Thomas A. Ban: Seminar on clinical methodology
Critical appraisal of Scientific Literature
Educational Series Number 19
Thomas A. Ban’s reply to Barry Blackwell’s comment
The objective of this seminar was to provide the necessary knowledge base about the methodology used in the clinical evaluation of psychotropic drugs that one should be able to translate findings presented in the language of statistics in publications into clinical use. It is of course important, as you point out, that one should be aware of the shortcomings of double-blind controlled trials, and the manner in which pharmaceutical companies have manipulated the system by concealing negative trial results, etc.
At the time the psychometric statistical methodology was introduced in the 1950s in the evaluation psychotropic drugs, to replace testimonials about their clinical actions, it was considered to be major progress. Yet, by the early 1960s, some of us recognized the “pitfalls” of the double-blind, randomized trial, and by the end of the 1960s, questioned whether the heterogeneous diagnostic populations in psychiatry meet the requirements for the employment of this methodology. Issues of this nature were covered by the seminar but nothing beyond.
Ban TA. Methodology and pitfalls of clinical testing of psychopharmacological drugs. Chemotherapia 1964; 9:223-30.
Ban TA. Psychopharmacology/ Baltimore: Williams & Wilkins; 1969.
Thomas A. Ban
July 7, 2016
Donald F. Klein, Max Fink, Edward Shorter and Thomas A. Ban: Comment Exchange on Flagrant Catatonic Behavior
HectorWarnes’ comment on Max Fink’s reply to Carlos Hojaij’s comment
The statement made by Max Fink that “…the present status of catatonia is akin to that of neurosyphilis, identifiable, verifiable and treatable” is misleading unless he underlines PRESENT time or actuality.
General Paresis of the Insane (luesvenerea) was isolated in 1822 as a chronic meningoencephalitis (Bayle 1822) which was confirmed by the discovery made by Hideyo Noguchi in 1913 of the treponema pallidum in the brain of patients affected with this form of tertiary syphilis (Noguchi 1913). Most cases of neuropsychiatric manifestations of neurosyphilisrespond to benzathine penicillin G unless it is diagnosed too late, i.e., when the cerebral atrophy and other brain lesions are far too advanced.
I don’t believe the remission rate of catatonic schizophrenia is as good and if they respond favorably(acute onset, reactive and affective factors, disturbances of consciousness, delusions,etc.) there is an important percentage of relapse or other forms of schizophrenic symptoms which may appear in follow-up studies. It is true that like conversion hysteria its incidence has decreased considerably except in third world countries.
Tom Ban, in one of his comments, mentioned C. Astrup whose book on Functional Psychoses includes follow up studies and was published in 1966. Astrup distinguishes “process” from “non-process” schizophrenia based on Jasper’s definition. It is quite original that in the evolution he uses Leonhard’s criteria of reactive or cycloid psychoses. In his comments addressed to Max Fink (Aug 20, 2017), Ban also introducesLeonhard’s nosology, at least as far as I understand, trying to distinguish classical catatonic schizophrenia in the Kraepelin sense from the hyperkinetic-akinetic motility psychoses. Ban further underlies the intense psychomotor retardation of some endogenous affective disorders, including mutism, which should be distinguished from the catatonic schizophrenic mutism, immobility, negativism, different kind of delusion (from the severe affective psychoses), wax flexibility and so on.
I am inclined to agree with Carlos Hojaij aboutthe requirement of a differential diagnosis including several forms of encephalitis (letus not forget the catatonic symptoms of the lucky survivors of the “Spanish Flu or Influenza” brilliantly described by Oliver Sacks in his book “Awakenings” and other neurological disorders such as the “Stiff Man syndrome” [MoerschandWoltman1956]). A more exacting psychopathological examination would sort out the differences between the schizophrenia group of illness from other disorders some with a clear organic basis. The more clinical experience I accumulate the more I am inclined to support Wernicke-Kleist-Leonhard classification including, of course, epigenetic and reactive factors which are taken into account in the excellent book of C.Astrup.
Astrup C. Noreik K. Functional Psychoses, Diagnostic and Prognostic Models. Springfield: Charles C. Thomas; 1966.
Bayle ALJ. Recherches sur L’ArachnitisChroniqueConsiderees Comme Cause d’Alienation. Paris: Gabon 1822.
Moersch FP, Woltman HW.Progressive fluctuating muscular rigidity and spasm ("stiff-man" syndrome); report of a case and some observations in 13 other cases.Proc Staff Meet Mayo Clin. 1956 Jul 25;31(15):421-7.
Noguchi, H. and Moore, J. W. A Demonstration of Treponema Pallidum in the Brain in Cases of General Paralysis. J Exp Med. 1913 Feb 1; 17(2): 232–238.