The relationship between expressed emotion and temperament traits in caregivers of schizophrenic patients

Öz

INTRODUCTION: In the present study, we were primarily interested in determining whether some temperamenttraits of the caregivers would be associated withtheir expressed emotion levels. We also examined the relationship of EE levels of the caregivers with some care and illness characteristics of the patients. METHODS: Seventy-six consecutive schizophrenic patients (aged between 18 and 65) according to the Psychotic Symptoms module of the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Edition (SCID-I/P, Version 2.0) and their primary caregivers who had no current DSM-IV diagnoses of schizophrenia, bipolar disorder, major depression, and any anxiety disorders were included in the study. Expressed Emotion Scale, Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A), Positive and Negative Syndrome Scale, The Calgary Depression Scale for Schizophrenia tools were used for evaluation during study. RESULTS: The total and criticism/hostility subscale scores of EES were significantly correlated with depressive (r=0.35, p=0.002; r=0.36, p=0.001, respectively), cyclothymic (r=0.26, p=0.019; r=0.26, p=0.022, respectively), hyperthymic (r=0.28, p=0.014; r=0.26, p=0.022, respectively), and anxious temperament traits (r=0.31, p=0.006; r=0.30, p=0.007, respectively). Irritable temperament scores had a significant association with total EES scores (r=0.23, p=0.037). We have found that duration of the illness and patient care had significant inverse associations with total (r= -0.24, p=0.03;r= -0.29, p=0.009, respectively) and warmth subscale scores of EES (r= -0.34, p=0.002; r= -0.31, p=0.006, respectively). Depressive (β=0.287, t=2.737, p=0.008) and hyperthymic temperaments (β=0.223, t=2.138, p=0.036), and duration of patient care(β= -0.268, t= -2.609, p=0.011) were significantly associated with improved expressed emotion scores.

Anahtar Kelimeler

• schizophrenia,Expressed emotion,temperament,caregiver

Şizofreni hastalarının bakım verenlerinde duygu dışa vurum ve mizaç özellikleri ilişkisi

Öz

GİRİŞ: Bu çalışmada, öncelikle bakım verenlerin bazı mizaç özelliklerinin duygu dışavurum düzeyleri ile ilişkili olup olmayacağını ve duygu dışavurum düzeylerinin hastaların bazı bakım ve hastalık özellikleri ile olan ilişkili olup olmadığını belirlemeyi hedefledik. MATERYAL VE METOD: DSM-IV Eksen I Bozuklukları Hasta Sürümü (SCID-I)’ne yaşları 18 ile 65 arasında, ardışık 76 şizofrenik hasta ve şizofreni, bipolar bozukluk, majör depresyon ve anksiyete bozuklukları tanısı olmayan bakımverenleri çalışmaya dahil edildi. Değerlendirme araçları olarak Duygu Dışavurum Ölçeği, TEMPS-A Mizaç Ölçeği, Pozitif ve Negatif Belirti Ölçeği ve Calgary Şizofrenide Depresyon Ölçeği kullanıldı. BULGULAR VE TARTIŞMA: Duygu dışavurum toplam ve eleştirellik/düşmancıllık alt ölçek puanları depresif, siklotimik, hipertimik ve anksiyöz mizaç özellikleri ile anlamlı şekilde ilişkiliydi. İrritabl mizaç puanları toplam duygudışavurum puanları ile anlamlı şekilde ilişkiliydi. SONUÇ: Bakım verenlerin depresif ve hipertimik mizaç özelliklerinin, duygu dışavurum düzeyleri için kuvvetli birer öngörücüdür. Bu bulgular, bakım verenlerin özellikle depresif ve hipertimik mizaç özelliklerinin yüksek duygu dışavurum düzeyleri ile anlamlı şekilde ilişkili olduğunu gösterebilir.

