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Biomedical subjects

A K Nyman

Publications and source records attributed to A K Nyman.

12 recordsLinked to original sources
PubMed1991

Predicting long-term outcome in schizophrenia.

Prediction of 14- to 17-year outcome from symptoms present at admission and psychological and personality data was attempted among the 92 survivors of a group of 110 first-admitted schizophrenic patients. Three different outcome criteria were used and the correlations between these varied from low to high. Using a discriminant analytical approach where all 107 predictor variables were used to predict a combination of outcome criteria, 23% of outcome variance could be explained, which should be compared with 49% in a previous 5- to 9-year outcome study on the same material. At least one outcome variable--economic self-support--could not at all be predicted. "Atypical" symptoms were associated with favourable outcome and longitudinal variables indicative of "high-risk personality", or duration and severity of illness, were related to bad prognosis. Overt psychotic symptoms had no significant correlation with outcome.

Activities of Daily Living↗
PubMed1991

The concept of cycloid psychosis: sensitivity and specificity of syndromes derived by multivariate clustering techniques.

A total of 154 patients admitted for the first time to hospital for a psychotic or affective disorder in 1925 were rediagnosed in accordance with DSM-III and Leonhard's diagnostic system. Symptoms were rated in accordance with a rating protocol containing 33 items based on Leonhard's descriptions of cycloid psychoses. The patients were followed up through parish registers and hospital records. Of 42 cases considered to be cycloid psychosis at index admission, 34 were prognostically verified. The symptom ratings of the 154 patients were analysed by K-means cluster analysis to test whether the patients with cycloid psychoses would separate from the rest of the material. With a 2-cluster solution, 30 of 34 cases (88%) were contained in the same cluster. The sensitivity of the ratings was therefore judged to be acceptable. Specificity was low, however, since 19 cases in the cluster were differently diagnosed. A subcohort of 64 patients, satisfying at least 5 items of the rating protocol, was then analysed by Q-factor analysis to test whether nuclear cases of cycloid psychosis differ from symptomatically related syndromes. No such differences could be statistically verified; no symptom profile specifically indicating cycloid psychosis could be found. Prominent confusion symptoms appear, however, to be prognostically favourable, whereas motility symptoms without confusion seem to indicate an unfavourable course.

Affective Disorders, Psychotic↗
PubMed1989

Differentiation and prediction in schizophrenia using the metacontrast technique.

A perceptgenetic, projective test procedure, the metacontrast technique, was performed in a series of 66 young schizophrenics at admission in a psychiatric institution. The test responses to tachistoscopic expositions of stimulus pairs with incongruent or threatening contents are classified in terms of defense strategies representative of neurotic and psychotic states. The sample tested was followed up clinically after 14-17 years. At inception the series of subjects was dichotomized into one nonregressive (latent, pseudoneurotic, n = 42) group and one regressive, with full-blown psychotic symptoms (n = 24). The distribution of response types did not differentiate between the groups; neurotic and psychotic patterns were represented in both. At follow-up, the initial presence of signs of repression was significantly more common in such initially nonregressive patients as had escaped a later psychotic breakdown. A compound expression of test signs, hypothesized to be a predictor of future development, was shown to differentiate also between categories of outcome in terms of clinical picture and working capacity.

Adult↗
PubMed1989

Nonregressive schizophrenia--a long-term comparative follow-up investigation.

A 14-17 year follow-up study of a first admission sample of nonregressive schizophrenic cases revealed a phenomenological and diagnostic consistency over time. Some improved and adapted well in society but a considerable proportion developed into chronic schizophrenic syndromes. Schizophrenic deterioration was also manifested among those who adhered to a nonregressive course without ever revealing frank psychotic decompensation. Treatment consumption and disability were high. Prognosis and outcome were, in the main, similar to a parallel series of regressive schizophrenic first-admission cases of similar sex and age composition. The sex difference noted in the intermediate-term outcome study in 1973, with a more favourable outcome among the women, was no longer present. The findings added further support to the validity of the concept of nonregressive schizophrenia and to the hypothesis of a joint nosology with classical schizophrenia.

Activities of Daily Living↗
PubMed1987

Attempt at predicting paraphrenic outcome in young, first admitted schizophrenic patients.

A sample of 110 consecutive first admission young schizophrenic patients treated between 1964 and 1967 was rediagnosed in 1981. Among 92 survivors, 27 could be labelled as paraphrenics. From information available at inception 97 variables were coded covering such areas as personality, previous disturbances, age and type of onset, and symptoms around admission. Sixty-three out of 97 variables were hypothesized to differentiate, at admission, future paraphrenics from the rest of the sample. Paraphrenics were found to have had less contact disturbance, better self-esteem, less neurotic symptoms in adolescence and childhood, and less complaints of unhappiness when growing up. They had more regressive and paranoid symptoms at admission, were older at onset of the disease, which was more acute, more often connected with precipitating events, and confusion. Certain non-regressive symptoms such as brooding, anhedonia and concentration difficulties were less common. A discriminant analysis yielded a proportion of correct predictions = 0.64 (p less than 0.05). The results are in accordance with the theory of more favourable energetic and organizational capacity in paranoid schizophrenics as compared with non-paranoids.

