Biomedical subjects

J Leff

Publications and source records attributed to J Leff.

At least 37 records · Page 2Linked to original sources

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↗

PubMed1997

Aiding resocialization of the chronic psychotic patient.

One difficulty of moving the focus of care for the mentally ill from hospital to the community is that some patients with severe mental illness, who have been in hospital for a long time, are difficult to place in the community. The main problems that appear to be barriers to community-based care are aggressiveness and adverse sexual behaviour. New antipsychotics, such as risperidone, are likely to increase the proportion of patients who can be successfully placed in the community because the low liability for extrapyramidal symptoms will contribute to better compliance. A crucial aspect of the move to the community is the attitudes of neighbours. Studies show that the public is deterred from making contact with the mentally ill because they expect them to have inadequate communication skills. The public also expect bizarre behaviour and aggressiveness. However, the majority of those living near proposed new community homes would welcome the establishment of mental health facilities in their neighbourhood. A study of a public education campaign focussed on the neighbours of a sheltered home found that fear of the mentally ill was reduced and willingness to socialize with them was increased. This change in attitudes was reflected in increased social contact between patients and their neighbours. Therefore, attempts to open community homes for the mentally ill as unobtrusively as possible are likely to lead to more objections than if well constructed public education campaigns focussed on the neighbours are undertaken.

Community Mental Health Centers↗

PubMed1997

Expressed emotion and schizophrenia: the efficacy of a staff training programme.

The presence of expressed emotion (EE) in five community care facilities was investigated and levels of high EE were found in some staff-client relationships. A training programme was developed drawing on a variety of research findings and based on a successful community psychiatric nurse training package for work with families. Its aims were to enable community mental health workers to increase their knowledge about schizophrenia and repertoire of strategies for managing a variety of difficulties in addition to decreasing levels of EE present in their relationships with clients. A small but non-significant increase in knowledge was achieved, in addition to increases in the use of strategies aimed at effecting change and involving the use of resources. No significant changes in EE levels were reported.

Adult↗

PubMed1997

Increased rate of psychosis among African-Caribbeans in Britain is not due to an excess of pregnancy and birth complications.

BACKGROUND: It has been suggested that the increased rate of psychotic illness among African-Caribbeans living in Britain is due to an excess of pregnancy and birth complications (PBCs). METHOD: We therefore compared the frequency of PBCs in a group of White psychotic patients (n = 103) and a comparable group of patients of African-Caribbean origin (n = 61); the latter consisted of 30 first-generation (born in the Caribbean) and 31 second-generation (born in Britain) individuals. RESULTS: White psychotic patients were more than twice as likely to have a history of PBCs as their African-Caribbean counterparts (odds ratio = 2.34, 95% confidence interval (CI) 0.88-6.47, P = 0.062). The same trend was observed among patients with a DSM-III diagnosis of schizophrenia (odds ratio = 1.65, 95% CI 0.56-4.97, P = 0.32). The rate of PBCs was similar among the first- and second-generation Caribbean psychotic patients. CONCLUSIONS: The increased rate of psychotic illness that has been reported among the African-Caribbean population in Britain is not due to an increased prevalence of PBCs.

Adult↗

PubMed1996

TAPS project 28: does reprovision benefit elderly long-stay mental patients?

A survey of all inpatients aged 70 years or more was conducted in one of London's mental hospitals in 1989. Baseline measures of cognitive and behavioural disabilities were established for each of the 130 functionally-ill long-stay patients. Three years later 71 patients were still alive, being equally distributed between hospital and community facilities. The study examines the outcomes of patients who had left hospital in comparison with a similar group who remained there. The results indicate that behaviour of patients who were settled in the community was stable and even improved slightly over time, as opposed to those who remained in hospital, who became more disturbed. Direct examinations demonstrate that while those who remained in hospital markedly deteriorated in their cognitive function, patients who left hospital had also declined, but to a much lesser extent. When considering the overall outcomes, we come to recognise the potential for stabilization and even improvement in the condition of ageing schizophrenics being moved from hospital to the community.

Aged↗

PubMed1996

Factors affecting the success of community placement: the TAPS project 26.

Long-stay patients who were discharged from Friern and Claybury hospitals during the 6-year period between September 1985 and August 1991 were followed up for at least 1 year and the details of all readmissions were recorded. Of the 615 hospital leavers, some 178 (29%) were readmitted at some time during the follow-up period. A proportional hazards regression analysis revealed a number of independent baseline factors which affect the risk of readmission at any time during the follow-up period. Younger patients were more at risk of readmission than were older patients and 'new' long-stay patients had a greater risk than baseline patients. Risk was also greater in patients who had a larger number of pre-discharge admissions, a higher abnormal behaviour score (PSE BSO) or a diagnosis of manic psychosis. An ordinal logistic regression analysis revealed that these same five factors tended to increase the actual number of readmission episodes. The proportion of post-discharge time spent in hospital among the readmitted patients was found to be greater for males, new long-stay patients and for patients with a higher number of positive social behaviour symptoms (SBSPOS score).