Anahtar Kelimeler

• Duygu dışavurum,bakımveren,şizofreni,mizaç

Kaynakça

1. Cutting, L.P, Aakre, J.M, Docherty, N.M, Schizophrenic patients' perceptions of stress, expressed emotion, and sensitivity to criticism, Schizophr Bull 2006, 32, 743-50.
2. Hooley, J.M. Expressed emotion and relapse of psychopathology, Annu Rev Clin Psychol 2007, 3, 329-52.
3. Miklowitz, D.J, The role of family systems in severe and recurrent psychiatric disorders: a developmental psychopathology view, Dev Psychopathol 2004, 16, 667-88.
4. Hahlweg, K, Goldstein, M.J, Nuechterlein, K.H, Magaña, A.B, Mintz, J, Doane, J.A, et al, Expressed emotion and relapse of psychopathology, Annu RevClin Psychol 2007, 3, 329-52.
5. Cook, W.L, Strachan, A.M, Goldstein, M.J, Miklowitz, D.J, Expressed emotion and reciprocal affective relationships in families of disturbed adolescents, Fam Process 1989, 28, 337-34.
6. Miklowitz, D.J, Goldstein, M.J, Doane, J.A, Nuechterlein, K.H, Strachan, A.M, Snyder, K.S, et al, Is expressed emotion an index of a transactional process? I.Parents' affective style, Fam Process 1989, 28, 153-67.
7. Strachan, A.M, Feingold, D, Goldstein, M.J, Miklowitz, D.J, Nuechterlein, K.H, Is expressed emotion an index of a transactional process? II. Patient's coping style, Fam Process 1989, 28, 169-18.
8. Wuerker, A.M, Relational control patterns and expressed emotion in families of persons with schizophrenia and bipolar disorder, Fam Process 1994, 33, 389-407.

