Biomedical subjects
Publications and source records attributed to A E Philip.
A survey is described which compared patients' rehabilitation status, activities, needs and reasons for attending at four different psychiatric day care units attached to one hospital. The views of staff and patients were also examined.
The development of a cohesive support system is vital to the success of community based services and day care is an essential component of any system of support. McCreadie et al in a Scottish study of psychiatric hospital provision showed that while there was wide variation around Scotland in the provision of hospital based care, there was a general dearth of health service and local authority community-based services. Philip and Stuckey in a survey of NHS long term non-resident patients of the Royal Edinburgh Hospital found that hospital staff felt that such patients would have benefited from additional daytime activity different from that provided in the health service. These authors found that some patients did make significant use of voluntary agencies, but were unable to elicit any systematic reasons for using or not using these agencies. Surveys in the statutory and voluntary sectors completed to date have tended to concentrate on the opinions of staff groups about the requirements and needs of clients. There has been no systematic survey of the facilities and opportunities most desired by users of voluntary sector support agencies. This survey, which received support from the Chief Scientist Organisation Mini-Project Scheme, aims to remedy this lack and to provide a factual basis from which the NHS, local authorities and voluntary agencies can draw, in their mutual aim of helping people with mental health problems. The results of the survey, while carried out in Edinburgh, may have relevance to planners and providers further afield in Scotland.
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Obesity and depression are common disorders which may co-exist. The management of the combination is complicated because some antidepressants cause weight gain fenfluramine, an effective antiobesity agent, may cause depression. Fluvoxamine is an antidepressant which, like fenfluramine, inhibits serotonin re-uptake within the brain. Forty obese female subjects with refractory obesity participated in a double-blind placebo controlled trial. During the twelve week study, those subjects receiving fluvoxamine achieved a mean weight loss greater than, but not significantly different from, that of the placebo group. The result suggests that fluvoxamine may be particularly useful in the management of obese patients requiring treatment with an antidepressant.
A sample of 208 psychiatric nurses and nursing assistants completed a questionnaire assessing attitudes to treatment and patients. Significant attitudinal differences between groups were found in relation to professional grade, age and sex. Staff with more professional training were less authoritarian and impersonal than staff more junior in the hierarchy. Younger males with Registered Mental Nurse training were found to be significantly less inclined towards physical methods of nursing and treatment. Male nurses tended to favour therapeutic techniques which emphasized independent nurse action and psychological proximity to patients. Female nurses were more favourably inclined to physical methods of treatment and were significantly more authoritarian and formal towards patients in line with the traditional stereotype of the general hospital nurse. Results are discussed in relation to the setting up of new treatment regimes within psychiatric hospitals and the influence that staff attitudes have on their functioning.
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We compare referrals made to a psychiatric service by two comparable general practices. One practice made its referrals through conventional channels; the other referred patients to a multi-professional team who saw patients at a clinic held on the practice premises. The members of the team and the general practitioners in the second practice also met regularly to discuss matters of mutual interest. More patients were referred by this method, which also made greater use of the multiple disciplines involved in psychiatric care.Patients referred through conventional channels were more likely to have had previous contact with the psychiatric service, were more likely to be admitted to hospital and spent 70 per cent more time as inpatients.These results confirm the findings of other workers in demonstrating that there are tangible benefits in a multidisciplinary specialist team working in primary care.
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The predictive value of the NOSIE, a ward behaviour rating scale, was investigated in a group of long-stay patients. After a follow-up period of 3 1/2 years, it was found that all NOSIE scales differentiated continuing in-patients from those discharged. Regression analysis showed that age and florid psychoticism carried most predictive weight. These findings and the value of reliable rating scales for rehabilitation purposes are discussed.
Details of a 22-item questionnaire used to assess the result of surgery for peptic ulcer are given. Tested in 47 patients the questionnaire correlates well with the Visick grading. The 100-mm line test and post-operative alkali consumption are less accurate measures of outcome. As an alternative to the Follow-Up Clinic, as a potential predictor of result, and as an indicator of the quality of life, the questionnaire has much to offer.
The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ inherent in a 'present state' inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.
The NOISE is a rating scale designed for use with long-stay schizophrenic patients with six scales derived from a series of factor analyses of data from American patients. The present paper reports an attempt to replicate these scales in a British setting. After factor analysis five NOSIE scales showed identical item content across the two cultures. In the British analysis the items of the Retardation scale were factorially complex so that the scale was not replicated. It was concluded that most of the NOSIE was cross-culturally robust and relevant to its declared purpose.
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