Biomedical subjects
Publications and source records attributed to T C Manschreck.
The authors report clinically relevant results from topographic brain electrical activity mapping of patients undergoing psychiatric evaluation. Topographic methods are discussed and compared with electroencephalographic (EEG) and evoked potential (EP) techniques. Suggestions are made for using topographic analysis of EEG and EP data in clinical psychiatric practice.
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The authors report four cases in which magnetic resonance imaging (MRI) provided diagnostic information not apparent by X-ray CAT in clinical investigations of patients with neuropsychiatric disorders. The relative capabilities and contraindications for MRI and CAT are reviewed. The authors suggest that MRI is indicated 1) instead of CAT when there is suspicion of neuropathology that is better visualized by MRI because of its type or location and 2) after CAT when an atypical psychiatric symptom or presentation has not been definitively evaluated by means of CAT.
This report examines two methodologic concerns pertaining to use of the cloze procedure in studying the predictability of schizophrenic speech, scoring criteria and raters' education (at or below college level). We find that two strategies for scoring the predictions of raters, one requiring the exact word, the other permitting a reasonable synonym, do not appear to differ in distinguishing groups of patients. The accuracy of raters' guessing is, however, correlated with raters' education: the more educated the rater, the more accurate the guessing. Thought-disordered schizophrenic speech is significantly less predictable than that of nonthought-disordered schizophrenics and normal controls when scored by less educated raters. These differences diminish when more highly educated raters are used. We conclude that raters' education can influence the sensitivity of cloze analysis.
Resistance to antidepressant therapy is a common clinical problem in the treatment of affective disorders. Adjunctive low dose lithium is a promising strategy based on biochemical models and encouraging clinical trials. After a mean duration of 9.2 months of conventional therapy, 16 healthy patients with treatment-resistant depression were treated for a minimum of 2 weeks with either adjunctive lithium or placebo using a double-blind design. We found no difference between the two groups in rate or degree of response. The two most dramatic responses occurred in patients treated with placebo, although 50% of patients treated with lithium had at least a partial response. The number of patients studied was clearly inadequate to avoid a type 2 error. The cumulative response rate reported in the literature of greater than 60%, however, suggests that lithium is indeed an effective adjunct in some patients with treatment-resistant depression. Our patients differed from those in other studies in that they were treated with a lower dose of lithium, the duration of conventional antidepressant therapy was longer, and, finally, they were less depressed and possibly depressed for a longer period. These differences may explain the comparable lithium and placebo responses in this study.
Repetition in the written language of schizophrenics and its possible relationships to other aspects of schizophrenic disorders are not well understood. We investigated repetitiousness in written utterances, finding schizophrenic subjects to be more repetitive than affective controls and normal controls. Over-all, written repetitiousness was more strongly correlated with psychopathologic features than oral repetitiousness. As in previous work, thought-disordered schizophrenic subjects produced the most repetitive responses. Poverty of content and illogical thinking were correlated with scores for written repetition. Measures of other negative features, disturbed mental functioning and motor behavior were also associated with repetitiousness in both written and oral modes. That these negative features are linked (namely, linguistic repetitiousness, negative formal thought disorder, voluntary motor abnormalities, and deficient mental functioning) is consistent with Crow's concept of a defect syndrome (Type 2) in schizophrenia.
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Dothiepin, a thio analogue of amitriptyline, has been used extensively in Europe during the past 15 years. It is a safe and effective agent for the treatment of major depressive disorder. Although the onset of action is comparable to that of other tricyclic antidepressants, dothiepin may cause fewer intolerable side effects and have less cardiotoxicity than these other compounds. In addition, dothiepin reduces the anxiety associated with some major depressive episodes. These features suggest that dothiepin may be particularly helpful for treating anxious depressed patients and patients who have underlying cardiac disease or who are elderly.
A laboratory measure of synchronization was used to assess the differential ability of schizophrenics, affectives, and normal controls to take advantage of stimulus predictability. It was hypothesized that (1) schizophrenics will perform on this task in a way that distinguishes them from other groups, (2) clinically observed motor anomalies will be associated with deficient motor synchrony, and (3) deficient motor synchrony will be associated with more severe clinical ratings of thought disorder. Twenty-one schizophrenic, 8 affective, and 16 normal controls were studied. The results were consistent with the hypotheses; schizophrenic subjects had distinctive performance patterns, especially at 40 bpm, which was associated with both motor and thinking disturbance. The authors discuss additional analyses that suggest that deficient motor synchrony is associated with negative symptoms, certain ward behaviors, and not with demographic variables, and that among unmedicated schizophrenic subjects, the performance patterns are worse.
Although it is widely recognized that inpatient psychiatry is different as it is practiced in the general, private, and state hospital, why and how it is different have not been clearly articulated. In this paper, the directors of inpatient units in a general hospital, a private hospital, and a state hospital first provide an analysis of how the history and the organizational structures of these units have shaped their identity. The authors then specifically detail the different patient populations, referral sources, financial bases, leadership arrangements, milieu philosophies, research and training activities, and lengths of stay on these units. Finally, on the basis of the reality and the value of different inpatient settings, a view toward the future of inpatient psychiatry is offered.
Prior research has indicated that the type-token ratio (TTR), a measure of repetition in language, correlates with clinical judgements of thought disorder when spoken language was examined, and differentiates statistically thought-disordered from non-thought-disordered schizophrenics and psychiatric and normal controls. We replicated this finding and examined the clinical sensitivity and specificity of the TTR measure in the diagnosis and in the assessment of thought disorder. The current clinical value of the TTR is limited, but further investigations of the nature of repetition in schizophrenic language are warranted.
Evidence of neurologic disturbance is widely reported in schizophrenic disorders. Few studies have attempted to determine the specificity of these abnormalities to schizophrenic disorders or their relationship to particular psychopathologic features. We assessed neurologic and psychopathologic features in a sample of 53 schizophrenic, 21 affective, and 20 normal subjects. The results indicate that neurologic (motor and sensory) disturbances occur with the highest frequency (92%) and severity in schizophrenic subjects. Affective subjects showed a high frequency (52%) but less severe abnormalities and normal controls had a frequency (5%) comparable to prior reports. Schizophrenic phenomenologic subtypes were not associated with distinguishable patterns of neurologic abnormality. Schizophrenic subjects and affective subjects tend to produce more right sensory errors although few of the latter produced errors. Neurologic abnormalities are highly correlated with evidence of disturbed thinking and cognitive performance. A noteworthy association between disturbed thinking and neurologic motor abnormality was detected in schizophrenic disorders. Anomalous laterality preferences also occur more frequently among schizophrenics and are associated with greater frequency of neurologic disturbance, formal thought disorder, and impaired cognitive performance than among schizophrenics with right laterality preferences.
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This study of two types of optokinetic nystagmus (OKN) provides evidence that previously reported pursuit impairments in schizophrenics may be due to a cortical dysfunction. Differences in responses to partial-field and full-field OKN stimuli strongly support the hypothesis that there are two functionally distinct but anatomically overlapping mechanisms that can produce nystagmus responses. Partial-field OKN is composed of alternating phases of pursuit and saccadic movements. The slow phases of partial-field OKN, like pursuit eye movements, are of significantly poorer quality in schizophrenics compared with normal controls. Full-field OKN, however, is intact in both groups. Partial-field OKN is an improved test for pursuit abnormalities that reflect disturbances of nonvoluntary attention.
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