Biomedical subjects

J Leff

Publications and source records attributed to J Leff.

At least 19 recordsLinked to original sources

PubMed2000

Family work for schizophrenia: practical application.

OBJECTIVE: To review the evidence for the efficacy, efficiency and effectiveness of family work for schizophrenia. METHOD: The review is based on the relevant literature but is not intended to be exhaustive, except in the area of practical application. RESULTS: The effectiveness of family work has been established by a series of randomized controlled trials. Relatives groups are efficient in terms of staff time, and multiple family groups may be more efficacious than sessions with single families. However, a substantial proportion of relatives refuse to attend a group and need sessions in the home. Family work skills can be acquired by clinicians working in ordinary settings, although few studies have addressed this question. Problems have been encountered regularly by trained community workers trying to practise their newly acquired skills. CONCLUSION: Difficulties in implementation may be remedied by adopting a systemic approach and including the managers of the service in the initial training sessions.

Adult↗

PubMed2000

Factors in the onset of schizophrenia: a comparison between London and Trinidad samples.

OBJECTIVE: Sociodemographic factors play an important role in the genesis of mental disorders. High rates of unemployment and other social factors have been reported previously among African-Caribbeans with schizophrenia in London. The aim of the present study was to compare these factors in Trinidad with London African-Caribbeans. METHOD: Using internationally defined criteria, patients with first-onset schizophrenia were recruited in both countries, and information on the onset of symptoms, help-seeking, pathways into care, premorbid personality and educational and employment status were collected. These two samples are compared on a number of these factors. A total of 56 cases of first onset of psychosis coming into contact with psychiatric services in Trinidad were studied. Of these, 46 cases were diagnosed as having schizophrenia using the CATEGO program. Over a period of 2 years, 38 African-Caribbean patients with schizophrenia were recruited in London. RESULTS: African-Caribbean patients with schizophrenia in London were more likely to be admitted for perceived threat to others and to have shown loss of interest and serious neglect and to have assaulted others. A lower proportion were admitted via a psychiatrist and a higher proportion by the police. The unemployment rate among the London sample of African-Caribbeans was much higher than that in the general population, whereas this was not the case for the Trinidad patients. CONCLUSION: These findings are discussed in the context of culture and aetiology of schizophrenia, and suggestions with regard to future research are made.

Adult↗

PubMed2000

Long-stay patients discharged from psychiatric hospitals. Social and clinical outcomes after five years in the community. The TAPS Project 46.

BACKGROUND: There have been no large-scale prospective studies evaluating the transfer of care from psychiatric hospitals to district-based services. AIMS: We aimed to compare the quality of life of patients in two north London hospitals scheduled for closure with that in the community homes to which they were discharged. METHOD: The total long-stay population of Friern Hospital and several hundred long-stay patients in Claybury Hospital were assessed with a batch of eight schedules while in hospital. They were followed up after one year in the community and then at five years. RESULTS: Of the 670 discharged patients, 126 died before the five-year follow-up. Data were obtained on 523 (97%) of the survivors. There was no change in the patients' clinical state or in their problems of social behaviour. However, they gained domestic and community living skills. They also acquired friends and confidants. They were living in much freer conditions and the great majority wanted to remain in their current homes. CONCLUSIONS: Community care has enhanced the quality of life of this group of patients, involved in a well-planned and adequately resourced reprovision programme.

Adult↗

PubMed2000

The London Depression Intervention Trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs.

BACKGROUND: Relapse of depression is associated with a criticising attitude of the patient's partner. AIMS: To compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner. METHOD: A randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner. RESULTS: Drop-outs were 56.8% [corrected] from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments. CONCLUSIONS: For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.

Adult↗

PubMed1999

Outcome of long stay psychiatric patients resettled in the community: prospective cohort study.

OBJECTIVE: To examine the outcome of a population of long stay psychiatric patients resettled in the community. DESIGN: Prospective study with 5 year follow up. SETTING: Over 140 residential settings in north London. SUBJECTS: 670 long stay patients from two London hospitals (Friern and Claybury) discharged to the community from 1985 to 1993. MAIN OUTCOME MEASURES: Continuity and quality of residential care, readmission to hospital, mortality, crime, and vagrancy. RESULTS: Of the 523 patients who survived the 5 year follow up period, 469 (89.6%) were living in the community by the end of follow up, 310 (59.2%) in their original community placement. A third (210) of all patients were readmitted at least once. Crime and homelessness presented few problems. Standardised mortality ratios for the group were comparable with those reported for similar populations. CONCLUSIONS: When carefully planned and adequately resourced, community care for long stay psychiatric patients is beneficial to most individuals and has minimal detrimental effects on society.

