Academic journal article The Spanish Journal of Psychology

Effects of Family Psychoeducation on Expressed Emotion and Burden of Care in First-Episode Psychosis: A Prospective Observational Study

Academic journal article The Spanish Journal of Psychology

Effects of Family Psychoeducation on Expressed Emotion and Burden of Care in First-Episode Psychosis: A Prospective Observational Study

Article excerpt

The present study aimed to examine the levels and interactions of family burden (FB) and expressed emotion (EE) in first episode psychosis (FEP) patients and, secondly, to observe the potential change after a brief psychoeducational group intervention implemented in a real world clinical setting. Twenty-three key relatives of FEP patients received a brief psychoeducational group intervention. FB and EE were assessed before and after the intervention. EE-change and correlations between variables were examined. Half of the sample of key-relatives showed high levels of EE. No severe family burden was observed. FB and EE did not change after the intervention. Family subjective and objective burden were correlated with emotional overinvolvement, but not with criticism. Brief psychoeducational groups may not be sufficient to reduce FB and EE associated to the experience of caregiving for a family member with a first-episode psychotic disorder.

Keywords: expressed emotion, burden, first-episode psychosis, psychoeducation, family intervention.

El presente estudio tiene por objetivo examinar los niveles y las interacciones de la sobrecarga familiar (SF) y emoción expresada (EE) en cuidadores de pacientes con un primer episodio de psicosis (PEP) y, secundariamente, observar su potencial cambio después de un grupo psicoeducativo breve implementado en un contexto asistencial rutinario. Veintitrés familiares clave de pacientes con un PEP recibieron una breve intervención grupal de tipo psicoeducativo. SF y EE fueron evaluados antes y después de la intervención. Se examinó tanto el cambio de la SF y la EE como las correlaciones entre ellas. La mitad de la muestra de familiares mostró altos nivel de EE. No se observó una SF grave. Ni la SF ni la EE cambiaron después de la intervención. La sobrecarga familiar objetiva y subjetiva correlacionaron con la sobreimplicación, pero no con los comentarios críticos. Los grupos psicoeducativos breves pueden no ser suficiente para reducir la SF y la EE asociada a la experiencia

Palabras clave: emoción expresada, sobrecarga, primer episodio de psicosis, psicoeducación, intervención con familias.

Ever since George Brown's seminal studies of the families of people with schizophrenia (Brown, Birley & Wing, 1972), the role of family in the course of the illness has been examined thoroughly. Family members' attitudes toward the patient, as measured by the level of expressed emotion (EE) and family burden (FB) associated with the caring role, have received most of the research attention (Awad & Voruganti, 2008; Wearden, Tarrier, Barrowclough, Zastowny & Rahill, 2000).

These concepts are especially important in the early stages of the illness since this is when most of the changes are observed (Birchwood & Macmillan, 1993) and a reappraisal of family expectations must be undertaken (Gleeson, Jackson, Stavely & Burnett, 1999). The few extant studies in the early stages of the illness suggest that approximately half of the families show high EE (Raune, Kuipers & Bebbington, 2004) which is a reliably predictor of relapse (King & Dixon, 1999). On the other hand, FB may be higher in carers of FEP patients compared to their counterparts later in the course of the illness (Martens & Addington, 2001). However, the origins of EE and FB have received little research attention, and their mutual interactions are not yet well understood. Recent research suggests that EE and FB may have a complex pattern of interactions. Longitudinal studies indicate that EE is a significant predictor of caregiver burden at 2-year follow-up, meaning that caregivers experienced a higher level of burden when they were more strongly emotionally involved (Moller-Leimkuhler & Obermeier, 2008). Álvarez-Jiménez et al. (2010) have postulated that emotional overinvolvement, not criticism, at index admission may be specifically influencing burden in key family members in the early course of the illness. …

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