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Biomedical subjects

S R Kay

Publications and source records attributed to S R Kay.

At least 55 records · Page 3Linked to original sources
PubMed1989

The Dysphorimeter: an objective analogue for the assessment of depression, anxiety, pain, and other dysphoric states.

This paper describes a newly invented apparatus, the Dysphorimeter. By manipulating a selector-slide, the patient can indicate the levels of depression or anxiety. The Dysphorimeter emits increasingly noxious sounds when moved downward on a scale of 1 to 10. The patient is asked to match the discomfort created by the sound to that of his depression or anxiety. In contrast to current means of measurements, the Dysphorimeter is not dependent on verbal response and factual reporting, and it is responsive to sudden mood changes. With schizophrenics and normal controls, the Dysphorimeter was found to show reliability and validity and better discriminative ability than methods currently in use.

Adult↗
PubMed1988

Differential diagnosis of mental subnormality and abnormality: the contribution of psychometrics.

In a psychiatric population, cognitive abnormality impacts on intellectual functioning and is often misconstrued as subnormality, i.e., mental retardation. Standard IQ and neuropsychological tests contribute little to the differential diagnosis, which hinges on the question of developmental failure. A developmentally rooted psychometric battery, one that assesses conceptual, perceptual-motor, and social maturity, is proposed as an objective diagnostic method. Research confirms the validity of this approach for distinguishing between psychosis with severe functional vs. developmental impairment, even when matched for IQ. Diagnostic and treatment implications are discussed.

Child Development↗
PubMed1988

Reliability and validity of the positive and negative syndrome scale for schizophrenics.

The Positive and Negative Syndrome Scale (PANSS) was developed out of the need for a well-operationalized method of assessing these syndromes in schizophrenia, including their relationship to one another and to global psychopathology. We surveyed 82 acute and chronic schizophrenics to analyze the psychometric properties of the four PANSS scales. The interrater reliabilities were in the 0.80's, and significant correlations emerged with corresponding criterion measures. The PANSS positive and negative scales were inversely intercorrelated once their shared association with general psychopathology had been partialed out. The results support the scales' reliability, criterion-related validity, and construct validity, while cross-validating some of our previous findings.

Adult↗
PubMed1988

High-dose naloxone in tardive dyskinesia.

Tardive dyskinesia (TD) is thought to result from nigrostriatal dopaminergic supersensitivity secondary to prolonged neuroleptic exposure. Preclinical studies have demonstrated that the opiate antagonist naloxone can acutely reverse a haloperidol-induced hyperdopaminergic state. In a trial of high-dose naloxone, 20 patients with TD received i.v. naloxone (20 mg, 40 mg, and placebo) under double-blind conditions. At baseline and at regular postdrug intervals, patients were evaluated using a battery of motor, clinical, and neuropsychological measures to study effects on neurological, behavioral, and cognitive functions. There was a significant improvement in involuntary movements at 30 min postnaloxone, together with improvement in clinical ratings at that time point, as well as some cognitive changes. The implications of these findings for the putative functional relationship between dopaminergic and enkephalinergic systems in the nigrostriatal area are discussed.

Adult↗
PubMed1988

Profiles of aggression among psychiatric patients. I. Nature and prevalence.

Based on the Yudofsky scale, a Modified Overt Aggression Scale (MOAS) with upgraded psychometric properties was developed to assess the nature and prevalence of aggression in a psychiatric population. The present report describes the standardization of this scale and the pattern of findings on two cohorts of 114 and 150 inpatients. The results support the discriminative validity of the MOAS and its internal, interrater, and retest reliabilities. Within 1 week some form of aggression was noted in about one fourth of the patient samples, with verbal aggression the most prevalent and autoaggression the least. Chronic patients showed the lowest incidence of physical assault and general aggression, whereas gender differences and daily variations were not significant. Greater stability of aggression was demonstrated for patient groups and for forms of aggression with higher base rates and for the short term (within 1 week) rather than the long course (3 months). The high prevalence of aggression and the consistency of profiles across patient samples suggested that sensitive, multivariable scaling can improve the accuracy of measurement and the depiction of the construct.

Adult↗
PubMed1988

Profiles of aggression among psychiatric patients. II. Covariates and predictors.

An Aggression Risk Profile was developed as an objective multidimensional scale for characterizing aggressive psychiatric patients and predicting verbal, physical, and general manifestations of aggression. Based on earlier studies, the 39-item Aggression Risk Profile incorporated demographic, diagnostic, historical, and clinical parameters. Its reliability, discriminative validity, and predictive validity were supported in its application to a total of 208 inpatients. Aggressive patients were more often found to be men, to be diagnosed with organic mental syndrome or substance abuse disorder, and to be notable in history of aggression. They tended to be angry and excitable but not more floridly ill than control subjects. The contemporaneous covariates of aggression, however, were not the same as the predictors, as determined by 3-month prospective follow-up. Twelve significant predictors were identified, and multiple regression analysis revealed different sets of measures that explain 45.0% to 52.5% of the variance for verbal, physical, and total aggression. The most reliable predictors were younger age, shorter length of illness, hostility, depression, anger, and difficulty in delaying gratification. We concluded that prediction is augmented by the combination of clinical and nonclinical predictors, and we discussed likely sources of disparity in previous research.

