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Title: Discrepancies in illness representations of mental health problems between patients with first episode psychosis and their relatives
Author: Powell, Natalie
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2008
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Evidence from studies exploring relapse rates in people with a diagnosis of schizophrenia has shown that the quality of the relationship between people with psychosis and their relatives is an important predictor in determining outcome (Butzlaff & Hooley 1998). The importance of the discrepancy between illness representations within family members was highlighted in the development of the Self Regulation Model (Leventhal et aI., 1985). A study by Lobban et aI., (2006) acknowledged the importance of patient beliefs about their mental health problem and how any discrepancies between these beliefs and their relatives' beliefs may cause such incongruence that this damages the quality of their relationship. Lobban et aI., (2006) explored the discrepancies in appraisals in patients with a diagnosis of schizophrenia and their relatives in relation to Expressed Emotion (EE) and found greater discrepancies between illness models of schizophrenia in patient-relative dyads with a high-EE relative than in those involving a low-EE relative. There is also evidence' to suggest that family difficulties occur early on in the psychosis (Gleeson et aI., 1999). As over 60% of those with a first episode of a major mental illness return to live with relatives, it is important to explore the impact of this within patient-relative dyads. Therefore, this study aims to further explore the relationship between discrepancies of mental health problem beliefs in patient-relative dyads in first episode psychosis using an in depth measure of EE. In this study, 63 patient-relative dyads were recruited. All patients were administered the Illness Perception Questionnaire for Schizophrenia (lPQS - Patient version) and they also took part in the PANSS interview to assess symptomatology of psychosis. All relatives were administered the IPQS (Relative version) and they also took part in the Camberwell Family Interview to assess their EE status. Following these assessments, the patient-relative dyads were categorised into high EE (n=32) and low EE (n=31). Contrary to Lobban et aI's study, there were no differences found in discrepancy scores in patient-relative dyads between the high and low EE groups. However, when the dimensions of high EE (criticism, emotional overinvolvement and hostility) were dichotomised into high and low groups, there were greater discrepancies in perceptions of illness identity in dyads low in criticism. High EOI dyads had greater discrepancies in perceptions of illness consequences and they attributed significantly more symptoms to medication as opposed to those dyads low in EOI. However, these results should be interpreted with caution, as the high EE groupings were not evenly distributed. These findings provide tentative evidence that illness representations held by patients and their relatives who are experiencing recent onset psychosis may be transient in nature and less entrenched than those who have experienced a more prolonged exposure to the impact of the mental health problems. As these beliefs may not be as crystallised as those in a more chronic population, this gives further weight to the argument of the importance of providing suitable early intervention support packages to not only the patient, but also their relatives.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available