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.
Highlights
A substantial number of patients with schizophrenia do not respond to traditional treatment [1]
Considering the lack of brief patients based questionnaires to measure how patients with schizophrenia perceive their interaction with relatives with emphasis on both critical comments and emotional over involvement, i.e. degree of worry and control, we developed a brief three-item questionnaire, the Felt Expressed Emotion Rating Scale (FEERS)
We examined c) the influence of severity of psychosis, cognitive function and mood influenced on FEERS responses and d) whether the amount of face-to-face contact influenced the association between Camberwell Family Interview (CFI)-derived expressed emotion (EE) dimensions and FEERS
Summary
A substantial number of patients with schizophrenia do not respond to traditional treatment [1]. One explanation has been increased level of expressed emotion (EE) in the family of patients [2] [3]. Only a few questionnaires have been published on this issue: Level of Expressed Emotion scale (LEE), Family Attitude Scale (FAS) and the Perceived Criticism Scale (PCS). The intention of those scales was to predict long-term outcome, not to measure how patients perceive relatives attitudes and behaviour per se. Level of Expressed Emotion scale (LEE) and the Family Attitude Scale (FAS) are scales that measure both relative’s and patient’s perspectives, but both are rather lengthy. Only a few studies have used the patient’s version [10] and no data are available on the test-retest reliability or how relatives CFI-scores relate to FAS scores, when completed by patients
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