A schizophrenic patient who resists phenothiazines.
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Adult↗
Biomedical subjects
W T Carpenter
Publications and source records attributed to W T Carpenter.
Risk factors in schizophrenia: season birth in Maryland, USA.
The association between the risk for schizophrenia and season of birth was studied using a standard actuarial life table method. This method of analysis eliminates the possibility of the previously described statistical artifacts from the data. An increased risk for schizophrenia for winter born individuals was demonstrated. The analysis also supported the hypothesis that season of birth is associated with an increased risk for a subtype of schizophrenia.
Actuarial Analysis↗
Who is culpable? The insanity defense.
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Expert Testimony↗
Further remarks on covert dyskinesia in ambulatory schizophrenia.
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Antipsychotic Agents↗
A comparison of nine systems to diagnose schizophrenia.
The files of 283 hospitalized patients discharged with a diagnosis of schizophrenia, schizoaffective schizophrenia, or paranoid state were examined without knowledge of the patient's subsequent history. These patients, most of whom had originally been diagnosed by DSM-I criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Have Schizophrenia Index (NHSI), the St. Louis criteria, Taylor-Abrams 1978 criteria, Schneider's first-rank symptoms (FRS), the Washington IPSS 12-Point Flexible System, Astrup's process/nonprocess distinction, and DSM-III. Kappa values measuring pairwise diagnostic agreement amont the nine systems were typically low except among RDC, DSM-III, and St. Louis criteria. Long-term followup status was not significantly predicted by the FRS, NHSI, or Taylor-Abrams criteria. Diagnosis by means of the other systems, especially the Astrup process/nonprocess distinction, was significantly correlated with followup. However, Astrup's "process" schizophrenia is not operationally defined and could not be expected to be used with the degree of interrater reliability desired by researchers. On the other hand, of the operationally defined systems, DSM-III schizophrenia has the highest correlation with followup and is thus suggested for use by researchers desiring a highly homogeneous, although narrowly defined, population. Investigators wishing to cast a wider net could use a less restrictive system such as the RDC, with or without schizoaffectives included.
Adult↗
Reactive psychoses.
Scandinavian psychiatrists have been pre-eminent in elucidating the concept of reactive psychoses. This diagnosis has never found much acceptance except in Scandinavia, and the new Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition category of brief reactive psychosis is quite different from reactive psychosis as described by most Scandinavian clinicians and researchers. The concept of psychogenic psychoses is, however, not new. Indeed, many psychiatrists of the early 20th century stressed the psychogenic factors in psychotic mental disturbances. Reactive psychoses have generally been considered illnesses distinct not only from schizophrenia but also from manic-depressive psychosis with a distinctive genetic component. Of 283 hospitalized patients at Johns Hopkins for whom long-term follow-ups were available and of whom all were first admissions, Astrup retrospectively diagnosed 91 as reactive psychoses. A contrasting group of 78 "systematic schizophrenics" by Leonhardt's criteria were identified. Stephens found that these two groups differed significantly in that the reactive patients had a) a more acute onset, b) more precipitating stress, c) more affective symptoms, d) more confusion, e) less affective blunting, f) a better premorbid adjustment, g) less premorbid schizoid traits, h) fewer schizophrenic relatives, and i) a much more favorable long term outcome.
Adult↗
Prognosis as the critical variable in classification of the functional psychoses.
