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Biomedical subjects

W S Fenton

Publications and source records attributed to W S Fenton.

At least 37 records · Page 2Linked to original sources
PubMed1993

Sexual abuse and psychopathology.

With the recognition that sexual exploitation of children is far more common than previously thought, a substantial research effort has aimed to describe its acute and long-term effects (Kluft 1990). Most studies have been quantitative and have pursued one of two strategies: Children identified by referral from child protective services as physically victimized are concurrently assessed for psychiatric sequelae; alternatively, adults with or without various psychiatric syndromes are retrospectively asked to recall the presence or absence of traumatic childhood experiences. Descriptive in focus, the results of these research efforts have broadened our understanding of the typical constellation of symptoms experienced by childhood incest victims and have delineated the adult psychiatric diagnostic categories most associated with a history of childhood trauma.

Adolescent↗
PubMed1993

Subtype progression and pathophysiologic deterioration in early schizophrenia.

It is important to elaborate what we know about the symptomatic, syndromal, and functional course of schizophrenia in order to test models for this illness. The sample of schizophrenic patients from the Chestnut Lodge followup study was subtyped using classical (modified DSM-III-R) criteria and deficit/nondeficit (Schedule for the Deficit Syndrome) criteria. During the first 5 years of manifest illness, the subtype phenomenologies were moderately stable. Instability consisted of a drift toward disorganization (hebephrenia) and nonspecificity (undifferentiated) among the classical subtypes, and toward the deficit subtype within that categorization. Over the same time, positive symptoms were relatively stable, but negative symptoms became significantly worse. Such changes probably reflect "deterioration" because they were associated with poorer functional outcome an average of 15 years later. These data dovetail with other reports in the literature and suggest a hierarchy of symptomatic/syndromal progression in early manifest schizophrenia that may reflect active deterioration processes at work. We suggest that any theory of schizophrenic pathophysiology must account for these patterns of symptom course.

Adult↗
PubMed1992

The positive-negative distinction in schizophrenia. Review of natural history validators.

A review of the interaction between the positive-negative symptom distinction in schizophrenia and multiple measures of illness natural history reveals some redundant and compelling patterns. Negative or deficit symptoms are often associated with inferior social/instrumental functioning premorbidly, more abnormal voluntary/involuntary movements at illness presentation, and poorer long-term outcome when present beyond the early phase of illness. Negative symptoms are semi-independent of positive symptoms. They are variable early in the illness but accrue in severity, stability, and prognostic weight with time. The nature of the processes that generate negative symptoms and their specificity to schizophrenia remain to be elucidated. Nevertheless, it is clear that negative symptoms are a common and valid component of schizophrenia and deserve recognition as such in our nosology.

Female↗
PubMed1992

Testing systems for assessment of negative symptoms in schizophrenia.

To compare methods of measuring negative symptoms, eight rating scales were employed to retrospectively assess and subtype 187 patients with schizophrenia from the Chestnut Lodge Follow-up Study. These included Andreasen's Schedule for Assessment of Negative Symptoms, Carpenter's Criteria for the Deficit Syndrome, Kay and Opler's Positive and Negative Symptom Scale, the scales developed by Krawiecka et al and Crow's modification of them, the Negative Symptom Scale developed by Lewine et al, Pogue-Geile and Harrow's Negative Symptom Scale, and Abrams and Taylor's Emotional Blunting Scale. The overlap and concordance, temporal stability, and predictive validity of these instruments are described. When rated from detailed medical records, the reliability of all scales was fair to good. Despite their inclusion of different items, there were high positive correlations between the scales when used to rate negative symptoms dimensionally. When used to classify individual patients as having the negative or deficit syndrome, however, concordance among criteria was low. Using the broadest criteria (Pogue-Geile and Harrow), 75 (40%) patients were diagnosed as having negative syndrome; the narrowest criteria (Andreasen and Olsen) yielded 11 (6%) diagnoses of negative syndrome. Narrower definitions tended to be subsets of broader ones. Carpenter's Criteria for the Deficit Syndrome focus on primary enduring negative symptoms and show the greatest temporal stability. Broader criteria, which diagnose the deficit or negative syndrome independent of severity of positive symptoms, had the greatest predictive validity.

Adult↗
PubMed1991

Natural history of schizophrenia subtypes. I. Longitudinal study of paranoid, hebephrenic, and undifferentiated schizophrenia.