Adult↗
PubMed1986

Patterns of self-destructive behaviour in schizophrenia.

Of 110 consecutive, young schizophrenic patients, 18 (16.4%) died during a follow-up period of 14-17 years from first admission. Fifteen of them met with a sudden death. Definite suicide was proven in 10 cases (9%). Suicide was associated with chronicity in course, social dependency, and lowered efficiency. Some type of warning was present in all suicide cases. The frequency of suicide thoughts and attempts was high in the whole material. Suicide attempts were associated with protracted non-regressive symptomatology, readmission to hospital, social intervention, and female sex. The disparity of characteristics between attempted suicide and definite suicide cases may partly be explained by the preponderance of women among the former and by the fact that only half of the suicidal deaths occurred when the frequency of attempts was at its peak. In attempted suicide in men their characteristics were compatible with those of the whole group, as well as with those of the suicide cases.

Adult↗
PubMed1986

Non-regressive schizophrenia: prediction of regressive course.

Regressive course during a 14-17 year follow-up in 54 non-regressive (pseudoneurotic, borderline, latent) schizophrenic subjects was predicted from about 100 variables studied on first admission. A significant prediction could not be achieved. This finding lends additional support to our previous interpretation that patients with a non-regressive syndrome are schizophrenics. A large number of them will run a typical schizophrenic course, but we are unable to predict from initial data who will do so. The few possibly predictive variables seemed to be of an unspecific, quantitative and longitudinal nature. They may act in a cumulative manner to increase the vulnerability to psychotic decompensation.

Borderline Personality Disorder↗
PubMed1985

Differential response to amphetamine in schizophrenia.

Amphetamine added to maintenance therapy with neuroleptic drugs was accompanied by relief of complaints in 32 of 48 chronic schizophrenic patients with a long-standing incapacity for work. In 22 cases this relief was followed by increased work efficiency. These gains were lost at experimental withdrawal of amphetamine. The response to amphetamine varied with type of schizophrenic symptomatology. All current regressive symptoms meant worsening in spite of concomitant neuroleptic treatment, in accordance with the dopamine hypothesis. Non-regressive subjects displaying florid symptoms, however, benefited. Worsening, in a few cases, occurred only in the absence of neuroleptics. A few subjects with negative symptoms only, seemed totally unresponsive. These findings point at variations in sensitivity to dopaminergic stimulation in schizophrenic subjects. Worsening and improvement with amphetamine were each clearly connected with type of symptomatology only when current psychotic or florid non-regressive symptoms were exhibited. In cases with negative symptoms only, the type of response could not be reliably based on clinical data. Studies of autonomic functioning and attention were therefore performed in a sub-sample. Skin conductance level, reactivity and habituation rate were found to be lower in positive responders before amphetamine. After amphetamine there were no such differences. Attention tests showed no initial differences between groups but the performance of positive responders improved with amphetamine.

Adult↗
PubMed1984

Prediction of outcome in schizophrenia.

Prediction of 5-8 year outcome from presenting symptoms and background data was attempted in a sample of 110 first-admitted schizophrenics. Correlations between outcome criteria and single predictors as well as factor analytically derived clusters of predictors were studied. A rather consistent pattern of symptom variables as well as personality and social variables was found to be predictive of outcome. 'Atypical' symptoms were associated with good prognosis while longitudinal variables indicative of 'high-risk personality', or duration and severity of illness, were related to bad prognosis. Overt psychotic symptoms usually gave no correlations with outcome. A discriminant analytical approach was also used to predict outcome from combinations of predictor variables. When all variables were used to predict a combined outcome score, a high accuracy was achieved.

Adult↗
PubMed1983

Differential evaluation of outcome in schizophrenia.

State of health, work and social relations functioning as outcome measures in 95 survivors out of 110 schizophrenic probands proved to be only moderately intercorrelated at follow-up 6-9 years after first hospital admission. Total sick-leave time was the only treatment measure mirroring combined outcome, while the hospital treatment variables were connected only to working and self-supporting ability. Among social competence data, only living in partnership, and producing children after falling ill were associated with a favourable outcome. Self-reports and simple judgements by near relatives in response to precise questions provided reliable information. Attitude questions were completely unrelated to outcome. Outcome did not vary with type of initial symptomatology (regressive/non-regressive) but long duration of regression meant an unfavourable outcome. A better outcome in women as to social competence, working ability and degree of psychopathology stresses the necessity of noting the sex composition of materials in prognostic investigations.

Adult↗