Bipolar I disorder and expressed emotion of families: A cohort study in Japan


The relationships between expressed emotion (EE) of the families and the course of bipolar disorder have been examined only in a limited number of cohort studies. No study has yet been reported from Asia. The subjects were 12 patients that had been diagnosed with bipolar I disorder according to DSM-IV and their 12 key family members. The families of the patients were interviewed using the Camberwell Family Interview (CFI) within 2 weeks of the admission of the patients, and their EE were evaluated. The patients were then followed up for 9 months after their discharge from the hospital. The patients were divided into a high-EE group and a low-EE group using the cut-off based on the number of critical comments (CC) and emotional overinvolvement (EOI), and the 9-month relapse risk was compared. When the subjects with 3 or more CC or an EOI score of 3 or more were regarded as the high-EE group, and the others as the low-EE group, the 9-month relapse risk was 100% (3/3) for the high EE group and 0% (0/9) for the low EE group. (Fisher’s exact test p = 0.005) EE based on the CFI appear to be correlated with relapse in bipolar I disorder in Japan.

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Shimodera, S. , Yonekura, Y. , Yamaguchi, S. , Kawamura, A. , Mizuno, M. , Inoue, S. , A. Furukawa, T. and Mino, Y. (2012) Bipolar I disorder and expressed emotion of families: A cohort study in Japan. Open Journal of Psychiatry, 2, 258-261. doi: 10.4236/ojpsych.2012.24035.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Leff, J., Vaughn, C. (1985) Expressed Emotion in Families. Guilford Press, New York.
[2] Butzlaff, R.L. and Hooley, J.M. (1998) Expressed emotion and psychiatric relapse, a meta-analysis. Archives of General Psychiatry, 55, 547-552. doi:10.1001/archpsyc.55.6.547
[3] Tanaka, S., Mino, Y. and Inoue, S. (1995) Expressed Emotion and schizophrenic course in Japan. British Journal of Psychiatry, 167, 794-798. doi:10.1192/bjp.167.6.794
[4] Mino, Y., Inoue, S., Tanaka, S. and Tsuda T. (1997) Expressed emotion among families and course of schizophrenia in Japan: A 2-year cohort study. Schizophrenia Research, 24, 333-339. doi:10.1016/S0920-9964(96)00129-6
[5] Mino, Y., et al. (1998) Expressed emotion of families and negative/depressive symptoms in schizophrenia: A cohort study in Japan. Schizophrenia Research, 34, 159-168.
[6] Hooley, J.M., Orley, J. and Teasdale, J.D. (1986) Levels of expressed emotion and relapse in depressive patients. British Journal of Psychiatry, 148, 642-647. doi:10.1192/bjp.148.6.642
[7] Miklowitz, D., et al. (1988) Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225-231. doi:10.1001/archpsyc.1988.01800270033004
[8] Priebe, S., Wildgrube, C. and Muller-Oerlinghausen, B. (1989) Lithium prophylaxis and expressed emotion. British Journal of Psychiatry, 154, 396-399. doi:10.1192/bjp.154.3.396
[9] Okasha, A.E.L., et al. (1994) Expressed emotion, perceived, and relapse in depression: A replication in an Egyptian community. American Journal of Psychiatry, 151, 1001-1005.
[10] Mino, Y., et al. (2001) Expressed emotion of families and the course of mood disorders: A cohort study in Japan. Journal of Affective Disorders, 63, 43-49. doi:10.1016/S0165-0327(00)00185-3
[11] Fukuzawa, K., et al. (2011) Family psychoeducation for major depression: Randomized controlled trial. British Journal of Psychiatry, 198, 385-390. doi:10.1192/bjp.bp.110.078626
[12] World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders, clinical description and diagnostic guidelines. WHO, Geneva.
[13] American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th Edition, APA, Washington DC.
[14] Mino, Y., et al. (1995) Training in evaluation of expressed emotion using the Japanese version of Camberwell Family Interview. Acta Psychiatrica Scandinavica, 92, 183-186. doi:10.1111/j.1600-0447.1995.tb09565.x
[15] Overall, J.E. and Gorham, D.R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799-812. doi:10.2466/pr0.1962.10.3.799
[16] Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology, 6, 278-296. doi:10.1111/j.2044-8260.1967.tb00530.x
[17] Kim, E.Y. and Miklowitz, D.J. (2004) Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy. Journal of Affective Disorders, 82, 343-352.
[18] Yan, L.J., et al. (2004) Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients. Journal of Affective Disorders, 83, 199-206. doi:10.1016/j.jad.2004.08.006
[19] Macneil, C., et al. (2011) Psychological needs of adolescents in the early phase of bipolar disorder: Implications for early intervention. Early Intervention in Psychiatry, 5, 100-107. doi:10.1111/j.1751-7893.2011.00273.x

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