:

.. , ..

,

, . .
.
.
. , .
, . , .
.

.
.

(expressed emotion) .

, . ()

(G. Brown ., 1962) , .
, ,
.
,
G. Brown 1958 , -

20

1 2008

. : , , 17 %; , 32 % 50 %
(G. Brown ., 1958).
, 128 , ,
,

, .
, ,
2 .
, , 76 % 56 %
,

28 %
21 % (G. Brown ., 1962).
, - .
. (Camberwell Family Interview, CFI)
G. Brown M. Rutter 1966 . (G. Brown ., 1972)
. CFI
(Vaughn, Leff, 1976):
1.
(
, )
. ,
(, ,
).
2. .
3.


.
,
, ,
, .
4.
, , , .
5. .
( ). ,

.
,

.
, 6 ,
,
3 .

-


, (
)
,
, . ,
,

.
, .

, .
,

, .
,
, , , . , -
(G. Brown ., 1972).
(D. Raune ., 2004, P. Patterson ., 2005).
,
(J. Leff, 1992).
, , (M. Scazufca,
E. Kuipers, 1998; P. Patterson ., 2005).
, , 35 , .
, . 12 ,
1962 1988 , , , , 3,7
, (Parker, Hadzi-Pavlovic, 1990).
D. Kavanagh 48 %

21 % (1992). (Bebbington, Kuipers,
1994) 25 ( 1346 ),
: 75 %

51 % .
28 18 %
. ,
,
. , - 27 Butzlaff, Hooley (1998) :
;

,
;
, .

,
.
- (stress-vulnerability). ,
, , . . , ,
, . ,

(Kavanagh, 1992).

,
. , , .
, (affective style).

(Doane ., 1981).
: , , , (
, ,
,
).

, (Strachan ., 1986). , , .
, , ,
(Hahlweg ., 1989). ,

, . , . ,
,
,
.
,
, .

21


, ,
, , , (Woo ., 2004).

, . ,
,
. ,
,
.
.
,
.
-
,

, , . . . , ,
, .
,
(McNab ., 2007). , , ,
(Brewin, 1991, Barrowclough, Hooley, 2003, McNab
., 2007). , , ,
, , . .
, ,
, , ,
(Weisman
., 1998). , , ,
: .
(Brewin, 1994).
, . ,
, ,
. ,

, .

,
(Pharoah ., 2006).

22

1 2008

Anderson (1980).
, , ;
;
. , .
, .
, (family intervention),
(family treatment), (family therapy). , , .
- .
,

.
.
(Goldstein ., 1978). . .
. 4 :
, ,
,
.
96 ,

.
6
.
, 4 :

-
;
, ;
,
;

.
. 6 :

48 % , / 14 %, 22 %

. , ,
-



.
,

(Falloon . 1982, Leff . 1982, Hogarty
. 1986). ,


(
. , , 2007). ,
. , (Leff ., 1982, 1985) , .
, ( ) , .
, , 8 %
, 50 % , (
9 ).
(Hogarty , 1986, 1991)
,
. , , ,
, .
,
. .
; ; , ,
.
, ,
, , . ,
,

, . . 39 % , ,

,
.
,
I. Falloon (1982, 1984, 1985). 36 , .

(behavioral family management), .
.
40

:
, 6 10 .
, .
( ) (Fallon , 1984):
1. .
.
, , ,
. -,

.
, . . . , .
2. .
, .
,
, . , . , ,
, (Fallon, Pederson, 1985).

, ,
.
3. . ,
,
.
.

:
;

;
;
;
;
,
.

,
.
, .
( ). 9 18

23


(6 %), (, ) 8 18 (44 %) (Falloon ., 1982).
2
3 18 (17 %), 15 18
(83 %) (Falloon ., 1985).
, ,
, . ,

( 3 ), , (Doane .,
1985, Goldstein, Strachan, 1986).
(affective style),
. (Doane ., 1985). , ,
,
3
( ).

