Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient–carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode. Aims To investigate the utility of a carer appraisal model of EE in first-episode psychosis. Method We compared high- and low-EE carers of people who had first-episode psychosis (n=46). Results High EE in carers was associated with higher avoidant

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... , higher subjective burden and lower perceived patient interpersonal functioning. Patient illness factors and carers 'distress levels were not associated with EE. Conclusions Even at the first episode, carers' psychological appraisal, not patient illness factors, is influential in determining high EE. Carers 'appraisal of their situation should be a primary target to lower or prevent high EE in early intervention for psychosis.