Goldstein (1988) Gottesman & Shields (1966) Clinical psychology Goldstein (1988) Gottesman & Shields (1966)

Goldstein’s study … This study relates to several aspects of the unit: Primary and secondary data (‘methodology/how science works’, a & b, spec. page 58) Validity and reliability of DSM diagnoses (‘content’, c, spec. page 59) Research methods (3a, spec. page 63)

Goldstein’s study: APRC ‘Gender differences in the course of schizophrenia’ A - Aims: 1) To see if there are gender differences with regard to the re-hospitalisation of people with schizophrenia and to the length of their hospital stays 2) To consider social factors (mainly factors present before diagnosis), to see if they had an impact on the course of the disorder with regard to gender 3) To look at DSM II and DSM III diagnosis to see if there were differences and to test the DSM for reliability and validity Main research question: do schizophrenic women have a less severe experience than schizophrenic men?

Goldstein’s study: APRC P – Procedure Sample Data was collected in the mid 1970s at a private psychiatric teaching hospital in New York; patients chosen were those who between 1972 and 1973 fulfilled specific criteria * 90 in total (58 male, 32 female) 52 were first-time admissions, the remaining 38 had had one previous hospitalisation They were aged between 18 and 45 (mean age 24)

Goldstein’s study: APRC * Criteria: Had a hospital diagnosis of schizophrenia or acute schizophrenia on admission and on discharge, using DSM II Had a hospital stay of less than 6 months Expected to return to their families Had no other mental health issues No drug or alcohol misuse P – Procedure Goldstein used both primary data (PD) and secondary data (SD) SD – The DSM III was used to look at gender differences in schizophrenic patients who were in the early stages of the disorder and were followed for 10 years

Goldstein’s study: APRC P – Procedure (SD) Statistical information about re-hospitalisations and lengths of stay were obtained from the New York State Department of Mental Health (NYSDMH) Re-diagnosis Patients were diagnosed using the DSM III; hospital records gave detailed histories for the re-diagnosis and a single blind technique was used (the psychiatrist was blind to the hypothesis) Goldstein also carried out re-diagnosis and she was not blind to the hypothesis; to test for reliability, two other experts carried out re-diagnosis of a random sample of patients (4 men and 4 women) – they achieved a 0.80 agreement and only one case disagreed with Goldstein’s diagnosis

Goldstein’s study: APRC P – Procedure (PD) Goldstein gathered information about symptoms, premorbid functioning (functioning before the diagnosis) and the course of the illness using interviews and questionnaires Symptoms Symptoms were rated by trained interviewers using specially developed questions; areas covered included hallucinations, paranoia, isolation, withdrawal, anxiety., depressive mood, somatic (physical) complaints, impulsivity, inability to function, obsessive thought and behaviour and agitation These all give an idea of the characteristics of the schizophrenia and other related mental illnesses

Goldstein’s study: APRC P – Procedure (PD) Premorbid functioning This was measured by questionnaires dealing with isolation, peer relationships, and interests from the ages of 6-13 and 14- 20; participants were given an overall rating Course of illness Measured by the number of re-hospitalisations and lengths of stay in hospital, with data being obtained over a 10 year period; results were considered at the 5 year and 10 year stages of the study

Goldstein’s study: APRC R – Results Secondary data: Re-diagnosis – out of an original 199 patients who had schizophrenia, acute schizophrenia or schizoaffective disorder according to the DSM II, 169 met the criteria of the DSM III for schizophrenia, schizophreniform disorder (a short-term type of schizophrenia, involving psychosis)or schizoaffective disorder NYSDMH statistics – these showed that men had a higher mean number of re-hospitalisations and longer stays in hospital over a 10-year period of the study than women; schizophrenic women had a significantly lower mean number of re- hospitalisations and shorter stays in hospital from 1973-1983 than men The effect is even stronger of the 5 year period is looked at

