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Biomedical subjects

W T Carpenter

Publications and source records attributed to W T Carpenter.

At least 109 records · Page 6Linked to original sources
PubMed1987

A comparative trial of pharmacologic strategies in schizophrenia.

An open comparative trial was conducted involving 42 schizophrenic outpatients randomly assigned to one of two methods of drug administration: continuous medication (N = 21) and targeted medication plus psychosocial intervention (N = 21). The results, which suggest an extensive similarity with respect to outcome for the two treatments over a 2-year period, argue for the continuation of research on the relative effectiveness of the targeted drug approach, particularly in cases judged suitable for drug reduction strategies.

Adolescent↗
PubMed1986

Thoughts on the treatment of schizophrenia.

The author contends that the clinical relationship is the foundation for treating the person with schizophrenia. However, the models and scientific data available to the clinician have been limited by prevailing ideologies. Despite important contributions from interpersonal, pharmacologic, and rehabilitation treatment perspectives, each has curtailed the range of clinical observation and the capacity for integration of treatments. Even recent advances in clinical science methodology have contributed to a short fall in treatment knowledge. The author espouses a broad medical model for defining the range of data and integration of techniques relevant to therapeutics. He views phenomenology as the crucial concept for clinical exploration, and contrasts this approach with the shallowness of purely descriptive approaches on the one hand and the distortion imposed by theoretical presentiments of psychotherapy on the other. Continuity of care and integration of therapies can emerge from phenomenology in the context of the clinical relationship.

Antipsychotic Agents↗
PubMed1986

Topographic differences between normals and schizophrenics: the N120 evoked potential component.

Topographic differences in evoked potentials were measured in 20 off-medication chronic schizophrenics and 24 normal controls. Four intensities of brief electrical shocks were administered to the subject's right forearm in a random order at 1-second intervals. Evoked potentials (EPs) were recorded from the scalp over the left hemisphere. The EP data from 16 left hemisphere leads were used to generate EP maps of brain response for individual subjects. The maps were normalized by z transformation. Group mean maps of EP activity and unpaired t tests were then computed. Normals showed strongly localized activity in the pre- and postcentral gyri, with increasing intensity resulting in the attenuation of parietal response. Schizophrenics showed more diffuse EP activity which did not vary with intensity. Significant differences between normals and schizophrenics were found for all four intensities in posterior frontal and anterior parietal cortex. This is consistent with the findings of small EPs reported by others in the somatosensory, visual and auditory modalities.

Adult↗
PubMed1986

Integrating treatments in schizophrenia.

Schizophrenia is a common and severe illness found throughout the world. Onset is usually in adolescence and young adulthood, and many individuals have illness-related impairments for life. Schizophrenia assaults the very essence of what is distinctly human. The personality is devastated, subjective experience and thought distorted, and the psychological building blocks of everyday life torn asunder. This article discusses diagnostic and conceptual considerations, pharmacotherapy, and interpersonal strategies of integrating therapeutics for schizophrenics.

Antipsychotic Agents↗
PubMed1985

Treatment of negative symptoms.

The rational treatment of the negative symptoms of schizophrenia requires a careful differentiation of those secondary to a range of other factors and those that constitute enduring primary or deficit symptoms. Secondary negative symptoms are usually responsive to treatment of the underlying cause. In contrast, there is no intervention currently available with established efficacy in treating deficit symptoms. These distinctions serve to reduce the heterogeneity of negative symptoms. A discussion of the diagnosis and treatment of the various forms of secondary negative symptoms is followed by suggestions for future research in the treatment of deficit symptoms.

Antipsychotic Agents↗
PubMed1985

Early insight and the management of schizophrenic decompensation.

Despite maintenance treatment, including the prophylactic use of neuroleptics, there is a significant rate of psychotic relapse and rehospitalization in schizophrenic outpatients. Thus comprehensive aftercare should ideally include clinical strategies of early intervention designed to abort decompensations in their earliest stages before florid psychosis and rehospitalization occur. Factors likely to improve the success rate of such strategies include the presence of a phase of prodromal symptoms preceding florid psychosis during which interventions could be made, as well as the patient's insight at such times that he/she is becoming ill, which would facilitate cooperation with intervention. While there is considerable evidence that a prodromal phase is typically present, there has been little exploration of "early insight." This study examines two hypotheses about early insight: 1) insight is present in a sizable portion of schizophrenic patients in the early phase of relapse; and 2) such early insight predicts a successful resolution of the relapse on an outpatient basis without the need for rehospitalization. In a retrospective research design utilizing clinical progress notes, both hypotheses were corroborated. Of the 38 patients in the sample, 24 (63%) demonstrated early insight, and of these only two (8%) were hospitalized as a result of the relapse. Conversely, seven of 14 (50%) uninsightful patients required rehospitalization (p = .006). This supports the feasibility of an early intervention strategy and confirms that early insight is an important patient attribute that predicts successful implementation of this treatment. Clinical experience in trying to develop early insight in the context of a psychotherapeutic relationship and the implications of early intervention for reducing the overall exposure to neuroleptics in schizophrenic populations are discussed.

Adult↗
PubMed1985

Prospective study of prodromal symptoms in schizophrenic relapse.

The authors examined the type and frequency of prodromal symptoms in 47 cases of schizophrenic relapse during which 30 patients were drug free and 17 were medicated. The findings indicate that clinicians who use patient and family reports can identify prodromal symptoms as they occur.

Acute Disease↗
PubMed1984

The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome.

