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Biomedical subjects

E Sturt

Publications and source records attributed to E Sturt.

At least 19 recordsLinked to original sources
PubMed1992

Antidepressants may not assist recovery in practice: a naturalistic prospective survey.

A total of 130 people attending psychiatric hospitals within 6 months of onset or relapse of an episode of depressive disorder were interviewed about their symptoms and treatment at the time of their initial contact. After a mean 4-month interval, 119 were reassessed to test the hypothesis that patients treated with antidepressants would be significantly more likely to be clinically improved compared with those untreated. Severity and duration of the episode emerged as the only significant clinical predictors of clinical improvement. Patients on treatment with antidepressants at the start of the study showed a nonsignificant trend for a lesser degree of clinical improvement, even when clinical severity and compliance were taken into account. Those who were not commenced on treatment until later in the study also fared no better than those who were never prescribed antidepressants. The effect of low doses of antidepressants (almost always a tricyclic) appeared to be less beneficial than either higher doses or clinical management without antidepressant drugs. The need for further experimental and naturalistic studies conducted over various periods of time and the implications for clinical practice, medical audit and the appropriate use of health outcome indicators are discussed.

Antidepressive Agents, Tricyclic↗
PubMed1992

Abnormalities of response processing in a chronic psychiatric group. A possible predictor of failure in rehabilitation programmes?

This study attempted to identify, in a mixed group of chronic patients, a specific measure of cognitive processing that may be of use in predicting dependence on psychiatric care. The measures investigated are derived from reaction-time tasks. Difficulties of response processing seem to account for the largest amount of variance in current service use. When compared with other variables shown to have some predictive power (e.g. social behaviour, symptoms and chronicity), the reaction time measures fare well. Functions derived from discriminant analyses using all the variables correctly classified 90% of those requiring day care and 95% of those requiring night care. Stepwise methods produced lower classification rates but always included reaction-time measures in the predictor set. Patients with continuing cognitive difficulties are likely to remain in more supportive psychiatric settings despite rigorous rehabilitation procedures.

Chronic Disease↗
PubMed1990

The relation between life events and social support networks in a clinically depressed cohort.

Life events and supportive social networks are often treated as separate independent variables in their relations with supposed dependent variables such as depressive disorder. It is important therefore to establish that they are independent of one another. One hundred and twenty one men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact by a research psychiatrist and a week later by a non-clinical research worker who enquired about life events (LEDS) and about social networks (IMSR). One hundred and eleven patients were successfully followed up in the same manner, typically 4 months later. Social networks were very stable over time. Where they did change, this could not be explained in terms of losses of social contact due to events such as death of a primary group member. The rating of threatening events and difficulties was also unrelated to the quality of social support networks. Institutional rearing in childhood was associated with substantially smaller adult primary networks. It was concluded that over short periods of time, measures based on the LEDS and IMSR are independent, but that major social disruptions may have life long effects on social support networks.

Adaptation, Psychological↗
PubMed1990

Gender, social support and recovery from depressive disorders: a prospective clinical study.

One hundred and thirty men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact. After a mean four month interval, 119 were reassessed in order to test the hypothesis that initial levels of social support predict clinical improvement even when other potential risk factors such as age, sex, diagnosis and severity of depression are controlled. Severity and duration of the episode emerged as the only significant background predictors of recovery. The explained variance in recovery from depression due to social support was equal in men and women, and was not diminished by the background clinical predictors. According to subset analyses however, the aspects of personal relationships and perceived support that predict recovery in men and in women appear to be different. The available multiple regression models of outcome favoured a main effect of social support and provided persuasive if inconclusive evidence for a statistical interaction effect with sex. The implications for further research and for theory are discussed.

Adult↗
PubMed1990

The prediction of rehabilitative success after three years. The use of social, symptom and cognitive variables.

A three-year follow-up study of 49 psychiatric patients, representative of those found in long-stay care, tested whether behavioural, symptom and demographic variables as well as response-processing difficulties could predict levels of psychiatric care. The researchers were blind to the criteria for allocating patients to particular forms of care and the staff responsible for care had no access to information collected by the research team. Not only was it possible, using only these few factors, to predict the form of care, but one factor, response processing, was related to whether patients moved to more independent forms of psychiatric care.

Achievement↗
PubMed1988

The Camberwell Collaborative Depression Study. I. Depressed probands: adversity and the form of depression.

The Camberwell Collaborative Depression Study is an investigation of a series of 130 patients (76 female; 54 male) attending the Maudsley Hospital Services with unipolar depression of recent onset (the probands), and of their first-degree relatives. This paper describes the first element of the study, the investigation of the index cases or probands, which was carried out by members of the MRC Social Psychiatry Unit over the period 1982-1985. A description of the methods of the study is followed by an analysis of life events in relation to the symptomatic pattern of the depressive state. An 'endogenous' group was defined as cases of depression falling within Catego classes D and R, and compared with a 'neurotic' group conforming to classes N and A. The hypothesis that the 'endogenous' group of disorders would be relatively independent of prior life stress was not confirmed. Depressed women were more likely to have experienced life events or difficulties than their male counterparts, and there was some evidence that sex, but not age or social class, influenced the relationship between adversity and the type of depression. Examination of the timing of life events was strongly suggestive of a causal effect, with a pronounced rise in the month before onset. This was not limited to the most severe events. Differences between the 'endogenous' and 'neurotic' groups in the temporal patterning of events before onset are discussed. The findings are interpreted in terms of the literature on the topic.

