Search PubMed⌕ Search

Biomedical subjects

D W Harder

Publications and source records attributed to D W Harder.

At least 37 records · Page 2Linked to original sources
PubMed1988

Social class and psychiatric disorder. The examination of an extreme.

Relationships between social status and various aspects of mental disorder have been of long-standing interest to both clinicians and researchers, and a large body of literature exists attesting to the importance of social status in understanding psychiatric illness and disability. Reports examining social status and schizophrenia suggest that relationships between socioeconomic status and psychiatric illness may rest heavily upon differences between the lowest socioeconomic stratum and the remainder of society. To investigate the extent to which relationships between socioeconomic status and psychiatric illness and disability reflect differences between a deviant lowest socioeconomic stratum and the remainder of society, data from 217 patients hospitalized for psychiatric disorder and reassessed at a 2-year follow-up were examined. At initial assessment, 17 patient characteristics were found to be associated with socioeconomic status; for seven of these 17 characteristics, the largest difference between classes was found between the lowest and the adjacent (next-lowest) social class. At follow-up, for five of 15 characteristics found to be related to social class, the greatest interclass difference occurred between the lowest and the adjacent social class. Both initially and at follow-up, significant associations between patient characteristics and social class remained when the lowest social class patients were excluded from the analyses.

Follow-Up Studies↗
PubMed1988

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric inpatients.

This study tested the hypothesis that the Last-Weiss (Last & Weiss, 1976) Rorschach Ego-Strength Scale would predict outcome among a representative sample of first-lifetime psychiatric admissions. One hundred seventeen patients were assessed with structured symptom, psychiatric history, and social data interviews at hospital admission, and 2-year follow-up. Outcome measures included a multidimensional variable involving rehospitalization time, social and work functioning, and recent symptom level and symptom measures. Unexpectedly, the Last-Weiss Sum E variable correlated significantly with negative multidimensional outcome, a result that was strengthened when any possibly confounding effects of social class, IQ, and number of Rorschach responses were partialled out. It was found that Sum E's predictive value for poorer outcome was due to the space response (S+) component of the ego-strength variable. Possible explanations of the findings and implications for the previously validated Klopfer's Rorschach Prognostic Rating Scale are discussed.

Adjustment Disorders↗
PubMed1988

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric outpatients.

This study tested the hypothesis that the Last and Weiss (1976) Rorschach Ego-Strength Scale (sigma E) would predict outcome among a representative sample of never-hospitalized psychiatric outpatients. 78 patients were assessed with structured symptom, psychiatric history, and social data interviews at the time of initial clinic contact and at 2-yr. follow-up. Outcome measures included the Menninger Health-Sickness Scale, a multidimensional variable involving social and work functioning and recent symptom level, symptom measures, and an index of diagnostic severity. sigma E, controlled for number of responses, correlated significantly with Health-Sickness, neurotic symptoms, diagnostic severity, and psychotic symptomatology. Among the components of sigma E, M+, and FC+ had significant relationships or contributed to significant relations with outcome variables. Considered with an earlier study of inpatients, in which S+ sigma E component correlated inversely with outcome, this study suggested that sigma E components have differing prognostic significance, depending on adaptational level of the patient.

Adolescent↗
PubMed1986

Social class and psychiatric outcome.

Although social status has been shown to relate to rates of certain types of psychiatric disorder and to treatment received, little information is available regarding social class and clinical improvement over time. This report presents findings from a prospective follow-up study of a representative sample of first-admission psychiatric patients. A variety of clinical characteristics were analyzed at hospital admission and 2-year follow-up. The social status of the individual patient, the social status of the patient's parents, and the social status associated with the patient's residential area were found to be correlated with improvement over the 2-year follow-up period.

Adolescent↗
PubMed1985

The severity of psychiatric disorder: a replication.

A prior report documented the importance of diagnosis and psychotic symptoms as components of a global rating of severity of psychiatric disorder. The availability of 2-year followup data on 174 (80%) of the original 217 patients permits examination of the stability of components of a global rating. Menninger Health-Sickness Rating Scale (MHRS) scores again correlated with diagnosis and with psychotic symptoms; unlike the initial report, followup MHRS ratings were closely associated with a depression-neurosis factor and social role performance. Age, race, and sex were independent of severity, while low socioeconomic status correlated with severity of illness.

Adjustment Disorders↗
PubMed1985

Sex and race of patients admitted for their first psychiatric hospitalization: correlates and prognostic power.

Much attention has been focused on the advantages enjoyed by white males in the general society. Are they similarly advantaged in a psychiatric population? Two hundred seventeen patients from two demographically heterogeneous catchment areas admitted to inpatient care during a 1-year period were interviewed using standardized procedures; 80% of the original sample was available for follow-up 2 years later. Race and sex showed no consistent pattern of relationships with psychiatric symptoms, disability, and outcome; being both white and male was not advantageous in terms of any of the characteristics examined.