, . , ,
,
(Goldstein, Strachan, 1986).
, , , .
,
,
. , ,
, -, .
, I. Fallon,

. , (Roncone ., 2007).
McFarlane . (1995)

.
172 ,
, .
, .
2 .
.

(multi-family groups): 2
28 %
,
42 % .

24

1 2008

, . ,
. .
,
(Bauml ., 2006). ,
. , ,


. ,
.

.

(-)
.
, 4
16 . :
; ; ; - ; ; ; ;
.
( , / )

.
(8 ),
.
21 % 38 %
; 2 41 % 58 %
. , , .
L. Dixon A. Lehman
(1995) 14 ,
1978 1995 .
:
1.
.

,
, . , 58 .
2.
.
3. -


.
. ,
, .
4. . , , ,
, . .
5. - , .
2000
(Dixon ., 2000) 16 . ,
, ,
. ,
9 .


.
, ,
-, , -, .
. / . . ,
,
,

.
- G. Pitschel-Walz . (2001) 25 . ( 20 %)
, . .
:
(family burden);
;
;
;
;
;
.
.
- 31 (Pfammatter ., 2006).
,
,

-

(Pfammatter ., 2006,
c. 571). , ,
(Pharoah ., 2006).

,
(2004),
, (2006), (NICE) (2002). , ( ),

. ,
1999 ,

,
(Hahlweg, Wiedemann, 1999). 2006
(Rummel ., 2006) , : 21 % 2 % .

(Hahlweg, Wiedemann, 1999):
1.
,
.
2. , , , ,
.
3.
.
4.
.
5.
. , , .
,

. , .
, .
, . ,
,
.

1. .., .. // . .: , 2007; 3: 3342.

2. American Psychiatric Association. Guidelines for Treatment of Schizophrenia. Washington, DC: American Psychiatric Association; 2004.
3. Anderson C.M., Gerard E., Hogarty G.E., Reiss D.J. Family treatment of

