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Biomedical subjects

W T Carpenter

Publications and source records attributed to W T Carpenter.

At least 91 records · Page 5Linked to original sources
PubMed1990

Continuous versus targeted medication in schizophrenic outpatients: outcome results.

The authors report on the outcome of treatment of 116 outpatients with chronic schizophrenia who were assigned to a 2-year, single-blind course of treatment with either targeted or continuous medication. These patients were not restricted to those who were good candidates for a medication reduction strategy. Continuous medication was superior to targeted medication in preventing decompensations and hospitalizations and in extent of employment at 2 years. Other measures of psychopathology and functioning at 1 and 2 years did not differentiate the two groups of patients. The targeted approach achieved a substantial reduction in total medication through a reduction in the number of days of medication administration.

Adult↗
PubMed1989

Increased temporal lobe glucose use in chronic schizophrenic patients.

Temporal lobe glucose metabolic rate was assessed in 21 off-medication patients with schizophrenia and 19 normal controls by positron emission tomography with 18F-deoxyglucose. Patients with schizophrenia had significantly greater metabolic activity in the left than the right anterior temporal lobe, and the extent of this lateralization was in proportion to the severity of psychopathology.

Adult↗
PubMed1989

Effect of neuroleptic withdrawal on plasma prolactin: a possible marker of receptor adaptation.

Stable schizophrenic and schizoaffective outpatients underwent abrupt withdrawal from a fixed dose of neuroleptic. Prolactin concentrations were determined preceding and following drug withdrawal. Basal prolactin concentrations were significantly lower 3, 4, or 5 days following drug withdrawal than on subsequent days. This rebound effect may be related to dopaminergic receptor changes in the tuberoinfundibular system that are induced by chronic neuroleptic administration.

Adult↗
PubMed1989

The Schedule for the Deficit syndrome: an instrument for research in schizophrenia.

The Schedule for the Deficit Syndrome (SDS) is an instrument for categorizing schizophrenic patients into those with and those without the deficit syndrome. In a study of 40 schizophrenic patients diagnosed by DSM-III criteria, raters using the SDS demonstrated good interrater reliability for this categorization, as well as for individual negative symptoms and a rating of global severity.

Affective Symptoms↗
PubMed1989

Diazepam treatment of early symptoms of schizophrenic relapse.

In an open trial, nine drug-free schizophrenic patients received oral diazepam, 10 to 40 mg/day, for the treatment of early symptoms of relapse. Diazepam treatment led to a return of the patient's usual condition in seven of 11 episodes.

Administration, Oral↗
PubMed1988

The power of analysis: statistical perspectives. Part 2.

A discussion of the importance of statistical power in research is presented accompanied by nomograms for determining sample size and statistical power for the Student's paired and unpaired t tests with a Type I error of 5%. A brief review of statistical inference is presented. Some findings from Part I are reviewed.

Clinical Trials as Topic↗
PubMed1988

Issues of design and methodology in long-term followup studies.

Beginning with Vaillant, followup studies of schizophrenia have devoted increasing attention to issues of design and methodology. The major advances and elements are described here and include: (1) conceptual framework, (2) design, (3) sample representativeness, (4) sample description, (5) data source and quality, (6) measures, (7) reliability, (8) diagnosis, (9) comparison groups, (10) assessment independence, (11) outcome, (12) missing subjects/bias testing, and (13) statistical techniques.

Follow-Up Studies↗
PubMed1988

Statistical issues in long-term followup studies.

The thesis of this article is that since followup studies of patients with schizophrenia have provided a rich body of informative knowledge, emphasis should now be on hypothesis testing in future studies. The consumer of research needs to have a general appreciation of statistical thinking, design, and methods to make an informed synthesis of results presented. This article presents a brief discussion of relevant statistics and statistical issues, as free of jargon as possible. Given the multivariable nature of psychiatric research, the natural focus is on multivariate statistics. A strong background in statistics is not required to understand the methods described and how and why they might be applied. Reference material for more detailed discussions is provided. It is a truism to say that the highest quality scientific work is dependent on an intimate collaboration with the expert in statistics and the expert in clinical methods, and this merits repeating only because it is so often ignored.

Follow-Up Studies↗
PubMed1988

The heterogeneity of the long-term course of schizophrenia.