To explore the validity of different approaches for subtyping schizophrenia, the conditions of 187 schizophrenic patients from the Chestnut Lodge follow-up study were rediagnosed with the use of classic subtype criteria. Independently collected data allowed construction of a longitudinal profile of the natural history of illness for patients who met operational criteria for paranoid (n = 78), hebephrenic (n = 26), and undifferentiated (n = 83) schizophrenia. Paranoid schizophrenia had an older age at onset, often developed rapidly in individuals with good premorbid functioning, tended to be intermittent during the first 5 years of illness, and was most associated with good outcome or recovery. Hebephrenia had an earlier age at onset, often developed insidiously, and was associated with a greater family history of psychopathology, poor premorbid functioning, and, frequently, a continuous illness with a poor long-term prognosis. While also early and insidious in onset, unlike hebephrenia, undifferentiated schizophrenia was poorly distinguished from the patients' premorbid state, associated with an early history of behavioral difficulties, and often resulted in a continuous but stable disability. We discuss implications for nosology. Although distinctive patterns were discernible, the considerable heterogeneity within subtypes calls for continued efforts to develop and explore alternate classification schemes.

Adolescent↗
PubMed1991

Natural history of schizophrenia subtypes. II. Positive and negative symptoms and long-term course.

The natural history and long-term course of schizophrenia divided by pervasiveness of positive and negative symptoms was explored among 187 schizophrenic patients from the Chestnut Lodge follow-up study. Schizophrenia with many negative symptoms was associated with poor premorbid functioning, insidious onset, partial or no remissions during the first several years of illness, and in most cases a progressive course leading to permanent disability. Schizophrenia with few negative symptoms was associated with good premorbid functioning, acute onset, intermittent early course, and a better prognosis. Positive symptoms predicted future hospitalizations but were less powerful and specific as indicators of differential illness history, course, and long-term functional incapacity. As predictors of long-term outcome, negative symptoms were of greater value measured at index admission several years after illness onset than at first hospital admission. Multivariate analyses indicated that two negative symptoms (anhedonia and affective flattening) contribute significantly to outcome variance independent of their association with premorbid functioning or positive symptoms. Patients with the poorest long-term outcome tended to show an increase in negative symptoms during the early years of their illness. Progressive negative symptoms early in the course of schizophrenia may thus reflect or signal a process leading to long-term functional disability.

Age Factors↗
PubMed1991

Classical subtypes for schizophrenia: literature review for DSM-IV.

The classical subtypes of schizophrenia include the paranoid, hebephrenic, undifferentiated, residual, catatonic, and simple. This review of studies, especially those conducted during the last decade, supports the validity of the subtypes, particularly the paranoid subtype. To a lesser degree, the same holds for the hebephrenic and undifferentiated subtypes. The catatonic subtype has seldom been studied, perhaps because it is so rare. The residual and simple subtypes have not been the focus of any studies of note. Subtype criteria for DSM-IV are suggested based on the review. The paranoid and undifferentiated subtypes should be retained with criteria identical to those in DSM-III-R. The disorganized subtype also should be retained but with modified criteria that are somewhat more stringent than those in DSM-III-R. Catatonia and residual schizophrenia should remain, but insufficient data exist upon which to base any changes in criteria. Given its historical precedence, as well as the emerging importance of deficit processes in schizophrenia, simple schizophrenia should be renamed and reintroduced as a subtype in DSM-IV. Two variations in criteria are offered.

Humans↗
PubMed1990

Training and career activity. The experience of the Yale Advanced Track Program.

The Advanced Track Program of the Yale psychiatric residency is examined by a study of the career patterns of 132 graduates of the program over a 9-year period (1973 to 1982). The findings demonstrate that specific track training sequences are associated with subsequent career activities and that track graduates differ significantly from each other along dimensions of professional activities, work settings, treatment modalities, and patient characteristics. These differences are discussed from the vantage of the relationship between training and professional activity.

Adult↗
PubMed1989

Diagnostic efficiency of DSM-III schizophrenia.

Using methods and statistics from actuarial decision theory, the authors evaluate the efficiency of constituent criteria and symptoms of DSM-III schizophrenia among 532 diagnostically heterogeneous patients participating in the Chestnut Lodge follow-up study. The conditional probability of meeting the full diagnostic set given each individual and combination of two, three, and four criteria is calculated. The best two-way (characteristic symptoms + absence of affective syndrome) and three way (characteristic symptoms + absence of affective syndrome + 6-month duration) combinations of criteria were associated with 93% and 100% probability of meeting the complete definition. Other criteria were relatively nonspecific. The data suggest that the efficiency and descriptive validity of future definitions of schizophrenia might be improved by including those features unique to the diagnosis and eliminating those that are relatively uninformative.

