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Biomedical subjects

S R Kay

Publications and source records attributed to S R Kay.

At least 73 records · Page 4Linked to original sources
PubMed1987

Amantadine in the treatment of neuroendocrine side effects of neuroleptics.

An open-label reversal drug study was undertaken on 10 neuroleptic-treated schizophrenic inpatients to assess the impact of amantadine hydrochloride on presumed prolactin-mediated neuroendocrine side effects. Measures were conducted across 7 weeks, including a 2-week neuroleptic baseline, a 3-week neuroleptic-plus-amantadine phase, and a 2-week return to the baseline regimen. Significant reduction with amantadine was observed on all six indices of neuroendocrine side effects: serum prolactin levels, body weight, gynecomastia/galactorrhea, breast tenderness, decreased libido, and amenorrhea. Improvement on these parameters was noted for as many as nine or all 10 patients, while in no cases was there worsening. In terms of motor and clinical effects, significant diminution of extrapyramidal and psycho-pathological symptoms was also achieved during this phase. The results suggested that amantadine may be beneficial for the treatment of neuro-endocrine side effects of antipsychotic medication owing to its ability to reverse neuroleptic-induced hyperprolactinemia.

Adult↗
PubMed1987

The positive-negative dimension in schizophrenia: its validity and significance.

It has been recently proposed that positive (productive) and negative (deficit) symptoms in schizophrenia constitute distinct syndromes that carry different etiological, prognostic, and treatment implications. Inconclusive results to date may be attributable to methodological weaknesses, including problems of measurement and lack of longitudinal, dynamic, and multiphasic investigation. We describe a series of multidimensional studies on the validity and significance of this distinction, deriving from a new rating instrument and separate typological, dimensional, longitudinal, phasic, and psychopharmacological research perspectives. The data suggest that positive and negative features represent opposing polarities of psychopathology which can be reliably assessed. Various sources of syndromal validation were demonstrated, including construct and criterion-related validity and differential response to psychotropic medication. Positive and negative syndromes were equally prevalent in the acute and chronic phases of schizophrenia but stable only in the latter. The meaning of the syndromes also varied according to chronicity. In the chronic stage, a negative profile was uniquely associated with ominous genealogical, premorbid, and phenomenological signs, whereas in acute schizophrenia it carried favorable import and predicted successful outcome. The results contest a monolithic concept of the positive-negative distinction and fail to support the prevalent hypothesis of structural organic impairment underlying the negative syndrome. We instead postulate a dual-process model that distinguishes between neuroleptic responsive arousal-related (positive) and neuroleptic resistant development (negative) components in chronic schizophrenia.

Antipsychotic Agents↗
PubMed1987

Attention deficit disorder psychosis as a diagnostic category.

The hypothesis is advanced that certain psychoses in adults devolve from attention deficit disorder (ADD), which has a fundamental impact on cognitive and social development and thus affects personality structure and psychodynamics. This 'ADD psychosis' often masquerades as schizophrenia or an affective disorder and hence is frequently misdiagnosed, precluding appropriate clinical intervention. Based upon clinical evidence and empirical research involving phenomenological comparisons, premorbid history, high risk studies, neurodiagnostic evaluations, and pharmacotherapeutic response, it is suggested that ADD psychosis in adults be regarded as a separate diagnostic entity. Distinguishing symptomatology, anamnesis, family history, therapeutics, as well as prognosis, are discussed. The concept of attention deficit disorder (ADD), until recently referred to as minimal brain dysfunction (MBD), has been conceived as a childhood affliction with rather specific and circumscribed manifestations. The diverse features which embrace this syndrome, such as hyperactivity and dyslexia, were first identified and subsumed under the collective banner of MBD about 2 decades ago. The complex hypotheses concerning its possible etiology have been detailed elsewhere and need not be repeated here. Rutter, based on his extensive literature review and seminal studies, has come to regard MBD as a subclinical brain disorder developing from a genetically determined biochemical abnormality, which produces symptoms of hyperactivity, impulsivity, attention deficit, aggressivity, and conduct disturbance. Indeed, factor analytic studies reviewed by Rutter support the co-occurrence of these pathological features in children, yet the empirical evidence for a distinct syndrome and for a precise etiology has been admittedly weak, with some contending that MBD or ADD is simply a catch-all for disparate neurological symptoms of unknown and variable pathogenesis.

