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Biomedical subjects

M J Goldstein

Publications and source records attributed to M J Goldstein.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Psychoeducation and relapse prevention.

This paper reviews the rationale underlying psychoeducational programs designed to prevent or delay relapse in persons with schizophrenia. Since most of these programs have been oriented toward patients and their close relatives, the studies reviewed have tested the effect of these programs when added to maintenance pharmacotherapy. The results of the first generation of studies carried out in the late 1970s and 1980s confirmed the positive effects of a family-based psychoeducational program on delaying the recurrence of a schizophrenic episode. More recent studies, termed the second generation, have built on these findings to test more specific hypotheses concerning the most efficient format for delivery of such programs (relatives-only groups, single family-unit therapy, multiple-family groups). No clear advantage has been found for any one format, suggesting that intensive family involvement in the community care of schizophrenic, and other psychotic patients as well, may be a critical ingredient in successful relapse prevention programs.

Behavior Therapy↗
PubMed1994

Family-expressed emotion, childhood-onset depression, and childhood-onset schizophrenia spectrum disorders: is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.

Adolescent↗
PubMed1994

Persisting negative symptoms and information-processing deficits in schizophrenia: implications for subtyping.

To test the hypothesis that schizophrenic patients with persisting negative symptoms have stable information-processing impairments compared with schizophrenic patients without persisting negative symptoms, 20 chronic schizophrenic outpatients were trichotomously subgrouped on the basis of the level of negative symptoms that they displayed across multiple rating periods over a 1-year period. Brief Psychiatric Rating Scale assessments of negative symptoms were used to assign subjects into either an operationally defined persisting negative symptom (PNS), transient negative symptom (TNS), or no negative symptom (NNS) subgroup. The level and pattern of these subgroups' performance on a visual information-processing task, the Span of Apprehension Test (SPAN), were compared. Although the three groups did not differ statistically in level of SPAN performance during a drug-free baseline, the PNS group had significantly poorer SPAN performance than the other two groups at the 1-year followup assessment. The SPAN performance of the TNS and NNS groups improved while the SPAN performance of the PNS group did not improve over the 1-year followup period.

Adult↗
PubMed1994

Childhood-onset schizophrenia: a followup study.

This article is an overview of our studies of childhood-onset schizophrenia. Data are presented demonstrating that (1) the majority of the sample showed continuing schizophrenia as they progressed through adolescence; (2) there was considerable variability in outcome, defined by global adjustment scores, with 56 percent of the sample showing improvement in functioning during a 2- to 7-year followup period and the other 44 percent showing minimal improvement or a deteriorating course; (3) schizophrenia in childhood could be diagnosed by the same criteria used for adults and was associated with severe dysfunction; and (4) some intrafamilial attributes found to be associated with schizophrenia in adults were also associated with schizophrenia in children, but there were some differences in the family environmental correlates of childhood- and later-onset schizophrenia. These data are consistent with the hypothesis that childhood- and later-onset schizophrenia represent the same illness or illnesses. Additional research is needed, however, to clarify the etiologic and clinical significance of the atypical early onset in childhood cases.

Activities of Daily Living↗
PubMed1994

Relatives' perceptions of their interactional behavior with a schizophrenic family member.

Relatives' (N = 77) perceptions of their recent interactional behavior with a schizophrenic family member (N = 51), as measured by an adjective checklist, were compared with outside observer ratings of the relatives' Affective Style (AS) and the patients' Coping Style (CS) during a family interaction task. Results indicated that, overall, the relatives in the present sample perceived their own interactional behavior toward the patient, as well as the patients' behavior toward them, in a way that paralleled their affective behavior as assessed by outside raters. Moreover, the relatives' rated their relationship with the patient in a fashion that was more predictive of the observed interactional behavior of both the relatives and the patients than were the outside observers' ratings of the relatives' Expressed Emotion (EE) measured either at the patients' index hospitalization (using the Camberwell Family Interview, CFI-EE) or during the post-discharge period (assessed with a brief Five-Minute Speech Sample method, FMSS-EE).

Adaptation, Psychological↗
PubMed1994

Psychoeducational and family therapy in relapse prevention.

