Thomas A. Ban and Heinz E. Lehmann
Experimental Approaches to Psychiatric Diagnosis Psychometric, Conditioning and Psychopharmacological Studies
Charles C. Thomas, Springfield, 1971. (119pages)
Presented by Thomas A. Ban
CONTENT: This monograph is based on experiments carried out from 1962 to 1968 in the Research Department of Douglas Hospital, a psychiatric inpatient facility in Verdun, Quebec, Canada. The studies employed different methods of assessment, the findings of which complemented the clinical information on patients. The book is divided into five chapters: I. Experimental Approaches to Geriatric Diagnosis; II. Psychometric Tests and Psychiatric Diagnosis; III. Conditioning and Psychiatric Diagnosis; IV. Psychopharmacology and Psychiatric Diagnosis; and V. Direction of Future Research: A Comprehensive Test Battery. The monograph opens with the authors’ Preface (and Acknowledgments), and closes with the authors’ Concluding Remarks (and a Name and Subject Index).
Chapter I (Experimental Approaches to Geriatric Diagnosis) is based on a study with 107 geriatric patients in which prediction of treatment outcome with six drugs (methylphenidate, meprobamate, amitriptyline, thioridazine, nicotinic acid and fluoxymeterine) was compared in diagnostic subpopulations derived by psychopathological symptom clusters (arousal, mood, affectivity, integration and organicity (based on the Modified Verdun Target Symptom Rating Scale), psychometric test performance (tapping speed, auditory reaction time, critical flicker fusion frequency, word association time, digit span forward, digit span backward and counting test) and psychopharmacological load tests (normal saline, 10 mg of methamphetamine, 250 mg of sodium amobarbital and the inhalation of a 95% oxygen and 5% carbon dioxide mixture).
Chapter II (Psychometric tests and psychiatric diagnosis) is based on three studies in which the psychometric correlates of psychiatric diagnosis were studied with 14 tests measuring 19 variables with the employment of a specially devised psychometric test battery. The battery includes three “afferent-perceptual tests” (Critical Flicker Fusion Frequency, Chromatic After – Image Disappearance Limen and Achromatic Spiral After Effect); six “central-intrinsic tests” measuring nine variables (Word Association Speed, Digit Span Forward and Backward, Stroop Color Word Test Time and Error, Time Estimation Production and Reproduction, Paired Associate Learning and Ideational Recall); and five “efferent-psychomotor tests” measuring seven variables (Simple Auditory Reaction Time, Tapping Speed, Track Tracer Test Time and Error, Cancellation Test Time and Error and Body Sway Test).The first study included 10 normal subjects and twenty patients (chronic schizophrenia, chronic organic brain syndrome); the second, 129 patients (personality disorders, psychoneurotic reactions, manic-depressive manic reactions, acute schizophrenic reactions, chronic schizophrenic reactions and organic brain syndromes); and the third 20 normal subjects and 100 patients (personality disorders, neurotic depression, psychotic depression, schizophrenia, organic brain syndrome).
Chapter III (Conditioning and psychiatric diagnosis) is based on two sets of studies in which conditional reflex (CR) variables were used in the differentiation among psychiatric diagnostic groups (2 studies) and in the differentiation of subpopulations within diagnoses (2 studies). In all these studies the Verdun Conditioning Procedure (VCP), based on measuring responses to stimuli by changes in galvanic skin resistance (GSR), was employed. The VCP provides information in terms of latency and amplitude in eight psychophysiological functions: startle response, orienting reflex, unconditional reflex, acquisition, extinction, disinhibition, differentiation, and reversal. The population of the first set of two studies focused on differentiation among diagnostic groups. One of these studies was conducted in 20 normal subjects and 100 psychiatric patients (personality disorder, neurotic depression, psychotic depression, schizophrenia, chronic organic brain syndrome) and the other in 15 normal subjects and 25 psychiatric patients (schizophrenia, chronic organic brain syndrome). The population of the second set of two studies focused on differentiation within diagnoses. One of these studies was conducted in 7 normal subjects and 21 depressed (neurotic, endogenous and schizophrenic) patients; and the other in 147 schizophrenic patients belonging to six different forms of schizophrenia: paranoid, simple, undifferentiated, hebephrenic, catatonic and schizoaffective.
Chapter IV (Psychopharmacology and psychiatric diagnosis) is based on four studies from which three was conducted in patients with a diagnosis of schizophrenia and one in patients with the diagnosis of depression. In all these studies prediction of treatment outcome was explored with the employment of the VCP00: in the first three studies to neuroleptics and in the fourth to tricyclic antidepressants. The four studies included a total of 105 patients: 30 patients in the first study, 20 in the second, 30 in the third and 25 in the fourth.
Findings in the studies reviewed in chapter IV generated hypotheses but did not identify any predictive variable of treatment outcome. Hence, in Chapter V (Direction of future work: A comprehensive test battery), the last chapter of this monograph, the VCP, was extended to measure CR variables also with the employment of other than the GSR technique. They includedvariables derived with the employment of “salivary secretion”, “eyelid closure”, “defensive finger withdrawal”, Ivanov-Smolenskys’s technique for studying the transmission from first (non-verbal) to second (verbal) signal system activity, a modification of Astrup’s ”word association technique” for studying second signal system activity, and Lehmann’s “active avoidance technique” for studying voluntary interference with a skeletomuscular CR. Chapter V also includes findings of a test-retest reliability study of the extended procedure conducted in 30 normal subjects and 30 chronic psychotic patients.
AUHOR’S COMMENT: In this monograph three different “approaches” (pharmacological loads, psychometric performance tests and conditioning procedures), are presented for complementing clinical (subjective) diagnostic information with experimental (objective) measures. The underlying assumption was that employment of these approaches might provide cues for the detection of the pathophysiology (pathology in the processing of signals) in the diagnoses studied and/or help to identify pharmacologically more homogenous psychiatric populations then derived by clinical diagnoses.
Thomas A. Ban
November 20, 2014