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Background: There is a strong evidence base for psychological treatments in younger adults with schizophrenia, but limited work has been done on adapting these interventions for older people., Aims: We describe a study of a pilot psychosocial intervention group specifically designed to meet the needs of older people with schizophrenia in NHS settings., Method: We used a mixed-methods approach to evaluate the group. We assessed feasibility and acceptability by monitoring uptake and retention in the study. We used a within groups design comparing participants on a range of potentially relevant outcomes at baseline and posttreatment. Treatment acceptability was also assessed by semi-structured interviews conducted at the end of treatment., Results: We recruited 11 participants to the study and 7 of these completed the majority of the group sessions. At a group level participants made improvements in self-esteem and negative symptoms that were statistically significant even in this small sample. Feedback interviews suggested that participants valued the social contact provided by the group and made actual changes in their day-to-day lives as a result of attending., Conclusion: The intervention could offer help with some of the secondary disability associated with the diagnosis of schizophrenia and is acceptable to older adults. Further evaluation is, however, warranted.

Purpose: The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes., Method: Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12- and 24-month follow-ups., Results: A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up., Conclusions: Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.

This study investigated the association between an interview-based measure of self-esteem and subsequent clinical outcome in recent-onset schizophrenia. A cohort 5-year follow-up design with retrospective chart assessment of clinical outcomes was used. Relapse rates during 5 years were very high, with 92% of the sample relapsing. Self-esteem consisted of two dimensions, negative evaluation of self (NES) and positive evaluation of self (PES). Survival analysis indicated that high NES was significantly associated with shorter time to relapse; and PES, with longer survival time. The participants with high PES were three times more likely to have delayed relapse; no other covariates were significant. PES seemed to buffer the adverse effects of NES. The results indicate that social cognition in the form of self-evaluation may be implicated in clinical outcome and symptom exacerbation in schizophrenia.This study investigated the association between an interview-based measure of self-esteem and subsequent clinical outcome in recent-onset schizophrenia. A cohort 5-year follow-up design with retrospective chart assessment of clinical outcomes was used. Relapse rates during 5 years were very high, with 92% of the sample relapsing. Self-esteem consisted of two dimensions, negative evaluation of self (NES) and positive evaluation of self (PES). Survival analysis indicated that high NES was significantly associated with shorter time to relapse; and PES, with longer survival time. The participants with high PES were three times more likely to have delayed relapse; no other covariates were significant. PES seemed to buffer the adverse effects of NES. The results indicate that social cognition in the form of self-evaluation may be implicated in clinical outcome and symptom exacerbation in schizophrenia.

Background: Ensuring good quality staff and patient relationships are key goals of long-stay inpatient services. It is therefore essential that staff have a good understanding of patients' needs and how to work with the challenges that can present in these environments., Aims: We evaluated the feasibility and acceptability of a workshop to help psychiatric staff with challenging behaviours., Design: We used a quasi experimental design with assessments carried out at baseline and post intervention. We provided the training to staff on one low secure psychiatric unit and recorded the uptake of outcome assessments and the workshop itself. We assessed staff-patient relationships, burnout and ward atmosphere and staff also completed satisfaction questionnaires., Results: Sixty-six percent of staff (n = 25) who were eligible to participate in the project completed initial outcome measures, but only 42% (n = 16) attended the workshop and only 34% (n = 13) completed follow-up measures. The workshop had no predicted effects on any of the outcomes assessed, but staff satisfaction with the training was generally positive., Conclusions: Building up positive relationships with staff, addressing negative expectations and seeking support from all levels of management are essential in terms of reducing barriers to training in psychiatric settings.

Objectives: The study investigated associations between adult attachment and voice hearing. We hypothesized associations between insecure attachment, severity of voice hearing, and distress in relation to voices. We also hypothesized associations between attachment and the nature of relationships with voices., Method: Seventy-three participants with a diagnosis of schizophrenia spectrum disorders completed measures of anxiety and avoidance in attachment relationships and we coded experiences of voice hearing from interviews., Results: There were modest but significant positive associations between attachment anxiety and both severity and distress in relation to voice hearing, but no associations between attachment avoidance and these dimensions. We found evidence of predicted associations between attachment avoidance and themes of rejection, criticism, and threat in relationships with voices. Contrary to predictions, there were no significant associations between anxious attachment and the theme of control in relationships with voices and no association between anxious attachment and the theme of threat., Conclusions: The study is promising in demonstrating some associations between attachment and the nature of relationships with voices. This suggests that the assessment of attachment styles may be a useful contribution in developing formulations of voice hearing., (©2011 The British Psychological Society.)

