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Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.

Education in the field in the Post-Psychopharmacology Era

Collated 17

 

Martin M. Katz: Depression and Drugs, a monograph  and Multivantaged vs Conventional Assessment, an essay

 

Martin M. Katz:  Depression and Drugs: Neurobehavioral Structure of a Psychological Storm with a Foreword by Thomas A. Ban

New York: Springer International; 2013 (92 pages)

 

Foreword by Thomas A. Ban

        This is a most impressive work by a pioneer generation psychopharmacologist. In this volume Dr. Martin Katz documents 40 years of research that led him to re-conceptualize depression and to develop a methodology for clinical research that could help to break the impasse in developing new antidepressants.

        Katz entered psychopharmacology in 1957, the year the first reports on imipramine and iproniazid (the first two effective drugs in the treatment of depression) were published. At age 30 he became Executive Secretary of the first Advisory Committee on Psychopharmacology to the National Institute of Health and, as a member of Jonathan Cole’s team at the Psychopharmacology Service Center, he was involved in the introduction of this new discipline in the United States by facilitating the development of clinical investigations with new psychotropic drugs. 

        In the late 1960s Katz became chief of the newly created Clinical Research Branch at the National Institute of Mental Health and was instrumental in the organization of the historic Williamsburg conference on Depression and Drugs. The conference was a turning point in depression research.  It was also a turning point in Dr. Katz’s research which in the years that followed has been focused on the psychopharmacology of depression.

        By the early 1980s, Katz recognized that psychiatric diagnoses as major depression, have created a stumbling block for research in the biology and psychopharmacology of depression. The problem is compounded by the methodology of clinical investigations that measures the antidepressant induced changes on the severity of the depressive disorder identified by the diagnosis.

        In this monograph Katz provides the readers with an account of his research in deconstructing the diagnosis of depression, uncovering its dimensional structure and developing a methodology that allows the measuring of drug induced changes on the three independent dimensions that comprise it. With the employment of the new methodology, Katz and his collaborators succeeded in dividing depression into biologically and clinically meaningful subtypes with predictive validity which can be identified reliably.

        Dr. Katz, a vigorous octogenarian is still active in research. We hope that presentation of his methodology in this monograph will facilitate the identification of suitable depressive populations for molecular genetic research and the translation of the pharmacological actions of antidepressants into therapeutic effects.

 

February 24, 2013                                                               

 

Review by Martin M. Katz

 

INFORMATION ON CONTENT: The discovery, in the early 1950s, of the role of the central neurotransmitters and that of the new drug treatments for the mental disorders sparked a wave of research in the new science of neuropsychopharmacology.  In the first two chapters, the book describes the impact of the new drugs on theory and research on the major depressive disorders, focusing on the interactions between neurochemistry and behavior and the role of diagnosis in clinical research.  The author sets the stage for later detailing the misplaced reliance on diagnosis and introduces dimensional analysis to replace it in framing both basic and clinical research.  In Chapter 3, “depression is a storm, not a lowering of spirit,” he describes the psychological factors that have been seriously neglected in the burgeoning of recent neurochemical studies.  He reports results of empirical studies of the clinical phenomena and the need to turn to literary artists who have been afflicted, to characterize the personal experience.  Combining these approaches led to a new strategy of measurement.  In Chapters 4 and 5, he describes the “Rashomon” approach to measuring the state, the “multivantaged method” and the resultant dimensions of anxiety-agitation-somatization, depressed mood-retardation, hostility-interpersonal sensitivity that represent the major part of the variance underlying its structure.  Chapter 6, “False Assumptions,” critiques the basis of most current drug research.  Much of that work is guided by earlier misconceptions of the disorder and of the nature and timing of drug actions.  New evidence contradicts these assumptions and cites a new path to research in this area.  Chapter 7, “New Hypotheses,” reports results from a follow up study that compared differently targeted antidepressants.  It was designed to test hypotheses about drug actions derived from the earlier NIMH’s Collaborative Depressive Study and to extend knowledge on how neurochemical and behavioral changes interact to resolve the disorder.  Chapter 8, describing a “more effective model for the clinical trial of new drugs,” demonstrates the advantages of applying the dimensional conception of depression and the “componential” model, in place of the now 50-year-old established “diagnostic” model.  Finally, in Chapter 9 the author presents conclusions and describes a new theory about the nature of the depressive state, “the conflictual neurobehavioral state” hypothesis, a concept that views it as one of turmoil, not as unidimensional, but as one of conflicting central nervous system states, a “down, depressed retarded state” concurrent in the experience with an opposed “aroused, negatively excited, anxious” state.

