Philip R. A. May

A Stopping Rule for Variable Selection in Multiple Regression

Abstract Stepwise regression is a member of a class of statistical methods which may be called opportunistic. The statistician is naturally concerned that an artifact should not be reported so he needs a stopping rule that is geared to the way in which variables are selected. A sampled permutation test is outlined which offers such a stopping rule for forward stepping.

Choice of criteria for the assessment of treatment outcome

Abstract One hundred first admission schizophrenic patients were assigned by a random method to 5 treatment groups, treatment being given until either the patient had left the hospital or for a minimum of 6–12 mth. Evaluation was carried out before and after treatment by psychiatrist, psychologist, psychoanalyst and nurse, using rating scales that covered ward behavior, psychodynamic factors and clinical status; psychological test measures including the MMPI, DAP, Shipley, Clyde Mood Scale and the Similarities and Proverbs subtests of the WAIS. The theses that different disciplines and different measures percieve the patient differently; and that inter-relationships are not so high that one can safely expect to reach a satisfactory verdict on outcome on the basis of assessment by a single measure or a single discipline are illustrated and supported by the inter-correlations between 100 outcome criterion measures (which ranged between 0 and 0.92) and by the inter-correlations between measures of global clinical status by the nurse, treating physician and psychoanalyst; self-report of psychotic psychopathology (MMPI) and the Shipley I.Q. There was relatively low correlation between length of hospital stay and other outcome criteria, indicating that the relationship between unidimensional criteria of outcome provided by a single discipline and ‘blanket’ criteria such as STAY and release rate, may be expected to be low. The inter-correlations with STAY indicate that the decision to release a patient is based on some interaction of change and final state and that, in terms of at least certain variables, the criteria for release become less rigorous with the passage of time from admission. They also suggest that, although certain variables which predict early release also predict giving up early, failure is not just the simple reverse of success. The decision to terminate treatment unsuccessfully may be based to a certain extent on variables that are not critical in deciding to release a patient. The question is raised as to whether one should use different outcome criteria or predictor variables to evaluate failure from those used to evaluate success .

Comparison of electromechanical measures and observer ratings of tardive dyskinesia

Thirty-three patients with tardive dyskinesia (TD) were studied with multiple-observer consensus ratings of videotaped examinations, ultrasound counts of movement, and electromechanical frequency measures of the movements. There were statistically significant correlations between orofacial ultrasound measures and TD severity determinations made by observers. Clinical ratings did not correlate with frequency measures. Ultrasound measures substantiate observer rating scales, whereas frequency measures appear to provide information not available from clinical rating scale scores.

Tardive Dyskinesia in Schizophrenic Patients: Correlation With Negative Symptoms

The relationship between severity of tardive dyskinesia (TD) and the prominence of negative symptoms was assessed in 25 right-handed, medicated schizophrenic patients. TD was quantified using ultrasound detectors and frequency measurement techniques as well as with observer rating scales. Electromechanical studies revealed a systematic relationship between TD severity and negative symptoms; TD was more severe in patients with fewer negative symptoms. The correlation was small in magnitude.

Lateral Asymmetries of Tardive Dyskinesia in Schizophrenia

Investigations of patients with schizophrenia have found evidence of asymmetric brain dysfunction involving primarily the left hemisphere (Gur 1977; Taylor et al. 1979; Piran et al. 1982; Tsai et al. 1983; Guenther et al. 1986). Although not all studies have consistently identified this relationship, sufficient evidence concerning lateralized disturbances exists to warrant further investigation Recently, lateralized dyskinetic movements in schizophrenic patients with tardive dyskinesia (TD) have been reported (Waziri 1980; Myslobodsky et al. 1984; Wilson et al. 1984). These studies have relied on observer rating scales of dyskinetic movements and have involved small numbers of patients. The current study was designed to assess the prevalence of asymmetric dyskinetic movements in a larger number of schizophrenic patients using quantitative electromechanical measures of TD as well as observer rating scales.

Assessment of psychiatric outcome—I. Cross section analysis ☆

Abstract Cross Section Analysis is a flexible method of depicting the outcome of a patients illness from chronological series data such as post-treatment measurements. Patient status is assessed by display of outcome in terms of ‘cross point values’ at fixed ‘cross points’ in time from a pre-determined origin. The method involved interpolates or extrapolates cross point values when observations are not available at cross point times, by utilizing information from the measurements actually obtained. The necessary procedures and computations are described with illustrations from case data. The cross section method has important practical and theoretical advantages.

Assessment of psychiatric outcome. II. Simple Simon analysis

Abstract Simple Simon analysis is a method of describing the outcome of a patients illness over time in simple terms that should be meaningful to the ordinary clinician and that give some insight into process trends occurring over the selected period. It can be used to compare individual patients or subsets of patients over a given period of time. The necessary procedures, computations and tabulations are described.

Body Ego Technique: An Educational Approach to Body Image and Self Identity

JERl SALKlN Center for Child Study and Development, Los Angeles PHILIP R. A. MAY, M.D. University of California at Los Angeles Body ego technique is a predominantly nonverbal teaching approach that was evolved as a form of therapy for psychiatric patients, both children and adults, who manifest severe disturbances of body ego, ego boundaries and identity, and as a method of facilitating development of the ego and self identity in normal children. The method focuses on body posture and movement as they relate to body image, on a person’s sense of time as experienced and expressed in different speeds of movement, on body boundaries and on reality contact and experience in movement. With body ego technique there is a deliberate attempt to create (or recreate) t h e physical experience of t h e postures and movements associated with a wide range of emotions and attitudes and by this route to develop ego structure.

Volunteers, voluntary organizations and the schizophrenic patient: Two psychiatrists' view on the role of lay persons in a therapeutic system

Volunteers and voluntary organizations can make a positive and special contribution to the care of chronic schizophrenic patients and to their restoration towards normal living. Not only can they contribute to the rehabilitation and treatment programme in ways that the usual health, welfare and rehabilitation services cannot, but they also represent a welcome addition to our limited resources.Constructive collaboration between volunteers and professional staff can be of great benefit in the healing and restitution process. Yet there are also some reservations, dangers and pitfalls. Properly organized, however, volunteer collaboration might be the best way of tackling one of the most difficult problems in schizophrenia, namely alienation.

The Role of Operations Research and Systems Analysis in Holding Down the Costs of Hospitals and Clinics

In the past, medical care facilities have concentrated primarily on professional clinical evaluation. With the cost of treatment rising rapidly, it is becoming increasingly important to critically review and analyze our delivery systems so that scarce resources can be used optimally. In this paper the applications of operations research (O.R.) and systems analysis techniques that have been employed successfully in private industry are explored to find ways to improve clinical operations and hold costs down.