9. Hahlweg, K, Goldstein, M.J, Nuechterlein, K.H, Magana, A.B, Mintz, J, Doane, J.A, et al, Expressed emotion and patient-relative interaction in families of recent onset schizophrenics, J Consult Clin Psychol 1989, 57, 11-8.
10. Hubschmid, T, Zemp, M, Interactions in high- and low-EE families, Soc. Psychiatr Epidemiol 1989, 24, 113-19.
11. Wuerker, A.K, Long, J.D, Haas, G.L, Bellack, A.S, Interpersonal control, expressed emotion, and change in symptoms in families of persons with schizophrenia, Schizophr Res 2002, 58, 281-92.
12. Barrowclough, C, Hooley, J.M, Attributions and expressed emotion: a review, Clin Psychol Rev, 2003, 23, 849-80.
13. Kopelowicz, A, Zarate, R, Gonzalez, V, Lopez, S.R, Ortega, P, Obregon, N, et al. Evaluation of expressed emotion in schizophrenia: a comparison of Caucasians and Mexican-Americans, Schizophr Res, 2002, 55, 179-86.
14. Cechnicki, A, Bielańska, A, Hanuszkiewicz, I, Daren, A, The predictive validity of expressed emotions in schizophrenia. A 20-year prospective study, J Psychiatr Res 2013, 47, 208-14.
15. Grandon, P, Jenaro, C, Lemos, S, Primary caregivers of schizophrenia outpatients: burden and predictor variables, Psychiatry Res, 2008, 158, 335-43.
16. Caqueo, U.A, Gutiérrez, M.J, Burden of care in families of patients with schizophrenia, Qual Life Res, 2006, 15, 719-24.
17. Brown, C, O’Brien, K.M, Understanding stress and burnout in shelter workers, Professional Psychology: Research and Practice 1998, 29(4), 383-85.
18. Levert, T, Lucas, M, Ortlepp, K, Burnout in psychiatric nurses: Contributions of the work environment and a sense of coherence, South Afr J of Psychol 2000, 30(2), 36-43.
19. Docherty, N.M, Cutting, L.P, Bers, S.A, Expressed emotion and differentiation of self in the relatives of stable schizophrenia outpatients, Psychiatr,y 1998, 61, 269-78.
20. Hooley, J.M , Hiller, J.B, Personality and expressed emotion, J Abnorm Psychol, 2000, 109, 40-4.
21. Sanger, L.J, Personality characteristics associated with the expressed emotion in family members of schizophrenic individuals, Diss. Abstr. Intern. Section B: Scienc Eng, 1997, 58, 2137.
22. Scazufca, M , Kuipers, E, Links between expressed emotion and burden of care in relatives of patients with schizophrenia, Br J Psychiatry, 1996, 168, 580-7.
23. Roseliza, M.A, Oei, T,P, Fatimah, Y, Asmawati, D, Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traitsmatter?, Compr Psychiatry, 2014, 55, 188-98.
24. West, A.E, Schenkel, L.S, Pavuliri, M.N, Early Childhood Temperament in Pediatric Bipolar Disorder and Attention Deficit Hyperactivity Disorder, J Clin Psychol, 2008, 64, 402-21.
25. Goldsmith, H.H, Buss, A.H, Plomin, R, Rothbart, M.K, Thomas, A, Chess, S, et al, Roundtable: what is temperament? Four approaches, Child Dev, 1987, 58, 505-29.
26. Rothbart, M.K, Bates, J.E, Temperament. Handbook of child psychology, Vol. 3. Social, emotional, and personality development, 6th edn. Wiley & Sons. New York, 2006, pp. 99-166
27. Akiskal, H.S, Hirschfeld, R.M.A, Yerevanian, B.I, “The relationship of personality to affective disorders. A critical review”, Arch Gen Psychiatry, 1983, 40, 801-10.
28. Elovainio, M, Kivimäki, M, Puttonen, S, Heponiemi, T, Pulkki, L, Keltikangas, J.L, Temperament and depressive symptoms: a population-based longitudinal study on Cloninger’s psychobiological temperament model, J Affect Disord, 2004, 83, 227-32.
29. Kendler, K.S, Gardner, C.O, Prescott, C.A. Personality and the experience of environmental adversity, Psychol Med, 2003, 33, 1193-202.
30. Kampman, O, Poutanen, O, Can onset and recovery in depression be predicted by temperament? A systematic review and meta-analysis, J Affect Disord 2011, 135(1-3), 20-7.
31. Clark, L.A, Temperament as a unifying basis for personality and psychopathology, J Abnorm Psychol, 2005, 114, 505-21.
32. Belsky, J, Pluess, M, Genetic moderation of early child-care effects on social functioning across childhood: a developmental analysis, Child Dev 2013, 84, 1209-25.
33. Carver, C.S, Connor, S.J, Personality and coping, Annu Rev Psychol, 2010, 61, 679-704.
34. Greene, R.W, The explosive child. New York: Harper Collins. 2001
35. First, M.B, Spitzer, R.I, Gibbo, M, Williams, J.B.W, Structured Clinical Interview for DSM-IV Axis I Disorder-Patient Edition (SCID-I/P, Version 2.0), Biometrics Research Department, New York State Psychiatric Institute, New York, 1996.
36. Corapcigil, A, Aydemir, O, Yildiz, M, Danaci, E, Koroglu, E, Adaptation into Turkish and Reliability of Structured Clinical Interview for DSM-IV (SCID), J of Drug and Treatment, 1999, 12, 233-6.
37. Cole, J.D, Kazarian, S.S, The level of Expressed Motion scale: a new measure of expressed emotion, J Clin Psychol 1988, 44, 392-7.
38. Ferguson, G.A, Takane, Y, Stastical analysis in psychology and education. 6th edn. McGraw Hill Book Co., Singapore 1989.
39. Berksun, O.E, Family factor in schizophrenia: Development and adaptation of expressed emotion scale, Unpublished postgraduate Thesis, University of Ankara, Ankara (Turkish).1992
40. Vahip, S, Kesebir, S, Alkan, M, Yazıcı, O, Akiskal, K, Akiskal, H.S, Affective temperaments in clinically-well subjects in Turkey: initial psychometric data on the TEMPS-A, J Affect Disord, 2005, 85, 113-25.
41. Akiskal, H.S, Akiskal, K.K, Haykal, R.F, Manning, J.S, Connor, P.D, TEMPS-A:progress towards validation of a self-rated clinical version of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego autoquestionnaire, J Affect Disord, 2005, 85, 3-16.
