Michael Alan Taylor

Development and validation of a multiple ability self-report questionnaire

We present results from three studies on the development and validation of the Multiple Ability Self-Report Questionnaire (MASQ), a self-report measure comprising items from five cognitive domains; language, visuo-perceptual, verbal memory, visual memory, and attention. In Study 1, we determined the content relevance of the questionnaire items. In Study 2, we assessed the basic psychometric properties (i.e., internal consistency and test-retest reliability) of the MASQ in 118 individuals without neurologic or psychiatric disorder, aged 25 to 88 years. In Study 3 we provide validity data for the MASQ by comparing the ratings of normals to people with unilateral temporal-lobe epilepsy, and examining the relationship of self-report to objective test performance. The potential use of the MASQ to study the neurologic and psychological correlates of accuracy and unawareness in self-appraisal across different cognitive domains and various clinical groups is discussed.

The catatonia syndrome: forgotten but not gone.

Catatonia is a motor dysregulation syndrome among psychiatric asylum patients that was delineated in 1874. The syndrome was so well characterized that within a few years its prevalence among psychiatric populations was reported from 6% to 38%, averaging 15% of hospitalized patients in the years since. 1 In the mid―20th century, as psychiatric practice shifted from the asylum to the ambulatory clinic with an emphasis on psychotherapy and the prescription of psychotropic agents, the role of the medical examination was degraded and the recognition of catatonia languished. 2 The perceived tight bond between catatonia and the diagnosis of schizophrenia led to the widespread assumption that catatonia is mainly a form of psychosis and is not appropriately classified elsewhere. 3 .

Issues for DSM-5: Whither Melancholia? The Case for Its Classification as a Distinct Mood Disorder

Melancholia, a syndrome with a long history and distinctly specific psychopathological features, is inadequately differentiated from major depression by the DSM-IV specifier. It is neglected in clinical assessment (e.g., in STAR*D [1]) and treatment selection (e.g., in the Texas Medication Algorithm Project [2]). Nevertheless, it possesses a distinctive biological homogeneity in clinical experience and laboratory test markers, and it is differentially responsive to specific treatment interventions. It therefore deserves recognition as a separate identifiable mood disorder. Melancholia has been variously described as “endogenous,” “endogenomorphic,” “autonomous,” “type A,” “psychotic,” and “typical” depression (3–6). In contrast to the current DSM criteria for the melancholia specifier (features of which are often shared with major depression), it has characteristic clinical features (5–7).

The many varieties of catatonia.

Abstract About 10 % of patients with severe acute psychiatric illness exhibit a cluster of motor signs (mutism, negativism, rigidity, posturing, stereotypy, staring, etc.) that are identified as the syndrome of catatonia. Catatonia responds to sedative anticonvulsant treatment (barbiturates, benzodiazepines) and to electroconvulsive therapy. These treatments raise seizure thresholds. The commonality in response indicates that catatonia, malignant catatonia, neuroleptic malignant syndrome, toxic serotonin syndrome, delirious mania, catatonic excitement, benign stupor, and oneirophrenia are best evaluated as diverse manifestations of one syndrome for clinical and neuroscience research purposes.

Catatonia Is not Schizophrenia: Kraepelin's Error and the Need to Recognize Catatonia as an Independent Syndrome in Medical Nomenclature

Catatonia is a motor dysregulation syndrome described by Karl Kahlbaum in 1874. He understood catatonia as a disease of its own. Others quickly recognized it among diverse disorders, but Emil Kraepelin made it a linchpin of his concept of dementia praecox. Eugen Bleuler endorsed this singular association. During the 20th century, catatonia has been considered a type of schizophrenia. In the 1970s, American authors identified catatonia in patients with mania and depression, as a toxic response, and in general medical and neurologic illnesses. It was only occasionally found in patients with schizophrenia. When looked for, catatonia is found in 10% or more of acute psychiatric admissions. It is readily diagnosable, verifiable by a lorazepam challenge test, and rapidly treatable. Even in its most lethal forms, it responds to high doses of lorazepam or to electroconvulsive therapy. These treatments are not accepted for patients with schizophrenia. Prompt recognition and treatment saves lives. It is time to place catatonia into its own home in the psychiatric classification.

