Rates of expressed emotions in Pakistani relatives of patients with schizophrenia

Background: Studies have reported substantial cross-cultural variations in rates of Expressed Emotions (EE) in relatives of patients with schizophrenia. As a first attempt from Pakistan, this study aimed to measure the components of EE among relatives of patients with schizophrenia in a different socio-cultural set-up. Method: Thirty-two key family members were interviewed using the Camberwell Family Interview (CFI) and Five Minute Speech Sample (FMSS). Results: Seventy-five percent of the family members appeared to be high EE with the majority (59%) rated so on the basis of hostility alone. Moreover, symptomatic behavior of the patient contributed more to the rating of relatives' hostility. Pakistani relatives showed higher levels of emotional over-involvement and hostility as compared to many other cultures. In comparison to CFI, the FMSS showed lower sensitivity for identifying high EE relatives, thus it may not be very suitable to use on its own in Pakistan for cultural reasons. Limitations: Lack of follow-up data and small sample size limit the scope of the study. Conclusions: Pakistani relatives appeared to be more hostile yet emotionally over-involved and warm toward their sick relatives as compared to the households reported in many previous studies. Psycho-educational programs need to be initiated for the concerned families to reduce their level of hostility. Outcome studies are also warranted in order to understand any link between high EE and relapse of schizophrenia in Pakistan