Biomedical subjects

M J Goldstein

Publications and source records attributed to M J Goldstein.

At least 19 recordsLinked to original sources

PubMed2001

Family transactions and relapse in bipolar disorder.

This study examined whether patient symptoms and relatives' affective behavior, when expressed during directly observed family interactions, are associated with the short-term course of bipolar disorder. Twenty-seven bipolar patients and their relatives participated in two 10-minute family interactions when patients were discharged after a manic episode. Results indicated that patients who showed high levels of odd and grandiose thinking during the interactions were more likely to relapse during a 9-month followup period than patients who did not show these symptoms during the family discussions. Relapse was also associated with high rates of harshly critical and directly supportive statements by relatives. Patients' odd thinking and relatives' harsh criticism were significantly more likely to be correlated when patients relapsed (r = .53) than when they did not relapse (r = .12). Results suggest that bipolar patients who show increased signs of residual symptomatology during family transactions during the post-hospital period are at increased relapse risk. The data also suggest that relatives of relapsing patients cope with these symptoms by increasing both positive and negative affective behaviors. Moreover, a bidirectional, interactional relationship between patients' symptoms and relatives' coping style seems to capture best the role of the family in predicting relapse in bipolar disorder.

Adaptation, Psychological↗

PubMed2000

Neurocognitive vulnerability, interpersonal criticism, and the emergence of unusual thinking by schizophrenic patients during family transactions.

BACKGROUND: This study examined whether the combination of patients' neurocognitive deficits and criticism by others would predict the emergence of patients' unusual thinking during stressful family transactions. METHODS: When clinically stable, 41 patients with recent-onset schizophrenia completed 2 versions of a visual vigilance task, the Continuous Performance Test (CPT). One CPT emphasized early perceptual processing, while the other stressed immediate, working memory. On a separate occasion, patients and family members participated in a 20-minute interaction in which the number of relatives' criticisms and patients' unusual thoughts was assessed. RESULTS: In a hierarchical regression model, after entering performance on the CPT demanding immediate, working memory, and the number of criticisms by family members, the interaction of CPT performance and criticism significantly predicted the number of patients' unusual thoughts during the family session (r(2) change = 0.09; P =.03). Post hoc analyses revealed that the number of criticisms and odd thoughts correlated significantly (r = 0.59, P =. 03) for patients who had poor memory-load CPT performance, but were unrelated (r = -0.07) for patients who did well on the memory-load CPT. The CPT emphasizing early visual processing, either alone or in combination with interpersonal criticism, did not predict the number of patients' unusual thoughts during the interaction. CONCLUSION: The results suggest that the combination of patients' working memory deficits and interpersonal criticism jointly predicts psychotic thinking, consistent with a model of schizophrenia that emphasizes the interaction of neurocognitive vulnerability and psychosocial stress factors. Arch Gen Psychiatry. 2000;57:1174-1179.

Adolescent↗

PubMed2000

Controllability perceptions and reactions to symptoms of schizophrenia: a within-family comparison of relatives with high and low expressed emotion.

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes.

Acute Disease↗

PubMed2000

A comparison of psychiatric symptoms between Anglo-Americans and Mexican-Americans with schizophrenia.

Culture is widely thought to influence the form, content, and extent of symptoms experienced and expressed by the mentally ill. However, little is known about how specific cultural groups differ in their symptomatic presentation of mental illness. Using data derived from the Present State Exam, the current study compared 63 Anglo-American and 53 Mexican-American patients with schizophrenia on ten psychiatric symptoms. A series of logistic regressions offered several interesting findings. For instance, as hypothesized, Mexican-American patients were more likely to report physical symptoms than their Anglo-American counterparts. Also in line with expectations, Anglo-American patients reported experiencing a greater frequency of several psychiatric symptoms such as persecutory delusions, nervous tension, and blunted affect. Results from this study suggest that the presentation of even a very biologically determined disorder such as schizophrenia can be shaped by sociocultural factors. Specific aspects of Anglo-American and Latino cultures that may influence symptom patterns in patients suffering from schizophrenia are discussed.