Concurrent psychiatric illness in non-Hispanic outpatients diagnosed as having posttraumatic stress disorder.

Twenty-five consecutive admissions to an outpatient group therapy program for combat veterans meeting DSM-III criteria for posttraumatic stress disorder were systematically screened using operational diagnostic criteria for other coexisting psychiatric conditions, past or present. Eighty-four percent had coexisting conditions which, with one exception, were not significantly different in prevalence from those of an inpatient sample of combat veterans previously reported by the authors. The exception was a lower frequency of drug dependence in the outpatients compared with the inpatients. The authors conclude that a high proportion of conditions and symptoms—particularly alcoholism, antisocial personality, drug abuse, depression, and anxiety—can be routinely expected to coexist with posttraumatic stress disorder when it is diagnosed in Vietnam combat veterans.

Catatonia in autistic spectrum disorders: a medical treatment algorithm.

Autism is a developmental syndrome with an unknown biology and inadequate therapeutics. Assessing the elements of the syndrome for the presence of depression, psychosis, mania, or catatonia, offers opportunities for systematic intervention. Since almost all descriptions of autism highlight the presence of motor symptoms that characterize catatonia, an assessment for this eminently treatable syndrome is recommended for all patients considered to be autistic. A minimum examination includes a catatonia rating scale and for those patients with defined catatonia, a lorazepam test. For those whose catatonia responds to lorazepam, high dose lorazepam therapy is recommended. If this fails, electroconvulsive therapy is recommended. The assessment and treatment of catatonia offers positive medical therapy for the victims of autism and their families.

Are schizophrenia and affective disorder related?: The problem of schizoaffective disorder and the discrimination of the psychoses by signs and symptoms☆

Schizophrenia and affective disorder are separately classified. Schizoaffective disorder has been considered a variant of these, or representing several diseases. Some hypothesize a psychosis continuum. One test of these contrasting views involves discriminating the psychoses by their classic symptoms. We used discriminant function analyses to assess the ability of systematically recorded psychopathology to distinguish 167 DSM-III schizophrenics from 74 affectives. We divided the schizophrenics into chronic and schizoaffective subgroups. We discriminated chronic schizophrenics from affectives, but schizoaffectives overlapped both groups. Schizoaffective/unipolars were like chronic schizophrenics, and schizoaffective/bipolars were like affectives. However, these discriminations also substantially overlapped, and among non-affective positive features formal thought disorder was best at discrimination. Our findings do not fully support the present classification system, and suggest that its emphasis on hallucinations and delusions is overvalued.

Unipolar mania revisited

In a more sophisticated replication of an earlier study (Abrams and Taylor 1974), we examined 77 manic patients, of whom 29 had never suffered a depressive illness, and had two or more manic attacks. These unipolar manics were similar to the 48 bipolar manics for a wide variety of clinical, phenomenological, historical, laboratory and demographic variables, generally supporting our earlier findings. However, the present sample showed a striking excess of males among the unipolar manics, as well as an increased morbid risk for unipolar depression in first-degree relatives. Although not readily explainable, these differences suggest that it is premature to equate unipolar mania with classical bipolar illness. Further studies of unipolar mania are in progress.

The classification of affective disorders — A reassessment of the bipolar-unipolar dichotomy: A clinical, laboratory, and family study

We studied a sample of 26 unipolar and 134 bipolar probands for a selection of familial, demographic, clinical and laboratory variables. We found a high proportion of unipolar illness in the relatives of bipolar probands and bipolar illness in the relatives of unipolar probands, inconsistent with the present dichotomous classification of affective disorders. The two groups were also similar on a number of clinical and demographic variables, and displayed equal amounts of cortical dysfunction as measured by electroencephalographic and neuropsychological techniques. The groups differed significantly on only 2 variables, with unipolars having a greater proportion of females and a later onset age than bipolars. We interpret these findings to be suggestive of homogeneity rather than heterogeneity for the more severe forms of affective disorders and offer several alternatives to the present unipolar/bipolar dichotomy which require further testing.