Recent shifts to briefer hospitalization and an emphasis on community care have emphasized the significance of patient-family interactions in this phase of treatment. Psychoeducational family programs designed to increase medication compliance and effectiveness in coping with stressors have been successful in reducing the risk of relapse in the first year following hospital discharge. Various models for family intervention are discussed and their strengths and weaknesses evaluated.

Chronic Disease↗
PubMed1994

Intrafamilial relationships and the course of schizophrenia.

This paper describes efforts to explicate the significance of schizophrenic patients' sub-clinical psychopathology (SCP) to affective attitudes expressed by relatives about these patients. Using data from two 10-minute interactions between patients and close relatives (usually parents), verbal and non-verbal behaviors were scored for signs of SCP by the patient. Scores reflective of more overt signs of SCP were highly related to relatives' expressed emotion status and their affective style when interacting with the patient, suggesting that a complex transactional model best explains the connection between high EE status of a relative and the risk for patient relapse.

Affect↗
PubMed1993

Multiple perspectives on family relationships: a latent variables model.

Many scholars are skeptical of family member reports on their interpersonal relationships. Familial reports are assumed to be biased by social desirability as well as other factors. In this study, a latent variables modeling approach was employed to evaluate rater reliability and bias in mother, father, and child ratings of parent-child negativity. Results based on 78 clinical families demonstrate that family member ratings contain a significant "true score" component that correlates with observer ratings of parental behavior. The presence of systematic rater effects is also demonstrated. The latent variables approach, which provides statistical control for rater effects, is recommended for the analysis of this type of data.

Adolescent↗
PubMed1993

One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion.

The association between 1-year post-hospitalization outcome and the brief Five Minute Speech Sample (FMSS) measure of expressed emotion (EE) was examined among children with depressive disorders. Results indicated a strong association between 1-year outcome and the FMSS-EE measure. Whereas children returning to high EE homes were likely to show persistent mood disorder, recovery was more common among children returning to low EE homes. This predictive relationship was independent of possible mediating variables such as treatment regimen and clinical characteristics. Results provide the first reported demonstration that (1) the brief FMSS-EE measure predicts clinical outcome, and (2) EE measures predict 1-year outcome for children with depressive disorders.

Adolescent↗
PubMed1993

Diagnostic specificity of a brief measure of expressed emotion: a community study of children.

The association between expressed emotion (EE) and psychiatric disorders was investigated in a community survey of 108 preadolescent children. Results indicated that the two components of EE, critical comments and emotional overinvolvement, identified non-overlapping subsets of families and displayed diagnostic specificity. Significantly higher rates of disruptive behavior diagnoses were observed in children of parents who expressed high levels of criticism, while children of parents who expressed high levels of emotional overinvolvement were significantly more likely to have an anxiety disorder when compared to the remaining sample. Findings support the utility of this brief measure of EE in epidemiologic samples.

Child↗
PubMed1993

Short-term stability of task-generated, interactional patterns in families of schizophrenic patients.

Both researchers and therapists who study schizophrenia make inferences about enduring family roles from observed patterns of interactional talking behavior within families. Evidence regarding the stability of these patterns is rarely investigated. The present study examined the short-term stability of intrafamilial speech patterns (who talks to whom) across two consecutive discussions. The sample was composed of families containing a recent-onset, adult schizophrenic patient. All discussions involved two biological parents and a young adult patient (N = 28). Families were classified into one of three interactional role-structure categories based on the intrafamilial speech patterns in two 10-minute discussions obtained in the same session. In addition, the affective style (Doane, West, Goldstein, et al., 1981) of the content of the discussions was coded. The results indicated that intrafamilial speech patterns were relatively stable across two discussions despite variations in the focus of the problem discussed. Further, when one parent was predominant in the discussion, a higher rate of negative affective statements was observed than when both parents were equal participants. The results provide further support for the use of discussion tasks in generating meaningful family interaction data.

Adolescent↗
PubMed1993

Relatives' awareness of their own expressed emotion as measured by a self-report adjective checklist.

