Biomedical subjects
A C Carr
Publications and source records attributed to A C Carr.
Treatment-resistant depression: a survey of practice habits of Canadian psychiatrists.
Treatment-resistant depression is a fascinating yet poorly defined condition. The various management strategies in use are a source of controversy. The objective of this survey was to determine how Canadian psychiatrists treat patients with "intractable depression." This information may be used to plan future research into the management of treatment-resistant depression. It may also provide information about the practices of Canadian psychiatrists and help direct residency training. Confidential questionnaires were mailed to all psychiatrists residing in Canada registered with the Canadian Psychiatric Association. Respondents indicated that 12.4% of their depressed patients were "resistant to treatment." Respondents were asked to rank a list of treatment choices in the order they would use them to treat patients with treatment-resistant depression. Ninety-five point eight percent of respondents used tricyclics as the first treatment of choice. Almost equal portions of respondents chose a second tricyclic, a monoamine oxidase inhibitor (MAOI) or a combination of lithium and tricyclics as their treatment of second choice.
Assessment of adult relatedness: a review of empirical findings from object relations and attachment theories.
Assessment techniques designed to measure adult behavior and mental representation that emphasize relatedness constructs are reviewed. These measures grow out of two traditions, object relations and attachment theories. Although these two paradigms are fairly well elucidated theoretically, the relevant assessment literature is only more recently expanding, especially that focusing directly on adult attachment as opposed to childhood attachment. In addition to a presentation of various projective and objective measures, this review highlights the clinical and research implications for integration of these two paradigms around the cognitive, affective, and behavioral vicissitudes of adult relatedness.
Reaction time impairment in schizophrenia and affective illness: the role of attention.
A young but chronic group of schizophrenic and affective disorders patients was tested for simple reaction time (RT) and RT while engaged in a concurrent task. The affective disorders patients were subdivided by the presence of psychotic features. The results show that extreme slowing of RT is due to psychoticism and is not characteristic of nonpsychotic affective illness. Extreme intrasubject variability, however, was specific to schizophrenia, and may be a trait marker of the disorder.
Computer-supervised exposure treatment for phobias.
Twenty phobic outpatients were treated by 9 weekly "interviews" at the console of a desk computer. Using a conversational style and multiple choice questions, the computer assessed the symptoms and agreed a hierarchy of self-exposure tasks. Each week the patient was given a diary sheet of tasks to practise daily. At his next visit his progress and motivation were assessed, and if he was succeeding he was encouraged to accept progressively more difficult tasks. This group was compared with a group of 20 patients (matched for age, sex and type of phobia) treated conventionally by a therapist in the preceding year. Progress was measured on standardized scales (both self- and clinician-rated). The two groups showed significant improvement on all the scales, and 75-80% of each group were much improved (scores reduced by 50%). The therapist treated group tended to be more severely ill at entry and to show greater improvement during treatment. Improvement was maintained at 6 month follow-up in both groups.
Therapist contact and outcome of self-exposure treatment for phobias. A controlled study.
Eighty-four chronic phobic patients were randomly assigned to self-exposure in vivo instructed by either a psychiatrist, a computer or a book; mean therapy time per patient was respectively 3.1, 3.2 and 0 hours. Seventy-one patients completed treatment. All three groups improved substantially and similarly to 6 months follow-up, with no significant difference between them; self-exposure treatment was effective even without therapist contact. Among the three groups, initial expectation of help and positive attitude to the psychiatrist were equally high and related to subsequent rating of help received. All three groups rated the psychiatrist as more tolerant, reliable, and understanding than the computer or book, but these attitudes did not relate to outcome, were initially similar among all three groups, and changed minimally at 6 months follow-up.
Automated cognitive assessment of elderly patients: a comparison of two types of response device.
Groups of 14 cognitively impaired elderly people were tested on two automated cognitive tests on several occasions. Patients registered their responses using either a touch-sensitive screen or a board with illuminated response buttons. The results indicate that the touch-sensitive screen is probably a more suitable response device than the button-board. Suggestions that it would prove disadvantageous to elderly patients were not supported, and its continued use is recommended.
