Expressed emotion as a predictor of the first psychotic episode - Results of the European prediction of psychosis study

Theresa Haidl; Marlene Rosen; Frauke Schultze-Lutter; Dorien Nieman; Susanne Eggers; Markus Heinimaa; Georg Juckel; Andreas Heinz; Anthony Morrison; Don Linszen; Raimo Salokangas; Joachim Klosterkötter; Max Birchwood; Paul Patterson; Stephan Ruhrmann; European Prediction of Psychosis Study (EPOS) Group

doi:10.1016/j.schres.2018.03.019

Expressed emotion as a predictor of the first psychotic episode - Results of the European prediction of psychosis study

Schizophr Res. 2018 Sep:199:346-352. doi: 10.1016/j.schres.2018.03.019. Epub 2018 Apr 13.

Authors

Theresa Haidl¹, Marlene Rosen¹, Frauke Schultze-Lutter², Dorien Nieman³, Susanne Eggers¹, Markus Heinimaa⁴, Georg Juckel⁵, Andreas Heinz⁶, Anthony Morrison⁷, Don Linszen⁸, Raimo Salokangas⁴, Joachim Klosterkötter¹, Max Birchwood⁹, Paul Patterson¹⁰, Stephan Ruhrmann¹¹; European Prediction of Psychosis Study (EPOS) Group

Affiliations

¹ Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany.
² University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Effingerstrasse 14a, 3011 Bern, Switzerland; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Bergische Landstraße 2, 40629 Düsseldorf, Germany.
³ Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam-Zuidoost, Netherlands.
⁴ Department of Psychiatry, University of Turku, Kiinamyllynkatu 4-8, Rakennus 11B, 20520 Turku, Finland.
⁵ Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Alexandrinenstraße 1, 344791 Bochum, Germany.
⁶ Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
⁷ School of Psychological Sciences, University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom.
⁸ Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam-Zuidoost, Netherlands; Department of Psychiatry and Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands.
⁹ Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom.
¹⁰ Birmingham Children's Hospital, Steelhouse Ln, Birmingham B4 6NH, Birmingham, United Kingdom.
¹¹ Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany. Electronic address: [email protected].

PMID: 29661524
DOI: 10.1016/j.schres.2018.03.019

Abstract

Objective: To investigate the impact of expressed emotion (EE) on the risk of developing the first psychotic episode (FEP).

Method: The European Prediction of Psychosis Study (EPOS) investigated 245 patients who were at clinical high risk (CHR) of psychosis. The predictive value of EE alone and as a part of the multivariate EPOS model was evaluated.

Results: "Perceived irritability", a domain of the Level of Expressed Emotion Scale (LEE), was found to be predictive for the First Psychotic Episode (FEP), even as an individual variable. Furthermore, it was selected in the multivariate EPOS prediction model, thereby replacing two of the original predictor variables. This led to an improved revised version that enabled the identification of three significantly different risk classes with a hazard rate of up to 0.911.

Conclusions: CHR subjects who perceive the most important person in their individual social environment to be limited in their stress coping skills had a higher risk of conversion to the first psychotic episode. The importance of this risk factor was further demonstrated by an improvement of risk estimation in the original EPOS predictor model. Perceiving a reference person as stress-prone and thus potentially unreliable might amplify self-experienced uncertainty and anxiety, which are often associated with the prodromal phase. Such an enforcement of stress-related processes could promote a conversion to psychosis.

Keywords: COGDIS; First Psychotic Episode (FEP); Level of Expressed Emotions (LEE) Scale; Prediction; Ultra-high risk.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Expressed Emotion*
Female
Humans
Male
Models, Psychological
Multivariate Analysis
Prodromal Symptoms
Prognosis
Proportional Hazards Models
Psychotic Disorders / diagnosis*
Psychotic Disorders / psychology*
Risk
Young Adult