Background: Cannabis use by people with schizophrenia has been found to be associated with family distress and poor clinical outcomes. Interventions to reduce drug use in this patient group have had limited efficacy. This study evaluated the effectiveness of a novel intervention for parents of young adults with recent-onset schizophrenia consisting of family-based motivational interviewing and interaction skills (Family Motivational Intervention, FMI) in comparison with routine family support (RFS)., Method: In a trial with 75 patients who used cannabis and received treatment for recent-onset schizophrenia, 97 parents were randomly assigned to either FMI (n=53) or RFS (n=44). Assessments were conducted at baseline and 3 months after completion of the family intervention by an investigator who remained blind throughout the study about the assignment of the parents., Results: At follow-up, patients' frequency and quantity of cannabis use was significantly more reduced in FMI than in RFS (p<0.05 and p<0.04 respectively). Patients' craving for cannabis was also significantly reduced in FMI whereas there was a small increase in RFS (p=0.01). There was no difference between FMI and RFS with regard to patients' other substance use and general level of functioning. Both groups showed significant improvements in parental distress and sense of burden., Conclusions: Training parents in motivational interviewing and interaction skills is feasible and effective in reducing cannabis use among young adults with recent-onset schizophrenia. However, FMI was not more effective than RFS in increasing patients' general level of functioning and in reducing parents' stress and sense of burden.

The concept of expressed emotion (EE) has been extended to the study of staff-patient relationships in schizophrenia. A comprehensive review of the literature identified a total of 27 studies investigating EE in this group published between 1990 and 2008. The article aims to assess whether the concept of EE is a useful and valid measure of the quality of professional caregiver and patient relationships, given that staff may be less emotionally invested in relationships than relatives. In doing so, it summarizes methods of measuring EE, the nature of professional EE compared with familial EE, associations between high EE and patient outcomes, associations between EE and both patient and staff variables, and intervention studies to reduce staff high EE. The available evidence suggests that the Camberwell Family Interview is an acceptable measure of EE in staff-patient relationships, although the Five Minute Speech Sample may provide a less resource intensive alternative. However, in contrast to familial research, neither the EE status on the Camberwell Family Interview nor the Five Minute Speech Sample show a robust relationship with outcomes. The presence or absence of a positive staff-patient relationship may have more predictive validity in this group. There is relatively consistent evidence of associations between staff criticism and poorer patient social functioning. Consistent with findings in familial research, staff attributions may play a key role in driving critical responses, and it may be possible to reduce staff high EE by modifying negative appraisals.

Objectives: We explored the extent to which a group of psychiatric staff differed in their ratings of patients' attachment styles and whether deviations in mean ratings were related to education, clinical experience, familiarity with patients, or staff attachment styles., Method: Fifteen mental healthcare workers assessed the attachment styles of nine patients with schizophrenia or schizoaffective disorder using the Psychosis Attachment Measure. Staff also reported on their own attachment styles. Similarity in ratings was investigated using two-way random interclass correlation coefficients (ICCs). An index showing how much each rater's assessments of attachment style deviated from the mean attachment style rating for each of the patients was used to investigate possible predictors of deviations from mean ratings., Results: Average staff ICCs for attachment anxiety and avoidance suggested reasonable levels of convergence between staff perceptions. Deviations from mean ratings were unrelated to staff qualifications or years of experience in mental health. However, staff who had known patients for longer periods tended to rate patients more similarly, whereas staff who had higher levels of attachment anxiety and avoidance tended to deviate from colleagues' ratings., Conclusions: Attachment styles in psychosis are observable characteristics that can be rated by mental health professionals, although length of time staff have known patients, as well as their own attachment styles are likely to influence perceptions.

There is a high incidence of trauma and posttraumatic stress disorder (PTSD) in people with a diagnosis of psychosis. Sequelae of trauma may affect the ability to engage in both attachment and therapeutic relationships. This study investigated associations between trauma histories, PTSD, attachment styles, and working alliance in a sample of 110 individuals with psychosis and substance misuse. Anxious attachment was associated with number of interpersonal traumas and PTSD reported, but there were no associations between trauma and alliance. There were discrepancies in number of traumatic events reported by care coordinators and patients. The findings of this study highlight the potential use of attachment theory in working with trauma and PTSD in psychosis.

