ObjectiveTo explore the influence factors of therapeutic compliance and emotional expression of first-degree relatives in acute schizophrenic patients with psychotic symptoms. MethodsThe Brief Psychiatric Rating Scale (BPRS) was used to measure the severity of psychotic symptoms in sixty schizophrenic patients from June to September 2014 in West China Hospital and the Toronto Alexithymia Scale (TAS) was used to survey the emotional expression in their family members. The homemade treatment adherence scale was used to survey the treatment adherence in patients for one week. ResultsThere was a poor therapeutic compliance in nineteen patients with acute schizophrenia (32%) and the other 41(68%) had good therapeutic compliance; the relatives of schizophrenic patients had high TAS scores (male: 67.61±10.03; female: 69.68±11.46) than the normal models did (P ＜ 0.05) . The differences between the patients with different therapeutic compliance in BPRS total score, reactivator, hostile and suspicion factor (P ＜ 0.05) . The therapeutic compliance was related to the severity of the psychotic symptoms (P ＜ 0.05) . Conclusions There is a bad emotional expression in the relatives of acute schizophrenic patients. The psychotic symptoms can influence the therapeutic compliance. The milder the psychotic symptoms, the better the therapeutic dependence.