Psychological Medicine

Research Article

Life events, relatives' Expressed Emotion and maintenance neuroleptics in schizophrenic relapse

Julian Leffa1 c1, Liz Kuipersa1, Ruth Berkowitza1, Christine Vaughna1 and David Sturgeona1

a1 MRC Social Psychiatry Unit, Friern Hospital, London; Schizophrenia Research Unit, Prestwick Hospital, Manchester; Department of Mental Health, University College, London


Data from two studies, one naturalistic and the other a controlled trial, were analysed to clarify the relationships between independent life events, Expressed Emotion of a key relative, maintenance neuroleptics and the relapse of schizophrenia. It was found that patients in the community who are unprotected by medication are vulnerable either to acute stress in the form of life events or to chronic stress in the form of living with a high Expressed Emotion relative. Patients on regular medication are protected against one or other stress, but are very likely to relapse if the two forms of stress occur together. A model of schizophrenic susceptibility to environmental stress is constructed to incorporate these observations.


c1 Address for correspondence: Dr J. P. Leff, MRC Social Psychiatry Unit, Friern Hospital, Friern Barnet Road, London N11 3BP.