Goldstein 1988 Flashcards

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1
Q

Goldstein 1988

High reliability

A

The study is reasonably
high in generalisability.

For example…the original sample was mode up of 199
males and females, ages ranging from 18-45.

90 of these
were then selected for further investigation, following rediagnosis using the DSM 3.

This is a strength because findings regarding schizophrenia Causes can be generalised more widely

to inform
psychiatrists of the impact of pre morbid functioning, gender
and reliability of diagnostic systems.

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2
Q

Goldstein 1988

Low Gen

A

The study is low in
generalisability.

For example, no participants were over the age of 45 at the
start of the study which may cause gender bias.

This is a weakness because there are a significant % of women
who have their first episode of schizophrenia after the age of
45
which is subsequently more severe in nature (Levine, 1981)

meaning that the findings, which imply that men have a
more severe course of schizophrenia, may not be 100% factual

as they were not representative of diagnoses in
women across the population.

So Low in Gen to Older Women with SZ

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3
Q

Goldstein 1988

High inter Rater Reliability

A

The study is high in interrater reliability.

when testing for reliability of diagnosis,
Goldstein herself re diagnosed clients before two other
experts re diagnosed 8 patients at random.

Findings
showed a 0.8 agreement between them

showing that only
1 psychiatrist disagreed with Goldstein one on singular
case.

This is a strength because it shows that Goldstein’s findings
were re assessed with results indicating a high degree of
psychiatric agreement

meaning findings regarding the DSM is
are highly credible and reliable

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4
Q

Goldstein 1988

High test retest

A

The study is high in test
re test reliability.

Angermeyer (1987)

confirmed Goldstein’s
findings that pre morbid functioning was important in
predicting the severity of the disorder.

This is a strength because it shows how Golstein’s study can be replicated and the same trends are observed

thus
demonstrating how occupation, isolation and relationships
prior to diagnosis are an important contributor to SZ’s Cause (Prognosis)

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5
Q

Goldstein 1988

Objective (credible reliable)

A

One strength of the
study is that the data
collected was highly
objective.

For example, data gathered regarding symptoms was
attained through use of a structured interview using ranked
scale questions and yes/ no responses.

+ data
gathered regarding rehospitalisations and length of stay
was gained from the New York State Department of Mental
Health.

This is a strength because secondary data and quantitative
data eliminate researcher bias, increasing the credibility of
Goldstein’s results. :D

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6
Q

Goldstein 1988

Application 1

A

One strength of the
study is that it has
positive implications for
understanding gender
differences in the cause and severity
of schizophrenia.

For example…males were found to have double the
amount of re hospitalisations than females after 10 years,
with this difference being even more significant after only 5
years.

This is a strength because it emphasises the need to consider
gender disparities in causes and severity

which can then inform
treatment and interventions for males aged 18-45 with a
schizophrenia diagnosis

:D

so nice aplication

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7
Q

Goldstein 1988

Aplication 2

A

One strength of the
study is that is has
positive application to
society

Cuz informs it us about the reliability of
the DSM when diagnosing
schizophrenia.

As it was established that there was a 0.8 level
of agreement between psychiatrist after re diagnosing
169/199 with schizophrenia using the DSM 3.

This is a strength because it shows that the DSM 2 and 3 were highly reliable systems

as if diagnosed using the DSM 2, rediagnosis was likely using DSM 3

good application

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8
Q

Goldstein 1988

Matched pairs = control good
Int Val

A

One strength of the
study is it had a matched
pairs design

the 199 ppts in study one

and therefore the 90 males (58) and females (32) aged 18-45 were matched on
marital status, education, age, religion and social class. All
were also from New York and from a similar cultural
background.

This is a strength because participant variables are reduced

meaning that any variables such as socio economic status were
not to compromise the validity of the study.

Giving the study high Internal Validity

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9
Q

Goldstein 1988

Primary and secondary data = Strength for Validity and Reliability apparently

A

primary data was gathered through use of:

questionnaires used to measure pre morbid functioning

interviews used to assess symptoms.

secondary data, regarding rehospitalisation rates and lengths of stay, were gathered using the New York State
Department for Mental Health records.

This is a strength cuz multiple sources were used to
investigate Goldstein’s aims, increasing internal validity and reliability
of the study.

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10
Q

Goldstein 1988

Ethics +

A

One strength of the
study is that ethical
guidelines were followed

no harm was caused to participants- with
some data being retrospective.

