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Biomedical subjects

J K Wing

Publications and source records attributed to J K Wing.

At least 55 records · Page 3Linked to original sources
PubMed1980

Innovations in social psychiatry.

Social psychiatry, like social medicine of which it is a part, has two basic sciences - biology and sociology. People with psychiatric disorders suffer from acute breakdowns or chronic impairments which can be severely disabling in themselves, but these are often precipitated, amplified or maintained by social pressures and social disadvantages and by personal reactions, such as a loss of self-esteem and self-confidence. It is impossible, therefore, to draw a line between the medical and the social aspects of treatment, care and prevention. The chief innovations during the past 40 years have been made in the context of a change-over from a system of care based on large institutions towards a more open but much looser and less-coordinated system of smaller units managed by staff from different professions who have developed their own, sometimes conflicting, views as to the best ways of helping the mentally disabled. Nevertheless, knowledge has accumulated which, if properly applied, could lead to a better quality of life for the ill and disabled and a decrease in the burden placed upon relatives. Further innovations are not required which will lead to the development of a responsible, comprehensive and integrated mental health service. It is not yet known whether social measures taken to relieve or prevent lesser psychiatric disorders will lead to a decrease in the incidence or prevalence of more severe conditions and this question deserves further investigation. There is evidence, however, that relatively inexpensive help can be useful in the short term. Progress will depend upon the accumulation of new knowledge. One of the most encouraging trends has been the improvement of evaluative designs and methods aimed at testing ideas for improving services, thus allowing planners to make better informed decisions.

Community Mental Health Services↗
PubMed1980

Social psychiatry in the United Kingdom: the approach to schizophrenia.

British contributions to theoretical and applied social psychiatry have been determined in large part by a traditional empiricism and by developments in social welfare legislation over the past 70 years. The establishment of a national health service covering the whole population and the attempt to provide comprehensive social services have created special opportunities for epidemiological research and for practical community psychiatry. These developments have by no means been uniform throughout the country, and there has been plenty of scope for individual initiative. Open-door policies, domiciliary visiting, social and occupational rehabilitation, therapeutic communities, and long-term continuity of care were first introduced in pioneering centers and subsequently adopted elsewhere. The idea that disorders such as schizophrenia not only have the character of acute illnesses but can also take the form of chronic disabilities has led to recognition of the fact that services must be tailored to the needs of individuals, and to an emphasis on the importance of the family and other social environments. There is a readiness to capitalize on successes and to learn from mistakes, assisted by a wide range of evaluative studies, which promises well for the future.

Chronic Disease↗
PubMed1979

Psychiatric disorders in two African villages.

Adults in two small Ugandan villages were interviewed, using a standard psychiatric examination and standard methods of case identification and diagnosis. Twenty percent had disorders just above threshold level, and a further 5% had more definite disorders. Most of these conditions were depressive, but hypomanic and anxiety states were also represented. A survey of women in southeast London found only half this frequency of disorders. Further studies are required to confirm these results.

Adolescent↗
PubMed1978

Who becomes chronic?

Chronic social disablement is caused by three types of factor: impairment, e.g. slowness in schizophrenia; social disadvantage, e.g. lack of opportunity to develop social or vocational skills; and an underconfidence or unduly low self-esteem which is reactive to impairment and disadvantage. The last of these factors is particularly evident in 'institutionalism', a condition in which the individual comes to acquire a contentment with institutional life and wishes to lead no other. Many long-stay patients in large mental hospitals used to be 'well-institutionalized' but it became recognized that retraining and rehabilitation could lead to successful resettlement outside hospital. For a time these striking successes suggested to some theorists that abolishing the hospitals would abolish disablement as well but it is now quite clear that this is not the case. Chronic impairments still occur and create a continuing need for sheltered environments. The frequency and type of problems still arising are discussed in the light of recent surveys in England. One small group requires highly-staffed accommodation, others need less supervised day and residential settings; all need long-term care. It is emphasized that some people living at home with relatives also have chronic mental disabilities as have a high proportion of the destitute. Such problems are less frequent than formerly but they still require detailed medical and social attention.

Adaptation, Psychological↗
PubMed1978

The concept of a 'case' in psychiatric population surveys.