Adolescent↗

PubMed2000

Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes.

Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment.

Bipolar Disorder↗

PubMed1998

Expressed emotion, attributions, and schizophrenia symptom dimensions.

Using a sample of 40 Anglo American family members of schizophrenic patients, the present study replicates and lends cross-cultural support for an attribution-affect model of expressed emotion (EE). Consistent with attribution theory, the authors found that highly critical relatives (high-EE) viewed the illness and associated symptoms as residing more within the patient's personal control as compared with less critical relatives (low-EE). A content analysis classified the types of behaviors and symptoms most frequently criticized by relatives. Symptoms reflecting behavioral deficits (e.g., poor hygiene) were found to be criticized more often than symptoms reflecting behavioral excesses (e.g., hallucinations). In line with an attribution-affect framework, relatives may be less tolerant of behavioral deficits because they are viewed as intentional, whereas behavioral excesses are easily recognized as core symptoms of mental illness.

Adolescent↗

PubMed1998

Early detection and intervention in schizophrenia.

During the course of schizophrenia, symptoms tend to increase at the highest rate during the first 5 years of the disease. Moreover, 10% of suicides by schizophrenic patients occur within the first 10 years of schizophrenia being diagnosed. These facts emphasize the importance of early intervention to improve the course of the disease before further deterioration. The use of psychosocial interventions and drug management programmes, in addition to maintenance antipsychotic medication, reduces the risk of psychotic relapse. Continuity of care from inpatient to outpatient treatment also significantly improves outcome, largely as a result of better drug compliance. It appears, however, that the addition of a behavioural family intervention alone to a standard programme offers little additional benefit. The benefits of intervention programmes last only as long as the programme, and patients should continue with such intensive treatment strategies for at least the duration of the critical phase. Under these circumstances, very mild psychotic complaints may be recognized at an early stage so that treatment can begin even earlier, further increasing the chance of an optimal long-term outcome. Further studies of early intervention and relapse prevention are required to support these findings.

Antipsychotic Agents↗

PubMed1997

Children with schizophrenia-spectrum disorders: thought disorder and communication problems in a family interactional context.

Thought disorder and communication patterns during an interactional task were examined in families of children with schizophrenia-spectrum disorders (schizophrenia and schizotypal personality disorder), depressed children, and normal controls. Children with schizophrenia-spectrum disorders showed significantly more thought disorder than their normal peers; levels of thought disorder among depressed children fell between those observed in the other two groups but did not differ significantly from either of them. Similarly, mothers of children with schizophrenia-spectrum disorders showed more thought disorder than mothers of normal control children but did not differ from mothers of depressed children. Children with schizotypal personality disorder did not differ from children with schizophrenia. These findings demonstrate that the thought disorder present in childhood-onset schizophrenia and schizotypal personality disorders is manifest in an important social context, the family.

Adolescent↗

PubMed1997

Depressive symptoms in the early course of schizophrenia: relationship to familial psychiatric illness.

OBJECTIVE: This study examined the relation between the presence of depressive symptoms in schizophrenic patients with a recent first psychotic episode and affective disorders among their relatives. METHOD: Data on depressive symptoms in 70 patients with schizophrenia diagnosed according to the DSM-III-R criteria, who had had a recent first psychotic episode, and psychiatric diagnostic information on 293 of their first-degree and 674 of their second-degree relatives were collected. Depressive symptoms in the schizophrenic probands were examined at the index psychotic episode (at study entry) and systematically over a 1-year follow-through period. The majority of first-degree family members were interviewed in person with the use of semistructured diagnostic interviews. RESULTS: The linear regression findings confirmed the hypothesis that depressive symptoms in the early course of schizophrenia are associated with a family history of unipolar affective illness. CONCLUSIONS: Because depression in the patients was associated with a family history of depression, this suggests that depression in schizophrenia is not solely either a reaction to having had a psychotic episode or part of the recovery process. The findings are consistent with a model in which a familial genetic liability to affective disorder, when present, is viewed a s exerting a modifying influence on the patient's schizophrenic illness to increase expression of depressive symptoms.

