Biomedical subjects
Publications and source records attributed to A C Carr.
Not necessarily belying usual symbolic interpretation of Rorschach content, Rorschach responses may represent a concrete experience reflecting a traumatic incident in the patient's past. This possibility should be considered particularly when the response in any way suggests undue preoccupation with the integrity of the body.
A program on an inexpensive microcomputer was designed to elicit personal histories from patients in a general psychiatric ward. Their answers were compared with the information recorded by the responsible psychiatric team. Where answers disagreed with the clinicians' records, the patient was interviewed to investigate the discrepancy. In the computer-elicited case-histories 90% of items were correct; a further 3% of items were considered correct by the patient. Most patients' computer histories revealed several items unknown to the clinicians and of importance in the management of the patient. Most patients (88%) found that the computer interrogation was as easy as a clinical interview. Computer assessment is proposed as a useful technique for the routine assessment of patients to augment the clinician's findings and to allow him to concentrate on the most relevant areas.
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Computerized assessment which is objective, standardized and easily repeated has been shown to be acceptable to general psychiatric patients. Fifty-three subjects (43 phobics and 10 normals feigning phobias) showed no unusual apprehension in approaching this novel procedure; all were able to complete the computer interview. Furthermore, half of them claimed that they found the interview more acceptable and found it easier to communicate with the computer than with a clinician. Only nine patients preferred the clinician. The reasons for this are discussed.
An automated assessment interview was given by a microcomputer to 26 randomly selected patients, referred for treatment of phobias. The results were compared with those of conventional clinical assessment by experienced behaviour therapists. Ratings of overall severity and intensity of specific types of agoraphobia and social phobia were derived from the computer interview, and correlated very closely with global ratings by the clinician and also with an independent structured clinical assessment. The computer also elicited behavioural targets to serve as a basis for exposure treatment. Blind assessors rated these targets as highly as those arrived at by clinicians in respect of their practicability, precision and appropriateness for treatment. The automated technique is inexpensive, saves clinicians' time and can be made widely available for screening, assessment and progress monitoring. It may also provide a basis for automated exposure treatment.
This study assesses the degree to which indicators from the Rorschach and the WAIS discriminate between the two groups of psychiatric inpatients diagnosed as having either borderline or psychotic personality organization by means of Kernberg's structural interview. A combination of WAIS scores focusing on the Picture Completion subtest, and Rorschach form level proved to be discriminators. These were interpreted as primarily reflecting reality testing. A linear combination of WAIS scale scores was identified that discriminated at least as well as the clinical WAIS-Rorschach comparisons.
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This study compared diagnoses arrived at through a structural interview developed by Kernberg which assesses levels of personality organization with those arrived at using DSM-III criteria of signs and symptoms among a group of hospitalized patients. Complete agreement was reached in 61 percent of the cases. Among the cases in which there was disagreement, 39 percent could nevertheless be considered to be compatible within the two systems, while the remaining cases were not. Discussion is directed to the different facets of clinical material addressed with each of these two diagnostic approaches, their discrepancies, and the underlying relationship between the two systems.
A self-rating depression questionnaire based on the Hamilton Depression Questionnaire was given directly by a microcomputer to 43 controls and 125 depressed patients. Scores obtained from the two groups differed very significantly; choosing an appropriate cut-off point, the computer-delivered questionnaire accurately detected the presence of depression. The severity of depression in the patients, as indicated by their scores, correlated significantly with assessments of severity by qualified clinicians. Patients commented favourably on the procedure, and the medical and nursing staff found it instructive and helpful. The use of this technique appears practicable and further evaluation is in progress.
The use of psychological tests in the diagnosis of borderline conditions by application of five approaches to the test battery is illustrated on a patient who was diagnosed as borderline by the criteria of both Gunderson and Kernberg. These approaches in terms of (a) structural variables, (b) response to confrontation, (c) severity of illness, (d) symptom diagnosis, and (e) differential response to tests of varying structure, may be used to strengthen each other and to facilitate the diagnosis of borderline patients.
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The research described in this paper stemmed from the hypothesis that borderline personality organization can be differentiated from neurotic and psychotic levels of personality organization by means of three structural criteria: degree of identity integration, level of defensive operations, and capacity for reality testing. In order to elicit these criteria, the "structural" interview has been developed that focuses on the "here-and-now" patient-interviewer interaction. The patient's responses to the interviewer's attempts to clarify, confront, and interpret various aspects of the patient's interview behavior provide the basis for judgments as to the patient's structural diagnosis. Specifically, the paper reports a study of the differential diagnosis of 48 hospitalized patients in which structural diagnoses of borderline or psychotic personality organization were made according to this diagnostic interview approach. These diagnoses were compared with ones obtained from Gunderson's Diagnostic Interview for Borderlines, with psychological test diagnoses, and with clinical diagnoses based on past history and current illness. Results show substantial convergent agreement among all of the diagnostic methods and support the utility of the structural interview. In most discrepant cases, other methods reflected disagreement among themselves despite the diagnoses obtained from the structural interview, suggesting that there are some cases difficult to classify by any means. Further analysis suggests that the structural interview may be eliciting a different dimension of personality functioning in arriving at borderline diagnoses than do the other methods studied. The results also indicate that borderline structural diagnoses refer to patients described clinically as having severe character pathology, and do not overlap with patients described as having schizophrenic disorders. The structural interview appears to warrant further study, and, at the same time, shows promise as a research tool in further studies of structural diagnosis and its relevance for prognosis and treatment.
Psychological tests of 32 borderline or nonborderline (psychotic) patients were compared with the structural diagnoses arrived at on the basis of two kinds of clinical-research interviews: The DIB (following Gunderson's criteria) and the structural interview (following Kernberg's criteria). Test results were reported in terms of the diagnosis based on the full test battery, as well as in terms of the structural diagnosis implied by the presence or absence of thinking disturbances on the (structured) WAIS as compared with the (unstructured) Rorschach test. Statistically significant agreement was shown among these four approaches.
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Isoleucyl-tRNA formation catalysed by isoleucine: tRNA ligase is stimulated by both Mg2+ and spermine in the pH-range 7.0 to 8.0 at 310 K. At low [Mg2+] the acceleration caused by both cations together exceeds the sum of their individual effects. 2. The spermine-stimulated reaction has a steeper temperature-dependence than reaction in the presence of Mg2+. Two phases in the kinetics of isoleucyl-tRNA formation are detected in the presence of Mg2+ plus or minus spermine, but only a single step is observed in the presence of spermine alone. Thus the rate-limiting steps under normal assay conditions are different for the two cations. 3. Enzyme-bound isoleucyl-AMP can be formed in the absence of Mg-2+ and plus or minus spermine. 4. It is concluded that there is no evidence for cation-dependent differences in the reaction mechanism of isoleucine: tRNA ligase, though there are certainly differences in the relative rates of some of the individual steps.