ABSTRACT 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.
 Leff, J., Vaughn, C. (1985) Expressed Emotion in Families. Guilford Press, New York.
 Butzlaff, R.L. and Hooley, J.M. (1998) Expressed emotion and psychiatric relapse, a meta-analysis. Archives of General Psychiatry, 55, 547-552.
 Tanaka, S., Mino, Y. and Inoue, S. (1995) Expressed Emotion and schizophrenic course in Japan. British Journal of Psychiatry, 167, 794-798.
 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.
 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.
 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.
 Miklowitz, D., et al. (1988) Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225-231.
 Priebe, S., Wildgrube, C. and Muller-Oerlinghausen, B. (1989) Lithium prophylaxis and expressed emotion. British Journal of Psychiatry, 154, 396-399.
 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.
 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.
 Fukuzawa, K., et al. (2011) Family psychoeducation for major depression: Randomized controlled trial. British Journal of Psychiatry, 198, 385-390.
 World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders, clinical description and diagnostic guidelines. WHO, Geneva.
 American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th Edition, APA, Washington DC.
 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
 Overall, J.E. and Gorham, D.R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799-812.
 Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology, 6, 278-296.
 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.
 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
 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