Adult↗

PubMed1999

Early manifestations, personality traits and pathways into care for Asian and white first-onset cases of schizophrenia.

BACKGROUND: Previous studies have shown that manifestations of symptoms and premorbid personality of patients with schizophrenia differ across cultures. However, these have only been demonstrated in cultural settings apart from each other. METHOD: We set out to compare these across different ethnic groups from a catchment area in west London. The Asian and the white group had similar inception rates of schizophrenia and we therefore decided to compare these two groups to ascertain similarities in social, demographic and personality factors and pathways into care. First-onset cases of schizophrenia were studied on a number of parameters using previously validated instruments. RESULTS: There were more similarities than differences between the two groups. When compared with the findings of a previous multicentre study in India, London Asians, like their counterparts in India, were more likely than the London white sample to present with loss of appetite, become more religious and behave as if hearing voices. However, compared to their Indian counterparts, the onset of symptoms was more likely to be insidious and alternative sources of healing were less likely to be approached. CONCLUSIONS: These findings are discussed in relation to the findings for white patients and recommendations made for future research.

Adult↗

PubMed1999

Fertility and marital rates in first-onset schizophrenia.

BACKGROUND: Many studies have demonstrated that in schizophrenia there are decreased rates of marriage, fertility and marital fertility. However, it is not clear whether this finding occurs as a social consequence of having the illness or is an inherent part of the illness. One would expect it to vary across cultures if it were being mediated by social and cultural factors. METHOD: We investigated this by reviewing the marital and fertility data from a multi-ethnic first-contact group of patients in London with CATEGO broadly defined schizophrenia, and comparing this with similar data from a group of controls who were matched for age, gender and ethnicity. RESULTS: Our sample comprised 38 White British, 38 Caribbean and 24 Asian subjects. The Asian group were significantly older (mean age 38, P < 0.003) and had a greater percentage of females (50%). When compared to controls, the White and Caribbean patients, but not the Asians, had decreased marital and stable relationship rates. There was also decreased fertility and marital fertility as evidenced by number of children among the Whites and Caribbeans, but again significantly not among the Asians. Marital status did not predict fertility rates, particularly among the Caribbeans. Regression analysis demonstrated an effect for age on the number of children but not on marital status. CONCLUSIONS: These findings suggest that marital and reproductive behaviour are reduced in schizophrenia, but this effect may be mediated by social and cultural factors and therefore not apply consistently across ethnicity. Further research is needed to prospectively investigate populations to determine whether impairments of this nature are inherent or consequential to the illness.

Adolescent↗

PubMed1999

Relatives' expressed emotion and the course of inflammatory bowel disease.

Thirty-one relatives of inflammatory bowel disease (IBD) patients referred to a specialist unit were assessed with the Camberwell Family Interview, and ratings of expressed emotion (EE) were made. These relatives were significantly less critical than relatives of psychiatric patients in previous studies (p<0.001). Outcome was assessed over a 12-month follow-up period by a clinician blinded to the EE ratings. Most patients in this study had a poor outcome, and 11 (38%) needed surgery. A significantly higher proportion of patients with low EE relatives were in the surgery outcome group (p = 0.02). Excluding the surgery group, there was a nonsignificant trend for patients with high EE relatives to have a worse outcome. Patterns of response suggested better tolerance by relatives of the more ill patients. In the group overall there was no relationship between psychiatric status and physical health, either initially or at follow-up. There was considerable agreement among relatives as to the "typical" IBD personality. A number of key findings concerning the IBD patient, patterns of relatives' EE, and how they relate to the course of the illness remain to be verified by more systematic assessment.

Adult↗

PubMed1999

The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population.

BACKGROUND: African-Caribbean patients have less desirable routes of entry into the psychiatric services than other ethnic groups in Britain but this may not apply to the first contact with services. METHODS: Patients' pathways to care, type of admission or referral and sectioning details were recorded for all first contact patients presenting to south London psychiatric services over a 2-year period. We also conducted a retrospective analysis of data from the Camberwell Register, comparing rates of compulsory admission between 'Whites' and 'African-Caribbeans' for first and readmissions, over a 20-year period. RESULTS: Our first contact sample comprised 38 White, 38 African-Caribbean and 24 Asian patients with CATEGO defined broad schizophrenia. GP referral was found to be the most common mode of contact and there were no significant differences between the ethnic groups with regard to compulsory admission. Similarly, data from the Camberwell Register showed no significant difference in rates of compulsory admission between first admission White and African-Caribbean patients. However, when all readmissions were examined, African-Caribbeans were more likely to be admitted involuntarily. CONCLUSIONS: Our findings suggest that reports of less desirable routes of entry for African-Caribbean patients into the psychiatric service do not apply to their first admission but are likely to develop over time and repeated contact with the services.

