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Biomedical subjects

W T Carpenter

Publications and source records attributed to W T Carpenter.

At least 163 records · Page 9Linked to original sources
PubMed1977

Monoamine oxidase in chronic schizophrenia: Studies of hormonal and other factors affecting enzyme activity.

Reported reductions in the activity of platelet monoamine oxidase (MAO) in chronic schizophrenic patients might be contributed to by alterations in hormones, platelet numbers or other non-specific factors thought to affect enzyme activity. In this study, MAO activity in 27 patients with chronic schizophrenia was measured, using benzylamine as the substrate in an assay based on platelet counts instead of platelet protein, and was found to be markedly lower than mean MAO activity in 375 normal controls. These results were similar to those previously reported with tryptamine as a substrate for the enzyme. Serum testosterone, triiodothyronine, iron and iron-binding capacity were within normal ranges in individuals with reduced MAO activities. Platelet MAO activity remained stable over time in patients and controls.

Benzylamines↗
PubMed1976

Postpsychotic depression in schizophrenia.

Several authors have described a severe depression in patients emerging from psychotic states. The clinical picture usually resembles that of a retarded depression with strong neurasthenic and schizoid components. It frequently emerges after a patient has been discharged from the hospital and may often go unnoticed. When manifest, the syndrome is usually stable phenomenologically, is often lengthy, and may be resistant to all modalities of treatment. Postpsychotic depression is a relatively neglected clinical area despite the risk of suicide and prolonged suffering. Therapeutic perseverence purportedly can improve the patient's long-term prognosis, and the phenomenon itself may be favorable prognostic sign. We present here a review and reformulation of this syndrome.

Affect↗
PubMed1976

Another view of schizophrenia subtypes. A report from the international pilot study of schizophrenia.

Schizophrenia subtypes are defined predominantly my manifest symptoms and behavior. This report, based on sign and symptom data from the International Pilot Study of Schizophrenia, addresses three questions: (1) Are traditional subtype diagnoses applied similarly across cultures? (2) Are the various traditional subtypes symptomatically distinguishable from one another? (3) Can cluster analytic techniques define a more distinctive set of schizophrenic subgroups? Present State Examination data were reduced to 27 psychopathologic signs and symptoms. Profile analysis of variance results indicate that each subtype appears similar, regardless of center of origin. However, this is based on a lack of distinguishing features between different subtypes. On the other hand, when a cluster analytic technique was used, it showed one large and three small subgroups, each readilty distinguishable from the others. These subgroups, labeled "usual," "flagrant," "insightful," and "hypochondriacal," are described clinically. If replicated or validated, such subgroups may prove meaningful in future considerations of subdivisions of the schizophrenia syndrome.

Culture↗
PubMed1976

A comparative study of art expression of schizophrenic, unipolar depressive, and bipolar manic-depressive patients.

The literature on art productions from psychiatric patients consistently suggests that specific graphic characteristics distinguish among various major diagnostic groups. These hypothesized differences are summarized. Systematic collection of art productions as part of separate research programs studying affective psychoses and schizophrenia has enabled us to amass a collection of psychotic patients' drawings which are used in an attempt to evaluate these hypotheses empirically. Art sessions were held with 104 patients hospitalized for affective psychoses and with 62 patients hospitalized for acute schizophrenia at NIH's Clinical Center. Comparing these drawings across diagnostic groups revealed, to our surprise and contrary to extant hypotheses, considerable within-diagnostic group variability and between-group overlap. There were, nonetheless, some trends in the hypothesized directions. These differences, however, disappeared when comparisons were made on a subsample of age-matched patients. This discrepancy between this research and expectations based on the literature is discussed. Our studies indicate that pictorial characteristics are not closely associated with diagnosis. We have, however, found that individual patient's art productions, and their associations to the pictures, are of great value in arriving at a dynamic understanding of the patient, regardless of diagnosis.

Age Factors↗
PubMed1976

Evoked response and kinesthetic measures of augmenting/reducing in schizophrenics: replications and extensions.

This study represents an attempt to replicate the central results of earlier work on stimulus intensity control. It uses a diverse sample of 40 hospitalized schizophrenic subjects, both chronic and acute. Two measures of stimulus intensity control were used: the Petrie kinesthetic figural aftereffects procedure (KFA), and the EEG method of average evoked response (AER). Finding the earlier results generally applicable, it presents a model of the function of stimulus intensity control in schizophrenia, which suggests that acute schizophrenics are particularly vulnerable to being inundated by stimuli, and therefore, that in order to protect themselves, they tend to reduce the perceived intensity of stimuli. Chronic schizophreniics have higher AER amplitudes and reduce less than acutes, suggesting that among chronics, the reducing mechanism either never was present or failed, whereas paranoid schizophrenics tend to be augmenters--a response style consistent with vigilant scanning.

