Goldstein 1988-Gender differences in Schizophrenia

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  • Goldstein 1988, gender differences in the course of Schizophrenia
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      • AIM
        • To see if there is any significant difference in the age of onset Schizophrenia between the two sexes, and to see if women have a less severe course of the disorder than men
        • sample of 199 men and women, all diagnosed with Schizophrenia and on discharge from psychiatric hospital, from a stay of less  than 6 months
          • They were all expected to live with a family member, either parent or spouse, and all were aged between 18 and 45 years.
            • None of them had any organic brain disorder e.g. epilepsy, and none had a drug problem, including alcohol abuse.
              • They were re-diagnosed 10 years later using the revised DSM. of the original 199, 169 were re-diagnosed, 30 were deemed not to be schizophrenic.
                • Of the 169, 52 were first-time admissions and 38 had had only one previous hospitilisationin the 70s. The remainder were studied by Goldstein. (79)
                  • How well the patients could function in everyday life was measured by looking at marital status, peer relationships, isolation and interests.
                    • The course and severity of the illness was measured by looking at the number of ties the patients had been in hospital, and ho long the hospital stays had been over a 10-year period.
      • FINDINGS
        • in the first 5 years, men were averagely rehospitalised1.4 times, women, 0.59. in the second 5 years (10) men=2.23, women=1.12.In the first 5 years, men stayed on average 267.41 days, women stayed for 129.97. After 10 years, men=417.83, women= 206.81
          • Women had significantly lower re-hospitalisation and shorter stays in hospital. Gender differences were stronger in the first 5 years, possibly as severity of schiz doesn't worsen after 5 years. Differences in premorbid (before diagnosis) functioning, affected the length of stays
        • Gender differences in the course of schiz are present in the early stages of the disorder, with poorer premorbid functioning in men being responsible for a poorer outcome
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      • whilst this was a longitudinal study, it did not suffer from the problem of participants dropping out, as data about their hospitalisation was obtained from the start of the study.
      • The men and women were well matched in terms of marital status, age, education, religion and socio-economic status.
      • Two experts who did not know the aim of the study tested the reliability of the re-diagnosis; there was an inter-rater reliability rate of 80%, showing that there was good reliability.
      • The sample size was 169, they added people who only had one hospital stay to increase generalisability
      • Supporting studies Gittelman-Klein and Klein 1969 found that men do tend to have poorer premorbid histories than women
        • Huber et al 1980 found that with  poorer premorbid history had a poorer outcome when it came to schiz
          • Angermeyer 1987 carried out a larger replication of this study and found the same results. This all increases the reliability
      • The data is objective and unbiased in terms of the number of hospital stays and length of the stays, as it came from an outside agency that accurately recorded these details.
      • Whilst the men and women were matched for employment status, they weren't for type of employment
      • Problems with generalising the results as all participants returned to their families after hospitalisation. May not be true for those who don't. However most in the early stages do rely on family so may be representative
      • The age limit was 45, whereas most women have their first schizophrenic episode after the age of 45.
      • If you argue the DSM is not valid, the validity of diagnosis of Schiz can be questioned


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