Mantosh J. Dewan

Cerebellar morphology in chronic schizophrenic patients: A controlled computed tomography study

Simple, objective, linear, and density measures were used to evaluate by computed tomography (CT) the cerebellum-fourth ventricular region of 23 chronic schizophrenic patients and 23 normal controls. Our data suggest that a subgroup of chronic schizophrenic patients have cerebellar atrophy associated with a strong but nonsignificant trend toward increased cerebellar density. The implications of these findings are discussed in view of previous CT and neuropathological studies.

Toward a definite diagnosis of Alzheimer's disease

There is a significant, and growing, number of patients who suffer from dementia of the Alzheimers type (DAT). However, due to clinical variability and symptom overlap, and despite millions of dollars spent in diagnostic work-ups, the diagnosis of DAT remains one of exclusion or by neuropathologic study (usually postmortem). This report evaluates two promising methods, the newly refined clinical criteria sets (e.g., NINCDS-ADRDA) and single-photon emission computed tomography (SPECT), on their capacity for definite, accurate, and early diagnosis of DAT patients. We found that clinical diagnosis of DAT can achieve a weighted average for sensitivity of 72%, specificity of 86%, and diagnostic confidence of 72%; however, when NINCDS-ADRDA criteria are used, these results improve to 88%, 91%, and 92%, respectively. SPECT scans could differentiate DAT patients from normals with 86% sensitivity, 96% specificity, and 98% diagnostic confidence. Comparable figures for DAT versus multi-infarct dementia (MID) are 82%, 81%, and 86%, respectively. We conclude that, although a definite clinical diagnosis of DAT is still elusive and more research is needed, the use of either NINCDS-ADRDA criteria or SPECT scans may enhance diagnostic accuracy.

Comparison of Three Depression Rating Scales

We directly compared scores on the self-rated Beck Depression Inventory with two other common rating scales that assess a wider range of psychopathology, including depression, the self-rated Symptom Check List-90—R (SCL-90—R), and the clinician-rated Brief Psychiatric Rating Scale for 71 inpatients who suffered from depression (n = 50) and other disorders. All measures of depression showed robust correlations among themselves. The self-rated scales correlated better between themselves than with the clinician-rated scale. Since the SCL-90—R assesses depression as well as the Beck inventories, is also a self-report instrument, yet provides a richer description of psychopathology with little extra effort, it may have some advantage over the latter.

Factors Associated With Antidepressant Choice

Previous studies have suggested that nonpsychiatrists tend to prescribe antidepressants (ADs) with the most side effects (SEs), whereas psychiatrists are more likely to prescribe more ADs with fewer SEs. The authors used a questionnaire to examine the antidepressant prescribing pattern, conditions for which ADs were prescribed, and SEs of concern to physicians. Of those surveyed, the psychiatrists reported prescribing significantly more nortriptyline and desipramine, whereas the nonpsychiatrists prescribed more amitriptyline. The nonpsychiatrists were more likely to prescribe ADs for pain, and they were significantly less concerned with orthostatic hypotension. Possible lower dosing and level of concern about orthostatic hypotension may be related. Further study is proposed to assess other factors that might influence AD choice.

A positive view of psychiatrists and psychiatry

A review of the literature on the personalities, mental health, and professional status of psychiatrists was the basis of a questionnaire designed to assess perceptions of these characteristics by psychiatrists themselves and by their medical colleagues. The 374 physician respondents were divided into two groups, psychiatrists and nonpsychiatrists, and beliefs and perceptions were compared between the two groups and with findings from the research literature. Results revealed some differences in opinion between psychiatrists and nonpsychiatrists, most notably concerning the mental health of psychiatrists. This was also the area in which the literature was least conclusive. Findings indicated, however, that physicians across specialties have a positive overall opinion of psychiatrists and their professional worth, and that psychiatrists see themselves as healthy, effective, and useful practitioners.

Relative Utility of Three Indices of Neuropsychological Impairment in a Young, Chronic Schizophrenic Population

The complete Halstead-Reitan Neuropsychological Test Battery and the Wechsler Adult Intelligence Scale were administered to 20 young, male, chronic schizophrenics. Three commonly used indices of neuropsychological impairment were calculated and compared. Although all three indices were similar in separating computerized axial tomography normal from abnormal patients, statistical significance was achieved only with the Halstead Impairment Index. Thus, the easier-to-obtain Halstead Impairment Index appears to be at least as good as, and possibly better than, the more-difficult-to-obtain indices of Percent of Ratings within the Impaired Range and the Average Impairment Rating. Reasons for these findings are discussed.