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Biomedical subjects

M J Goldstein

Publications and source records attributed to M J Goldstein.

At least 73 records · Page 4Linked to original sources
PubMed1988

Family factors and the course of bipolar affective disorder.

Measures of family attitudes (expressed emotion [EE]) and interactional behaviors (affective style [AS]), both of which have been found to predict relapse in schizophrenia, were obtained from key relatives of 23 hospitalized recently manic bipolar patients. Patients were then followed up for a period of nine months after hospital discharge and rated on measures of clinical course, social adjustment, and medication compliance. Levels of intrafamilial EE and AS were found to predict likelihood of patient relapse at follow-up, especially when used as conjoint predictors of patient outcome status. Levels of AS also predicted degree of social adjustment at follow-up. The predictive relationships observed were independent of patient medication compliance, treatment regimen, baseline symptoms, demographics, and illness history. Results suggest that the emotional atmosphere of the family during the postdischarge period may be an important predictor of the clinical course of bipolar disorder.

Adolescent↗
PubMed1988

Parental communication deviance: its relationship to parent, child, and family system variables.

Audiotape recordings of family interaction samples from 30 nondistressed and 32 multiproblem families were coded for communication deviance (CD). Maternal CD was found to be higher in families high on measures of "preschizophrenic" child behavior, externalizing or "acting out" offspring behavior, overall family distress, and maladaptive marital and family alliance structures. Paternal CD was found to be higher in families in which offspring were rated high on externalizing behaviors.

Acting Out↗
PubMed1988

The impact of education about schizophrenia on relatives varying in expressed emotion.

The demand for information by relatives and the success of family intervention programs with an initial didactic component has resulted in a proliferation of educational interventions in schizophrenia. The present study assesses the impact of a single educational session on relatives of recent-onset schizophrenic patients. Results suggest that relatives who participated in family education experience an increased sense of support from the treatment team and a nearly significant tendency toward a decrease in self-blame regarding the schizophrenic illness. Despite findings in previous studies suggesting information acquisition immediately after education and retention after 6 months, the present study found no information retention after a 2-month period. After family education, relatives rated as high in expressed emotion (EE) reported a significantly increased sense of understanding of the illness and expressed increased feelings of support from the treatment team, whereas low EE relatives did not change significantly in these attitudes as a function of the educational session. Low EE relatives demonstrated more actual information about the illness and were less likely to perceive the symptoms as being done intentionally to bother them.

Adult↗
PubMed1988

Parental communication deviance in childhood onset schizophrenia spectrum and depressive disorders.

Rates of parental communication deviance (CD) were compared in children with schizophrenia and schizotypal personality disorder and in contrast groups of children with major depression and dysthymic disorders. Results indicated significantly higher rates of CD in parents of schizophrenic and schizotypal children than in parents of children with major depression and dysthymic disorders. Schizophrenic and schizotypal children from high CD families showed the most severe impairments and the poorest attentional functioning. However, the small number of schizophrenic and schizotypal children with low CD parents underscored the strong association between schizophrenia spectrum disorders, parental CD and psychosocial and attentional impairment in the child.

Attention↗
PubMed1987

Psychosocial issues.

This article uses a version of the vulnerability-stress model to examine psychosocial factors related to the onset, course, and treatment of schizophrenia. High-risk studies, most of which study offspring of a schizophrenic parent, suggest that signs of vulnerability to the disorder may emerge in early to middle childhood in neuromotor integration, attentional and information-processing abilities, and deviant social behavior. It is still not clear that these markers are specific to the subsequent development of schizophrenia. The evidence for stressful family relationships as potentiators of the disorder in vulnerable off-spring is also reviewed. Although few studies are available that bear directly on this issue, the preliminary evidence suggests that further investigation is warranted. Stressors, particularly those arising from within the family, are also examined as they relate to the course of schizophrenia. The data on expressed emotion (EE) have been replicated more often than not, although the origins of high EE attitudes are not precisely understood. These attitudes do not arise as reactions to the form or severity of a relative's disorder, but they may relate to the length of time between initial onset of the disorder and first hospitalization. Family-based intervention programs, overlaid on regular antipsychotic drug treatment, appear to reduce the risk for relapse in the short-term. At least one of the mechanisms of action of these programs is to reduce the negative affective climate in the family.

Adaptation, Psychological↗
PubMed1987

The UCLA High-Risk Project.

The UCLA High Risk Project studied a cohort of 64 families over a 15-year followup period. At entry to the study, the families each contained one adolescent who was having behavioral difficulties for whom help was sought from a psychological clinic. Two criteria of the degree of risk for schizophrenia were devised initially, one based on the form of the adolescent's problem and the other on the parental attributes of communication deviance (CD), affective style (AS), and expressed emotion (EE). It was hypothesized that schizophrenia would be the likely outcome when certain patterns of adolescent disturbance and negative communicational and affective patterns were present in the family. The index offspring of 54 of the 64 families were successfully followed up over the 15-year period (mean age = 30 at last followup), and blind psychiatric diagnoses were done. Contrary to the initial hypothesis, the form of the adolescent problem had limited prognostic value; however, the combination of CD and AS correctly identified the overwhelming number of cases who developed schizophrenia and related disorders. CD did even better if the dependent variable was the risk for schizophrenia spectrum disorder in any offspring in the family.

