الفهرس 
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Abstract
Expressed emotions are construct that has been used to describe family members’ criticism, hostility and emotional involvement with a mentally ill relative within the context of family interactions and care giving. This constructs are used as an outcome measure of interventions for families of people with mental illness (Acton, 2011).
Family Caregivers had different levels of expectations for the patient’s functioning, with low expressed emotions expressed emotions caregivers allowing for low functioning due to an illness episode, while high expressed emotions caregivers were intolerant of any deficits or unmet expectations. Finally, low expressed emotions caregivers differed from high expressed emotions caregivers in their calm emotional reactions and flexibility when dealing with the patient’s symptoms.
Over the last 20 years a sound evidence base has established for the effects of the family environment on mental illness. Based on psychological and sociological theories, family dysfunction and over-emotional and critical environments clearly contribute to the emergence of mental illness, these affect on the disease course and influence the achievement and maintenance of treatment gains by patients (O’Brien, 2012).
The emotional climate within a family can greatly impact on individual members; the presence of a high expressed emotions relative is associated with worse course of illness. Mental illness patients with relatives of high expressed emotions tend to participate in negative interactions along with family members. Low expressed emotions families have fewer negative interactions with one another. Therefore, it is necessary to conduct this study to assess the caregivers’ expressed emotions in response to patient psychiatric symptoms (Vijaya, 2016).
Aim of the Study
This study aims to assess levels and patterns of expressed emotions among families with schizophrenic patient.
Research questions:
1-What are the levels of expressed emotions that the family deals with their patient?
2- What are the patterns of expressed emotions that the family deals with their patient?
Setting:
The current study was conducted at the outpatient clinic in El-Abbassia Mental Health Hospital (AMHH).
Sample:
A sample of convince of 100 caregivers having patient with schizophrenia who attended the outpatient clinic at El-Abbassia Mental health Hospital.
Tools:
Tools that were used for data collection for the current study included socio-demographic data sheet, expressed emotions questionnaire.
1- Socio-demographic data and clinical data on the patient sheet (Appendix A):
It was designed by the researcher and included:
A- Socio-demographic data on the patient such as age, gender, marital status, level of education, occupation, type of occupation, income, residence,
B- Clinical data such as date of admission, number of previous admissions, last hospital admission, duration of illness and medication compliance.
2-Socio-demographic data on the caregivers (Appendix B):
It was designed by the researcher and included:
Socio-demographic data on the caregivers such as age, gender, marital status, level of education, occupation, type of occupation, income, physical illness and relation with patient. Also, data related to patient’s care such as spending on the patient, patient’s need for special care.
3- Expressed emotions scale: (Appendix C): It was modified by the researcher based on Expressed emotions scale (EES) developed by Berksun (1992), The Family Attitude Scale (FAS) developed by Kavanagh et al. (1997) and Expressed Emotions Scale (LEE) developed by (Cole & Kazarian, 1988), Berlin Social Support Scales (BSSS) developed by Schwarzer & Schulz, (2013). It includes 49 items, divided into 3subscales:
A- Family over involvement scale in this study consisted of 7 items to assess exaggerated emotionsal responses by caregivers toward patient.
B- Family warmth and positive remarks scale consisted of 13 items to assess the warmth and positive remarks of the caregiver toward the patient.
C- Hostility and criticism scale divided into 2 categories:
1- Critic and hostile attitude toward the illness consists of 19 items to assess attitude of hostile and criticism toward the illness.
2- Negative perception consists of 9 items to assess perception of caregiver of hostile and criticism toward the patient.
Pilot study:
A total of 10 subjects were recruited for the pilot study randomly chosen from the outpatient clinics who were excluded from the main study sample.
The main findings of this study revealed that:
1- The socio-demographic characteristics of the studied caregivers. Caregiver’s age ranged between 16-79 years. It can be observed that 42% of patient’s caregivers aged from 40-59 years. More than half of the studied caregivers were married (59%) while 2% were single, 16% were divorced and 23% were widow. Nearly half of the studied caregivers were either primary education (41%) and 28% were illiterate. On the other hand 21% had a secondary education, and only 10% had higher education about half of the caregivers were working (46%), while (33%) of them have free work. On the other hand, 54% were not working. About two thirds of the studied caregivers (42%) stated that they had satisfied income, while 58%have unsatisfied income. Additionally, 65%of caregivers were spending with their patient and only 35% weren’t spending with them. Nearly half of them41% were brothers/sisters and 34% were parents. In addition to 14% were husband or wife and only 7% were son or daughter. Almost all caregivers (81%) stated that, their patients needed special care while only 19% didn’t need it. Nearly half of caregivers (49%) were complain from physical disease while 51% didn’t complain physical disease.
2- The socio-demographic characteristics of patients. The subjects had a mean age of 37. 3 years, about two thirds of patients (62%) in the age group from 20 to 39 years. (69%) of the patients were males. More than one third of the studied patients had primary education (37%) and about one third of patients were illiterate (30%). On the other hand (26%) of subjects had a secondary education, in addition to 7%had higher education. The highest percentage of the patients were either not working (78%) while 15 only 22% were working. 61% of patients had not income while39%of patients had income. More than half (56%) were single while about one third 32% were married. Besides 10% were divorced and 2% were widow. The majority of patients (76%) were living in urban, while only 24% were living in rural.
3- The clinical data of the studied patients 73% have been admitted hospital and it can be observed that patients’ duration of illness mean was8. 33 years. The highest percentage of patients’ duration of illnessfrom4-6years was 37%. Nearly half (49%) have been previous hospitalized for once to two times while 24%of them have been previous hospitalized for more than3 times. More than half (53%) of patients had been admitted to hospital after 2010 and 20% of patients had been admitted to hospital before 2010.All patients were receiving drug treatment with the majority of them (65%) stating being compliant to medications, While 35%of them being non compliant.
4- Regarding levels of expressed emotions, more than half 57% of studied caregivers show low expressed emotions while nearly half of them 43% show high expressed emotions with a mean score of 46.72.
5- Regarding patterns of expressed emotions, 73% of studied caregivers show high over involvement while 27% show low level. 59% of studied caregivers show high warmth and positive remarks while nearly half 41% of them show low level of warmth and positive remarks. 57% of studied caregivers deal with low hostility and criticism toward the patient while nearly half 43% of them deal with high criticism and hostility.
6- Regarding the relationship between patient and caregiver socio demographic and expressed emotions, there was significant relation between patient‘s occupation and medication compliance. Also, there was significant relation between income of caregiver and patient’s need for special care.
In the light of these findings, it is recommended that:
1) For families:
Caregivers should be informed about treatment plan and changes whenever occurring. A structured support programs, rehabilitation programs, workshop for the caregivers focused on behavior management, stress management, community resources. It would also be useful to make counseling. It is important to make family therapy , support group for the family caregiver help in the relieve stress and psycho educational program for family to facilitate an increased understanding of the illness as well as to suggest strategies that may be useful in dealing with difficult behaviours.
2) For nurses
There must be training a program for nurses to know how to assist the caregiver to deal with his stressors, helps aliniate and reduce the negative impact by teaching a new skills to deal with stress in a positive and productive manner.
3) For research
Research about factors related to high or low expressed emotions and how to prevent conflict between patient and caregiver preventing negative effect on patient or caregiver. researches on these issues should be implemented and supported by government.
4) For community
Crisis management teams, support workers and suitable respite and residential care facilities are also needed.