Adult↗
PubMed1986

Thought deficit in psychotic depression and chronic paranoid schizophrenia: methodological and conceptual issues. Commentary on Marjorie L. Carter's "The assessment of thought deficit in psychotic depression and chronic paranoid schizophrenia".

Based on test comparisons involving psychotic depressives and chronic paranoid schizophrenics, Carter (J. Nerv. Ment. Dis. 174: 336-341, 1986) inferred that cognitive disorder may reflect a general psychosis factor rather than a differential diagnostic marker. Review of the design and analysis raises methodological and conceptual issues that obviate such interpretation. Problems include absence of control for IQ and chronicity of illness, sample bias incurred by selectively matching groups for education, use of parametric statistics on ordinal data, measures that do not differentially assess cognitive deficit, plausible alternative explanations for nonsignificant outcome, and inadequate data base for generalizing about larger diagnostic groups or psychosis itself. Significant differences found by Carter and others suggest, instead, some fundamental distinctions in the nature if not extent of cognitive disorder in these two groups. It was proposed that a general psychosis factor may be a pervasive interfering variable that obscures diagnostic differences in cognition and thus needs to be rooted out by proper statistical or research design.

Chronic Disease↗
PubMed1986

Positive and negative syndromes in schizophrenia as a function of chronicity.

The construct validity and extended stability of positive and negative syndromes were studied via multidimensional cross-sectional assessment of 134 schizophrenics in the acute, chronic, and long-term chronic stages. For all groups the syndromes were internally reliable, not significantly intercorrelated, and of similar severity. The syndromal correlates with clinical, motor, historical, and genealogical dimensions, however, differed as a function of chronicity. In acute schizophrenics, a negative syndrome was associated with clinical and genealogical indicators of good prognosis, whereas the converse obtained for a positive syndrome in the acute stage and a negative syndrome in the chronic stage. The relationship of education, marital status, and attention disorder to the positive-negative distinction also varied according to length of illness. Its meaning, therefore, appeared phase-specific and subject to evolution, obviating generalizations across all phases. Implications for theory, prognosis, current research, and future study are presented.

Acute Disease↗
PubMed1986

Significance of positive and negative syndromes in chronic schizophrenia.

Positive and negative syndromes were studied in relation to demographic, historical, genealogical, clinical, psychometric, extrapyramidal, and follow-up measures of 101 chronic schizophrenic patients. The criterion scales proved to be reliable, normally distributed, and strongly correlated with general psychopathology, but otherwise inversely related to one another. Multiple regression analysis identified sets of 4-6 independent variables that explained 74%-81% of the scales' variance. A positive syndrome was associated chiefly with productive features, family history of sociopathy, more previous hospital admissions, and longer in-patient stay during the 30-month follow-up period. A negative syndrome correlated with deficits in cognitive, affective, social, and motor spheres, higher incidence of major psychiatric illness but less affective disorder among relatives, lower education, and greater cognitive developmental impairment. The results underscore the importance of genetic and biodevelopmental variables for understanding schizophrenic syndromes.

Adult↗
PubMed1986

Mesoridazine and thioridazine: clinical effects and blood levels in refractory schizophrenics.

Seven schizophrenic (according to DSM-III criteria) inpatients completed a two-phase study; each phase had a 1-week drug-free period followed by 6 weeks of a drug trial. The first phase uniformly involved treatment with chlorpromazine, and in the second phase patients received either mesoridazine (N = 3) or thioridazine (N = 4). Clinical ratings (Brief Psychiatric Rating Scale and Clinical Global Impressions) and neuroleptic blood levels were obtained weekly throughout the study. Whereas patients failed to respond to chlorpromazine 1800 mg/day, response to mesoridazine 400 mg/day and to thioridazine 800 mg/day was established on all Brief Psychiatric Rating Scale factors except for anxiety-depression. A higher neuroleptic blood level was achieved with mesoridazine or thioridazine at less than half the reference chlorpromazine dosage. Correlations between neuroleptic blood level and clinical response were positive for mesoridazine, negative for chlorpromazine, and nonsignificant for thioridazine. These findings are consistent with earlier research. We conclude that drug-resistant schizophrenics seem to improve clinically with mesoridazine or thioridazine, unlike with chlorpromazine, and that for mesoridazine this difference may be a function of selective dopamine receptor blockade.

