This study examines the hypothesis that negative labelling of individuals with a first episode of schizophrenia is related to the length and intensity of behavioural disturbance prior to first hospitalization. Forty-five individuals with first episode schizophrenia were assessed at admission to hospital for the presence and severity of symptoms, duration of untreated illness and premorbid social and occupational functioning. Negative labelling was assessed from ratings obtained from individuals designated as a significant other by the individuals with schizophrenia. Identical measures of labelling were obtained from individuals designated as a significant other by a comparison group (n = 70) who had no history of psychiatric disorder. The results indicated that the individuals with schizophrenia received more negative labels than the asymptomatic individuals. The negative attributions were associated with older age at onset of psychosis, a long period of deterioration before the onset of psychosis, and poor occupational functioning in the 9 months prior to hospitalization. These findings are consistent with results from studies that have examined expressed emotion (EE) in first episode schizophrenia and suggest that the reported association of high EE with relapse in first episode schizophrenia may be confounded with premorbid functioning that is typically associated with poor outcome.
Bibliographical noteFunding Information:
Supported by a NARSAD junior investigator award to G.B. Funding to conduct the research was provided by a National Health Scientist Award (M.B.) from the Canadian Health and Welfare National Health Research and Development Program; by a grant from the British Columbia Health Care Research Foundation and by a NIMH grant (to W.I. and M.B.). The authors thank Drs. Tsung-Yi, Margaret Moreau and Jonathan Fleming for their contributions to the clinical aspects of this study.
- expressed emotion (ee)
- first episode
- negative labels
- premorbid functioning