Adult↗
PubMed1988

Pimozide treatment of the negative schizophrenic syndrome: an open trial.

Reports over the last 20 years suggest that pimozide, a neuroleptic of the diphenylbutylpiperidine (DPBP) group, might be helpful in the treatment of negative symptoms of schizophrenia, which are considered less responsive to standard neuroleptics than are positive symptoms. Research suggests that neuroleptic drugs of the DPBP group possess a unique property--potent calcium channel antagonism--which could explain their ability to relieve negative symptoms. Earlier reports, however, used measures not specifically designed to assess the negative syndrome. The Positive and Negative Syndrome Scale (PANSS) was developed and standardized to measure the negative syndrome in schizophrenia. The authors used the PANSS to study the effects of pimozide in a 6-week, open clinical trial with 10 neuroleptic-resistant schizophrenic inpatients who had prominent deficit features. Negative but not positive symptoms improved significantly, suggesting that the drug might target the negative profile. The authors discuss possible pharmacologic mechanisms for pimozide's potentially distinct clinical properties.

Adult↗
PubMed1987

Anticholinergic-neuroleptic antagonism in terms of positive and negative symptoms of schizophrenia: implications for psychobiological subtyping.

In three studies of comparable design, 47 schizophrenics received anticholinergic anti-Parkinsonism (AP) medications for two to four weeks along the course of neuroleptic treatment. Clinical ratings during the AP phase were contrasted against the preceding and following two-week periods on neuroleptic alone, and these changes were analysed for a total of 27 psychopathology dimensions and for clusters of seven positive and seven negative symptoms. Schizophrenics overall exhibited significant exacerbation of total psychopathology, and positive but not negative symptoms. Only those with a predominantly positive syndrome when drug-free were susceptible to AP therapeutic reversal. However, other subgroup analyses revealed worsening of total psychopathology and positive symptoms among catatonic, schizophreniform, chronic, and good outcome cases, but negative symptoms alone were significantly increased among paranoids. The results were not supportive of a positive-negative dichotomy of schizophrenia, but instead suggested a tripartite model: a distinct paranoid group and a division of the non-paranoids into a positive and a negative type.

Adolescent↗
PubMed1987

The positive and negative syndrome scale (PANSS) for schizophrenia.

The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

Adult↗
PubMed1987

Outcome predictors in acute schizophrenia. Prospective significance of background and clinical dimensions.

In a prospective 2-year follow-up of 37 young acute schizophrenics, we examined the predictive significance and relative contribution of historical, genealogical, course, and clinical dimensions. Patients were evaluated multidimensionally at index admission and after 21 to 33 months, at which time 19 cooperated in follow-up involving clinical, functional, psychometric, and objective outcome measures. Multiple regression analysis found that combinations of 3 to 4 index variables significantly predicted 13 of 14 outcome measures, yielding multiple R values between .63 and .93 (X = .78). In total, a set of eight parameters contributed in explaining the outcome variance. The strongest overall predictor of favorable outcome was baseline negative syndrome. Other significant predictors were good premorbid school functioning, favorable prior disposition, sudden onset of illness, nonparanoid subdiagnosis, family history of alcoholism, psychomotor retardation, and depression. Accordingly, a patient's premorbid adjustment, course of illness, and presenting clinical profile provided nonoverlapping sources of outcome prediction. Of these three dimensions, it was proposed that the prognostic significance of the clinical profile may be phase specific, carrying different implications when assessed in the acute vs. chronic stage of illness.

Acute Disease↗
PubMed1987

Affective impairment in young acute schizophrenics: its structure, course and prognostic significance.

In order to investigate the structure, longitudinal course, and significance of affect impairments in young acute schizophrenics, we prospectively studied a group of 37 consecutively admitted acute inpatients at baseline and 26 months later (n = 19). They were evaluated at both points on a multidimensional affect rating scale, psychopathology rating scales, and tests of attention and motorium. Additionally, they were assessed on historical and subdiagnostic variables at baseline and on level of functioning at follow-up. Factor analysis revealed three reliably measured affect components: emotional unrelatedness, expressive immobility, and inappropriateness of affect. The first two factors were strongly interrelated and associated also with the BPRS depression factor at baseline. All four affective dimensions proved unstable over the course of 2 years and produced different sets of correlates at the two points of time. In the acute phase, only the depression factor carried favorable prognostic import (r = 0.52, P less than 0.05). Emotional unrelatedness and expressive immobility were of unfavorable consequence only when observed in the follow-up stage. Thus, the affect profile seemed to be an evolving rather than a static phenomenon, precluding generalizations across the early course of schizophrenia. Possible interpretations of the baseline overlap between affect deficits and depression were discussed as well as their different prognostic implications.

Acute Disease↗