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Biomedical subjects

R E Kendell

Publications and source records attributed to R E Kendell.

16 recordsLinked to original sources

Prognostic implications of six alternative definitions of schizophrenia.

The ability of six different operational definitions of schizophrenia to identify prospectively patients whose eventual prognosis would be poor was studied using data from a six-year follow-up of a series of 134 patients with functional psychoses. All six definitions were more successful at predicting a poor symptomatic outcome than a poor social outcome. Spitzer's Research Diagnostic Criteria, Carpenter's flexible criteria, and Langfeldt's criteria predicted a poor outcome as well as the original clinical diagnoses and were considerably better than the New Haven criteria, Schneider's first rank symptoms, or the computer program Catego.

Adult

The distinction between the affective psychoses and schizophrenia.

In an attempt to demonstrate a valid boundary between schizophrenia and the affective psychoses, discriminant function analyses have been carried out with history, mental state and follow-up data in two populations of patients. A bimodal distribution of discriminant scores was obtained in one of them (a general psychotic sample of 128 patients), using a discriminant function derived from the same sample; but when the function was applied to the second population (a schizoaffective sample of 106 patients) the distribution was ambiguous. Functions derived from the schizoaffective sample produced highly skewed distributions of discriminant scores in the general psychotic sample. Kraepelin's hypothesis that the functional psychoses consist of two distinct disease entities receives some support from our findings, but there is still no compelling evidence that the universe of psychotic patients falls naturally into these two groups.

Bipolar Disorder

The hierarchy model of psychiatric symptomatology: an investigation based on present state examination ratings.

Psychiatric diagnoses are arranged in a rough hierarchy, generally regarded as a convention to enable patients with a wide range of symptoms to be allocated to single diagnostic categories. Foulds, on the basis of self-report questionnaire responses, claimed that patients with symptoms at the higher levels of this hierarchy not only may but characteristically do exhibit symptoms at all lower levels as well. Foulds' hierarchy model was tested here, using PSE ratings from two large series of in-patients; at least 75% fulfilled the requirements of the model, but up to 50% of schizophrenic and manic patients failed to do so. Almost two-thirds of all patients with psychotic symptoms establishing them in one of the upper two classes of the hierarchy did not exhibit the neurotic symptoms they required lower in the hierarchy.

Affective Symptoms

Definitions of schizophrenia: concordance and prediction of outcome.

The study reports a comparison of 10 definitions of schizophrenia (Feighner's, Taylor's, Schneider's, Longfeldt's, Spitzer's, Carpenter's, Astrachan's, 2 from Forrest & Hay and Catego) in respect of their reliability, concordance and prediction of outcome. Some (including Feighner's) proved too strict, and others (including Schneider's) were weak predictors of clinical and social state. Four definitions (Spitzer's, Langfeldt's, Carpenter's and Catego) emerged as relatively effective and these also had a somewhat more satisfactory mutual concordance.

Employment

Trials of lithium, chlorpromazine and amitriptyline in schizoaffective patients.

Two drug trials in schizoaffective patients are reported. Nineteen "schizomanic" patients were treated for one month, on a double blind basis, with chlorpromazine or lithium and 41 "schizodepressive" patients with amitriptyline, chlorpromazine or both. In the schizodepressive patients there was a trend to a better response to chlorpromazine, but drug response generally was poor, only 20 per cent of patients recovering within the month. In the schizomanic patients lithium seemed as effective as chlorpromazine, which supports the view that these patients were suffering from a variant of mania.

Amitriptyline

Smooth pursuit eye movements of schizophrenics and normal people under stress.

Eye movements while watching an oscillating pendulum were recorded in 24 chronic schizophrenies and 24 matched normal controls. As others have reported previously, abnormal tracking movements were significantly commoner in the schizophrenics. However, in a series of experiments with normal subjects it was found that conditions designed to distract attention, or to produce declining arousal and attention, produced abnormal tracking movements indistinguishable from those observed in schizophrenics. As chronic schizophrenics are known to perform badly on a variety of psychomotor tasks and there is evidence that this is due to impaired attention or heightened distractibility, it seems likely that these same factors are responsible for their poor eye-tracking performance.

Adult

The influence of childbirth on psychiatric morbidity.

The Camberwell Psychiatric Register was searched for contacts by the 2257 women resident in the register catchment area who were known to have had a child in 1970. Of these, 99 women (and 39 of their husbands) were found to have had a 'new episode' of psychiatric illness in the two years before or the two years after the birth of their child. The distribution of these 'new episodes' relative to the time of childbirth was then studied. In the women, both functional psychoses and depressive illnesses showed a sharp rise in the new episode rate in the three months immediately after delivery. There was also a suggestion of a secondary rise, less dramatic but more sustained, from the 10th to the 24th month after delivery. There was no comparable rise in the husbands. Women whose children were illegitimate had high new episode rates throughout the four-year study period, but not particularly so in the puerperium itself.

Adjustment Disorders