This paper reports on the development of a questionnaire to assess self reported reasons for substance use in schizophrenia: the 'reasons for substance use in schizophrenia' (ReSUS) scale and explores the relationship between reasons for use, psychiatric symptoms and substance use in a sample of 230 people with psychosis. Principal components analysis revealed three subscales: "coping with distressing emotions and symptoms", "social enhancement and intoxication" and "individual enhancement". Predicted associations were partially supported. 'Coping' reasons for use were related to positive symptoms, general symptoms, global functioning, depression and suicide behaviour as well as substance use (quantity of use and problems related to use). 'Individual enhancement' reasons were related to positive symptoms, to global functioning and to negative consequences of substance use. 'Social enhancement and intoxication' reasons were related to negative consequences of use but not to psychopathology. The findings suggest that the ReSUS is a reliable and valid instrument which can be used to explore self reported reasons for substance use and their relationship to psychotic symptoms in people with schizophrenia and other psychotic disorders.

Background: Aggression and violence are serious problems in schizophrenia. Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for psychosis although there have been no studies to date evaluating the impact of CBT for people with psychosis and a history of violence., Aims: To investigate the effectiveness of CBT on violence, anger, psychosis and risk outcomes with people who had a diagnosis of schizophrenia and a history of violence., Method: This was a single-blind randomised controlled trial of CBT v. social activity therapy (SAT) with a primary outcome of violence and secondary outcomes of anger, symptoms, functioning and risk. Outcomes were evaluated by masked assessors at 6 and 12 months (trial registration: NRR NO50087441)., Results: Significant benefits were shown for CBT compared with control over the intervention and follow-up period on violence, delusions and risk management., Conclusions: Cognitive-behavioural therapy targeted at psychosis and anger may be an effective treatment for reducing the occurrence of violence and further investigation of its benefits is warranted.

People with a diagnosis of schizophrenia are at increased risk of suicidal behaviour yet little is understood of the psychological underpinnings of this vulnerability. The biopsychosocial 'Cry of Pain' model [Williams, J.M.G. (1997). Cry of pain. Harmondsworth: Penguin.] provides a broad framework from which to understand suicidal behaviour. However, the utility of the model in relation to suicide in schizophrenia has not yet been explored. This was the primary goal of this paper. Six components of the 'Cry of Pain' model were identified and evaluated with respect to whether they contributed to i. common transdiagnostic factors underlying suicide, ii. factors relating to co-morbid depression which account for suicidal behaviour, or iii. factors which are specific to schizophrenia and underlie suicide risk. The potential for applying the model to clinical management of suicide in schizophrenia is illustrated.

Background: Suicide rates amongst schizophrenic patients are high. There are disadvantages in investigating successfully completed suicides which make suicidal ideation and previous attempts important proxy measures of suicidal risk. The aim of this study was to investigate factors associated with these risk measures., Method: Fifty-nine patients suffering recent onset schizophrenia were assessed for suicidal ideation and history, and a range of demographic, clinical, social (including relatives' Expressed Emotion) and self-esteem measures. Univariate comparisons were made between those with and without suicide ideation and previous attempts. Path analysis was conducted to identify factors directly or indirectly associated with a composite scale of risk (low, medium or high)., Results: Approximately 25% of the sample reported a current desire to kill themselves and 47% had made one or more previous attempts. There were numerous significant univariate differences between those with or without ideation or history. Path analysis indicated that greater hopelessness (OR 1.22) and longer duration of illness (OR 1.13) increased risk. Hopelessness was associated with higher negative self-evaluation and social isolation. Negative self-evaluation was associated with more relatives' criticism which was associated with more negative symptoms. Being a male, unmarried and unemployed were all significantly associated with an increase in negative symptoms. Social isolation was associated with being unemployed, older, more positive symptoms and longer illness duration. Duration of illness was not itself predicted by any other variables., Conclusion: Non-fatal suicide ideation and behaviour are significantly associated with an array of demographic, clinical, interpersonal and psychological factors. To reduce risk of suicide, these factors need to be assessed and methods developed to reduce their influence.