Kraepelin used a disease entity concept to define the two major functional psychoses (i.e., distinctive patterns of onset, symptoms, and course of illness). There have been many subsequent studies using patient outcome or distribution of illness among relatives to test the validity of these nosological classes. Differences between chronic schizophrenia and (predominantly nonchronic) affective disorders are often reported, but it is difficult to discern whether these differences are associated with diagnostic symptomatology rather than premorbid prognostic status. The evidence suggesting a genetic link between good prognosis schizophrenia and affective disorders may be misinterpreted if premorbid prognostic processes are the distinguishing heritable components between chronic schizophrenia and nonchronic illnesses. Which components of severe psychiatric disorders are heritable is not yet clear. The developmental, psychological and neurological processes associated with premorbid and early morbid characteristics of illness appear good candidates. Considering such variables as prognostic (early morbid or premorbid) rather than diagnostic would permit examination of class assignment (e.g., schizophrenia, bipolar affective disorder) and premorbid development. The literature now suggests that chronicity in psychiatric illness breeds true and that symptom constellations breed true. Both of these views may be corrects, and the taxing study design required to simultaneously study these two attributes of disease entities is warranted. This may establish good prognosis schizophrenia as a "third psychosis," or may affirm its standing within traditional nosology.
Bipolar Disorder↗
The DSM-III diagnosis of schizophrenic-like illness and the clinical pharmacology of psychosis.
The classification of schizophrenia-related psychoses under DSM-III into five classes--schizophrenia itself, schizophreniform psychoses, schizoaffective disorders, brief reactive psychoses, and atypical psychoses--classifies groups of psychotic individuals with few distinct pharmacological characteristics. Although ideally established disease entities imply a specific pharmacological regimen, only broad guidelines can be provided in matching an efficacious drug regimen with a diagnostic category. For this reason individualization of pharmacotherapy by each practicing physician is encouraged.
Antipsychotic Agents↗
Cortisol's effects on human mental functioning.
Popularization of the dexamethasone suppression test has focused attention on the relation between cortisol metabolism and mood and behavior. This article considers the biochemistry, physiology, and pharmacology of cortisol and cortisol-like substances. In addition, the effects of external stresses on cortisol metabolism and circadian rhythmicity of secretory patterns are reviewed. Finally, managing exogenous cortisol excess in a clinical setting is discussed.
Affect↗
Zinc and copper in patients with schizophrenia.
Patients with acute and chronic schizophrenia, on or off treatment with various major tranquillizers, did not show any significant deviation from normal in concentrations of zinc or copper in serum, urine, or gastric fluid, in serum ceruloplasmin or in hair zinc. Although depletion of body zinc and increases in brain copper have been previously associated with severe changes in mentation and personality, there are at present no published, controlled clinical studies which support the hypothesis that administration of exogenous zinc and/or depletion of body copper is useful in the treatment of schizophrenia.
Adolescent↗
Autonomic nervous system activity in acute schizophrenia: I. method and comparison with normal controls.
Many reports of autonomic dysfunction in schizophrenia may have been influenced by the chronicity or medication status of patients, or both. This study eliminates these sources of variation. Skin conductance (SC) and heart rate (HR) base levels and activity were compared in 118 controls and 46 recently admitted, drug-free, acute schizophrenic patients during rest, 20 mild-tone stimuli, and reaction time (RT) and mental arithmetic tasks. Patients showed higher than normal HR and spontaneous SC responses but lower SC base levels. Schizophrenics showed less SC and HR reactivity to tones and RT stimuli, slow habituation of the SC orienting response, an attenuated tonic response to stress, and disproportionately more spontaneous than elicited SC activity. The findings are similar to previous results for unmedicated, chronic schizophrenics and suggest that autonomic activity in schizophrenics is determined relatively more by endogenous factors than by external stimuli.
Acute Disease↗
Autonomic nervous system activity in acute schizophrenia: II. relationships to short-term prognosis and clinical state.
Autonomic nervous system (ANS) activity in acute schizophrenic patients was assessed to examine predictive relationships to clinical course. Unmedicated patients were rated on global psychopathology and tested on skin conductance, heart rate, and skin temperature during rest, a series of tones, and reaction time and mental arithmetic tasks three weeks after admission and again about three months later. On the admission tests, a pattern of ANS activity found in schizophrenics in general (high resting "arousal," slow habituation, and attenuated ANS reactivity, particularly to demanding stimuli and situations) was found in patients who were to remain clinically ill but not in patients whose recovery was more complete, especially in males. Thus, ANS activity is predictive of short-term outcome in acute schizophrenia. Minimal ANS changes accompanied clinical improvement, which suggests a "'trait" interpretation, but "state" effects cannot be completely ruled out.