Adolescent↗
PubMed1986

Information processing and communication deviance in schizophrenic patients and their mothers.

Tests of attention/information processing, the continuous performance test (CPT) and the span of apprehension task (SAT), were given to 25 schizophrenic patients and their mothers. Measures of communication deviance also were obtained from the mothers. Comparison of these assessments in the mothers revealed different transactional profiles for good attenders and poor attenders on the CPT and on the SAT. The relationships between generations (patient and mother) differ from the within-individual relationships. CPT performance by the patient is not significantly correlated with scores from the mother. However, SAT performance by the patient could be related to SAT performance by the mother and specific communication deviance factor scores.

Adolescent↗
PubMed1986

The impact of individual and family treatment on the affective climate of families of schizophrenics.

Measures of parental affective style were compared for families of schizophrenics participating in a controlled treatment study which contrasted individual and family-based therapeutic programmes. The total number of critical statements and non-critical, intrusive remarks was significantly lower after three months for parents of schizophrenics participating in family therapy, compared to those whose offspring received only individual therapy. An increased risk for relapse was associated with an increase in the number of critical and/or intrusive remarks for patients in individual treatment. A significant increase in non-emotional, problem-solving statements was observed in parents who received family therapy, compared with those who did not. The results suggest that a behaviourally-oriented, problem-solving family approach may have reduced the risk of relapse in the first nine months after discharge from hospital by teaching families concrete ways of solving problems and concomitantly reducing the amount of negative emotional relating between family members.

Adolescent↗
PubMed1986

Emotional attitudes and direct communication in the families of schizophrenics: a cross-national replication.

To examine how the measure of expressed emotion relates to family life, 30 relatives of schizophrenic patients were assessed for EE and then observed in ten-minute discussions with the patients. It was found that high-EE relatives express more negative emotional statements than low-EE relatives when face-to-face with the patient; they also talk more rapidly, and this speech rate is correlated with the patient speech rate. Whereas low-EE relatives expressed few criticisms or intrusive statements, high-EE over-involved relatives were more intrusive, and high-EE critical relatives were more critical as well as more intrusive in direct interaction. These findings emphasise the importance of understanding divergent EE sub-styles and the complementary behaviour of patients. The findings of an earlier Los Angeles study were replicated.

Attitude↗
PubMed1985

Parental affective style and the treatment of schizophrenia. Predicting course of illness and social functioning.

In a randomized controlled study, the affective style (AS) of parents of schizophrenics in clinic-based individual treatment groups and home-based family treatment groups was compared prior to treatment and again three months after treatment had begun. Affective style is an index reflecting the quality of the family emotional climate, measured from face-to-face discussion. Pretherapy and posttherapy measures of negative AS were significantly predictive of relapse within the nine-month treatment period for patients in individual treatment. In addition, for both treatment groups, a negative AS pattern at the posttherapy reassessment was significantly associated with decreased patient social functioning, reduced ability of the family to absorb the family intervention, and lower capacity of the family to cope with everyday family stresses. The results suggest that AS is an important intrafamilial attribute, with implications for treatment strategy and planning.

Adolescent↗
PubMed1985

Family factors that antedate the onset of schizophrenia and related disorders: the results of a fifteen year prospective longitudinal study.

The present study evaluates, within the context of a prospective study, whether certain discrete, pathological styles of communication antedate the onset of schizophrenia and schizophrenia-spectrum disorders. The three parental styles evaluated were: communication deviance (CD; Wynne & Singer), affective style (AS; Doane), and expressed emotion (EE; Vaughn and Leff). These measures were obtained on a sample of 64 intact families who appeared for help, from a psychological clinic, for their moderately disturbed teenager over 15 years ago. The sample of offspring and selected siblings were followed up at two subsequent time periods, 5 and 15 years after the initial family assessments at which times blind psychiatric evaluations were done. The lifetime prevalence of schizophrenia and schizophrenia-spectrum disorders in the sample were evaluated. Of the 64 teenagers, follow-ups were feasible on 50 of the cases. Of these, 45 had all three parental measures available. Within that subsample, schizophrenia-spectrum disorders were predominantly associated with the combined parental pattern of high CD, negative AS and high EE. When data for siblings was included, the predictive value of CD was even greater. These findings strongly suggest that disturbed patterns of intrafamilial communication and affect expression antedate the onset of schizophrenia-spectrum disorders and are not reactions to psychotic behaviors in already schizophrenic offspring.

Adolescent↗
PubMed1984

Interactional correlates of expressed emotion in the families of schizophrenics.

Measures of intrafamilial expressed emotion (EE) predict relapse in schizophrenic patients, but previous research has not investigated whether EE scores are representative of ongoing family transactions. Parents of 42 hospitalized schizophrenic patients were rated for level and type of EE. Following the patient's discharge, families participated in two 10-minute direct interaction tasks. Transcripts from these interactions were coded on dimensions of affective communication. High-EE parents exhibited more negatively charged emotional verbal behaviour in direct transaction with their schizophrenic offspring than did low-EE parents. Some parents rated high-EE were distinguished by their frequent usage of critical comments during the interactions, whereas high-EE overinvolved parents used more intrusive, invasive statements. These findings support the construct validity of expressed emotion.

Adolescent↗