Intra-interrater reliability of SAFTEE using videotape interviews and clinical trial data.
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Biomedical subjects
Publications and source records attributed to W Guy.
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In an international survey of chronic schizophrenia, data were collected on the Abnormal Involuntary Movements Scale (AIMS) to ascertain the prevalence of tardive dyskinesia. Abnormal movements were found to present in 28% of the sample of 739 patients. Using the more stringent Research Criteria for Tardive Dyskinesia (RD-TD) the prevalence rate was found to be 13.6%. Statistically significant differences were obtained between patients meeting RD-TD criteria and patients with abnormal movement who did not meet RD-TD criteria on total score, global severity, degree of incapacity and patient awareness--all reflecting greater severity in the RD-TD group. A much lower rate of moderate/severe tardive dyskinesia than that reported in the literature was obtained in this sample. Using the Leonhard classification of chronic schizophrenia, it was found that patients with prominent negative symptomatology had a high prevalence of tardive dyskinesia--confirming the previous reported relationship between these variables. Prevalence differences, possibly related to specific psychopathological syndromes, were also obtained.
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As part of an international study of chronic schizophrenia, data on tardive dyskinesia were collected by clinical judgment and a standard rating scale, on over 700 patients. The frequently-reported positive correlation between age and prevalence rate was confirmed in this sample. While not statistically significant, high prevalence rates were associated with higher dosage levels and length of hospitalization. Positive relationships were also found to exist among prevalence rates and schizophrenic subtypes--particularly among those with high degrees of negative symptomatology.
Prescription practices were examined as part of a multinational study of chronic hospitalized schizophrenic patients. The study included a total of 768 patients from 8 countries. All patients had a diagnosis (ICD-9) of schizophrenia and met defined criteria for chronic hospitalization. The patients were treated with psychotropic drugs from 6 categories, i.e., neuroleptics, antidepressants, lithium salts, anxiolytics, anticonvulsants, and antiparkinsonian medications, as well as with a variety of nonpsychotropic drugs. The majority of the patients received concurrently more than 1 neuroleptic, medications from 2 or more categories, and neuroleptics combined with other agents. Polypharmacy appeared to be universal in this population.
In the framework of a multi-national collaborative study carried out in eight countries, 768 chronic hospitalized schizophrenic patients were surveyed. Skin pigmentation was found to be present in 13 patients (1.7%), that is, within the same range (1-2.9%) of the initial reports. While the mean age and mean duration of hospitalization in the skin-pigmented population was slightly higher and larger than in the total population of our survey, no definitive relationships between sex, diagnosis, drugs and dosage of medication were revealed.
Of the two generally recognized processes through which learning occurs--imprinting and conditioning--only the latter with its two paradigms, classical and operant, has both practical and heuristic implications for disease. From the classical conditioning experiments of Pavlov's laboratory over 100 years ago to the later work in operant conditioning by Skinner and others in the past four decades has evolved much of the basis of modern learning theory and its applications to disease in the form of behavior therapy. Variants of behavior therapy have been employed in the treatment of wide variety of medical and psychiatric illnesses. Recent developments in the study of brain function and biochemistry have led to renewed interest in the conditioning paradigm and its value as tool in these areas of research.
With the introduction of effective antidepressants, pharmacotherapy has not been limited exclusively to the psychiatrically ill, but has been expanded to include medically ill patients exhibiting depressive symptomatology as well. This has led to problems in diagnostic differentiation and, just as important, problems with interactions resulting from multiple medications. By describing the coexistence of depressive symptomatology in a large variety of physical illness, the physician is alerted to the complexities of psychiatric illness in the medically ill patient as well as the caution necessitated by the poly-pharmacotherapy required in this population.
The conceptual development of Leonhard's classification of the chronic schizophrenias is outlined. The recognition within that classification of the importance of the polarity dimension has led to the identification of two distinct populations--atypical nonsystematic and typical systematic schizophrenia--each with a variety of different subtypes. It is hoped that recognition and validation of this group of illnesses which, for three-quarters of a century, have been called "schizophrenia" will provide a basis for meaningful biological research. Increasing interest in the system has already produced an awareness that future progress in the understanding of mental illness will greatly depend upon re-establishing the central place of psychopathology in psychiatric research.
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Prior to the introduction of neuroleptics a lack of interest in complex classifications of the chronic schizophrenias was due to the lack of effective treatment. With the recognition of neuroleptic response heterogeneity, and of the hazards of long-term neuroleptic administration, interest in subtype classification such as that of Leonhard has grown. A simplification of the Leonhard scheme is presented. The first distinction drawn is between systematic or process schizophrenia and nonsystematic or episodic schizophrenia. Both groups are further subdivided according to whether the symptomatology is dominated by cognitive, affective or motor features. In the case of the systemic schizophrenias, further subdivision of the 3 major types is made on the basis of both severity and specific symptom characteristics. If such a scheme were a natural or biologically-based classification, rather than merely an artificial subdivision of schizophrenia, one might expect that similar proportions of the different subtypes would be found in independently selected samples. Preliminary data composing subtype proportions in Leonhard's original group, a population reported by Astrup, and a recently obtained international sample are presented. Some significant correlations between the samples are observed, and despite methodological short comings, the similarities in the distribution of subtypes across time and across countries give some support to Leonhard's taxonomy.
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There is evidence to indicate that 15% of patients diagnosed as schizophrenic will become chronically hospitalized, and that worldwide one-third to one-half of all psychiatric beds are occupied by schizophrenic patients. In spite of these figures and the public health problem they represent, little attention is paid to chronic hospitalized schizophrenic patients. Even the most recent classification schemas fail to recognize the heterogeneity, exemplified by differential responsiveness to psychotropic drugs, within the chronic schizophrenic population. One systematic approach to classification which does address this problem has been proposed by Leonhard. In this paper, findings and procedures that demonstrate the clinical relevance of Leonhard's system along with some preliminary results and observations from psychopharmacological studies that indicate Leonhard's different subtypes of chronic schizophrenia may represent biologically distinct populations are presented.
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