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Role of Expressed Emotions in Relapse of Schizophrenia

By Kritika Suri (A Clinical Psychologist & Mental Health Professional) The attitude of family members, relatives and friends towards the person plays a very crucial role in any psychiatric illness. The understanding of caregivers towards the patient’s illness and their reaction to patient’s experiences are key factors which are responsible for improvement in any psychiatric illness. The caregiver’s reaction to illness and their emotional expression towards illness can also influence the extent to which the person is able to recover.

Have you ever wondered, “Why do some schizophrenic patients repeatedly come with deterioration in their symptoms after hospital discharge?” 

As caring for a person with schizophrenia is highly challenging for families and it might result in negative emotional atmosphere in the patient's family. This emotional atmosphere means the quality of caregiver's attitudes and relationships toward the patients and when it becomes negative then it can negatively affect both the patients and caregivers. Moreover, this negative family atmosphere causes not only relapse of symptoms and re-hospitalization, but also significantly affect the course/improvement of the illness.

Negative emotions particularly, Criticism, hostility, and emotional over-involvement expressed by close kin toward a relative who suffers from schizophrenic illness are known as "Expressed emotion". Below are certain behaviors which show how caregivers show expressed emotions towards the patient.

Like, patients who are unable to get up in the morning, who fail to wash regularly, or who do not participate in household tasks are criticized for being lazy and selfish; unfortunately, the caregivers fail to understand that these could be potential manifestations of negative symptoms of schizophrenia. Caregivers often state that patients are causing problems for them, patient can control himself, he is acting and may shout at the patient, easily get angry and irritated.

At an extreme end of it you will observe that caregivers blame themselves for everything and will feel like everything is their fault; show pity, will not allow the patient to carry out his/her day-to-day activities.

It has been seen in various researches, when a patient with any psychiatric illness particularly schizophrenia, if is living in environment where he/she is yelled, shouted, criticized for his /her behavior and hostile comments are made for his/her illness then there are high chances that patient’s outcome may deteriorate.

Inadequate knowledge of information about illness results in negative behavior therefore, family members at the initial stage of illness should be educated regarding the symptoms and illness. They should also be made aware about the impact of expressed emotions in the deterioration or relapse. CUT STIGMA!! NOT SUPPORT!! 

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