Background: Using the theoretical framework of the Self Regulation Model (SRM), many studies have demonstrated that beliefs individuals hold about their physical health problems are important in predicting health outcomes. This study tested the SRM in the context of a mental health problem, schizophrenia., Method: One hundred and twenty-four people with a diagnosis of schizophrenia were assessed on measures of symptom severity, beliefs about their mental health problems, coping and appraisal of outcome at two time points, 6 months apart., Results: Using multivariate analyses and controlling for severity of symptoms, beliefs about mental health were found to be significant predictors of outcome. Beliefs about greater negative consequences were the strongest and most consistent predictors of a poorer outcome in both cross-sectional and longitudinal analyses., Conclusions: These results suggest that the SRM is a promising model for mental health problems and may highlight important areas for development in clinical, and especially psychosocial interventions.

Objective: This study examined the psychometric properties of the Family Questionnaire (FQ): a self-report measure of relatives' perceptions of the behaviours and symptoms of schizophrenic patients in terms of three dimensions: the frequency of symptoms, the relatives' concern (primary appraisal) and their ability to cope (secondary appraisal) with the symptoms., Method: Factor analysis of the FQ, test-retest and inter-rater reliability, and measures of validity were examined., Results: Factor analysis supported the validity of five subscales labelled negative symptoms, antisocial behaviours, interpersonal problems, affective symptoms and psychotic symptoms. Test-retest reliability for all scales was good and the prediction that there would be limited correspondence between two different relatives' scores was supported for the subscales of negative symptoms and affective symptoms. Concurrent measures of relatives' distress, burden and patients' symptomatology indicated that the FQ showed acceptable validity. In particular, the study showed that high expressed emotion relatives have higher scores on the appraisal dimensions of some subscales., Conclusion: The study provides evidence that the FQ is a useful tool for measuring relatives' perceptions of schizophrenic illness, particularly within the context of family interventions where it may be utilized to help to understand the factors mediating relatives' burden and distress.

Participants with schizophrenia (N = 59) were assessed on self-evaluation, symptomatology, and positive and negative affect (expressed emotion) from significant others. An interview-based measure of self-evaluation was used and two independent dimensions of self-esteem were derived: negative and positive evaluation of self. As predicted, negative self-evaluation was strongly associated with positive symptoms, a more critical attitude from family members was associated with greater negative self-evaluation, and analyses supported a model whereby the impact of criticism on patients' positive symptoms was mediated by its association with negative self-evaluation. The interview-based method of self-esteem assessment was found to be superior to the questionnaire because its predictive effects remained after depressed mood was accounted for.

Background: . A variety of factors are related to compliance with medication in schizophrenia, but little attention has been paid to the role of families. Carers' knowledge or expressed emotion (EE) may be related to compliance. The aim of the present study was to evaluate the relevance of these two factors, as well as their relationships with other variables for the prediction of compliance., Method: A sample of patient-carer pairs (N = 79) involved in a family intervention for schizophrenia trial was recruited. Compliance, symptoms, social functioning and attitudes to their carers were assessed in patients. Carers' EE, knowledge and psychopathology were also evaluated., Results: A number of factors were related to compliance, including carers' EE and patients' psychotic symptoms, which contributed independently to not taking medication. Carers' knowledge about schizophrenia and other groups of symptoms was not related to compliance., Conclusions: EE may be an important factor to account for in the understanding of patients' compliance and the direction of the relationship between EE and compliance should be the subject of further study.

Objective: To examine longer-term effectiveness of a needs-based family intervention for carers and out-patients suffering from schizophrenia., Method: Seventy-nine unselected patient-carer pairs were recruited from a geographical area and allocated randomly to one of two conditions. One group received needs-based cognitive-behavioural family intervention in combination with general family support plus the standard care. The control group received the general family support and standard care only., Results: Analysis was carried out on an intention-to-treat basis. There was a significant advantage for family intervention, in terms of relapse (37% relapsed compared to 72%, NNT=3) and on other clinical measures. Treatment group and medication compliance were significant and independent predictors of relapse. There was a significant reduction in carer needs in the intervention group., Conclusion: Family intervention directed at carers' needs within a standard mental health service can produce benefits for patients beyond the term of intervention.