25


adult schizophrenic patients: a psycho-educational approach // Schizophr Bull.
1980; 6: 490505.
4. Barrowclough C., Hooley J.M. Attributions and expressed emotion: a
review // Clin. Psychol. Rev. 2003; 23: 6: 849880.
5. Bauml J., Frobose T., Kraemer S., Rentrop M., Pitschel-Walz G. Psychoeducation: A basic psychotherapeutic intervention for patients with schizophrenia and their families // Schizophr Bull. 2006; 32: 1: 19.
6. Bebbington P., Kuipers L. The predictive utility of expressed emotion in schizophrenia: An aggregate analysis // Psychological Medicine. 1994; 24: 707717.
7. Brewin C.R., MacCarthy B., Duda K., Vaughn C.E. Attribution and
expressed emotion in the relatives of patients with schizophrenia // Journal of
Abnormal Psychology. 1991; 100: 4: 546554.
8. Brewin C.R. Changes in attribution and expressed emotion among the
relatives of patients with schizophrenia // Psychol med. 1994; 24: 4: 905911.
9. Brown G.W., Carstairs G.M., Topping G. Post-hospital adjustment of
chronic mental patients // The Lancet. 1958; 2: 7048: 685688.
10. Brown G.W., Monck E.M., Carstairs G.M., Wing J.K. Influence of family life
on the course of schizophrenic illness // Brit. J. Prev. Soc. Med. 1962.; 16: 5568.
11. Brown G.W., Rutter M. The measurement of family activities and relationships: methodological study // Human Relations. 1966; 19: 241263.
12. Brown G.W., Birley J.L.T., Wing J.K. Influence of family life on the course
of schizophrenic disorders: a replication // Br. J. Psychiatry. 1972; 21: 241258.
13. Butzlaff A.M., Hooley J.M. Expressed emotion and psychiatric relapse:
a meta-analysis // Archives of General Psychiatry. 1998; 55: 547552.
14. DGPPN. S-3-Behandlungsleitlinie Schizophrenie. Darmstadt, Germany:
Steinkopff; 2006.
15. Dixon L., Lehman A. Family Interventions for Schizophrenia // Schizophr
Bull. 1995; 21: 4: 631643.
16. Dixon L., Adams C., Lucksted A. Update on Family Psychoeducation for
Schizophrenia // Schizophr Bull. 2000; 26: l: 520.
17. Doane J.A., West K.L., Goldstein M.J., Rodnick E.H., Jones J.E. Parental
communication deviance and affective style: Predictors of subsequent schizophrenia spectrum disorder in vulnerable adolescents // Arch Gen Psychiatry.
1981; 38: 679685.
18. Doane J.A., Falloon I.R.H., Goldstein M.J., Mintz J. Parental affective
style and the treatment of schizophrenia: predicting course of illness and social
functioning // Arch Gen Psychiatry. 1985; 42: 3442.
19. Falloon I.R.H., Boyd J.L., McGill C.W., Ranzani J., Moss H.B., Gilderman
A.M. Family management in the prevention of exacerbation of schizophrenia: A
controlled study // New England Journal of Medicine. 1982; 306: 14371440.
20. Falloon I., Boyd J., McGill C. Family care of schizophrenia. New York:
Guilford Press, 1984
21. Falloon I., Boyd J., McGill C., Williamson M., Razani J., Moss H., Gilderman A., Simson G. Family management in the prevention of morbidity of schizophrenia: Clinical outcome of a two year longitudinal study // Archives of General Psychiatry. 1985; 42: 887896.
22. Falloon I.R.H., Pederson J. Family management in the prevention of morbidity of schizophrenia: The adjustment of the family unit // British Journal of
Psychiatry. 1985; 147: 156163.
23. Goldstein M.J., Rodnick E.H., Evans J.R., May P.R., Steinberg M.R. Drug
and family therapy in the aftercare of acute schizophrenics // Archives of General Psychiatry. 1978; 35: 11691177.
24. Goldstein M.J., Strachan A.M. Impact of family intervention program on
family communication and the short-term course of schizophrenia // Treatment
of schizophrenia: Family assessment and intervention / Goldstein M.J., Hand I.,
Hahlweg K. (eds.) // Berlin Heidelberg: Springer, 1986; 185192.
25. Hahlweg K.H., Goldstein M.J., Nuechterlein K.H., Magana A.B., Mintz
J., Doane J.A., Mikowitz D.J., Snyder K.S. Expressed emotion and patient-relative interaction in families of recent-onset schizophrenics // Journal of Consulting and Clinical Psychology. 1989; 57: 11-18.
26. Hahlweg K., Wiedemann G. Principles and results of family therapy in
schizophrenia // European Archives of Psychiatry and Clinical Neuroscience.
1999; 249: 4: 108115.
27. Hogarty G.E., Anderson C.M., Reiss D.J., Kornblith S.J., Greenwald D.P.,
Javana C.D., Madonia M.J. and the Environmental/Personal Indicators in the
Course of Schizophrenia Research Group. Family psychoeducation, social skills
training and maintenance chemotherapy in the aftercare treatment of schizo-