Research has demonstrated considerable heterogeneity in the long-term course of schizophrenia. In the period preceding the onset of frank psychosis (onset), patients vary relative to the rapidity of onset, the presence or absence of associality, and the presence or absence of semipsychotic symptoms. Following the onset of psychosis (middle course), patients may suffer from episodic or unremitting psychosis, and may or may not exhibit the deficit syndrome. In late adult life (late course), patients vary relative to the presence or absence of an improvement in psychosis and social capability. The usual approach to the study of putative course subtypes is to define a subtype by a number of features; they may include features of more than one epoch. In addition, the course of psychosis has not been distinguished from enduring personality impairments in these subtypes. Another approach to defining putative course subtypes would be based on dichotomizing patients according to the presence or absence of a particular feature of a single epoch. This second approach has important advantages: the availability of larger study populations and a diminished liability for confounding due to the correlates of features other than those under scrutiny.

Follow-Up Studies↗
PubMed1988

Deficit and nondeficit forms of schizophrenia: the concept.

The authors provide a rationale for distinguishing the primary, enduring negative symptoms of schizophrenia (termed "deficit symptoms") from the more transient negative symptoms secondary to other factors. They argue that the former are more likely to provide a basis for meaningful subtyping of the schizophrenic syndrome, while the latter are more likely to respond to currently available treatments. They describe their experience in using clinical judgment based on longitudinal observations to identify deficit and nondeficit subtypes of schizophrenic patients and propose criteria for defining schizophrenia with the deficit syndrome.

Adult↗
PubMed1988

Long-term followup studies of schizophrenia: editors' introduction.

What are the major long-term followup studies of schizophrenia from around the world? What have we learned about schizophrenia and its vicissitudes over a lifetime? Does the lifelong vantage point help us to identify the primary psychopathologic components of schizophrenia and to distinguish it from other forms of mental illness? What are the implications of the longitudinal perspective for reducting heterogeneity, for transcultural comparisons, and for updating nosology? Is it time to emphasize hypothesis testing in longitudinal studies? These and other questions about schizophrenia are addressed in the Bulletin issue which focuses upon the long-term followup study, its productivity, and its promise.

Follow-Up Studies↗
PubMed1988

Reactive psychosis. I. Does the pre-DSM-III concept define a third psychosis?

Reactive psychosis, schizoaffective disorder, and schizophreniform disorder have each been considered as possible third psychoses that are separate from schizophrenia and the affective psychoses. We review the history of one of these diagnoses, reactive psychosis, and critique studies that attempt to validate the category. Studies using modern research methods with well-defined criteria based on experience with patients who have received this diagnosis should test this category more rigorously. The salient features of the diagnosis are delineated by considering the rationale for its existence and examining the empirical form it has taken. In a second paper, we explore how these features may form a basis for criteria that may provide a more meaningful category in subsequent revisions of the DSM.

Adult↗
PubMed1988

Reactive psychosis. II. Does DSM-III-R define a third psychosis?

The DSM-III and DSM-III-R criteria for "brief reactive psychosis" change the original concept of this disorder in a manner so restrictive as to virtually eliminate the diagnosis. In a companion paper to this one, we have reviewed the original concept and data supporting further study of this classification. We now argue that the operational criteria of the DSM-IIIs do not enhance the study of this putative disease entity, but rather thwart this goal by restricting the diagnosis so severely that too few cases will be found to test the third psychosis hypothesis. We suggest revised criteria that will retain the essential features of the traditional concept while defining explicit criteria in the style of the DSM-IIIs.

Humans↗
PubMed1987

Deficit and nondeficit forms of schizophrenia: neuropsychological evaluation.

The neuropsychological function of 15 deficit and 15 matched nondeficit syndrome schizophrenics was compared to that of 15 age- and sex-matched normal subjects. Both schizophrenic groups performed poorly on the Psychomotor factor compared to the normals. Only the deficit group performed more poorly on the General Performance factor. The results were not associated with severity of either positive or negative symptoms at the time of testing. These findings support the usefulness of the deficit syndrome distinction in contradistinction to the cross-sectional positive and negative symptom dichotomy.

Adolescent↗
PubMed1987

Approaches to knowledge and understanding of schizophrenia.

The author describes the breadth of theories, concepts, and inquiry in psychiatry, and notes areas of major impact on medicine, the brain sciences, and severe mental disorders. Conflicts that sometimes divide the field are often based on a misunderstanding of competing methods. The major explanatory methods are based on the disease construct and questions of mechanism on the one hand, and the life story approach and questions of meaning on the other. Instead of being mutually exclusive alternatives, these methods are complementary and each can enhance the other. The author briefly defines schizophrenia, and notes the major advantages and assumptions associated with choice of a medical model. He argues that a broad medical (the biopsychosocial) model has advantages over more reductionistic models, particularly in accounting for alterations at one level (e.g., biological) associated with perturbation of the system at another level (e.g., psychological). In concluding, the author finds new directions emerging from several disciplines and a mature scientific psychiatry prepared to capitalize on converging opportunities.

Humans↗