Adolescent↗

PubMed1997

Relatives' expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients.

BACKGROUND: Previous research has generally found that variations in relatives' affective attitudes (expressed emotion; EE) towards a schizophrenic family member could not be accounted for by differences in the severity or form of the patient's symptomatology. These findings have been based on clinicians' ratings of psychopathology in patients. METHOD: To approach the question from a different perspective, videotaped interactions between a patient and family members, obtained four to five weeks after hospital discharge, were coded for subclinical signs of psychopathology expressed by the patient. The Behavioral Subclinical Rating Scale (BSRS) was developed to compare subclinical levels of non-verbal and paralinguistic symptoms expressed by patients from both high- and low-EE families. RESULTS: Highly significant differences were found in the BSRS data. Patients from high-EE families showed more hostile and unusual behaviour with relatives than those from low-EE homes, who, in contrast, showed more anxious behaviour. CONCLUSION: These data suggest that a complex transactional model is necessary to understand how family attitudes evolve during the course of a relatives' schizophrenic disorder.

Adult↗

PubMed1996

Treatment, expressed emotion and relapse in recent onset schizophrenic disorders.

The effect of in-patient and individual orientated psychosocial intervention (IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate. Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may increase stress in low EE families, thus affecting relapse in their children.

Adolescent↗

PubMed1996

Gender differences in family attitudes about schizophrenia.

Recent studies have found that the expressed emotion (EE) status of relatives of female schizophrenics may not possess the prognostic value found previously for male schizophrenics. In the present study, relatives of 110 recent onset schizophrenic patients were assessed using the Camberwell Family Interview (CFI-EE), the Five Minute Speech Sample Method (FMSS-EE) and a measure of Affective Style (AS) to determine whether affective attitudes or behaviours varied by patient gender. Brief Psychiatric Rating Scale (BPRS) ratings made during in-patient and out-patient periods were examined to assess patient symptomatology. No differences were found by patient gender for CFI-EE, FMSS-EE, or subcomponents of the CFI-EE measure. However, when the subcomponents on the FMSS associated with a high EE critical rating were examined, males were found to be recipients of more harsh criticism than female patients. Similarly, for the AS measure, there was a distinct subgroup of male patients who received a level of criticism not seen in female patients. When the concordance across the two EE measures was examined, relatives of males were more consistent in their affective attitudes than relatives of female patients. Analysis of the BPRS data from the in-patient to the out-patient periods suggested variations by patient gender which may explain some of the differences in relatives' affective attitudes.

Adolescent↗

PubMed1996

Psycho-education and family treatment related to the phase of a psychotic disorder.

There has been a replicated finding that psycho-educational family programs, in combination with medication management, can make a substantial contribution to preventing a relapse in psychotic patients. Different formats have been suggested for implementing these programs (relatives-only groups, single family units, multiple family groups). We have reviewed the appropriateness and the efficacy of these formats for different phases of a specific psychotic episode or in the history of the disorder. The data reviewed indicate that psycho-educational programs focusing on the individual family unit are particularly effective for first or recent-onset schizophrenic patients, particularly during the stabilization phase of treatment. Data on groups for relatives only or multiple-family groups suggest greater effectiveness during later phases of treatment (maintenance) and with more chronic patients.

Caregivers↗

PubMed1996

Nonverbal interactional behavior in the families of persons with schizophrenic and bipolar disorders.