Primary data was gathered
from patients using trained interviewers

and participants
were aware of the study’s intentions.

This is a strength because it shows that Goldstein’s procedure
was ethical and had positive applications to society to show the reliability of:

diagnostic tools, gender differences in cause and severity

and impact of
premorbid functioning.

Thus making the study Highly Ethical

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11
Q

Goldstein 1988

Key Q

A

Do SZ women have less severe experiences than SZ men?

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12
Q

Goldstein 1988

Aims

A

See if Gender diff in Rehospitalise SZ ppl and length of Hospital stay

Consider social Factors, Mainly b4 diagnosis, to see if had an impact on the course of the dissorder regarding Gender

Look at DSM II and DSM III diagnsis to see if there were diff + test Reliability and Valididty

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13
Q

Goldstein 1988

Study 1

A

199 ppts male and Female

all rediagnosed 10 yrs later with DSMIII

data collected in mid 70s at private Psychiatric teaching hospital in NY

aged 18-45

patients Rediagnosed with DSM III

Single blind procedure used ( Psychiatrist blind to Hypotheseis)

Goldstein herself carried our Rediagnosis and was not blind to hypothesis

the 2 experts who were also carried out Rediagnosis on a random sample of 4 men and 4 women

they acheived a 0.80 agreement with Goldstein.’s diagnosis

with only 1 in a single case disagreeing

this was to test reliability

169/199 patinets who were diagnosed with SZ with DSM II, rediagnosd with SZ with DSM III

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14
Q

Goldstein 1988

STUDY 2

A

90 of the 169 rediagnosed PPts selected

58 M 32 W

mean age is 24

All have high lvl of ED
and 87/90 were Non-hispanic White and Middle Class

Whole sample had lots of diff types of SZ

Goldstein gathered info abt symptoms, Functioning b4 diagnosis (PreMorbid Functioning) and the Course of the illness using Interviews and Questionaires

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15
Q

Goldstein 1988

Study 2: Symptoms

A

Symptoms were rated by trained master lvl interviewers

using an instrument developed specificaly for og Study

Areas covered: Halluciantions, Formal thought dissorders, Paranoia, grandosity, isolation, withdrawal, anxiety ect

all give idea of SZ characteristics

its assumed Goldstein used the trained interviews to rate symptoms using Specialy developed Questions

that interviews would been Structured using Rating scales and Perhapse Yes/no Answeres (Closed Qs)

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16
Q

Goldstein 1988

Study 2: PreMorbid Functioning

A

PreMorbid Functioning (Functioning b4 the illness)

ie behaviours, day to day functioning, relations and interests ect.

measured via Questionaire

Dealing with: Isolation, Occupational status, peer relationships and Interests

Overall ratings then Found

17
Q

Goldstein 1988

Study 2: Course of Illness

A

Course if the illness was opperationalised by:

Number if ReHospitalisations

Length of Hospital Stay

with the data being obtained over 10 yr perioid (Longitudional)

Statistical info abt them

=

Obtained from New York State Department for Mental Health’s Records

(Secondary Data)

18
Q

Goldstein 1988

Results

A

Study 1

0.80 Agreement from 2 Experts in Goldstein’s Rediagnosis (DSMIII) of 4 random Men and 4 random women, while both being blind to Hypothesis (exept her (Goldstein))

(only 1 disageed once)

So relaible

169/199 patients Rediagnosed with SZ with DSM III who were og diagnosed by DSM II

Study 2

Found that Men had Higher mean number of Rehospitalisations and length of stay than women

SZ W sig lower For both from 1973-83 than M

this effect is even Stronger in a 5 yr perioid looked at

All findings Sig:

ReHosp Number

0-5 yrs

M = 1.4

W = 0.59

0-10 yrs

M = 2.24

W = 1.12

Length of Hospital stays

0-5 yrs

M = 267.41 days

W = 129.97

0-10 yrs

M = 417.83 days

W = 206.81

19
Q

Goldstein 1988

Conclusion

A

Females with SZ experience less ReHospitalisations and Shorter time in Hospital over 5 and 10 yr perioid than Males

Gender Diff = strong, even when DSM III used ( Its more Stringent than DSM II) even with relativly small sample

Gender Diff seem to Start early in Disorder

Study Suggest males have poorer outcomes than Females interms of SZ severity

(Its worse for them between 19-45)