Review of Schizophrenics in a Rural Practice over 26 Years

Watts, C. A. H.

doi:10.1136/bmj.1.5851.465

Cited by 11 publications

(6 citation statements)

References 1 publication

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“…Schizophrenic subjects with no such contact would not be registered on the LPCR. It has been reported that 97-5% of new cases of schizophrenia presenting to general practitioners in Scotland are referred to a psychiatrist (Watts et al 1964), but there is also evidence that some schizophrenic patients are managed entirely within primary care and are never seen by the psychiatric services (Watts, 1973). Some may avoid detection by the medical services altogether, but the very large field surveys necessary to detect such subjects have not been attempted in the UK.…”

Section: Discussionmentioning

confidence: 99%

Schizophrenic subjects with no history of admission to hospital

Geddes

Kendell²

1995

Psychol. Med.

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SYNOPSISIt has often been assumed that all subjects with schizophrenia will eventually be admitted to hospital and therefore little bias is introduced by restricting research to hospitalized subjects. Using the Lothian Psychiatric Case Register, 66 subjects were identified who had been diagnosed in Edinburgh as suffering from schizophrenia between 1978 and 1989 but had no history of hospital admission by December 1991. This represented an adjusted average of 6·7% of the estimated annual rate of first diagnosis of schizophrenia: the proportion of such patients did not change over the period. Using a case–control design, the index cases were compared with a control group of schizophrenic patients who had been admitted to hospital within 3 months of diagnosis. At the time of diagnosis, the cases were generally less disturbed with lower levels of violent behaviour and less evidence of neglect or hallucinations. They had a longer duration of illness prior to diagnosis, were more often diagnosed by a consultant and unemployed. In a follow-up study of the index cases, 59 (89%) were traced, of whom 6 (10%) were deceased. The outcome of the illness was heterogeneous although the course was often chronic. The general practitioner provided most of the care they received. The small proportion of such patients suggests that their exclusion from most published series does not seriously bias our picture of the natural history of schizophrenia. Moreover, as there was no increase in the proportion over the period, first admission rates for schizophrenia in Scotland are a reasonable approximation to incidence rates.

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Section: Discussionmentioning

confidence: 99%

Schizophrenic subjects with no history of admission to hospital

Geddes

Kendell²

1995

Psychol. Med.

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“…This is, however, not always the case. Thus, in his survey over 26 years of all schizophrenics occurring in a general practice population of eight thousand, Watts has reported that 15 (21 %) of the 72 schizophrenics whom he found were not admitted to hospital; furthermore, nearly three-quarters (11) of this group were not seen by a psychiatrist and over one-quarter (4) received no further medical attention (Watts, 1973). Admission to a psychiatric hospital is sometimes precipitated more by a crisis in the patient's immediate social network than by a decision made on medical grounds and will thus accord an unsatisfactory reflection of the clinical severity of the disorder (Wing, 1968).…”

Section: The Natural History Of Schizophrenia: a Five-year Follow-upmentioning

confidence: 99%

“…Thus, in his survey of general practice Watts (1973) reports a small number of schizophrenics who were not caught in the hospital net. Thus, in his survey of general practice Watts (1973) reports a small number of schizophrenics who were not caught in the hospital net.…”

Section: Limitationsmentioning

confidence: 99%

The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics

Shepherd¹,

Watt²,

Falloon³

et al. 1989

Psychol. Med. Monogr. Suppl.

262

136

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Longitudinal studies of schizophrenia based on at least 70 subjects and a minimum five-year follow-up period are reviewed in respect of the requirements of adequate method. A cohort of 121, PSE-diagnosed, schizophrenic admissions from a defined population was identified. The sex-distribution of the subjects was almost equal. Forty per cent were first admissions; 65% of the men and 24% women were unmarried; the mean age of onset for men was 28.6 years, for women 33.2 years. Almost half (48%) were continuously employed (including house and child care) for 2 years prior to admissions. First rank symptoms of schizophrenia were present in 79% of the men and 86% of the women. Comprehensive, standardized assessments of clinical state and social function were made on discharge from hospital and at follow-up by home interview of patient and relative(s). Outcome was also assessed by duration and frequency of readmission and by duration of employment. First admissions were analysed separately from the whole cohort. There were 49 first admissions generating an incidence of 7.4 per 100,000 general population per annum. Sixty-nine per cent of men and 13% of women were unmarried. The mean age of admission for men was 30.8 years, women 40.3 years and the mean age of onset 30.7 and 38.6 respectively. After 5 years first rank symptoms were present in 46% of the males and 35% of the females. The proportion showing depressive symptoms fell from 39% at intake to 22% at five years. In terms of a combination of symptoms and readmissions there was a good outcome in 50% of men and 65% of women, a trend comparable to that found in the whole cohort. For the whole cohort a combination of the number of symptoms and admissions disclosed a good outcome for 48%. The mean total duration of readmissions during the five years for men was 76 weeks and for women 27 weeks. Depressive symptoms were present in 38% at intake and 21% after 5 years. An overall rating of social functioning at 5 years showed no more than mild impairment for 47% of men and 74% of women, although individual items were more impaired. However, 38% of the group showed no more than mild impairment in any aspect of social functioning rated. Clinical and social outcome were, in general, closely correlated. The difference in outcome between men and women and the relations between clinical and social outcome are discussed. By means of an application of measures of association between independent and dependent variables to the onset data the clinical and social categories of pathology and impairment at 5 years were forecast.(ABSTRACT TRUNCATED AT 400 WORDS)

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“…Research in the early years of community care for the mentally ill showed that between 9% and 11% of patients with acute schizophrenia had been treated entirely within the primary care setting ( Watts 1973, Freeman & Alpert 1986) and up to 25% of those discharged from mental health facilities had received aftercare solely from their GP ( Parkes et al . 1962 , Hassell & Stilwell 1997, Johnstone et al .…”

Section: Introductionmentioning

confidence: 99%

Characteristics of severely mentally ill patients in and out of contact with community mental health services

Barr

2000

Journal of Advanced Nursing

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Community mental health nurses have been criticized for failing to prioritize work with people with a severe or enduring mental illness, many of whom have no contact with specialist mental health services and rely entirely on their general practitioner and primary care team. It is important to ensure that those in contact with specialist services actually need this level of input but, conversely, that those in contact with only primary care receive a service that is equipped to meet their needs. This study examines the differences between these two groups of patients. A sample of 253 community-based patients with a severe or enduring mental illness was divided into those with mental health service contact and those without. Differences in the demographic characteristics of the two groups were assessed and further, more detailed, comparisons were made with a sub-sample of 49 individuals randomly drawn from this larger sample. Instruments adopted for these purposes comprised the Camberwell Assessment of Need and the Life Fulfilment Scale. It was found that patients with a psychotic disorder were more likely than those with neurosis to be in contact with mental health services and patients with schizophrenia were significantly more likely to be on the active caseload of a community mental health nurse than those from all other diagnostic groups. However, patients' levels of need, unmet need and quality of life did not differ in relation to their service contact. Whilst the study provides limited evidence that community mental health nurses are targeting people with the most serious disorders, questions remain about the large proportion not receiving specialist care. Because primary care plays a significant role in the care of severely mentally ill people living in the community, the further mental health training of general practitioners and practice nurses is becoming increasingly important.

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Review of Schizophrenics in a Rural Practice over 26 Years

Cited by 11 publications

References 1 publication

Schizophrenic subjects with no history of admission to hospital

Schizophrenic subjects with no history of admission to hospital

The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics

Characteristics of severely mentally ill patients in and out of contact with community mental health services

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