Life events

Brown and Birley(53) reported an excess of life events in the 3 weeks preceding schizophrenic relapse. Further studies were conflicting in their findings, possibly due to methodological problems. The recent study of Bebbington et al.(54) avoided many of the methodological pitfalls, assessing life events in 97 psychotic patients (52 with schizophrenia) and general population controls. There was a significant relationship between life events and onset of relapse of schizophrenia, although it was not as strong as for depressive psychosis. One possibility is that certain types of schizophrenic patients are particularly vulnerable to relapse following adverse life events. For example, Bebbington et al.(54) found females to be particularly prone, whilst van Os et al.(9) found life events to be associated with a less severe good-outcome illness.

There is also evidence that families who exhibit high 'expressed emotion' (comprising critical comments, hostility, and/or overinvolvement) can provide an environment which enhances the risk of relapse in a family member with schizophrenia. Again, cause and effect are difficult to tease apart. Thus, it is possible that patients with more severe and intractable illnesses may induce more expressed emotion in their relatives.

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