The course of schizophrenia is influenced by environmental factors and for this reason, a good family may be therapeutic; however there may be misunderstanding of the chronic symptoms, especially negative symptoms e.g. poverty of speech, flattening of affect, a lack of motivation and emotional responsiveness.
Misunderstanding may lead to tension within the family which increases the risk of a relapse. Tension will be reduced if the family is informed about the illness and is provided with ongoing support and practical advice. Patients from so-called "high expressed emotion families" are at greater risk of relapsing. In these families a relative typically is highly critical of the patient, and yet spends a lot of time with him or her. Such relatives should be counselled and taught to be more constructive, and daily contact with relatives might be reduced by, for example, attendance at a day centre.
Doctor, community nurse, social worker and relatives' self-help groups, such as the National Schizophrenia Fellowship, all have important roles to play.
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