Adolescent↗
PubMed1984

The Urist Rorschach Mutuality of Autonomy Scale as an indicator of psychopathology.

The Urist Rorschach Mutuality of Autonomy Scale (MAS), which assesses development along a self-object differentiation and mutuality dimension, has shown considerable promise as an index of interpersonal relationship capacities. As such, MAS scores were predicted to correlate significantly with three measures of psychological pathology/health. The reliability of the scale was investigated with non-S Rorschachs and found to be satisfactory. Four-card Rorschachs from 60 previously hospitalized adults comprised the data source for the hypothesis test. Results suggest that the Mutuality Scale accurately reflects observed pathology severity at time of hospitalization and over a lifetime, but not at the time of assessment. Hence, the Urist MAS may indicate potential for pathology.

Adult↗
PubMed1984

Self-derogation and psychopathology.

To test empirically the oft-repeated clinical hypothesis of a relationship between the self-derogation component of low self-esteem and severity of psychopathology across the entire range of pathology, including nondepressive disorders, the present study examined this relationship in two samples of Ss. The first were 152 patients and expatients from two community mental health catchment areas followed up two years after their first functional-disorder psychiatric admission. The second group were 97 outpatients from the same catchment areas beginning therapy at a community mental health clinic. Within each sample self-derogation was related significantly to severity of diagnosis, overall health-sickness, numerous indices of symptomatology severity, and a measure of difficulty in social/employment functioning. These findings point to the need to recognize and treat self-derogation in psychopathological states other than depression. In addition, they raise the important question of direction of causality between self-derogation and observed psychopathology.

Adolescent↗
PubMed1982

First-admission psychiatric ward milieu: treatment process and outcome.

A two-year, prospective study of 123 first-admission patients examined the impact of different inpatient treatment decision-making styles on patient outcome on a therapeutic community ward and a medically oriented psychiatric ward. Ward philosophy, programmatic and administrative structure, and ward atmosphere defined the ward milieus. Data on length of stay and the use of various therapeutic modalities provided comparisons of treatment process. Standardized ratings of psychopathologic condition and levels of function, readmissions, and illness attitudes were used to assess two-year outcomes. The major finding was the absence of outcome differences despite longer lengths of stay on the therapeutic community ward. Hence, differences in ward decision-making style may not influence outcome, but may affect the process of care among diagnostically heterogeneous, first-admission patients treated in a university setting.

Adolescent↗
PubMed1982

WISC scatter and behavioral competence in high-risk children.

Examined the relationship between WISC scatter and school competence measures for 101 boys at risk for psychiatric disorder. This sample, shown in previous research to be less competent in school than controls, was predicted to have greater scatter than a standardization sample. Further, within the high-risk sample, an association was predicted between two measures of scatter and lowered school competence, as measured by Fisher's (1980) peer and teacher ratings. The results suggested that the mean scatter variable available for both samples is significantly higher in the high-risk group than in the intelligence test standardization sample. This scatter measure also measures. The second measure did not relate significantly to any of the school measures. These findings suggest that one of the two scatter measures is a valid index of less competent school functioning and may be in combination with other measures, a useful predictor of future psychopathology.

Child↗
PubMed1981

The Case Record Rating Scale: a method for rating symptom and social function data from case records.

Case records provide a vast resource of information for clinical research, yet their value has been limited by several methodological problems. One of these has been the absence of standardized approaches for making diagnoses and other clinical judgments from case record data. This report describes the Case Record Rating Scale, an instrument designed to provide a standardized method for abstracting case record information. The reliability of the scale is demonstrated, and the advantages and problems encountered using case record data for research are described.

Humans↗
PubMed1981

Established chronicity of psychotic symptoms in first-admission schizophrenic patients.

The course of schizophrenia before a patient's first admission is important theoretically, prognostically, and from a preventive psychiatric perspective. However, there is little systematically collected information on this topic. In this evaluation of a representative sample of first-admission schizophrenic patients, there was a wide variation in chronicity of psychotic symptoms before admission, with 20% of the patients having been symptomatic for more than 2 years and 28% for less than 1 week. Delusions of grandeur, delusions of reference, and suspiciousness were more common in the more chronic patients than in the most acute patients; symptoms of withdrawal and retardation showed the opposite pattern. The authors discuss the implications of these findings for prognosis, prevention, and theory.

Acute Disease↗
PubMed1980

The severity of psychiatric disorder.

Evaluating the severity of psychiatric illness is important, but it involves many implicit hypotheses and models. To investigate empirically characteristics entering into judgments of severity, a representative sample of 217 patients hospitalized for the first time for functional psychiatric illness was studied. Results indicated that psychotic symptoms and bizarre disturbed behavior were more associated with severity than were depression, anxiety, and other nonpsychotic symptoms. There was a strong relationship between severity and psychotic/nonpsychotic dichotomy, but relatively little relationship between severity and diagnostic categories. Severity was also related to certain measures of chronicity and social function.

Humans↗