There is growing interest in deficit symptoms in studies of the course and treatment response of schizophrenia. However, existing clinical assessment instruments focus primarily on productive symptoms. The authors describe the Quality of Life Scale (QLS), a 21-item scale based on a semistructured interview designed to assess deficit symptoms and thereby fill an important gap in the range of instruments now available. Data regarding reliability and training in the use of the QLS are presented. A factor analysis of the items yields results compatible with the conceptual model on which the scale is based. The factor analysis was also performed separately by sex and was fundamentally similar for men and women.

Factor Analysis, Statistical↗
PubMed1984

A perspective on the psychotherapy of schizophrenia project.

Psychotherapy of schizophrenia has engendered widespread interest and controversy. Etiologic theories and ideologic orientation toward psychopathology have unduly influenced clinicians' therapeutic approach, and only recently has the drug versus psychotherapy polemic given way to scientific study and integration of seemingly distinct treatments. The Psychotherapy of Schizophrenia Project provides an important new perspective on methodology and data analysis. A differential effect between two psychotherapies was hypothesized, but results support the view that supportive psychotherapy is at least as effective as more intensive psychotherapy based on psychoanalytic theory and psychodynamic practice. The more general question of efficacy of psychotherapies is not addressed, but it is a vitally important issue which demands the critical attention of advocates rather than advocacy devoid of efficacy data.

Clinical Trials as Topic↗
PubMed1983

The therapeutic efficacy of hemodialysis in schizophrenia.

Prompted by previous reports of substantial clinical improvement in most schizophrenic patients given hemodialysis for their psychiatric condition, we studied the efficacy of hemodialysis in 15 schizophrenic outpatients, under double-blind, controlled conditions. The patients were randomly assigned to either a real-sham or sham-real sequence of dialysis treatment. Results of repeated measurement and other analyses of data on symptoms and behavior that were collected before study treatment, at crossover, and at the end of treatment revealed no difference between the effects of real and sham dialysis. These results provide important experimental evidence of the lack of therapeutic efficacy of hemodialysis in schizophrenia.

Adolescent↗
PubMed1983

Multivariate statistics and meaning in the study of psychopathology.

A recent article dealing with Schneiderian first-rank symptoms illustrates a frequent occurrence: the use of sophisticated statistical data analysis without clear concepts of either psychopathology or statistics. The purpose of this article is to present some guidelines for the interpretation of multivariate statistics and to increase sensitivity to the importance of integrating underlying clinical concepts with statistical data analysis.

Humans↗
PubMed1983

What is schizophrenia?

One of the main questions related to schizophrenia is, naturally enough, what is it? Such a question may seem obvious, naive, impossible, or any combination of these. And certainly it is a bit demanding to expect that anyone could say what schizophrenia is in 1,000 words. On the other hand, we felt that it was worth the effort. We hope that presenting these brief discussions on "what is schizophrenia" by persons who have worked extensively in the field will allow the reader to note areas of overlap and disagreement as well as variations in emphasis. Although no one may yet be able to provide the definitive answer, at least this collection of informed opinions may help clarify the major questions. The essays by John S. Strauss and William T. Carpenter, Jr. are the third in this series. Further collections of these statements will be presented in subsequent issues. Readers' responses and comments are cordially invited.

Humans↗
PubMed1983

Lifetime psychotic symptoms assessed with the DIS.

Data on a lay interviewer's use of the Diagnostic Interview Schedule (DIS) to ascertain lifetime psychotic symptoms in patients where these experiences have been previously documented is reported. The subjects in this study had been identified as patients 11 years previously and had participated in several followup research interviews with research psychiatrists. Frequent failure to recall and/or report psychotic symptoms in these patients suggests this technique will seriously underestimate the lifetime occurrence of psychotic symptoms.

Adolescent↗
PubMed1983

New drug treatment strategies in schizophrenia: editorial introduction.

The recognition of both the value and limitations of antipsychotic drug treatment has led to research on effective alternative strategies for treatment. The authors review assumptions underlying such strategies and introduce five articles pertinent to the topic. These articles address: the use of drugs other than antipsychotic neuroleptics; the use of reduced dosages of antipsychotic drugs; the initiation of antipsychotic drugs early during periods of symptom exacerbation to prevent full relapse; the use of psychosocial treatment strategies in relation to drug treatment; and the development of antipsychotic drugs following models based on restitutive systems in the brain.

Antipsychotic Agents↗
PubMed1983

Early intervention, time-limited, targeted pharmacotherapy of schizophrenia.

A growing appreciation of the risks of long-term, continuous neuroleptic use in the aftercare of schizophrenic patients has led to a search for alternative strategies. The authors report their experiences with the clinical strategy of "targeted" medication, in which patients are followed drug free until prodromal signs of impending relapse appear. Medication is then initiated to abort the impending episode and discontinued when patients restabilize clinically. Preliminary experience suggests that control of schizophrenic symptomatology comparable to that obtained with maintenance drugs can be achieved with a marked reduction in medication use when the targeted strategy is applied in the context of a broad-based program of psychosocial intervention based on a comprehensive medical model.

Antipsychotic Agents↗
PubMed1983

Schizophrenia and dialysis.

Open-trial reports of substantial clinical improvement in most schizophrenic patients on hemodialysis for their psychiatric condition prompted the present study to determine the efficacy of hemodialysis under double-blind, controlled conditions. Fifteen schizophrenic outpatients were randomly assigned to either a real-sham or sham-real dialysis treatment sequence. Presented in detailed, graphic form, results of repeated measurement and other analyses of symptom and behavioral data collected initially, at crossover, and at the end of treatment revealed no differential effects between real and sham dialysis. These results provide important experimental evidence of the lack of therapeutic efficacy of hemodialysis in schizophrenia.

Adult↗