship, based on the appraisal of problems. (3) The appraisal of problems is dependent on the characteristics of the stressor and of the environment, as well as on the individual's coping styles. (4) The culture and socioeconomic environment of a community have marked effects on the characteristics of the stressors that are experienced in that community, on the resources available for coping with those stressors, and on the coping strategies. (5) Specific attitudes and behaviours such as the EE subscales are cultural dimensions of family response and interpretation of mental illness. (2) Some cultures may have a different social constraint in hostility so that hostility is not invariably associated with a high level of criticism. (6) In the emotional overinvolvement (EOI) subscale, for example, none of the Indian relatives, (7) 11% of Mexican-Americans, (8) 15% of Anglo-American, (9) and 21% of the British relatives (10) had scores on this item that were rated as high. Studies from the Chinese population may reveal very different findings. Such studies have been performed in Mainland China (11) and Taiwan. (12) It is, however, doubtful if it is appropriate to extrapolate their finding to Hong Kong due to differences in social and political structure. Furthermore, these studies have only shown a non-significant increase in risk of relapse associated with high EE relatives. (11) It is under such circumstances that we conducted another prospective longitudinal study on the naturalistic course of relapse in patients living with either high or low EE relatives. The hypothesis is that living with high EE relatives will have an increased risk for relapse of schizophrenia. MATERIALS AND METHODS STUDY PARTICIPANTS This study was conducted at Castle Peak Hospital, the oldest and largest mental hospital in Hong Kong. Patients were recruited from team 4 of Castle Peak Hospital, as the patients admitted to team 4 were from the Tuen Mun catchment area and follow-up in Castle Peak Hospital was more acceptable and accessible to them. …