Goldstein’s study: APRC R – Results Primary data about premorbid functioning, symptoms and course of illness was combined with secondary data to generate the following results: 13% of the gender effect on re-hospitalisation was due to premorbid functioning; however, this only accounted for 4.3% of the effect of gender on length of stay Social functioning accounted for the gender effect on re-hospitalisation only 4.2% more than if premorbid effects alone were considered

Goldstein’s study: APRC R – Results Social functioning explained11.3% more of the length of stays than premorbid factors alone Both premorbid factors and social functioning appeared to play a part in gender differences to varying extents, depending on whether the focus is on length of stay or re- hospitalisation Goldstein examined psychotic and emotional symptoms to investigate the effects of subtypes on gender differences in the findings – diagnosis of subtype accounted for just 1.2% more than premorbid factors and social functioning of the effect of gender on 5-year re- hospitalisations; this differences was 4.8% more for length of stay

Goldstein’s study: GRAVE Evaluation: Generalisability – can the findings be applied beyond the sample studied? Reliability – can the study be replicated (under the same conditions and using the same variables)? How easy/difficult would this be? Applicability – can the findings be used to any effect? (Do they have a ‘real-life’ application?) Validity – different types: construct and ecological Ethics – were participants treated in an ethical manner?

Gottesman & Shields - APRC The researchers used a twin study methodology to investigate the concordance rates of schizophrenia in twins They replicated previous studies to test reliability A – Aim: to examine whether schizophrenia has a genetic basis

Gottesman & Shields - APRC P – Procedure: This study utilised both primary and secondary data Data came from: Secondary - hospital notes, case histories based on self report questionnaires and interviews with twins and parents Primary - tape recorded 30 minute samples of verbal behaviour and semi structured interviews, personality testing, testing to measure disordered thinking (conducted on both twins and parents)

Gottesman & Shields - APRC P – Procedure: Researchers looked at patient records from a psychiatric hospital from 1948 – 1964 392 patients were twins of the same sex, and of those, 68 had a diagnosis of schizophrenia 6 patients were discounted either because their twin was unable to participate or it was unclear if they were MZ or DZ twins

Gottesman & Shields - APRC P – Procedure: Sample - out of the 62 patients, half were male and half were female; ages ranged from 19 – 64, with an average age of 32. Three methods were used to assess whether they were MZ or DZ twins; fingerprint testing, blood testing, and resemblance testing (DNA testing was not around at this time)

Gottesman & Shields - APRC If one twin had been diagnosed, researchers wanted to know if the other twin would soon be diagnosed (using concordance rates) The data was analysed between the twin who was first admitted and their other twin, with twins being categorised in 4 ways:

Gottesman & Shields - APRC R – Results: Category 1: both twins had been diagnosed with schizophrenia - 10 MZ twins, 3 DZ twins Category 2: first twin has schizophrenia, but the other twin had another diagnosis related to schizophrenia - 3 MZ twins, 6 DZ twins Category 3: the 2nd twin had some psychiatric abnormality that wasn’t related to schizophrenia - 6 MZ twins, 9 DZ twins Category 4: The first twin had schizophrenia but the 2nd twin was analysed as ‘normal’ - 5 MZ twins, 18 DZ twins

Gottesman & Shields - APRC R – Results: Concordance rates – Severe schizophrenia (longer than 2 years) MZ – 75% DZ – 22% Mild schizophrenia (less than 2 years) MZ – 17% DZ – 0%

Gottesman & Shields - APRC R – Results – summary: There was a significant difference found between MZ and DZ twins in all measures MZ twins were always more similar in diagnosis than DZ twins; in each case where the co-twin had some diagnosis Concordance rates were higher in MZ and DZ twins for severe schizophrenia compared to mild schizophrenia

Gottesman & Shields - APRC C – Conclusions The closer the genetic relationship between two people, the greater the chance that both people in that relationship will be diagnosed with schizophrenia or a related psychotic disorder Although schizophrenia cannot be solely down to genes, genetic factors predispose someone to developing schizophrenia