Lorazepam dependence and chronic psychosis.
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Comparison of computerised self-rating scales for depression with conventional observer ratings.
Highly significant correlations are demonstrated between a microcomputer-delivered self-rating Hamilton Rating Scale and conventional Observer Hamilton Rating Scales. These results demonstrate that self-rating using a microcomputer can provide a clinically useful tool in assessing the severity of depressive illness and monitoring progress with treatment.
Controlled study of self-exposure treatment for phobics: preliminary communication.
Patients with phobic disorder (mainly agoraphobics ) of minimum one year duration were treated by self-administered exposure in vivo treatment. Seventy-one patients were randomly assigned to one of three groups: (A) book-instructed, (B) computer-instructed, or (C) therapist-instructed. All three groups improved significantly to a similar extent on various phobic measures at the end of the treatment and maintained their treatment gains at 6-month follow up. Mean clinicians' time spent with each patient was 40 minutes, 4.2 hours and 3.2 hours in group A, B and C respectively. Similar small numbers of patients defaulted from each group.
Content interpretation re: Salley and Teiling's "Dissociated rage attacks in a Vietnam veteran: a Rorschach study".
Not necessarily belying usual symbolic interpretation of Rorschach content, Rorschach responses may represent a concrete experience reflecting a traumatic incident in the patient's past. This possibility should be considered particularly when the response in any way suggests undue preoccupation with the integrity of the body.
Can a computer take a psychiatric history?
A program on an inexpensive microcomputer was designed to elicit personal histories from patients in a general psychiatric ward. Their answers were compared with the information recorded by the responsible psychiatric team. Where answers disagreed with the clinicians' records, the patient was interviewed to investigate the discrepancy. In the computer-elicited case-histories 90% of items were correct; a further 3% of items were considered correct by the patient. Most patients' computer histories revealed several items unknown to the clinicians and of importance in the management of the patient. Most patients (88%) found that the computer interrogation was as easy as a clinical interview. Computer assessment is proposed as a useful technique for the routine assessment of patients to augment the clinician's findings and to allow him to concentrate on the most relevant areas.
Malignant hypercalcaemia and leucocytosis associated with carcinoma of the bronchus.
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Response of phobic patients to direct computer assessment.
Computerized assessment which is objective, standardized and easily repeated has been shown to be acceptable to general psychiatric patients. Fifty-three subjects (43 phobics and 10 normals feigning phobias) showed no unusual apprehension in approaching this novel procedure; all were able to complete the computer interview. Furthermore, half of them claimed that they found the interview more acceptable and found it easier to communicate with the computer than with a clinician. Only nine patients preferred the clinician. The reasons for this are discussed.
Accuracy of behavioural assessment by computer.
An automated assessment interview was given by a microcomputer to 26 randomly selected patients, referred for treatment of phobias. The results were compared with those of conventional clinical assessment by experienced behaviour therapists. Ratings of overall severity and intensity of specific types of agoraphobia and social phobia were derived from the computer interview, and correlated very closely with global ratings by the clinician and also with an independent structured clinical assessment. The computer also elicited behavioural targets to serve as a basis for exposure treatment. Blind assessors rated these targets as highly as those arrived at by clinicians in respect of their practicability, precision and appropriateness for treatment. The automated technique is inexpensive, saves clinicians' time and can be made widely available for screening, assessment and progress monitoring. It may also provide a basis for automated exposure treatment.
The WAIS and Rorschach test in diagnosing borderline personality.
This study assesses the degree to which indicators from the Rorschach and the WAIS discriminate between the two groups of psychiatric inpatients diagnosed as having either borderline or psychotic personality organization by means of Kernberg's structural interview. A combination of WAIS scores focusing on the Picture Completion subtest, and Rorschach form level proved to be discriminators. These were interpreted as primarily reflecting reality testing. A linear combination of WAIS scale scores was identified that discriminated at least as well as the clinical WAIS-Rorschach comparisons.