Whereas verbal interactional behaviors have been repeatedly found to distinguish the families of persons with and without major psychiatric disorders, there has been comparatively little examination of the discriminative value of nonverbal interactional behaviors. We developed the Nonverbal Interactional Coding System to measure "affiliative" and "distancing" nonverbal behaviors in 18 schizophrenic and 18 bipolar patients and their parents during 10-minute interactions conducted during a posthospital period. Bipolar patients and their parents displayed affiliative nonverbal behaviors ("illustrator gestures" or "prosocial behaviors") for longer durations than schizophrenic patients and their parents. In contrast, parents of schizophrenic patients displayed distancing nonverbal behaviors (looking away) for longer durations than those of bipolar patients. The nonverbal interactional data added to the statistical strength of patients' and parents' verbal interactional data in distinguishing between these diagnostic groups. Nonverbal interactional behaviors are important variables to consider in interventions aimed at improving the communication skills of families coping with psychiatric disorders.

Adolescent↗

PubMed1995

Schizophrenic patients' perceptions of their relatives' attitudes.

Although the attitudes of family members as revealed by measures of expressed emotion (EE) have been shown to be associated with the course of schizophrenic illness, little is known about how the patients perceive these attitudes. A detailed interview was used to assess patients' perceptions of their family members' behaviors toward them. Family member's EE was assessed with the Five-Minute Speech Sample (FMSS). Overall, patients' perceptions of criticism were congruent with a component of the FMSS-EE that measures criticism. Results indicated that when family members had high EE/critical scores, patients perceived them as displaying more instances of critical behavior. All cases in which patients' perceptions of criticism were incongruent with measures of FMSS-EE occurred among ethnic minority group members. Although the FMSS-EE did not predict outcome in this study, patients who perceived their relatives as higher in criticism had more negative outcomes at 1 year. These findings suggest that when family environments are examined in patients from ethnic minority groups, the patients' perspective may be a more potent predictor of outcome than traditional measures of EE.

Adult↗

PubMed1995

Expressed emotion and subclinical psychopathology observable within the transactions between schizophrenic patients and their family members.

The authors examined whether young, recently discharged schizophrenic patients from high (n = 34) and low (n = 14) expressed emotion (EE) families differ in their level of subclinical symptomatology during a direct interaction task. Compared with patients from low-EE homes, patients from high-EE home showed significantly more odd and disruptive behavior with family members. High-EE relatives were more likely than low-EE relatives to respond with criticism to the first unusual thought verbalized by the patient; when this occurred, the probability of a second unusual thought was augmented. Results suggest that high-EE family members may display negative attitudes toward patients in part because they are exposed to higher levels of unusual or disruptive behavior than low-EE relatives. The data also support a bidirectional, transactional model of the relationship between relatives' EE and patients psychopathology.

Adolescent↗

PubMed1995

Verbal interactions in the families of schizophrenic and bipolar affective patients.

Do verbal interactions between psychiatric patients and family members covary with the diagnosis of the patient? This study compared relatives (usually parents) of schizophrenic (n = 42) and bipolar (n = 22) patients on affective style (AS) or emotional-verbal behavior toward patients in family interaction. Patients were compared on coping style or verbal interactional behavior toward relatives. Relatives of schizophrenic patients made more negative AS (particularly intrusive) statements to patients than relatives of bipolar patients. Schizophrenic patients made fewer supportive statements and more self-denigrating statements to relatives than bipolar patients. Among families of bipolar patients, negative AS in relatives was associated with oppositional, "refusing" styles in patients. Implications for psychosocial interventions with these disorders are discussed.

Adaptation, Psychological↗

PubMed1995

Modification of performance on the span of apprehension, a putative marker of vulnerability to schizophrenia.

The present study examined the effectiveness of 2 types of intervention (contingent monetary reinforcement and enhanced instruction) on span of apprehension performance. Forty chronic schizophrenia inpatients (26 men, 14 women) received a 3- and 12-letter array version of the span of apprehension task 4 times: baseline, intervention, immediate posttest, and 1-week follow-up. All patients were randomly assigned to 1 of 4 groups that differed according to method of intervention: repeat administration, monetary reinforcement only, instruction only, and monetary reinforcement plus instruction. The combination of monetary reinforcement plus instruction yielded significantly greater improvement in span accuracy than the other methods of intervention. These findings suggest that performance on this putative vulnerability indicator can be modified through certain interventions.

Adult↗