TITLE:
How do Patients with Schizophrenia Perceive Relatives’ Levels of Expressed Emotions? A Brief Patient Rated Scale
AUTHORS:
Heidi Bjørge, Tor Helge Notland, Turid Birgitte Boye, Ingun Dina Ulstein, Nina Aarhus Smeby, Ulrik Fredrik Malt, Håvard Bentsen
KEYWORDS:
Expressed Emotion, Perceived Criticism, Schizophrenia, Validity
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.7 No.3,
July
28,
2017
ABSTRACT: Background : Patients’ perspective on relatives’ attitude and behaviour towards
them (Expressed emotion—EE) may be an important addition to the
current focus on relatives’ perspective only, as measured by Camberwell Family
Interview (CFI) or other methods. Based on the theory of EE, we have designed
a brief, three-item questionnaire completed by patients, named Felt
Expressed Emotion Rating Scale (FEERS). FEERS measures the patient’s experience
of criticism (Cri) and emotional over involvement (i.e. worry (Wo),
and control (Con). Aims: To investigate the test-retest reliability of the FEERS
and associations between the FEERS and the CFI and to which extent FEERS
scores were modified by severity of psychotic symptoms, cognitive function,
patient mood and amount of face-to-face contact with relatives. Methods :
Forty-five patients with schizophrenia and related psychoses admitted to a
psychiatric hospital and 67 relatives were included. Assessments included
FEERS, CFI and Positive and Negative Syndrome Scale (PANSS). Results :
FEERS-Cri test-retest intra-class correlation (ICC1,1) was 0.71 among patients
with low total PANSS scores, low cognitive impairment (0.59) and depression
(0.63). For low levels of cognitive impairment, the ICCs of the FEERS-Wo and
the FEERS-Con were 0.62 and 0.83, respectively. The FEERS-Cri and FEERSHowWo correlated significantly with CFI-CC and CFI-positive comments, respectively.
Among the relatives that the patient deemed “not at all critical” (low
FEERS-Cri scores), 94% had low CFI-CC levels. Conclusions : The FEERS
may be a brief, time-saving alternative for identifying relatives with low levels
of criticism. However, illness severity, cognitive function and mood influence
FEERS test-retest reliability and link to CFI.