 

AUTHOR’S STATEMENT: The book is a product of the author’s experience in two major Collaborative studies of the Psychobiology of Depression that extended over a period of several decades.  The themes covered, ranged from results of basic studies which detail the specific relationships between central neurotransmitter systems, serotonergic and noradrenergic, and the elements of behavior, to a rethinking of the neurobehavioral concept of the disorder itself.  Noting the neglect of behavior in more recent drug research, it views depression, not as a singular disorder, but as comprised of multiple dimensions.  It further recommends replacing the dominant role that diagnosis plays in framing most all clinical research with the dimensional profile.  To achieve that goal, a new conception of the disorder is presented and a new strategy of measurement, the multivantaged method, as the framework for future research.  The empirical results of two collaborative studies characterize the behavioral phenomena.  The components of depression are then combined with the descriptions by literary artists of the actual experience of the disorder.  These results lead to a re-conceptualization of how the drugs act to resolve the disorder, and a new theory as to the experience of the depressed state, based on the interaction of opposed neurobehavioral states. In introducing the new methodology, the author seeks to change the approach to clinical trials. The established model, developed more than 50 years ago, is out dated and does not do justice to the many drug actions and forms in which the disorder is manifested.  There is a Postscript. In the appendices, detailed descriptions are presented of the brief form of the Multivantaged Assessment Method and the newly developed Video Interview Behavior Evaluation Scales (VIBES).

 

August 8, 2013

 

Martin M. Katz: Multivantaged vs. Conventional Assessment Method

Katz                      May 22, 2014                         essay

Klein                     August 18, 2016                     comment

Katz                      November 10, 2016                reply to Klein’s comment

Klein                     February 23, 2017                  response to Martin M. Katz’s reply

 

Martin M. Katz’s essay

        The Multivantaged Assessment Method (MVAM) of clinical evaluation was adopted to describe an approach to the measurement of the diverse patterns of psychopathology displayed in the various forms of mental disorder and to measure changes in the patterns before and after treatment. The approach assumes that most disorders are comprised of dimensions, components of disturbed affect, behavior and cognition, which interact to define their structure. It is further assumed that no one vehicle of measurement whether the observations of the experts or the subject’s report of the experience is capable of fully or accurately describing the complex nature or the critical facets of the disorder. Because of the many ways that the disorder can be expressed it requires more than one “vantage” on its expression to achieve accurate measurement.  To achieve a more “objective” picture of the behavior, the multivantaged assessment method (MVAM) involves combining such perspectives to achieve a consensual estimate of the type and severity of the behavior or emotion, at issue.  In the case of serious emotional disorders such as “depression,” a collection of valid clinical methods are recommended exemplifying the multivantaged approach, to measure the facets and severity of the disorder and to assess the impact of various interventions on the disorder. This is called the “Multivantaged Assessment Method.” The currently established method for clinical trials of antidepressants relies on a sole method of evaluation, the Hamilton Depression Scale, which measures change in overall severity of the disorder, but which provides no further validated information on the specific clinical actions of the experimental drug. The MVAM was designed to extend and enhance the conventional assessment by providing, in addition to a measure of overall severity, a profile of the clinical and psychological actions of the trial treatment.

Further Elaboration of MVAM

        Accurate measurement of the various facets of psychopathology cannot be accomplished through any one vehicle of measurement.  It requires combining the observational ratings, the report of the subject, and the subject’s performance on cognitive and psychomotor tasks. The term “multivantaged” takes on important meaning particularly where observation of behavior and physical expression is concerned since it is known that the perspectives of observers of emotionally charged incidents can vary widely.  The author of the term refers in his book (Katz 2013) to the “Rashomon” effect, best demonstrated in a classic Japanese film, showing how the emotional aspects seriously influence the perceptions of different observers, but in different ways. To achieve a more “objective” picture of the behavior, the MVAM involves combining such perspectives to achieve a consensual estimate of the type and severity of the behavior or emotion, at issue.  In the case of serious emotional disorders such as “depression,” a collection of valid psychological methods are recommended exemplifying the MVAM, to measure the facets and severity of the disorder and to assess the impact of various interventions on the disorder. These methods include the Schedule for Affective Disorders and Schizophrenia-Change version (SADS-C), the Hamilton Depression Rating Scale, the Symptom Checklist (SCL-90), NIMH Mood Scale, Video Interview Behavior Evaluation scales (VIBES) and selected psychomotor tests. This is called the “Multivantaged Assessment Method.”

        Descriptions of the MVAM, the rationales for the derivation of the methods, and evidence for their validity are presented in the following references:

 

References:

Katz MM, Koslow SH, Berman N, Secunda S, Maas JW, Casper R, Kocsis J, Stokes P.A multivantaged approach to the measurement of behavioral and affect states for clinical and psychobiological research. Psychological Reports Monograph 1984;55:619-73.