Actuarial Analysis↗
PubMed1989

Risk of schizophrenia in character disordered patients.

Inpatients from the Chestnut Lodge follow-up study diagnosed with character disorder were studied to predict future schizophrenic decompensation. Individually, three DSM-III criteria for schizotypal personality disorder predicted schizophrenia at long-term follow-up: magical thinking, suspiciousness or paranoid ideation, and social isolation. Additionally, lower IQ, poorer premorbid quality of work, and transient delusional experiences were predictive. No borderline personality disorder criterion was predictive. This suggests that schizotypal but not borderline personality disorder belongs in the schizophrenic spectrum. Within schizotypal personality disorder, criteria from both familial and clinical traditions appear to be dimensions of vulnerability to psychosis.

Adult↗
PubMed1988

A comparison of DSM-III and DSM-III-R schizophrenia.

The authors compared DSM-III and DSM-III-R definitions of schizophrenia among 532 inpatients treated in a long-term residential setting and reevaluated an average of 15 years later. Largely by excluding those with nonbizarre delusions (somatic, grandiose, or religious) without hallucinations, DSM-III-R reduced the number of patients diagnosed with schizophrenia by 10%. With the exception of the sign and symptom variables used to define them, the DSM-III schizophrenic patients included (N = 164) and excluded (N = 18) by DSM-III-R did not differ with respect to demographic, premorbid, or long-term outcome characteristics. The authors argue that frequent changes in diagnostic schemes in the absence of evidence of improved validity are likely to impede progress in research.

Adult↗
PubMed1987

Prognostic scale for chronic schizophrenia.

Although prognostic scales are available for schizophrenia, these focus on acute or subacute populations where premorbid functioning and established chronicity are the best predictors of outcome. Their usefulness in chronic schizophrenia is limited. The authors describe a simple and reliable 5-item, 12-point prognostic scale for chronic schizophrenia independent of chronicity. It measures prognosis as the product of a dynamic interplay between the highest level of adaptive occupational and social functioning ever achieved by the individual and the "invasiveness" of the Axis I disorder as manifest by genetic loading (family history of schizophrenia), erosion of reality testing (psychotic assaultiveness), and preservation of affect in psychopathology (depressed mood). Among chronic schizophrenic patients in the Chestnut Lodge Followup Study (n = 163), the prognostic score (based on history and admission clinical picture) allowed strong probabilistic statements to be made about long-term outcome. Tables present the conditional probability or risk of specific outcomes in the domains of institutionalization, work functioning, social relations, and global outcome for patients at varying levels along the prognostic spectrum. Close examination of these predictor-outcome relationships suggests that prognosis in chronic schizophrenia may be thought of as the variability (as opposed to fixedness) remaining in the individual's future life course, and poor outcome can be predicted with greater sensitivity than good outcome.

Adaptation, Psychological↗
PubMed1987

Sustained remission in drug-free schizophrenic patients.

The inability to determine which schizophrenic patients do not require maintenance medication is a significant gap in current knowledge. This report describes 23 largely chronic DSM-III schizophrenic patients who, after a period of inpatient treatment, sustained good outcome without maintenance antipsychotic medication over an average of 15 years. Retrospective study of these patients revealed that their distinguishing characteristics at admission included better premorbid social and occupational adjustment, higher levels of accrued psychosocial competence and acquired skills, fewer hebephrenic traits, and the preservation of affect (depressed mood). Hence, even within a largely chronic patient sample, classic predictors of good outcome may also be useful in predicting sustained remission without medication.

Adult↗
PubMed1987

Male and female psychiatrists and their patients.

Data from a national survey were used to explore whether the patients of male and female psychiatrists differed substantially in demographic or clinical characteristics and whether there were any differences in psychiatrists' treatment of same-gender versus opposite-gender patients. Women constituted about two-thirds of the female but only one-half of the male psychiatrists' patient loads. Female psychiatrists tended to see all of their patients more frequently, but few other differences were found. Better educated patients of both genders tended to have same-gender therapists; patients experiencing marital disruption tended to be seen by therapists of the opposite gender. Implications of these differences for training and manpower development are discussed.

Attitude of Health Personnel↗