42. Kostakoglu, E, Batur, S, Tiryaki, A, Gögus A. Turkish reliability and validity of the positive and negative syndrome scale (PANSS) for schizophrenia, Turkish J of Pschology1997, 14, 23-32.
43. Kay, S.R, Fiszbein, A, Opler, L.A, The positive and negative syndrome scale (PANSS) for schizophrenia, Schizophr Bull, 1987, 13, 261-76.
44. Addington, D, Addington, J, Schissel, B.A, depression rating scale for schizophrenics, Schizophr Res, 1990, 3, 247-51.
45. Oksay, S.E, Aksaray, G, Kaptanoglu, C, Bal C, Validity and Reliability of the Turkish Version of Calgary Depression Scale in Schizophrenic Patients. Turk Psikiyatri Derg, 2000, 11, 278-84.
46. Glynn, S.M, Randolph, E.T, Eth, S, Paz, G.G, Leong, G.B, Shaner, A.L & Strachan, A, Patient psychopathology and expressed emotion in schizophrenia, Br J Psychiatry, 1990, 157, 877-880
47. Weisman, A.G, Nuechterlein, K.H, Goldstein, M.J, Snyder, K.S, Expressed emotion, attributions, and schizophrenia symptom dimensions, J Abnorm Psychol, 1998, 107, 355-9.
48. Barrowclough, C, Tarrier, N, Johnston, M, Distress, expressed emotion, and attributions in relatives of schizophrenia patients, Schizophr Bull, 1996, 22, 691-702.
49. Jansen, J.E, Gleeson, J, Cotton, S, Towards a better understanding of caregiver distress in early psychosis: a systematic review of the psychological factors involved, Clin Psychol Rev, 2015a, 35, 56-66.
50. Jansen, J.E, Haahr, U.H, Harder, S, Trauelsen, A.M, Lyse, H.G, Pedersen, M, et al, Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology, Soc Psychiatry Psychiatr Epidemiol, 2015b, 50, 371-8.
51. Onwumere, J, Bebbington, P, Kuipers, E, Family interventions in early psychosis: specifity and effectiveness, Epidemiol Psychiatr Sci, 2011, 20(2), 113-9.
52. Martens, L, Addington, J, The psychological well-being of family members of individuals with schizophrenia, Soc Psychiatry Psychiatr Epidemiol, 2001, 36(3), 128-33.
53. Addington, J, The prodromal stage of psychotic illness: observation, detection or intervention?, J Psychiatry Neurosci, 2003, 28, 93-7.
54. Goldsmith, H.H, Buss, A.H, Plomin, R, Rothbart, M.K, Thomas, A, Chess, S, et al, Roundtable: what is temperament? Four approaches, Child Dev, 1987; 58: 505-29.
55. Rothbart, M.K, Bates, J.E, Temperament. In W. Damon & R. M. Lerner (Series Eds.), &N. Eisenberg (Vol. Ed.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development, 6th ed. New York, Wiley, 2006, pp. 99-166.
56. Smoller, J.W, Tsuang, M.T, Panic and phobic anxiety: defining phenotypes for genetic studies, Am J Psychiatry, 1998, 155, 1152-62.
57. Hirshfeld, B.D.R, Biederman, J, Calltharp, S, Rosenbaum, E.D, Faraone, S.V, Rosenbaum, J.F, Behavioral inhibition and disinhibition as hypothesized precursors to psychopathology: implications for pediatric bipolar disorder, Biol Psychiatry, 2003, 53, 985-99.
58. Bruder, C.B, Warner, V, Talati, A, Nomura, Y, Bruder, G, Weissman, M, Temperament among offspring at high and low risk for depression, Psychiatry Res, 2007, 153, 145-51.
59. Chronis, T.A, Degnan, K.A, Pine, D.S, Perez, E.K, Henderson, H.A, Diaz, Y, et al, Stable early maternal report of behavioral inhibiton predicts lifetime social anxiety disorder in adolescence, J Am Acad Child Adolesc Psychiatry 2009, 48, 928-35.
60. Schwartz, C.E, Snidman, N, Kagan, J, Adolescent social anxiety as an outcome of inhibited temperament in childhood, J Am Acad Child Adolesc Psychiatry, 1999, 38, 1008-15.
61. Signoretta, S, Maremmani, I, Liguori, A, Perugi, G, Akiskal, H.S, Affective temperament traits measured by TEMPS-I and emotional-behavioral problems in clinically-well children, adolescents, and young adults, J Affect Disord, 2005, 85, 169-80.
62. Naragon, G.K, Watson, D, Markon, K.E, Differential relations of depression and social anxiety symptoms to the facets of extraversion/positive emotionality, J Abnorm Psychol, 2009, 118, 299-310
63. Akiskal, H.S, Khani, M.K, Scott, S.A, Cyclothymic temperamental disorders, Psychiatr Clin North Am, 1979, 2, 527-54.
64. Akiskal, H.S, Mallya, G, Criteria for the ‘‘soft’’ bipolar spectrum: treatment implications, Psychopharmacol Bull, 1987, 23, 68-73.
65. Perugi, G, Toni, C, Maremmani, I, Tusini, G, Ramacciotti, S, Madia, A, et al, The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: a study on bipolar I Italian national sample, J Affect Disord, 2012, 136, 41-9.
66. Gray, J.A, McNaughton, N, The Neuropsychology of Anxiety. An inquiry into the functions of the septo-hippocampal system. 3rd edn. Oxford University Press, London, 2000.
67. Parker, G, The parental bonding instrument. A decade of research, Soc Psychiatry Psychiatr Epidemiol, 1990, 25, 281-282
68. Belsky, J, Hsieh, K.H, Crnic, K, Mothering, fathering, and infant negativity as antecedents of boys’ externalizing problems and inhibition at age 3 years: differential susceptibility to rearing experience?, Dev Psychopathol, 1998, 10, 301-19.
69. Vasey, M.W, Daleiden, E.L, Williams, L.L, Brown, L.M, Biased attention in childhood anxiety disorders:a preliminary study, J Abnorm Child Psychol, 1995, 23, 267-79.
70. Schippell, P.L, Vasey, M.W, Cravens, B.L.M, Bretvelt, R.A. Suppressed attention to rejection, ridicule, and failure cues: a specific correlate of reactive but not proactive aggression in youth, J Clin Child Adolesc Psychol, 2003, 32, 40-55.