Relatives' ratings of their affective attitudes toward a schizophrenic family member (N = 54) on a self-report adjective checklist were compared with two methods for rating expressed emotion (EE)--the original Camberwell Family Interview (CFI-EE) and a Five-Minute Speech Sample method (FMSS-EE). Eighty-four relatives were included in the sample. Results indicate that, in general, the relatives in the present sample perceive in themselves attitudes toward the patient that parallel those assessed by outside raters. A higher rate of correspondence was found between adjective ratings and concurrent FMSS-EE status than with prior CFI-EE status. Relatives classified as high-EE, critical by either method, were more readily discriminable in their adjective ratings from those rated low-EE than were relatives rated high-EE on the basis of emotional overinvolvement.

Adult↗
PubMed1993

Electrocardiographic changes during cesarean section: a cause for concern?

A Holter monitor was used to record ST segment changes during cesarean section in 170 consecutive healthy parturients starting 2 h before and ending 3 h after surgery. Lumbar epidural anesthesia (LEA, n = 120) or subarachnoid anesthesia (SA, n = 50) was used. Transthoracic 2-D echocardiograms were obtained in 30 patients from the LEA group. ST depression or elevation occurred 160 times in 44 patients from both groups. Ninety-eight percent of these changes occurred between induction of anesthesia and the end of surgery, with 78% of the episodes registering -1 mV. In the LEA group, the number of episodes tended to increase after delivery, but in the SA group, the frequency remained constant. ST segment depression was recorded in 38% and 14% of patients in the LEA and SA groups, respectively (P < 0.05, x2 analysis). No wall motion abnormality was noted in the echocardiogram during ST segment depression. Neither the 12-lead electrocardiogram nor plasma myocardial specific creatine kinase suggested myocardial damage. The operative events, alone or in combination, including hypertension, tachycardia, hypotension, bradycardia, air embolism (precordial Doppler) were neither specific nor sensitive as predictors of ST segment change (stepwise logistic regression). Tachycardia was associated with ST segment changes in 10% of time epochs (5 min) (P = 0.05, x2 analysis). Thus, ST segment changes during cesarean section are not caused by myocardial ischemia and are not of any clinical consequence.

Adult↗
PubMed1992

Prodromal symptoms and signs of bipolar relapse: a report based on prospectively collected data.

Prospectively collected data on 19 recently hospitalized patients with bipolar disorder were examined for prodromal changes preceding relapse. The 4-month periods before six manic and six depressive relapses were compared with each other and with a comparable period for seven patients who did not relapse. The Brief Psychiatric Rating Scale was used to assess symptoms. Significant elevations in unusual thought content were found 1 month before manic relapse. Depressive relapsers evidenced higher levels of conceptual disorganization throughout the prerelapse period. Nonrelapsers showed very stable symptom profiles.

Adult↗
PubMed1992

Developmental Processes in Schizophrenic Disorders: longitudinal studies of vulnerability and stress.

The Developmental Processes in Schizophrenic Disorders project is a longitudinal study of schizophrenic patients who have recently had a first episode of psychosis. The project focuses on discriminating characteristics of schizophrenic patients that are "stable vulnerability indicators," "mediating vulnerability factors," and "episode indicators" by comparing normal subjects to schizophrenic patients assessed in clinically remitted and psychotic states. A parallel project goal is to identify predictors of relapse, social and work impairment, and illness course among potential psychobiological vulnerability factors and environmental potentiating factors. Hypothesized vulnerability factors and potential environmental stressors are examined first under standardized maintenance antipsychotic medication conditions for at least 1 year. Patients showing stable remission of psychosis after 1 year of maintenance antipsychotic medication are invited to enter drug crossover and withdrawal protocols to determine the need for continuous antipsychotic medication. Vulnerability and stress factors are again assessed. A summary of results to date is presented. Deficits in early components of processing visual arrays and in sustained discrimination of successive ambiguous perceptual inputs are relatively stable across psychotic and clinically remitted states in the schizophrenic patients. Performance on a vigilance task demanding active, working memory also remains abnormal during clinical remission but covaries significantly with psychotic state and is a candidate for a mediating vulnerability factor. Autonomic activation level does not appear to be an enduring vulnerability factor, but it predicts the extent of short-term symptomatic recovery and may mediate the impact of stressors. Under conditions of standardized, injectable antipsychotic medication, independent stressful life events and highly critical attitudes toward the patient in the social environment predict relapse risk. Prospective data suggest that signs and symptoms prodromal to psychotic relapse may be present in about 60 percent of patients.

Adolescent↗