John E. Overall

Physostigmine: Effects on cognition and affect in normal subjects

Physostigmine was given intravenously to a total dose of 3 mg to 13 subjects; a placebo of 0.25 N saline was given intravenously to 10 other subjects; both groups received 1 mg of methscopolamine bromide subcutaneously preceding the intravenous infusions. A “physostigmine syndrome” consisting of decreased speech, slowed thoughts, mild sedation, expressionless faces, nausea, and decreased spontaneous activity was evident following doses of 1.5 to 2.0 mg of physostigmine. The capacity of short-term memory (STM) as measured by digit span tasks was significantly less for the subjects who received physostigmine than for the subjects who received placebo. No difference was observed between the two groups on tasks of consolidation from STM to long-term memory (LTM).Subiects who received physostigmine did not significantly differ from subjects who received placebo in their mood. However, two subjects in the physostigmine group, and no subjects in the saline group became tearful and depressed.

The MMPI-168 for Psychiatric Screening

A convenient short-form administration of the MMPI is described. Rather than selecting items out of context, it is recommended that the abbreviated administration consist of the first 168 items of the standard MMPI. The usual scoring stencils can be applied to obtain scores which can be used to estimate k-corrected clinical scale scores by application of regression weights.

CONCEPTUAL VALIDITY OF A PHENOMENOLOGICAL CLASSIFICATION OF PSYCHIATRIC PATIENTS

No SOONER were computers able to handle the data than did psychologists and psychiatrists interested in establishing a more objective and reliable classification of psychiatric patients begin to apply empirical classification methods to psychiatric phenomena. Methods of factor analysis, cluster analysis, Q-sorts and a variety of other techniques have been used. The objective has been to identify the distinct patterns that occur repeatedly in nature in highly similar form. From a simple classification point of view, such distinct homogeneous types should provide the basis for most reliable segregation of patients. Some investigators have reasoned further that syndromes, which are recognized by the coexistence of particular unique patterns, are often found to be associated with distinct disease processes. Others have been more pragmatic, being concerned only with objective, reliable, and useful descriptive classification. WITTENBORN et al.,’ were perhaps first to report extensive multivariate analyses of the phenomena of psychopathology in 1953. BECKY followed the next year with an application of Q-sort methodology that resulted in description of six distinct types of schizophrenia, and GRINKER et al.,3 followed shortly with the description of four sub-types of depression (which bear considerable similarity to those identified in our own work). LORR et al.,4 undertook extensive cluster analyses of symptom and behavior rating profiles for large samples of patients from the general inpatient psychiatric population and identified six major phenomenological types. It is not possible, in this brief introduction, to analyze in detail the similarities and differences in classification concepts that might be derived from these and other empirical investigations. We would note, however, that given certain tolerance for minor discrepancies (due probably to differences in observational techniques, data bases, and methods of analysis), a substantial thread of consistency emerges. Our own work, which was the direct basis for the investigation reported here, is in many particulars not inconsistent with the empirical results obtained by others using different data bases. The primary question left unresolved by all of the empirical classification research concerns whether the typologies have clinical meaning. One aspect of this question involves the extent to which the empirically derived types “ring true” in clinical experience. It is our impression that previous investigators have stopped short of considering this important question.

Comparison of differential diagnostic discrimination for abbreviated and standard MMPI.

MMPI response protocols for 194 psychiatric patients were scored on the basis of the first 168 items and then on the usual 400 items. The MMPI-168 raw scores were converted to estimates of conventional clinical scale scores. The Ss were divided into 10 major categories on the basis of final clinical diagnosis. Multiple discriminant analysis was used to compare the discriminant validity of the abbreviated and standard scoring. The results indicated no loss in discrimination to result from scoring based on only the first 168 items. Conversion tables that can be used to transform MMPI-168 raw scores to standard MMPI clinical scale scores are presented for further research and clinical use.

Relationships of psychopathology to age, sex, ethnicity, education and marital status in state hospital patients.