Katz MM, Houston JP, Brannan S, Bowden CL, Berman N, Swann A, Frazer A. A multivantaged behavioral method for measuring onset and sequence of the clinical actions of antidepressants. International Journal of Neuropsychopharmacology 2004;7:471-9.

Katz MM. Depression and Drugs: The Neurobehavioral Structure of a Psychological Storm. New York: Springer; 2013.

 

May 22, 2014

 

Donald F. Klein’s comment

These few paragraphs by Katz on Multivantaged vs. Conventional Assessment Method (MVAM) has three references that supposedly establish its validity vs. conventional systems. The first two, dated 1984 and 2004, are not available online. The third is Katz's book, Depression and Drugs, which is commented on in the INHN Book section. The Book expounds on MVAM, but no methodological comparative basis for MVAM vs. conventional systems is found. Unique advantages are claimed but not substantiated.

An attempt to find methodological discussions of MVAM in the literature failed.

The term "Multivantaged" has not achieved general usage or understanding.

 

August 18, 2016

  

Martin M. Katz’s reply

 

          The established method in clinical trials of antidepressants for describing the severity of the depressive disorder and for measuring change effected by a treatment drug, is the Hamilton Rating Scale. The “Multivantaged Assessment Method” (MVAM) was created to provide a more detailed analysis of the structure of the depressive disorder and a more complete, more sensitive profile of the changes effected by treatment agents. Although the MVAM has not been taken up by many investigators, as Klein notes, its validity has been well established and described in several publications (Katz, Koslow, Berman et al. 1984; Katz, Houston, Brannan et al. 2004; Katz 2013). As a composite of several already established methods, the overall MVAM, combines these validated methods, e.g., SCL-90 (Derogatis, Lipman, Rickels et al. 1984), the NIMH Mood scale (Raskin, Schulterbrand, Reatig and Mckeon 1969), SADS (Endicott and Spitzer 1978) to generate the profile. When Klein comments that the MVAM’s validity has not been established, it signals that he has not grasped the concept underlying the “multivantaged” method, has not read the relevant literature. On the point that it has not been compared with an established method, a direct comparison with the Hamilton method in a clinical trial is clearly presented in the book (Katz 2013). Klein apparently, declined to read that section.

In sum, I welcome Klein’s attention to the new method, but find that his comments on its validity have little foundation when viewed against the clear positive evidence from several sources, so far developed on the MVAM.


References:
Derogatis, LR, Lipman R, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL) a measure of primary symptoms. In: Pichot P, editor. Psychological Measurements in psychopharmacology. Basel: Karger; 1974, pp.  98-110.


Endicott J, Spitzer RK. A diagnostic interview: the schedule for affective
disorders and schizophrenia. Arch Gen Psychiatry, 1978;35:837-44.


Katz MM. Depression and Drugs: The Neurobehavioral Structure of a Psychological Storm. New York: Springer; 2013.


Katz MM, Houston JP, Brannan S, Bowden CL, Berman N, Swann A, Frazer A. A multivantaged behavioral method for measuring onset and sequence of the clinical actions of antidepressants. International Journal of Neuropsychopharmacology, 2004;7:471-9.

 

Katz MM, Koslow SH, Berman N, Secunda S, Maas JW, Casper R, Kocsis J, Stokes P.A multivantaged approach to the measurement of behavioral and affect states for clinical and psychobiological research. Psychological Reports Monograph, 1984;55,619-73.


Raskin A, Schulterbrand JG, Reatig N, Mckeon JJ. Replication of factors of psychopathology in interview, ward behavior and self-ratings of hospitalized depressives. J Nerv and Mental Disord. 1969;13:31-41.

 

November 10, 2016

  

Donald F. Klein’s response

  

          Katz states: “...a direct comparison with the Hamilton method in a clinical trial is clearly presented in the book (Katz 2013).  Klein apparently, declined to read that section.”

          Ordinary referencing about a specific point is not to a whole book. However, I went through the book diligently and can't find that point. Maybe I'm going blind. Giving Katz benefit of the doubt, maybe I missed it. I would like a page citation before saying it's not there. This prompted an unanswered editorial inquiry.

          Perhaps Katz has declined to read my specific criticisms or more likely has read them, can’t answer directly, so must resort to generalities. With regard to the multivantaged behavioral method, Katz only cites three non-Katz works, all prior to 1979. Thirty-seven years seems sufficient to demonstrate whether other psychopharmacologists have found it useful. With regard to Katz’ assertions about neurotransmitter effects, their lack of relevant effects in normal subjects seems critical. Like other specific criticisms, it goes unremarked. Unfortunately, this has been a pattern that defeats discussion.

 

Reference:

Katz MM. Depression and Drugs: The Neurobehavioral Structure of a Psychological Storm. New York: Springer; 2013.

 

February 23, 2017

 

January 23, 2020