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Expressed Emotion — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisExpressed EmotionMRCPsych Paper B

A 22-year-old man with first-episode psychosis lives with family members who display marked criticism, hostility and emotional over-involvement towards him. Which family-environment construct does this pattern describe?

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Correct answer: CExpressed emotion

The correct answer is **A, expressed emotion**. High expressed emotion describes a family climate characterised principally by criticism, hostility and emotional over-involvement. In psychosis and schizophrenia, it is associated with an increased risk of relapse, although it is a relational risk marker rather than a diagnosis or evidence that relatives caused the illness. Family intervention is a treatment that may address stressful family interactions, not the name of the pattern. Enmeshment refers to excessively diffuse interpersonal boundaries and captures only part of the described presentation. Triangulation involves conflict between two people being managed through a third person, which is not described here. “Systemic dysfunction” is a broad, non-specific formulation rather than the established construct defined by these three features.

Reference: Ma CF et al. The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression. Psychological Medicine. 2021;51(3):365–375. https://pubmed.ncbi.nlm.nih.gov/33568244/