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Biomedical subjects

R L Spitzer

Publications and source records attributed to R L Spitzer.

At least 127 records · Page 7Linked to original sources
PubMed1977

The family history method using diagnostic criteria. Reliability and validity.

Data concerning familial history of psychiatric disorders are often used to assist in diagnosis, to examine the role of genetic or nongenetic familial factors in etiology, or to develop new methods of classification. Information concerning familial prevalence may be collected by two different methods: the family history method (obtaining information from the patinet or a relative concerning all family members), and the family study method (interviewing directly as many relatives as possible concerning their own present or past symptomatology). This study compares these two methods. In general, the family study method is preferred since information is likely to be more accurate. The family history method leads to significant underreporting, but this can be minimized through the use of diagnostic criteria. This study reports on an instrument that has been developed for collecting information concerning family history and that provides criteria for 12 diagnoses--the Family History-Research Diagnostic Criteria. Using diagnostic criteria leads to greater sensitivity, but underreporting remains a major problem of the family history method.

Diagnosis, Differential↗
PubMed1977

Brief hospitalization: a two-year follow-up.

The author present two-year follow-up data of a controlled study of 175 newly admitted inpatients who lived with families, comparing the relative efficacy of brief hospitalization (with and without transitional day care) and standard hospitalization (with all patients offered outpatient aftercare). The long-term results confirm the preliminary finding that brief hospitalization is preferable to longer term hospitalization for most patients. Briefly hospitalized patients spent significantly less time as inpatients and showed less psychopathology and impairment in role functioning. In contrast to preliminary findings, the long-term results indicate that use of day care reduced the number of inpatient days.

Adult↗
PubMed1977

Trends in the frequency of schizophrenia by different diagnostic criteria.

The authors report results of rediagnoses of 128 cases from two decades (1932-1941 and 1947-1956) by clinicians using the Research Diagnostic Criteria as guidelines and compare these results to rediagnoses by clinicians in a previous study using more general guidelines. Although hospital records indicated an increased frequency of schizophrenia over the two decades, the rediagnosticians found no change or a decrease. Severity of symptoms did not change during the two decades, but patients in the second decade showed more borderline symptoms, leading to more diagnostic disagreement. The authors conclude that changes in diagnostic criteria and pateints' conditions influence admission trends for schizophrenia.

Delusions↗
PubMed1976

More on pseudoscience in science and the case for psychiatric diagnosis. A critique of D.L. Rosenhan's "On Being Sane in Insane Places" and "The Contestual Nature of Psychiatric Diagnosis".

Rosenhan's 1973 article, "On Being Sane in Insane Places," was pseudoscience presented as science. Just as his pseudopatients were diagnosed at discharge as having "schizophrenia in remission", so a careful examination of this study's methods, results, and conclusions leads to a diagnosis of "logic in remission." Rosenhan's study proves that pseudopatients are not detected by psychiatrists as having simulated signs of mental illness and that the implementation of certain invalid research designs can make psychiatrists appear foolish. These rather unremarkable findings are irrelevant to the real problems of the reliability and validity of psychiatric diagnosis and only serve to obscure them. A correct interpretation of his own data contradicts his conclusions. There are purposes to psychiatric diagnosis that Rosenhan's article ignores. His more recent suggestion that certain requirements be met prior to the adoption of a new psychiatric classification system is unrealistic.

Auditory Perception↗
PubMed1976

The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance.

The Global Assessment Scale (GAS) is a rating scale for evaluating the overall functioning of a subject during a specified time period on a continuum from psychological or psychiatric sickness to health. In five studies encompassing the range of population to which measures of overall severity of illness are likely to be applied, the GAS was found to have good reliability. GAS ratings were found to have a greater sensitivity to change over time than did other ratings of overall severity or specific symptom dimensions. Former inpatients in the community with a GAS rating below 40 had a higher probability of readmission to the hospital than did patients with higher GAS scores. The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.

Hospitalization↗
PubMed1976

A study of psychopathology of parents of psychotic children by structured interview.

To improve observer uniformity and objectivity in the psychiatric appraisal of parents of psychotic children, structured psychiatric interviews were administered to 64 parents of psychotic children, including 28 husband--wife pairs and 8 single parents. Judgments were recorded on the Spitzer--Endicott Psychiatric Status Schedule and the past section of their Current and Past Psychopathology Scales. There were no significant differences between fathers and mothers of organic and nonorganic children (children with and without evidence of neurological dysfunction). As a whole, the 56 parents in the 28 participating husband-wife pairs fell between a contrast group of 55 adult subjects attending a psychiatric clinic and another contrast group of 130 subjects living in the community in upper Manhattan in their trends to pathological symptoms as judged by the Psychiatric Status Schedule. Similarly, in the past section of the Current and Past Psychopathology Scales the parents showed a trend to more psychopathology than a community sample of 36 nonpatient adults. Finally, computer diagnoses based on the Psychiatric Status Schedule showed more schizophrenia in the parents of the psychotic children than in a sample of 130 nonpatient adults in the community. The data thus tend to support findings based on the unstructured interview of elevated schizophrenia rates in parents of psychotic children.

Adult↗
PubMed1976

Brief versus standard hospitalization: the families.

A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patients. There was no major differential family burden as a function of length of hospitalization. Generally, brief hospitalization had several positive effects on family functioning, primarily earlier resumtption of occupational roles and less financial burden, with few significant deleterious effects.

Adult↗
PubMed1975

Clinical criteria for psychiatric diagnosis and DSM-III.

The authors identify the differences in formal inclusion and exclusion criteria used to classify patient data into diagnoses as the largest source of diagnostic unreliability in psychiatry. They describe the efforts that have been made to reduce these differences, particularly the specified criteria approach to defining diagnostic categories, which was developed for research purposes. On the basis of studies showing that the use of specified criteria increases the reliability of diagnostic judgments, they suggest that including such criteria in the next edition of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) would improve the reliability and validity of routine psychiatric diagnosis.

Humans↗
PubMed1975

Brief hospitalization of patients with families: initial results.

A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patients. The three groups showed no significant differences as to amount of improvement in levels of psychopathology at 3 and 12 weeks, but the briefly hospitalized patients were able to resume their vocational roles sooner. There were no significant differences among the groups in readmission rates.

Adolescent↗