THE INCREASING use of symptom and behavior rating scales in clinical research during the past two decades has created a renewed respectability for descriptive psychiatry. This has led us back to a concern for directly observable manifestations, the phenomenology of mental illness.l-3 Rating scales such as the BPRS (Brief Psychiatric Rating Scale)4 and the IMPS (Inpatient Multidimensional Psychiatric Scale)5 have proven very useful in the field of psychopharmacology. Not only have they permitted quantitative evaluation of symptom change, but they have also provided a basis for description and classification of patients.6 The classification of patients solely on the basis of current symptom manifestations is a radical departure from usual psychiatric diagnostic practice in which history, etiology and sociocultural information enter into classificatory decisions. Although phenomenological description and classification have advantages, we must also recognize a growing body of evidence indicating that phenomenological differences are substantially related to personal, social and cultural variables.’ The significance of observed psychopathology may depend on the context of background factors within which it occurs. It is important that symptom rating scales, rather than clinical diagnoses, be used in evaluating the psychiatric relevance of background variables. Clinical diagnostic classification involves consideration of historical and sociocultural factors; thus certain built-in relationships are to be expected, whereas the use of quantitive rating scale profiles to describe psychopathology avoids most of this problem. In addition, well known problems related to the absence of clearly defined diagnostic criteria and consequent unreliability of clinical diagnoses are avoided. Although numerous variables are potentially interesting with respect to implications for manifest psychopathology, a relatively small number are almost universally considered

Validity of the MMPI-168 for Psychiatric Screening1

Validity of an abbreviated 168-item administration and the standard MMPI was compared with reference to discriminating psychiatric patients from normal college students. Better discrimination was obtained from clinical scale scoring than from factor scoring. The abbreviated MMPI-168 actually produced slightly better discrimination than did the longer parent instrument. Revised equations for converting MMPI-168 scores to conventional MMPI validity and clinical scale scores are presented.

Statistical relationships of weight of the human pineal to age and malignancy.

A study of 147 human pineal glands from autopsy cases of all ages revealed a direct correlation between size and weight and a significant correlation of these with age but not with body weight, brain weight, sex or color. The growth pattern was nonlinear, with a sharp increase in size in the fifth and sixth decades. This increase was reduced but still apparent after removal of malignant cases from the sample. Pineal glands from malignant cases were significantly larger than the others. Histologic studies revealed a striking similarity of pineocytes from pineals of patients between ages 2 and 91, with no apparent differences in malignant cases. The authors conclude that the human pineal does not undergo cellular atrophy after puberty and that there is some relationship between the presence of malignancy and the weight of the human pineal.

A simple test for heterogeneity of variance in complex factorial designs

A simple procedure for testing heterogeneity of variance is developed which generalizes readily to complex, multi-factor experimental designs. Monte Carlo Studies indicate that the Z-variance test statistic presented here yields results equivalent to other familiar tests for heterogeneity of variance in simple one-way designs where comparisons are feasible. The primary advantage of the Z-variance test is in the analysis of factorial effects on sample variances in more complex designs. An example involving a three-way factorial design is presented.

Broad-spectrum screening of psychotherapeutic drugs: thiothixene as an antipsychotic and antidepressant.

Thiothixene was studied simultaneously in both schizophrenic and depressed patients. Seventy‐two newly admitted schizophrenic patients and 64 depressed patients were treated for 4 weeks with relatively modest doses. As indicated by interview ratings coded on 2 psychiatric rating scales, the drug was highly efficacious in both types of patients, the degree of improvement for each general group of patients being among the highest of our series of evaluations of antipsychotic and antidepressant drugs. When the results of treatment of 5 different schizophrenic Stlbtypes were reviewed, there were no differences between the responses of various types of schizophrenic reactions. The same situation applied to 3 subtypes of depressive reactions. Side effects were chiefly related to weight gain, extrapyramidal syndromes (including akathisia), anticholinergic effects, and sedation.

Discriminant Analysis with Categorical Data

A method for studying relationships among groups in terms of categorical data patterns is de scribed. The procedure yields a dimensional rep resentation of configural relationships among mul tiple groups and a quantitative scaling of cate gorical data patterns for use in subsequent assign ment of new individuals to the groups. Two ex amples are used to illustrate potential of the method. In the first, profile data that were pre viously analyzed by metric multiple discriminant function analysis are reanalyzed by the nonmetric categorical data pattern technique with highly similar results. The second example examines re lationships among psychiatric syndrome groups in terms of similarities in patterns of categorical background variables. Results appear consistent with other available information concerning the epidemiology of psychiatric disorders.