Autonomic Nervous System Diseases↗
Treatment-relevant subtypes of schizophrenia.
The heterogeneity of schizophrenia and the failure of classical subtypes to predict treatment response reliably have led to two contrasting assumptions. The first is that the treatment approach is essentially the same for all schizophrenics. The second is that the treatment needs of schizophrenic patients can be based only on clinical "hunches" or the biases of the therapist, because meaningful criteria for making therapeutic decisions are lacking. Both assumptions tend to discourage careful and critically reasoned treatment planning. This report argues that current knowledge permits the formulation of subtypes that can assist in the rational choice of individualized treatment approaches. It proffers a number of such subtypes and deals with their application to therapeutic decision-making at various phases of the illness.
Diagnosis, Differential↗
Methodologic standards for treatment outcome research in schizophrenia.
Considerable progress has been made in increasing the formal correctness of outcome research in schizophrenia by employing strict methodologic standards. However, based on a recent review of the literature, the authors note that insufficient attention has been directed toward the meaningfulness of such research. The interest of a particular study derives from its application beyond the specific patients treated; lack of attention to meaningfulness encourages the researcher to posit unjustified or overly generalized conclusions, resulting in the widespread adoption of questionable treatment strategies or the dismissal of potentially useful ones. Increased attention to meaningfulness will make the conclusions of this type of research more valuable, both from pragmatic and theoretical standpoints.
Follow-Up Studies↗
Does attitude toward psychosis relate to outcome?
In a previous follow-up of recovered schizophrenic patients, it was found that a positive, integrating attitude toward illness correlated with good outcome. In similar research at NIH, the authors of this study obtained partial replication of these findings. Specifically, the less negative patients were about their illness and future, the better their outcome. A very positive attitude was not associated with good outcome. Hence, the absence of a negative attitude appears critical. The authors failed to find a relationship between integration or isolation of the psychotic experience and outcome, which suggests the incidence of this (unconscious) psychological coping style from a conscious attitude and opinion about illness and the future.
Adolescent↗
Statistical basis for exploring schizophrenia.
The authors illustrate the use of multivariate statistics as a tool for exploring diagnostic factors in schizophrenia in two areas: the derivation and replication of the 12-point flexible diagnostic system and the definition of schizophrenic subtypes. They suggest an interactive approach between clinician and statistician to ensure the optimal combination of clinical judgment and systematic data analysis. Statistical concepts are presented with a minimum of statistical terminology.
Diagnosis, Differential↗
Beyond diagnosis: the phenomenology of schizophrenia.
The authors believe that sharp distinctions of schizophrenia based on cross-sectional signs and symptoms provide the basis for precise and reliable diagnoses, but they do not believe that diagnoses derived from a narrow descriptive base are generously informative on the broad range of human functioning vulnerable to impairment in the course of schizophrenic illness. They comment on the 12-point flexible diagnostic system, illustrating the strengths and weaknesses of well-defined but narrow models for diagnosis, and on the results of testing the predictive validity of several diagnostic approaches. Finally, they contrast the phenomenologic approaches to schizophrenic illness with modern-day descriptive psychiatry, noting implications for clinical practice.
Humans↗
New directions in diagnosis: the longitudinal processes of schizophrenia.
Kraepelin's description of "dementia praecox" was a synthesizing influence in a field that had for too long been fragmented in its thinking about severe psychiatric disorders. Now, once again, the field is attempting to deal with some of the complexities involved in psychopathology and its evolution, complexities that have been reemphasized by newer descriptive research methods. To account for patients deviations from stereotyped diagnostic and prognostic concepts, multiple aspects of course of disorder have been defined and principles of multiaxial diagnosis supported. These principles can provide a basic structure for practice and research using a biopsychosocial orientation within the context of a system model.
Follow-Up Studies↗