Adult↗
PubMed1984

Values and therapy orientations of psychotherapy trainees: a twelve-year update.

Psychotherapy orientations, self-declared fortes in conducting therapy, and interpersonal values were studied among psychiatry residents and psychology interns in the late 1960s and early 1980s. A distinct pattern of psychotherapy orientations and fortes emerged which transcended professional backgrounds and proved stable across generations, despite some interactions between training and time. Subjects' professed areas of expertise were closely aligned with their beliefs about what methods are most effective in psychotherapy, and both these variables were significantly associated with their value profiles. The correlation matrix suggested a three-factor model of related psychotherapy and value orientations surrounding the three predominant modalities: insight, corrective emotional experiences, and learning. It was proposed that the data support the importance of value dimensions in contributing to psychotherapists' adoption of specific treatment strategies and their developing expertise in corresponding techniques.

Attitude↗
PubMed1984

Positive and negative syndromes in chronic schizophrenic inpatients.

This study considered whether chronic schizophrenics with positive and negative syndromes represent distinct subtypes. From a survey of 47 schizophrenic inpatients, 18 showed preponderance of productive or deficit features, and four were mixed. The discrete groups were compared on clinical symptoms, cognitive tests, demographic and historical data, and drug side effects. They were significantly distinguished on most criterion symptoms and affect scales but, otherwise, essentially comparable in psychopathology and extrapyramidal symptoms. The tests revealed similar levels of intellectual impairment and visual-motor deficit, yet the negative patients displayed more primitive cognitive mode and greater psychomotor retardation. They also proved older, less educated, more often born in winter-time, hospitalized later in life, and less heavily medicated. The results supported the validity of the positive-negative dimension for identifying schizophrenic subtypes and suggested etiological implications regarding developmental deficiency.

Adult↗
PubMed1983

LSD psychosis or LSD-induced schizophrenia? A multimethod inquiry.

We studied whether patients hospitalized for LSD psychosis are clinically separable from acute schizophrenics. The family histories, manifest symptoms, premorbid adjustment, and profiles on an extensive test battery were analyzed for 52 LSD psychotics and 29 matched first-break schizophrenics. The LSD patients did not differ from schizophrenics in incidence of psychosis or suicide among the parents. However, the rate of parental alcoholism for LSD psychotics far exceeded that for schizophrenics and the general population. The two groups were distinguished on some clinical features but were equivalent in premorbid adjustment, on most cognitive measures when initially hospitalized or reassessed three to five years later, and in number of subsequent rehospitalizations. Thus, in most respects the LSD psychotics were fundamentally similar to schizophrenics in geneaology, phenomenology, and course of illness. The findings supported a model of LSD psychosis as a drug-induced schizophreniform reaction in persons vulnerable to both substance abuse and psychosis.

Acute Disease↗
PubMed1982

The therapeutic value of psychotherapists' values and therapy orientations.

This study investigated novice psychotherapists' personal values and therapy orientations as a therapist variable affecting their therapeutic rapport with psychotic patients. Both types of therapist characteristics were found significantly related to their initial success in terms of rapport with patients, while psychological differentiation and A-B types (Whitehorn and Betz 1954) were not so related. "Equilitarianism" among the values, expressive-experiential qualities among self-declared fortes, and directiveness among therapy orientations were the specific areas found associated with therapists' initial rapport. Conversely, emphasis on "identification" and "suggestive powers" as modes of change produced inverse correlations with success. The results underscore the importance of these variables as therapist attributes but do not necessarily argue for the absolute or intrinsic advantage of these values and doctrines. The composite picture which emerged of the effective therapists suggested equalitarianism combined with some degree of individualism and eclecticism underlying their personal and professional orientations. This may reflect the prevailing actual pragmatism in the professional community, even though it may contrast with their declared ideological loyalties.

Adult↗