A series of in-patients, a series of out-patients and a series of women from a general population sample, all aged under 65, and all living in the same area of south-east London, were examined using the ninth edition of the Present State Examination (PSE). An 'index of definition' (ID), based on number, type and severity of PSE symptoms, was constructed in order to define a threshold point above which sufficient information was available to allow classification into one of the functional psychoses or neuroses. The index specified 8 levels of definition of disorder; the threshold point for a 'case' lying between levels 4 and 5. The identification of 'cases' by this means in the general population series was highly concordant with global clinical judgement. When the 3 series were compared, the in-patient series contained the most definite cases, the outpatient series was intermediate, and the general population series was characterized mainly by below-threshold conditions. Disorders above the threshold point were classified using the CATEGO program. The clinical severity of the depressive disorders and anxiety states identified in this way in the 3 series was compared on the basis of symptom and syndrome profiles and PSE scores. As expected, the inpatients had the most severe, and the general population 'cases' the least severe disorders. It is suggested that the PSE-ID-CATEGO techniques can be used to help standardize certain aspects of case-finding and case-description in both referred and non-referred populations and thereby make the results of surveys more comparable.

Adolescent↗
PubMed1978

The social context of schizophrenia.

During the past 25 years psychiatry has increased its understanding of the social context of schizophrenia in four major areas. Reasonable reliability can now be achieved in describing and recognizing many of the acute and chronic syndromes, so that comparability can be achieved between different research teams. Much is now known about the proximate social causes of symptoms and disabilities. The relationship between social and pharmacological treatments is now better understood. A more rational approach to the planning and prescription of services and to the counseling of patients and relatives can be made. Each of these lines of advance promises to lead to further progress in the future.

Antipsychotic Agents↗
PubMed1978

The effectiveness of a service for helping destitute men.

The effectiveness of a voluntary organization which aimed to help destitute men contacted by means of a 'soup run' was evaluated. The assessment was carried out in stages. At the end of each stage results were discussed with the organization and a set of recommendations for further action put forward. At the end of the first stage, it was agreed that the organization's aim should be restricted to attempting to help men settle in one of its houses (staffed by young volunteer workers) for a period of at least three months. A number of recommendations intended to achieve this result were unsuccessful. Following the setting up of a night shelter, it was observed that many men attended regularly. An assessment procedure was instituted which resulted in the selection of men who did settle in the houses for long periods, so much so that no further admissions became possible.

Cultural Deprivation↗
PubMed1977

Reliability of the PSE (ninth edition) used in a population study.

A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that non-medical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviews. Over a short period of time, such as a week, repeatability is satisfactory.

Adolescent↗
PubMed1977

The rating of symptoms by a psychiatrist and a non-psychiatrist: a study of patients referred from general practice.

A psychologist interviewing patients referred to the psychiatric service of a health centre rated twice as much morbidity, measured by total PSE score, as a psychiatrist interviewing equivalent patients. Scores on the self-rated GHQ showed no difference between the 2 groups. It is suggested that such differences could be avoided by giving careful attention to training interviewers.

Humans↗
PubMed1976

Diagnosis of functional psychoses. Comparison of clinical and computerized classifications.

The results of a comparison between the clinical diagnoses of 115 probands with functional psychoses, made on the basis of careful clinical history-taking, interviewing and examinations, and those made by computerized evaluation (CATEGO) on the basis of the present state examination (PSE) were presented. The clinical diagnoses of the project psychiatrist and the provisional classification resulting from the application of the CATEGO program to the PSE symptom profiles were in an overall concordance of 82%. In a second step the 20 cases with differences in diagnoses were reevaluated on the basis of the full history and psychopathology and a syndrome checklist was completed. This reevaluation led to a practically full diagnostic agreement.

Adult↗
PubMed1976

A technique for studying psychiatric morbidity in in-patient and out-patient series and in general population samples.

Many surveys of general populations have suggested a high untreated psychiatric morbidity, vairously referred to as mental illness, pre-clinical neurosis, minor neurosis, untreated depression, etc. An Index of Definition psychiatric disorders is described which incorporates cut-off points on the basis of symptoms rated in the Present State Examination. Eight degrees of definition are specified. At the "borderline disorder" level and above, disorders are sufficiently well defined to apply the CATEGO program of clinical classification. This procedure enables in-patients, out-patients and samples of the general population to be compared. Data from surveys in south-east London are presented in order to illustrate the technique. The main conclusion at this stage is that it is possible to identify, by strictly defined and repeatable procedures, a substantial proportion of people in the general population who have "borderline disorders" that can be tentatively classified in terms of the ICD. Whether it is clinically useful to do so requires further investigation. It is also suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.

Ambulatory Care↗