, Volume 13, Issue 5, pp 359-386

Psychiatric diagnosis and a typology of clinical drug effects

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Summary

Analyses of clinical drug effects have largely been derived from univariate rating scale or global improvement scale data. In general, global improvement scales have proved more sensitive and clinically useful than univariate scales. Another approach, presented here, is to use qualitative outcome categories to which patients are assigned on the basis of the configuration of multiple changes. Such a systematic qualitative outcome typology is presented as used in an experimental study of 309 non-chronic voluntary psychiatric patients who, regardless of symptomatology or diagnosis, were randomly assigned to placebo, imipramine or chlorpromazine-procyclidine, in a fixed dosage double-blind study.

This outcome typology is compared with a global improvement scale and related to diagnosis. In general, the drug outcome categorization was equal or superior to the global improvement scale in detecting the differences between drugs and placebo. Furthermore, by utilizing the author's diagnostic schema, as well as the qualitative outcome typology, the prediction of specific drug induced qualitative outcomes by diagnosis was demonstrated.

Max Fink, M.D. and Max Pollack, Ph.D. were Principal Investigators in the initial study. Aethur Willner, Ph.D. participated in the clinical evaluations. Mr. Sydney Feldman did the statistical analyses.
Supported, in part, by grants MH 02715, MH 04798 and MH 08004 of the National Institute of Mental Health, U.S.P.H.S. The cooperation of Geigy Pharmaceuticals, Smith, Kline and French Laboratories and Burroughs Wellcome and Co. is gratefully acknowledged. The unfailing collaboration of the staff of Hillside Hospital made these studies possible.