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W T Carpenter

Publications and source records attributed to W T Carpenter.

At least 145 records · Page 8Linked to original sources
PubMed1980

Diagnostic criteria for schizophrenia: prognostic implications and diagnostic overlap.

The files of 120 hospitalized patients who had participated in drug studies between 1964 and 1966 were examined without knowledge of the patient's subsequent history. These patients, who had originally been diagnosed by DSM-II criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Haven Schizophrenia Index (NHSI), the St. Louis criteria, Bland and Orn's modification of the St. Louis critera, Schneider's first rank symptoms (FRS) criteria, and the 12-point "Flexible" system developed by the Washington field center of the International Pilot Study of Schizophrenia. By RDC criteria, 12 patients were diagnosed as major depressive disorders and the remaining 108 patients were diagnosed either schizophrenias, schizoaffective disorders, or unspecified functional psychoses. Of these 108, 97 were also diagnosed schizophrenic or schizoaffective by at least three other sets of critera. Ten-year followups were obtained on 82 (68%) of the 120 patients. Outcome was not significantly predicted by either presence or number of FRS, by an NHSI diagnosis of schizophrenia, or by a diagnosis of schizophrenia using the 12-point Flexible system with a 5-point cutoff. However, a significant relationship was found with the St. Louis criteria and the Bland-Orn score obtained from these criteria. An even higher correlation was found between followup and the Stephens-Astrup scale and the Strauss-Carpenter prognostic scale. RDC and DSM-II diagnoses were also significantly correlated with followup but to a lesser degree.

Adult↗
PubMed1980

A postscript on the 12-point flexible system for the diagnosis of schizophrenia: a report from the international pilot study of schizophrenia.

The 12-point Flexible System for diagnosing schizophrenia has undergone considerable testing and application by a number of investigative groups. Its application appears practical and the flexible attributes of the system permit the clinician or investigator to set stringency levels according to specific needs, with a reasonable prediction of the extent to which false positive and false negative classifications will be associated with this system. The present report describes the specific similarities of several other diagnostic groups to schizophrenia when this system is used. Attention is focused on the special problem of mania. The user is reminded that the Flexible System does not provide for a broad differential diagnosis, and therefore will usually be embedded in a clinical diagnostic workup providing access to all relevant information.

Bipolar Disorder↗
PubMed1979

An attempted integration of information relevant to schizophrenic subtypes.

The usefulness and validity of traditional subtypes are questionable. The subtypes described in earlier years no longer emerge with the clarity previously described. The four classical subtypes cannot be reliably distinguished and have not been shown to have predictive validity. Subtypes classified along course or prognostic lines may be more clinically useful. Attempts to subdivide schizophrenia along biologic and genetic lines offer promise. Recent efforts to describe new subdivisions of schizophrenia are readily justified, but new descriptive subtypes are likely to prove useful only when validated by biological, genetic, treatment response, and outcome data.

Adult↗
PubMed1979

Affective symptoms and the diagnosis of schizophrenia.

In a recent article in the Schizophrenia Bulletin, Goplerud and Depue (1978) discuss our writings on postpsychotic depression (McGlashan and Carpenter (1976a and 1976b). They argue that postpsychotic depression is the depressed phase of bipolar affective illness and thus join many workers who now challenge the diagnosis of schizophrenia in patients in whom affective disturbance is a significant part of the manifest psychopathology. In our response, we place special emphasis on the fallacy of using nondiscriminating similarities between groups (e.g., suicidal ideation) as a basis for positing disease homogeneity. Contrariwise, we argue the value of emphasizing nosologically discriminating features of individual patients in reaching diagnostic decisions. Concern is expressed with the current trend of defining diagnostic criteria such that acute and episodic psychoses are increasingly classified as affective disorders. We present arguments in favor of maintaining such cases within an ambiguous or uncertain category and reassert the time-honored (but recently forgotten) observation that schizophrenic patients can be affectively disturubed and still be schizophrenic.

Bipolar Disorder↗
PubMed1978

The prognosis of schizophrenia: rationale for a multidimensional concept.