Adult↗
PubMed1987

Assessment schedules for chronic psychiatric patients.

The Social Behaviour Schedule (SBS) was examined as a measure of disability in a series of 66 chronic psychiatric patients, who were also assessed using the Social Role Performance Schedule (SRP) and the ninth edition of the Present State Examination (PSE). All three schedules have been used in previous studies in their present form. SBS and SRP measures were correlated with each other and neither showed any relationship with subjectively described current PSE symptoms. SBS deficit was associated with a clinical diagnosis of schizophrenia and with problems in supervised occupational activity. Long-term hospital residents showed greater SBS deficit than chronic patients in active rehabilitation programmes, although impaired SRP was the major correlate with the type of supervision provided. SRP measures can be compared with population norms, unlike measures derived from the SBS, which cover more severe ranges of disability.

Adaptation, Psychological↗
PubMed1987

Social networks, social support and the type of depressive illness.

We hypothesised that there would be greater deficiencies in the quality and quantity of close personal relationship and social support in "neurotic" than in "endogenous" depressives, and that the relation between support and recovery would be stronger in the former. One hundred and thirty men and women who contacted hospital psychiatric services with depression were interviewed, and 119 (92%) reinterviewed after approximately 4 months. The association between the type of depression and deficiencies in social relationship was not impressive. However, differences were apparent in the prognostic implications of social relationship. For "neurotic" depressives, about half the social support variables assessed were significantly related to outcome, whereas the only significant predictor for "endogenous" cases was the presence of a close confidant. The results argue for further research on social support in clinical samples of acute depression.

Adaptation, Psychological↗
PubMed1986

Application of survival analysis to the inception of dementia.

The age at onset of dementia of the Alzheimer, Pick or senile type in relatives of probands with early onset dementia was examined using survival analytical techniques applied to data collected by Sjögren et al. (1952). Female relatives were found to have a higher risk of dementia than males, and there was a deficit of affected brothers compared with fathers of probands. In these comparisons due allowance was made for age at the last observation of each relative. Relatives of probable and definite Pick probands had a higher risk than relatives of probable and definite Alzheimer probands, but the difference was not significant and dementia did not occur at an earlier age to the former group. For the relatives as a whole, and for subgroups of relatives, the risk of dementia increased with age, at least up to age 80. It is hypothesized that the pattern of the age-related hazard of dementia is due to the nature of the dementing process; that this slow degenerative process is widespread; and that individual differences in the rate of the process are under the influence of genes. The statistical methods are explained in detail as they have rarely been applied to dementia before, though Chase et al. (1983) have used life tables and survival analysis in testing genetic hypotheses, with an application to Alzheimer's disease.

Aged↗
PubMed1986

Genetic markers in schizophrenia.

A genetic contribution to schizophrenia is the best established aetiological clue for this common and serious condition. Purely statistical attempts to establish the mode of inheritance have yielded inconclusive results although SML models where a major gene is the sole cause of concordance between relatives can be effectively excluded. The question of genetic heterogeneity is also unresolved. Genetic marker studies offer potentially productive strategies for detecting major genes for schizophrenia or schizophrenia subtypes, but also offer the possibility of detecting contributory (minor) susceptibility loci. The most consistent genetic marker finding, to date, of an association between HLA A9 and paranoid schizophrenia may fall into the latter category. This and other possible associations discovered by recent population studies (e.g. with complement factors) merit further investigation. On the other hand, the findings of linkage studies, including those with HLA, have been predominantly negative. Recent advances in recombinant DNA technology, and the potential availability of many more polymorphisms, make genetic marker studies an increasingly attractive prospect in schizophrenia. However, as in other disorders with complex and non-Mendelian patterns of inheritance, there remain formidable problems in the statistical analysis of the results.

Blood Group Antigens↗
PubMed1986

The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule.

This paper describes the standard version of the MRC Social Performance Schedule, which covers 21 behaviour areas such as hygiene, initiating conversations, etc. and was designed to be used with long-stay populations, within a hospital or the community. Data on the schedule's consistency over raters, informants, time, and situation showed that the reliability was reasonable over all four areas. The schedule is recommended as a standard instrument to describe the behavioural difficulties of patients likely to be dependent on psychiatric services for some time. Recent data are provided on the levels of problem behaviours found within both long-stay hospitals and community settings, together with references for more detailed behaviour profiles of such groups.

Adult↗
PubMed1985

Sex concordance for schizophrenia in proband-relative pairs.

Some hypotheses about the cause of schizophrenia are based on the puzzling tendency for mental illness to affect the same sex when two close relatives become psychiatrically ill. Sex-concordance rates were examined in 71 schizophrenic probands, who had at least one first-degree relative suffering from the same disorder, in order to test this tendency in a population of recently admitted patients. No unusual concordance rates were found when unaffected sibs were taken into account and relatives were stratified to take account of possible confounding factors. It would seem premature to construct hypotheses about the aetiology of schizophrenia based on evidence of this type.

Adult↗