Paths to Relapse: Possible Transactional Processes Connecting Patient Illness Onset, Expressed Emotion, and Psychotic Relapse

Abstract

A vulnerability/stress framework for schizophrenia is one means by which the strong evidence for genetic and other biological factors in schizophrenia can be combined in a useful way with persistent evidence that stressful environments may play a role in precipitating psychotic episodes (Gottesman & Shields, 1972; Zubin & Spring, 1977; Nuechterlein & Dawson, 1984; Nuechterlein, 1987; Ciompi, 1989). Within a large longitudinal study of the early course of schizophrenia, we have been attempting to examine several possible ways in which both psychobiological vulnerability factors in the patient (Dawson & Nuechterlein, 1987; Nuechterlein et al, 1991) and external environmental stressors (Ventura et al, 1989) individually and jointly influence the course of schizophrenia. At the Second International Symposium on Schizophrenia in Bern, we focused on two promising mediating factors in schizophrenia — those involving persistent information-processing abnormalities and stress-triggered autonomic arousal (Nuechterlein et al, 1989). We focus here on recent analyses that relate to current controversies in the literature on interpersonal attitudes that are typically called expressed emotion (EE) — socio-environmental attributes that have been statistically associated with psychotic relapse in schizophrenia.