26

1 2008

phrenia: I. One-year effects of a controlled study on relapse and expressed emotion // Archives of General Psychiatry. 1986; 43: 633642.
28. Hogarty G.E., Anderson C.M., Reiss D.J., Kornblith S.J., Greenwald D.P.,
Ulrich R.F., Carter M. Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia: II. Two-year
effects of a controlled study on relapse and adjustment // Archives of General
Psychiatry. 1991; 48: 340347.
29. Kavanagh D.J. Recent developments in Expressed Emotion and schizophrenia // Br. J. Psychiatry. 1992: 160.: 601620.
30. Leff J., Kuipers L., Berkowitz R., Eberlein-Vries R., Sturgeon D. A controlled trial of social intervention in the families of schizophrenic patients. British
Journal of Psychiatry. 1982; 141: 121134.
31. Leff J., Kuipers L., Berkowitz R., Sturgeon D. A controlled trial of social
intervention in the families of schizophrenic patients: Two year followup // British Journal of Psychiatry. 1985; 146: 594600.
32. Leff J. Achieving emotional separation between high EE relatives and
schizophrenic patients // Psychotherapy of Schizophrenia: Facilitating and
Obstructive Factors / Werbart A., Cullberg J. (Eds.). Oslo: Scandinavian University Press. 1992; 212224.
33. McFarlane W.R., Lukens E., Link B., Dushay R., Deakins S.A., Newmark M.,
Dunne E.J., Horen B., Toran J. Multiple-family groups and psychoeducation in the
treatment of schizophrenia // Archives of General Psychiatry. 1995; 52: 679687.
34. McNab C., Haslam N., Burnett P. Expressed emotion, attributions, utility
beliefs, and distress in parents of young people with first episode psychosis //
Psychiatry Research. 2007: 151: 1-2 97-106.
35. National Institute for Clinical Excellence: Schizophrenia. Core interventions in the treatment and management of schizophrenia in primary and secondary care. London, 2002.
36. Parker G., Hadzi-Pavlovic D. Expressed emotion as a predictor of schizophrenic
relapse: an analysis of aggregated data // Psychol. Med. 1990; 20: 4: 961965.
37. Patterson P., Birchwood M., Cochrane R. Expressed emotion as an adaptation to loss: Prospective study in first-episode psychosis // Br J Psychiatry.
2005; 187: Suppl48: 5964.
38. Pfammatter M., Junghan U.M., Brenner H.D. Efficacy of Psychological
Therapy in Schizophrenia: Conclusions From Meta-analyses // Schizophr Bull.
2006; 32: 1: 64-80.
39. Pharoah F., Mari J., Rathbone J., Wong W. Family intervention for schizophrenia. Cochrane Database of Systematic Reviews. 2006. Issue 4.
40. Pitschel-Walz G., Leucht S., Bauml J., Kissling W., Engel R.R. The effect
of family interventions on relapse and rehospitalization in schizophreniaa
meta-analysis // Schizophr Bull. 2001; 27: 7392.
41. Raune D., Kuipers E., Bebbington P.E. Expressed emotion at firstepisode psychosis: investigating a carer appraisal model // Br J Psychiatry.
2004. Vol. 184. P. 321326.
42. Roncone R., Mazza M., Ussorio D., Pollice R., Falloon I.R.H., Morosini
P., Casacchia M.. The Questionnaire of Family Functioning: A Preliminary Validation of a Standardized Instrument to Evaluate Psychoeducational Family Treatments // Community Mental Health Journal. 2007; 43: 6: 591607.
43. Rummel C., Pitschel-Walz G., Bauml J., KisslingW. Psychoeducation in
schizophreniaresults of a survey of all psychiatric institutions in Germany, Austria and Switzerland // Schizophr Bull. 2006; 32: 765775.
44. Scazufca M., Kuipers E. Stability of expressed emotion in relatives of
those with schizophrenia and its relationship with burden of care and perception
of patients social functioning // Psychological Medicine. 1998; 28: 453461.
45. Strachan A.M., Goldstein M.J., Mikowitz D.J. Do relatives express
expressed emotion? // Treatment of schizophrenia: Family assessment and
intervention / Goldstein M.J., Hand I., Hahlweg K. (eds.). Berlin Heidelberg:
Springer, 1986; 5158
46. Weisman A.G., Nuechterlein K.H., Goldstein M.J., Snyder K.S.
Expressed emotion, attributions, and schizophrenia symptom dimensions // J
Abnorm Psychol. 1998; 107: 2: 355359.
47. Woo S.M., Goldstein M.J., Nuechterlein K.H. Relatives' affective style
and the expression of subclinical psychopathology in patients with schizophrenia // Family process. 2004; 43: 2: 233247.
48. Vaughn C. E., Leff J. The measurement of expressed emotion in the families of psychiatric patients // British Journal of Social and Clinical Psychology.
1976; 15: 157165.