Expressed emotion, medication adherence and association with disease prognosis in patients with schizophrenia at Teaching Hospital, Anuradhapura

Background

High expressed emotion is a robust predictor of relapse in schizophrenia. In spite of significant involvement of the family in caring for mentally ill in Sri Lanka, studies on expressed emotion in Sri Lanka are limited.

 

Aims

To explore associations between high expressed emotion, treatment adherence, and the number of relapses needing admission among patients diagnosed to have schizophrenia who were managed at Teaching Hospital, Anuradhapura, Sri Lanka.

 

Methods

A cross sectional study was conducted among a sample of 170 patients with schizophrenia and their primary caregivers. The Level of Expressed Emotion questionnaire was used to assess for high expressed emotion.

 

Results

Females constituted 52% of the participants. Mean age was 40 years. Most were married, unemployed and had poor treatment adherence. Low expressed emotion was reported by 58% of the study population. The primary caregiver was most often a married female, with a mean age 51 years. Patients who experienced high expressed emotion and had poor treatment adherence had a higher number of relapses (p<0.01). Expressed emotion, illness duration and compliance were independent risk factors for relapse (p<0.05). Gender and living with primary caregiver did not significantly predict relapse.

 

Conclusions

The findings of this study were consistent with previous research findings. High expressed emotion, mainly due to hostile attitudes towards illness, and poor medication adherence were associated with frequency of relapses in a group of Sri Lankan patients with schizophrenia. Further research is needed to explore cultural and geographic differences.