Adolescent↗

PubMed1999

Social factors and first onset schizophrenia among Asians and whites.

Previous studies from the Indian subcontinent had suggested that the onset and outcome of schizophrenia is linked with social factors. We set out to study the inception rates and social factors in whites and Asians who were presenting for the first time ever to various catchment facilities in Ealing catchment area. A total of 62 cases (38 white and 24 Asians) were diagnosed as having schizophrenia. Using well established and previously validated standardised instruments we collected information on various social factors and inception rates of schizophrenia. The inception rates and social factors were largely similar in these two groups. By and large the social factors in the two groups were broadly similar except that Asians were significantly more likely to show increased religious activity compared with their white counterparts. Contrary to previous findings Asians were more likely to have had longer duration of symptoms prior to seeking help. These findings are discussed in relation to Asian support systems and suggestions made for future research.

Adult↗

PubMed1999

First-contact incidence rate of schizophrenia on Barbados.

BACKGROUND: The incidence rate for broad schizophrenia among second-generation African-Caribbean people in the United Kingdom has been reported as high. Ethnicity, migration and psychosocial stressors have been suggested as causal factors. AIMS: To determine the incidence of schizophrenia for the whole population of Barbados using an identical methodology to two previous studies in Trinidad (Bhugra et al, 1996) and London (Bhugra et al, 1997). METHOD: A 12-month study of all persons in the 18-54-year age group presenting with a psychosis for the first time was carried out on the population of Barbados. Information was collected using World Health Organization screening and measurement instruments. RESULTS: On an island of just over a quarter of a million, 40 out of the 53 patients that met the inclusion criteria were categorised as S+ (narrow) schizophrenia, giving an incidence rate of 2.8/10,000 (95% CI 1.97-3.7). The incidence rate for broad schizophrenia was calculated at 3.2/10,000 (95% CI 2.3-4.1), which is significantly lower than the comparable rate for London's African-Caribbeans of 6.6/10,000 (95% CI 4.5-8.7). CONCLUSIONS: The very high rate for broad schizophrenia among African-Caribbean people in the UK is probably due to environmental factors.

Adolescent↗

PubMed1999

An investigation of shame and guilt in a depressed sample.

A self-report measure of proneness to shame and guilt was administered to 86 patients with moderate to severe depression, with the prediction that there would be a positive correlation of shame with severity of depression. Contrary to other, non-clinical studies, we found that guilt but not shame was associated with levels of depression. Shame-proneness demonstrated a unique association with a stable attributional style for negative outcomes, global negative self-evaluation, submissive behaviour and internalized anger. Contrary to prediction, no relationship was found between shame- or guilt-proneness and a reported history of childhood sexual abuse.

Adult↗

PubMed1998

The Taps Project 40: quality of care provisions for the elderly mentally ill--traditional vs alternative facilities.

The study evaluates some aspects of care reprovision for psychogeriatric patients. Seven hospital wards are compared with four community settings, established as part of the reprovision programme for Friern Hospital in London. Each facility was assessed for policy and programme, social climate and physical characteristics; staff attitudes in regard to their tasks, training needs and job satisfaction were also explored. Community settings were superior to hospital wards in providing more privacy for the residents and were better equipped with physical amenities and safety features. There were relatively small differences between the way staff perceived the social climate in community homes and in hospital. The former were regarded as encouraging greater independence. Care staff in the hospital were more likely to express dissatisfaction with pay, working conditions and social status, while community staff were more dissatisfied with the quality of cooperation between staff members. Clients transferred to Social Services facilities had a higher level of functioning and needed less on-site medical care. This was further reflected by the lower frequency of nursing care tasks being performed by staff in community facilities. Overall, the shift towards a less medical model of care in community-based homes appears to be beneficial to psychogeriatric patients, provided that current and prospective physical needs of the residents are adequately addressed.

Attitude of Health Personnel↗

PubMed1998

The TAPS project 32: social networks of two group homes ... 5 years on. Team for the Assessment of Psychiatric Services.

Long-stay psychiatric patients discharged to two group homes from Friern Hospital were studied 1 year and 5 years after discharge. A much greater cohesiveness of social relationships was noted in the smaller home at both time points, whereas in the larger home residents had failed to develop friendships and intimacy within their social group. A number of hypotheses were explored to explain this difference. None of the factors investigated provided an explanation, including the mental state of the patients prior to discharge, their problems of social behaviour, the size of the group homes, whether they were staffed or unstaffed, and the patients' age. However, the development of friendships and intimacy over a 5-year period was strongly determined by the quality of the patients' social networks while in hospital. Consequently, when selecting groups of patients to share homes in the community, it is deemed advisable to form groups that fully reflect the range and diversity of their social networks.