Aim: Many researchers and clinicians in the mental health field have given much attention over the last few years to patients with co-morbid problems of schizophrenia and substance use. This population is becoming a focus of attention for all service providers owing to the suggested increase in numbers of patients with these dual diagnoses and the observed negative effects on patients and costs to services. The advantages for providing family interventions in schizophrenia are now well established and increasingly these interventions are being evaluated for families of dual diagnosis patients. Many dually diagnosed patients do not, however, have a great deal of contact with a carer/relative. This paper looks at whether differences exist between patients with a dual diagnosis that have carer contact and those who do not have carer contact in terms of their illness history and type of substance use. For the purpose of this article 'carer' refers to an individual who is an informal carer or relative with whom the client has weekly contact of 10 h. Many of these carers provide the client with emotional, physical and material support., Method: The identification process for both'carer contact' and 'no carer contact' patients was conducted through the screening of the hospital's care programme approach (CPA) lists and through contact with care coordinators and consultants. Case notes of all patients identified were screened and information on demographic data, duration of illness, admissions and substance use was collected., Results: Results indicated that the 'no carer contact' group was older and had significantly more days in hospital at last admission., Conclusions: It is possible that as patients get older their contact with significant others decreases, i. e. loss of contact with key relatives is due to age rather than severity of substance use. Furthermore, patients' reduced contact results in them having longer stays in hospital possibly because they will not receive additional support when discharged.

Much research has been carried out on the impact of family relationships on the development and course of different illness. Research on Expressed Emotion (EE) developed out of studies of the impact of family members on patients with schizophrenia, and has provided us with a robust measure of relatives' emotional attitudes towards patients, which has now been applied in the study of numerous psychiatric and medical illnesses. This review outlines the history of EE research in schizophrenia, and discusses the evidence for the association between family EE and the course of schizophrenic illness. Some of the factors which might moderate the association between EE and illness course are outlined and the issues of the meaning and development of EE are discussed in the light of recent theoretical advances. The application of the EE methodology in other psychiatric and medical conditions is then reviewed and conclusions are drawn about the extent to which EE predicts illness course in conditions other than schizophrenia. Consideration is given to the ways in which the application of the paradigm to a variety of illnesses or conditions with different features can enhance our understanding of the EE construct.

Background: The methodology for measuring the needs of patients with severe mental illness is now well established through the MRC Needs for Care Assessment Schedule and its modification in the form of the Cardinal Needs Assessment. This paper reports the rationale and construction of a relatives' version of the Cardinal Needs Schedule and looks at preliminary data reporting on reliability and validity., Methods: Potential problem areas for relatives were identified from the literature. The criteria determining Cardinal Needs for each problem included objective threshold, carer concern, and carer cooperation. The reliability of the Schedule was assessed in a study whereby 27 relatives of patients with established schizophrenic illness completed two Schedules administered by two independent raters within a short time period., Results: The Schedule was acceptably reliable for most areas of need although there were some difficulties associated with the cooperation criteria. Concurrent measures of relatives and patients including EE, relative distress and patient psychopathology indicated that the Relatives' Cardinal Needs Schedule shows acceptable validity when used with a sample of 45 relatives., Conclusions: The paper suggests that the Schedule may prove to be a useful tool for both clinicians and researchers interested in establishing and evaluating family interventions.

This article investigates the level of distress in relatives at the time of an acute episode of illness in the schizophrenia sufferer. Guided by attributional literature on the prediction of distress and depression, the association between relatives' distress and their explanations and beliefs concerning the illness is examined in the context of the expressed emotion status of the relative. The study found that although distress levels were unrelated to the relatives' beliefs about the patient's role in negative events, beliefs that illness events were caused by factors internal to the relatives themselves ("self-blaming" beliefs) were associated with distress in the relatives. The authors argue that understanding the cognitive appraisal processes involved in how caregivers perceive schizophrenia is important to understanding their response to the illness and helping them to adapt to the problems.

The direct costs to the mental health services for patients who participated in a trial of a behavioural family intervention to reduce schizophrenic relapse were estimated. Comparisons were made between two patient groups from households of high expressed emotion (HEE): one group received a nine-month family intervention (HEE Intervention) and the other group routine treatment (HEE Control). A third group consisted of patients from low-EE households (LEE Control). The significant decrease in relapse rates in the HEE Intervention group compared with the HEE Control group has previously been reported; the analysis of costs indicates that any increase in costs due to the family intervention is outweighed by a decrease in usage of the established mental health services. The intervention resulted in a decrease of 27% in mean cost per patient.

