published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

It has in this review article been cited several different studies and sources, all concerning the prevention of relapse of schizophrenia and related psychotic disorders; The different approaches to treatment (programs, type of psychotherapy etc.) have been discussed according to evidence based research and randomized controlled trials. Although some explanations have been given about terms used in the literature, as well as some definitions to enable classifications in future studies, it has been focused only on the preventive measures used in schizophrenia; a detailed description of different subgroups of schizophrenia, as well as detailed descriptions of pharmacology in euroleptics is beyond the scope of this article. The recognition of relapse symptoms was first considered and defined, and the different approaches was then discussed; Outpatient treatment plans and relapse prevention plans, as well as the impact of cognitive behavioral therapy and psychotherapy have been discussed in subsequent chapters. In this section, it was especially focused on the ITAREPS program and its impact on the relapse prevention. The role of medications was then defined and supported with clinical studies and trials.

The impact of the emotional climate in the home of the schizophrenic on relapse has been researched extensively through the construct of Expressed Emotion (EE). Most often patients from high EE homes have a higher relapse rate than those from low EE homes. This is a robust finding throughout many western and some non-western countries. However, no published research documents EE status and relapse in African countries. This study reports on the EE status and rehospitalisation rates of 29 Zulu-speaking schizophrenic patients in a South African sample. EE was assessed using a translated version of the Level of Expressed Emotion (LEE) scale, a 60 - item, self-report measure developed in Canada (Cole & Kazarian, 1988). A multistage translation procedure, comprising back-translation, the committee approach and decentering was employed. The Zulu SCL-90-R was administered as an indicator of psychological distress. Follow-up data on rehospitalisation was collected nine months after index admission. Results indicated somewhat unsatisfactory internal reliabilities on some of the subscales of the Zulu LEE scale. High scores on the Zulu LEE scale were not significantly predictive of rehospitalisation at follow-up; however, they were significantly predictive of greater previous admissions. The psychometric properties of the Zulu SCL-90-R were found to be satisfactory, indicating the validity of using this instrument for the purpose of screening for psychiatric illness. Zulu schizophrenics were found to have a lower rehospitalisation rate (17% at nine month follow-up) than found in international studies. The course for female schizophrenics was better than that for male schizophrenics. Findings are inconclusive regarding the impact of EE on the course of schizophrenia in a Zulu sample. / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 2000.