Age Distribution↗

PubMed1998

The TAPS Project 41: homes for life? Residential stability five years after hospital discharge. Team for the Assessment of Psychiatric Services.

This paper describes pathways followed by 567 long-stay patients who were resettled into the community, as part of a program to close two psychiatric hospitals in London and replace them with community-based services. Sixty-one percent of the former patients remained in their original placement--mostly group homes--over the five-year follow-up. Transition from one house to another mostly took a direct course, with only 27 patients changing houses by way of long intermediate hospitalisation. Change of residence was at the same level of support, with only a slight trend towards less supervised facilities. Ten patients could not be traced and have possibly become homeless. Only 3 patients were in prison during the five-year follow-up. More than a third of the sample were readmitted at least once during that period. It is concluded that community residences established under the resettlement program served as relatively stable homes for the majority of patients.

Adult↗

PubMed1998

The TAPS Project 42: the last to leave hospital--a profile of residual long-stay populations and plans for their resettlement. Team for the Assessment of Psychiatric Services.

This study aims to assess the service needs of residual hospital populations and the adequacy of the alternative facilities provided for them following the closure of psychiatric hospitals. The remaining 368 long-stay patients in four representative English hospitals scheduled for closure within 1 year were assessed by means of a standardized schedule devised to rate problem behaviours. The residual populations consisted predominantly of elderly, male and very long-stay patients. The most frequent problem behaviours were hostility, physical aggression and incontinence. The one hospital which allowed new admissions to continue indefinitely had the highest proportion of problematic patients. Alternative care facilities were provided by a diverse range of agencies. Large residential homes were the predominant type of provision for most patients, and private nursing homes often accommodated mixed groups of elderly people. NHS trusts catered for most of the 'difficult to place' patients within specialized facilities, based in the community. There were some indications that compromises led to insufficient and understaffed specialist facilities. In view of the increasing demand for long-term intensively staffed facilities, this policy might put an extra burden on the local health services.

Adult↗

PubMed1997

Cognitive impairment in geriatric chronic schizophrenic patients: a cross-national study in New York and London.

Severe cognitive impairment has been reported in large numbers of geriatric chronic schizophrenic patients in the US, with this impairment also being related to severe negative symptoms and adaptive deficits. It is not clear if this impairment is related to the particular environment of the American state hospitals and would not generalize to other countries. In this study, a sample composed of geriatric (age > 70) chronic schizophrenic patients in London, who were assessed by the Team for Assessment of Psychiatric Services (TAPS) (N = 137), and a group of geriatric chronic schizophrenic patients in a New York psychiatric center (N = 86) were compared for the severity of cognitive impairment and on measures of adaptive functioning. Patients received essentially identical Mini-Mental State Examination (MMSE) scores, but differed on 3/4 measures of adaptive functioning. The correlations among all four aspects of adaptive deficit and MMSE scores were very similar in the two samples, suggesting that cognitive deficits and their relationship with adaptive impairments are relatively invariant across different psychiatric systems of care, while adaptive functioning deficits are more variable and possibly more influenced by environmental factors. These data add to previous results suggesting that cognitive impairment is a common feature in poor outcome geriatric patients with schizophrenia.

Aged↗

PubMed1997

Incidence and outcome of schizophrenia in whites, African-Caribbeans and Asians in London.

BACKGROUND: Several previous studies have indicated high rates of schizophrenia in African-Caribbeans in the UK compared to White population. METHOD: All people aged 18 to 64 years residing in two health districts in London who made contact with hospital or community services over a 1-year (Whites) or 2-year (ethnic minorities) period were screened for psychotic symptoms. RESULTS: One hundred and twenty-three patients passed the screen, of whom 100 were assigned a schizophrenic class by the CATEGO program. Of these, 38 were White, 38 African-Caribbean and 24 Asian. The incidence rate for broad schizophrenia was significantly higher for African-Caribbeans than for Whites. Asians showed a high rate among people age 30 and over, particularly women. Poor outcome at 1-year follow-up was significantly more common for African-Caribbeans than for the other two groups. The proportion of African-Caribbeans with a poor outcome was two and a half times greater than that of Whites. On a range of seven socio-demographic variables, African-Caribbeans differed from the other two groups only on unemployment. CONCLUSIONS: A multitide of factors play a role in the aetiology of schizophrenia. Comparison of environmental factors in these groups may identify factors that contribute to the aetiology of schizophrenia.

Adolescent↗