Fifty-six patients who were hospitalised for a schizophrenic episode were followed up for nine months after discharge. The Psychiatric Assessment Scale (PAS, Krawiecka et al., 1977) was administered at monthly intervals during this period. Twenty-three patients relapsed of which data were available for sixteen. In these sixteen patients who relapsed comparisons were made of the PAS symptoms between the month prior to relapse and the month preceding this. Sixteen patients who did not relapse were randomly matched with the relapsing patients and an index point comparable in time to relapse onset in the matched relapsed patient was identified. Comparisons were made on the PAS symptoms using a repeated measures ANOVA to compare relapsers and non relapsers on the month prior to relapse and the month which preceded this. Discriminant function analysis was used to predict relapse by analysis of those PAS symptoms which showed an increase in the month before relapse. This suggested that the measures of depression and hallucinations significantly increased in the month prior to relapse compared to the preceding month in relapsers but not non-relapsers. The results of this study closely agree with previous published results even though there were some differences between studies in the patient samples.

Studies that have attempted to reduce schizophrenic relapse by the use of family interventions are described. Results from studies that implemented behavioral family interventions with patients who were identified as high risk because of the expressed emotion status of their relatives have demonstrated that relapse rates can be significantly reduced over a 2-year postdischarge follow-up period. A number of ongoing studies, especially those that are investigating the interaction of family interventions and different medication regimes, are also discussed. Areas for further investigation are identified, for example: the use of multiple outcome measures, the use of single-case studies and the development of ideographic assessment measures, the interaction of biological and environmental influences, the alleviation of the burden of care, the involvement of the consumer in services, the development of behavioral formulations and analysis of family engagement and compliance, staff training in intervention methods, and the translation of research results into clinical practice.

The relationship between the social functioning of schizophrenic patients and the EE levels of their relatives is examined. Patients living with a high EE relative function significantly worse than those living with low EE relatives. This appeared to be due to a poorer social functioning in patients who lived with hostile relatives. Patients who participated in a nine month behavioural family intervention showed greater improvements in social functioning than control groups. The improvements could not be explained as being due to medication since high neuroleptic dosage over nine months was associated with poorer social functioning.

The association between electrodermal arousal and social functioning was investigated. It was predicted that poor social functioning would be associated with higher levels of arousal. Patients were tested for a 15 minute period without their relative and for 15 minutes with their relative present. The prediction received some support from the results in that three subscales of the Social Adjustment Scale (SAS) showed a significant association between lower social functioning and higher arousal. This association showed a trend towards significance in the SAS Overall Score. When patients with high EE and low EE relatives were analysed separately, significant associations were only found for the high EE group. These results were interpreted as giving some support to the hypothesis that patients who are functioning poorly have relatively stable high levels of arousal.

Previous research has demonstrated a different psychophysiological response of schizophrenic patients depending on whether their key relative was rated high or low on Expressed Emotion (EE). A case assessment is described in which a young man suffering from schizophrenia, who lived with both a high EE and a low EE parent, was tested psychophysiologically in their presence using an ABAC design. The patient demonstrated a significantly higher amount of spontaneous activity in skin conductance level when the high EE parent was present. The high EE parent also demonstrated a greater perceived inability to cope, and a higher level of personal distress.

An instrument for assessing and evaluating what relatives know about schizophrenia was evaluated as both a pre- and a post-test for an educational programme. The Knowledge About Schizophrenia Interview (KASI) places emphasis on the functional value of the reported knowledge rather than on the recall of information; it is quick, easy to administer, can be rated reliably, and has face-validity for the relative. The educational programme increased scores from pre-test to a post-test one week after the programme. Relatives with high criticism ratings on the Camberwell Family Interview had lower scores at both tests. Relatives of less chronic patients showed lower scores at pre-test and acquired significantly more information from the programme, while relatives of more chronic patients were less influenced by the information sessions.

The relapse and readmission rates of schizophrenic patients who participated in a controlled trial of a nine-month behavioural family intervention trial based on the EE status of their relatives are presented at two years. The patients who received the behavioural family intervention had lower rates of relapse and readmission than patients from high-EE homes who had received a short educational programme or routine treatment. The relapse rate of the behavioural family intervention group (33%) was the same as that of the low-EE group (33%), and significantly lower than that of the non-intervention high-EE group (59%).

Electrodermal activity and self-report of affect were recorded from schizophrenic patients with their relative absent and present, at index admission and on two subsequent occasions after discharge. It was hypothesised that it would be possible to discriminate at index admission patients who relapsed in the subsequent 2-year period from those who remained well, and that these differences would be stable over time and independent of illness episode. The former hypothesis was supported in part, but not the second. The results did not support electrodermal hyperactivity as a stable, enduring vulnerability marker.