Acute Disease↗
PubMed1976

On the methods and theory of reliability.

This paper reviews the most frequently used and misused reliability measures appearing in the mental health literature. We illustrate the various types of data sets on which reliability is assessed (i.e., two raters, more than two raters, and varying numbers of raters with dichotomous, polychotomous, and quantitative data). Reliability statistics appropriate for each data format are presented, and their pros and cons illustrated. Inadequancies of some methods are highlighted. The meaning of different levels of reliability obtained with various statistics is discussed. This critique is intended for the reading professional and the investigator who has an occasional need for reliability assessment. Statistical expertise is not required and theoretical material is referenced for the interested reader. Necessary formulas for computations are presented in the appendices. A summary table of some suitable reliability measures is presented.

Humans↗
PubMed1976

Impact of the seclusion room experience.

The seclusion room is a repository of intense feeling and strongly held opinion for members of psychiatric inpatient units. Patients, nurses, and doctors often find themselves in intrapsychic and/or interpersonal conflict over its use and misuse. Perhaps because of general discomfort, relatively little is known about what a patient actually experiences while secluded. In this report, we utilized an unexpected source of information on the meaning of the seclusion room experience for our patients: their art productions. The observations are based upon our therapeutic and research experience with acutely schizophrenic patients hospitalized on an NIMH clinical research unit located in NIH's Clinical Center. On this unit, pharmacotherapy was not used during investigation periods and, in keeping with the unit's treatment philosophy, was used sparingly or not at all during noninvestigative periods. As a result, the seclusion room was used frequently for severe management problems. Systematic collection of art productions was a routine part of the research protocol. Patients attended three individual art therapy sessions: during drug-free periods 2 to 3 weeks after admission, 2 to 3 weeks before discharge, and at follow-up 1 year after admission. The patient was asked to use pastels to draw the following pictures: a free picture (patient's choice), a self-portrait, a picture of his/her psychiatric illness, a picture of any hallucination experienced, and a picture of any delusion experienced. After completing each picture, the patient was encouraged to discuss it. Sixty-two patients were evaluated with this methodology. Particulary noteworthy is the fact that in no instance was a patient requested to draw a picture about a seclusion room experience. Nevertheless, over one third of the patients did so, underscoring the prominence of the experience for them. Furthermore, these pictures did not emerge from a large array of patient art, but from only threee art sessions per patient. The nature of the pictures fell into the following patterns: a) pleasurable hallucinations occurring while in seclusion; b) frightening delusions connected with the experience of seclusion; c) strong nondelusional feelings about being in seclusion (often the picture of the psychiatric illness was a representation of the seclusion room experience); d) special focus on the staff member in attendance outside the seclusion room door. The implications of these graphic expressions are discussed, with particular emphasis on the impact of the seclusion room experience for the patient.

Adolescent↗
PubMed1976

Television in the hospital: programming patients' delusions.

Systematic collection of art products from 55 schizophrenic patients provided unexpected documentation of the impact of television on delusion-formation. Patients' drawings and descriptions demonstrate the ease with which they incorporate TV program material in their psychotic experience. It is suggested that clinicians consider television viewing a relevant variable in the design of treatment programs.

Acute Disease↗
PubMed1976

An investigation of the postpsychotic depressive syndrome.

Postpsychotic depression is an important clinical phenomenon about which little is known. Using data from a cohort of 30 schizophrenic patients, the authors examine the frequency of the syndrome, predictive variables, and its prognostic implications. Their findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.

Acute Disease↗
PubMed1976

Current diagnostic concepts in schizophrenia.

The diagnosis of psychiatric disorders currently relies primarily on clinical observation and evaluation of manifest psychopathology. Symptom-based diagnosis of schizophrenia defines a highly variable patient population and thus makes replication of research results difficult. However, this diagnostic approach is useful because it has established communicative value, encourages clinicians to rely on the diagnostic data most readily available (i.e., the patient's behavior), and relates directly to treatment plans. The author describes a 12-point symptom-based diagnostic system for schizophrenia that enhances the reliability and (presumably) validity of the diagnostic process. He then illustrates methods that can be used to select homogeneous schizophrenic populations for specialized research purposes.