Three main ways of viewing schizophrenia exist that have different prognostic, practical, and conceptual implications. The mixed cross-sectional/longitudinal view of Kraepelin and others states essentially that there is a disease, schizophrenia, that can be identified by considering both characteristic symptoms and course. Prognosis in the disorder so defined is guarded, but because of the composite diagnostic criteria used, the characteristics most important for relating to outcome remain unknown. The second view defines schizophrenia primarily in terms of the cross-sectional symptom picture alone. It has been shown empirically that defining a disorder in this way has relatively limited prognostic implications. The third approach identifies schizophrenia in terms of several "axes," such as type of schizophrenic symptoms, their duration, the person's social relations, and his work function. These axes are viewed as relatively independent processes with somewhat different determinants, implying the need for different specific treatments. The authors believe this last view is the one most supported by currently available data.

Cross-Sectional Studies↗
PubMed1978

Signs and symptoms as predictors of outcome: a report from the International Pilot Study of Schizophrenia.

The prognostic significance of signs and symptoms taken individually rather than in diagnostic clusters was investigated in 61 schizophrenic patients seen at 5-year follow-up in the Washington Center of the International Pilot Study of Schizophrenia. Best and worst outcome patients (Ns = 20) were selected on the basis of total outcome score from a reliable 9-item schedule; 21 middle-outcome patients were excluded. Data from these two groups were analyzed to determine which signs and symptoms assessed 5 years previously were associated with outcome. Only restricted affect predicted poor outcome: depression, anxiety, and nuclear symptoms of schizophrenia were not significant predictors. The findings are discussed within the conceptual framework of productive and defect symptoms.

Adolescent↗
PubMed1978

Immunoglobulins and viral antibodies in psychiatric patients.

The serum and CSF of 66 patients with functional psychoses were tested for immunoglobulins and antibodies to measles, HSV-I, CMV, and rubella viruses. Ten surgical and 80 neurological patients were controls. There were no significant findings in the serum, consistent with most previous studied. In the CSF 6 of 17 multiple admission schizophrenic patients had definite elevations of IgG or measles antibody and differed significantly from the surgical controls. Immunologically this group resembled the seriously ill neurological patients. No previous study has been made of immunoglobulins or viral antibodies in the CSF of psychiatric patients. It is concluded that further work is warranted in a search for biological subgroups of schizophrenia.

Adolescent↗
PubMed1977

Prediction of outcome in schizophrenia. III. Five-year outcome and its predictors.

Recent studies of schizophrenia have begun to demonstrate the complex nature of its outcome characteristics and their predictors. However, generalization of findings has been limited by methodological problems such as relatively short-term follow-up the use of retrospective data, or employment of evaluation techniques without demonstrated reliability. This report describes a prospective, five-year follow-up using reliable evaluation techniques to determine whether specific relations between predictors and outcome variables represent behavior patterns persisting over an extended period. Results demonstrate the prognostic importance and specificity of certain predictors over five years. These results support the view that outcome function is comprised of persisting open-linked systems of behavior.

Employment↗
PubMed1977

Art and recovery style from psychosis.

The concepts of integration and sealing-over as recover styles from acute psychosis are common clinical parlance. Our experience with acute schizophrenic patients has led to specific operational definitions and a scale which can reliably assign patients to these two categories. All acutely schizophrenic patients on an NIH Clinical Center research ward participated in individual art sessions during drug-free periods at admission, at discharge, and at 1-year follow-up. In each session, the patient drew: a) a picture of his choice; b) a self-portrat; and c) a picture of his psychiatric illness. We hypothesized that integrators would pictorially represent themselves and their illness with greater expression, ideational fullness, and affective force than patients who sealed-over. Twenty-four patients were divided equally into integrator and sealing-over groups (based upon ratings at follow-up) and matched for age, sex, and race. Their art productions were presented randomly to two independent raters unfamiliar with the patients. They scored pictures quantitatively for color, motion, detail, empty space, and global expressiveness. Inter-rater reliability was satisfactory. A mean rating was obtained for all pictures from each patient on each of the five art variables. Paired t-tests (two-tailed) were applied to contrast the two groups on each of the five art variables. The results were that the integrators used more color (p less than .05), drew with greater detail (p less than .01), and more globally more expressive (p less than .05). Integrators also tended to depict more motion (p less than .10), but were not different from the sealing-over patients in amount of space left empty. These results support the validity of integration and sealing-over as defined and support the use of art as a medium through which differences in individual styles of coping with the psychosis can be discriminated. Slides of the patients' artwork illustrate the findings.

Adult↗