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Fulltext Relationship of expressed emotion with relapse of schizophrenia patients in Kelantan

Azhar MZ, Varma SL

Singapore Med J, 1996 Feb;37(1):82-5.
PMID: 8783920

The families of 83 schizophrenic patients were studied to find out the level of expressed emotion in them leading to the relapse of these patients. The patients were having more than two episodes of schizophrenia (DSM-III-R). The most salient finding was the virtual absence of high level of expressed emotion as the cause of relapse. It was found that the majority of the families (72.3%) had low expressed emotion while only 25.3% had high expressed emotion and only 2.4% families were equivocal in this respect. This finding is in contrast with various other findings in this area. The most likely explanation for this disagreement is the cultural differences between Malaysian patients and Western patients.

Matched MeSH terms: Expressed Emotion*
Fulltext An fNIRS investigation of novel expressed emotion stimulations in schizophrenia

Wang C, Zhang Y, Lim LG, Cao W, Zhang W, Wan X, et al.

Sci Rep, 2023 Jul 10;13(1):11141.
PMID: 37429942 DOI: 10.1038/s41598-023-38057-1

Living in high expressed emotion (EE) environments tends to increase the relapse rate in schizophrenia (SZ). At present, the neural substrates responsible for high EE in SZ remain poorly understood. Functional near-infrared spectroscopy (fNIRS) may be of great use to quantitatively assess cortical hemodynamics and elucidate the pathophysiology of psychiatric disorders. In this study, we designed novel low- (positivity and warmth) and high-EE (criticism, negative emotion, and hostility) stimulations, in the form of audio, to investigate cortical hemodynamics. We used fNIRS to measure hemodynamic signals while participants listened to the recorded audio. Healthy controls (HCs, [Formula: see text]) showed increased hemodynamic activation in the major language centers across EE stimulations, with stronger activation in Wernicke's area during the processing of negative emotional language. Compared to HCs, people with SZ ([Formula: see text]) exhibited smaller hemodynamic activation in the major language centers across EE stimulations. In addition, people with SZ showed weaker or insignificant hemodynamic deactivation in the medial prefrontal cortex. Notably, hemodynamic activation in SZ was found to be negatively correlated with the negative syndrome scale score at high EE. Our findings suggest that the neural mechanisms in SZ are altered and disrupted, especially during negative emotional language processing. This supports the feasibility of using the designed EE stimulations to assess people who are vulnerable to high-EE environments, such as SZ. Furthermore, our findings provide preliminary evidence for future research on functional neuroimaging biomarkers for people with psychiatric disorders.

Matched MeSH terms: Expressed Emotion
Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traits matter?

Roseliza-Murni A, Oei TP, Fatimah Y, Asmawati D

Compr Psychiatry, 2014 Jan;55(1):188-98.
PMID: 23374905 DOI: 10.1016/j.comppsych.2012.12.026

Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia.

Matched MeSH terms: Expressed Emotion*
Expressed emotion and help-seeking behaviours among elderly adults with depression symptoms in northeast Malaysia: qualitative findings from a mixed methods investigation

Sanggar A, Razak AA, Phoa PKA

Psychogeriatrics, 2025 Jan;25(1):e13218.
PMID: 39557512 DOI: 10.1111/psyg.13218

BACKGROUND: Stressful life events greatly increase the risk of depression, which affects about 22% of older persons in northeast Malaysia. But how emotional distress manifests itself in reaction to these stressful events differs from person to person. Therefore, this study aims to delve into the nuances of emotional expression among older adults with depression symptoms in northeast Malaysia, alongside their help-seeking behaviours and utilisation of professional support.
METHODS: Using a qualitative interpretative phenomenological approach, we conducted in-depth face-to-face interviews with participants, guided by Kleinman's explanatory model of illness. Nineteen older adults who screened positive for depression were included in the research.
RESULTS: None of the participants explicitly acknowledged experiencing depression. However, they articulated their distress through three primary themes: 'Life is miserable,' 'Depression is a sign of weakness,' and 'Belief in pre-determination.' Remarkably, despite screening positive for depression, participants demonstrated a lack of awareness regarding available professional mental health services. Moreover, they expressed a reluctance to seek such services, citing reasons related to stigma and misconceptions. The predominant themes that emerged concerning help-seeking behaviours were 'Self-efficacy,' 'Social support,' and 'Formal assistance from non-mental healthcare professionals.'
CONCLUSION: The expression of emotion among older adults is restricted by socio-cultural influences. Thus, there is a need to improve mental health literacy among older adults in Malaysia, and their preferred source of support such as religious leaders and non-mental healthcare physicians.

Matched MeSH terms: Expressed Emotion*
Emotional expressiveness and the quality of life of patients with schizophrenia

Mubarak AR, Barber JG

Soc Psychiatry Psychiatr Epidemiol, 2003 Jul;38(7):380-4.
PMID: 12861444 DOI: 10.1007/s00127-003-0645-0

Background: The present research aims to study the association between emotional expressiveness of primary care-givers and quality of life of patients with schizophrenia.
Method: The data for the present study were collected from 174 purposively selected patients with schizophrenia and their primary care-givers. The Quality of Life Interview (QOLI) (Lehman 1988) was used to collect information related to the quality of life of patients. The care-givers‘ emotional expressiveness was assessed using three questions on home environment from Disability Assessment Schedule (WHO/DAS) (WHO 1988).
Results: Three components of emotional expressiveness were included in the present research, namely, emotional involvement, control and attitude of rejection. Among these three components, emotional involvement of key care-givers was found to have a significant association with quality of life of schizophrenia patients.
Conclusion: Based on this result, the present study argues that emotional involvement of key care-givers needs careful attention while planning psychosocial rehabilitation programmes aimed at enhancing the quality of life of schizophrenia patients.
Keywords: emotional expression – quality of life – schizophrenia – emotional involvement – community – Asia

Matched MeSH terms: Expressed Emotion