Computers↗
PubMed1976

Evaluating signs and symptoms: comparison of structured interview ans clinical approaches.

Are research interview techniques adequate in assessing signs and symptoms? This question is investigated by obtaining two sets of interview schedule ratings on 49 patients, one by a research psychiatrist applying the interview and one by the patient's psychiatrist using all available information. The latter was considered a clinical standard with which a cross-sectional research interview could be contrasted. These two data sets were subjected to several types of analysis commonly undertaken with research interview ratings. Results indicated that the research interview adequately represents symptom data, but is seriously lacking in the assessment of observed behaviour. The effect of this difference depends on the goals of the study and the nature of the data analysis. If overall group findings are desired, or if analysis relies primarily on symptom data, results with a research interview may be similar to results based on a far more extensive evaluation. On the other hand, if conclusions are to be drawn on individual patients, or if data analysis relies heavily on observed behaviour, then data derived from research interviews are questionable.

Behavior↗
PubMed1976

Further examination of a biochemical test for suicide potential.

The use of biological data, especially adrenal cortical activity, to enhance the assessment of suicide potential has been suggested and briefly argued in the literature. In this report data is presented on two suicide patients. One patient suicided 8 months after her 4-month hospitalization during which time her 17-hydroxycorticosteroid (17-OHCS) excretion remained at low levels. The second patient suicided on his thirteenth hospital day; his 17-OHCS excretion was moderately elevated, but consistent with his high anxiety and depression ratings. One case is used to support the previous findings that low 17-OHCS affords the clinician no reassurance regarding suicidal risk in the future. The other case illustrates the difficulty in interpreting moderate elevation in arousal sensitive endocrine systems in light of clinically manifest anxiety and/or depression.

17-Hydroxycorticosteroids↗
PubMed1975

Diagnostic criteria and five-year outcome in schizophrenia. A report from the International Pilot Study of schizophrenia.

Systematic psychiatric assessment was undertaken on 131 patients (the American cohort of the International Pilot Study of Schizophrenia). Nine areas of outcome functioning were assessed five years later at follow-up evaluation on 63% of these patients. An analysis of 66 clinical and demographic variables established that the patients sucessfully followed-up were representatives of the entire cohort. Diagnostic data from initial evaluations and follow-up outcome assessment were used to examine the relationship between diagnostic criteria and outcome in schizophrenia. Applying the criteria for schizophrenic diagnosis defined by Langfeldt, by Schneider, and Carpenter et al failed to define a poor outcome group. No difference in outcome was found when traditional schizophrenic subtypes were contrasted. Overall outcome in 61 patients with conditions diagnosed as schizophrenic was heterogeneous. However, despite overlap, the mean outcome in the schizophrenic cohort was poorer than in the 19 nonschizophrenic patients.

Activities of Daily Living↗
PubMed1975

Psychotherapy in hospitalized research patients.

Operations at the clinical-research interface exert a signal influence on the therapy of patients being treated on investigative units. The effect on the treatment milieu has been described but the impact of a research climate on individual psychotheraphy of hospitalized patients has not. We observed research-therapy interaction in 25 acutely schizophrenic patients. Analytically oriented psychotherapy was carried out on a National Institutes of Health clinical research unit where drugs are only occasionally used, and patients are subjects in psychobiological investigation. The subtle, and often neglected, interplay between therapy and research is examined, with emphasis on the shifting meanings of the patient's participation or refusal to participate in therapy, research, or both. A research transference and countertransference are defined, and some special behavioral patterns of research patients receiving dynamic therapy are considered in this framework.

Adolescent↗
PubMed1975

Cerebrospinal fluid amine metabolites in acute schizophrenia.

The metabolites of serotonin, dopamine, and norepinephrine, 5-hydroxyindoleacetic acid (5HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxy-phenylethylene glycol (MHPG), respectively, were studied in cerebrospinal fluid of patients with acute schizophrenia. Base line levels of these metabolites were not significantly different from those in normal, neurological, and affectively ill controls. Accumulations of 5HIAA and HVA following probenecid administration, which provide a measure of serotonin and dopamine turnover, were also not significantly different in patients with acute schizophrenia and affective illness. After patients had recovered from their acute schizophrenic illness, HVA accumulations were significantly reduced. We discuss results in relation to amine hypotheses of schizophrenia and the suggestion that altered dopamine metabolism may reflect a biological change predisposing to acute schizophrenia.

Acute Disease↗