Activities of Daily Living↗

PubMed1996

Difficult to place patients in a psychiatric hospital closure programme: the TAPs project 24.

A group of 72 long-term patients, who were retained in Friern Hospital until the final stage of its closure programme, underwent a comprehensive psychiatric and social assessment shortly before moving to other hospitals. These patients were then compared with the rest of the long-stay patients who were considered suitable for community placement. The residual group consisted of younger patients with shorter duration of stay, compared with the rest of the hospital population. Although not excessively disabled functionally or physically, the residual patients were slightly more disturbed in mental state in comparison with the rest, with notably higher levels of subjective anxiety. A range of 13 problem behaviours were designated by staff as a direct impediment to placing a patient in a community setting. Most common problem areas were aggressiveness, non-compliance with medication and inappropriate sexual behaviour. Fourteen per cent of the residual group had none of these special problems. Some other patients have remained in hospital solely because they refused to leave. It is argued that a distinction should be made between the residual patients who were actually transferred to other hospitals, and a core group of extremely disturbed patients for whom further hospitalization is likely to be the only alternative.

Hospitalization↗

PubMed1996

Team for the Assessment of Psychiatric Services (TAPS) Project 33: prospective follow-up study of long-stay patients discharged from two psychiatric hospitals.

OBJECTIVE: The purpose of this study was to evaluate the policy of closing psychiatric hospitals and replacing their functions with community-based services. METHOD: All long-stay nondemented patients in two U.K. hospitals scheduled for closure were assessed with a series of schedules. All patients in one hospital and a proportion of those in the other hospital were reassessed 1 year after discharge to community facilities. RESULTS: Of the 737 patients discharged from the two hospitals, 24 died before follow-up, two by suicide. Follow-up was successful for 94.6% of the survivors. Only seven patients were lost to follow-up and are presumed to have become homeless. Only two patients went to prison, one briefly. There was very little change in patients' psychiatric symptoms or social behavior problems. The community homes provided a much less restrictive environment than the hospital wards. Discharged patients were very appreciative of their increased freedom, and over 80% wished to stay in their community homes. There was an increase in the proportion of patients with incontinence and immobility. The patients' social lives were enriched by an increase in friends, and some made contact with neighbors and others in the community. However, there was a decrease in contact with relatives following discharge. CONCLUSIONS: When the capital and revenue resources of a psychiatric hospital are reinvested in community services, based on staffed houses, there are few problems with crime or homelessness. With such well-resourced services, the benefits greatly outweigh the disadvantages for both old and new long-stay patients.

Attitude to Health↗

PubMed1996

Quality of life of long-stay patients discharged from two psychiatric institutions.

OBJECTIVE: The study compared the quality of life of long-stay psychiatric patients after they had been discharged to community residences for one year with that of long-stay patients who remained hospitalized. METHODS: Long-stay patients (that is, those with stays of at least one year) who were discharged from two psychiatric hospitals in London were closely matched with patients likely to stay in the hospital for another year. Baseline (in-hospital) and one-year follow-up assessments were conducted using six instruments to measure factors related to quality of life such as problems in social functioning and size of the social network. RESULTS: A total of 494 discharged patients were compared with 279 patients who remained in the hospital. The death rate did not differ between the two groups. Only six discharged patients became vagrants, and only two were imprisoned, one briefly. Discharged patients were living under much less restrictive conditions, they preferred their life in the community, and the number of their friends increased, as did the number of acquaintances in the community such as neighbors. No adverse effects of discharge on mental state or social behavior were noted. CONCLUSIONS: The results indicate that community care is a beneficial alternative to long-term care in psychiatric hospitals for the majority of patients, provided it is well planned and adequate resources are available.

Activities of Daily Living↗

PubMed1996

Community attitudes to mental illness.

BACKGROUND: The baseline findings from a controlled study of the effect of a public education campaign on community attitudes to mental illness are presented. METHOD: A census of attitudes to mental illness was conducted in two areas, prior to the opening of supported houses for the mentally ill. Factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory revealed three components: Fear and Exclusion, Social Control and Goodwill. RESULTS: The only determinant of Fear and Exclusion was having children. The main determinants of Social Control were social class, ethnic origin, age, having suffered mental illness and having children. The main determinant of Goodwill was educational level. The attitude factors were predictive of respondents' behavioural intentions toward the mentally ill. Respondents with children and non-Caucasians were more likely to object to the mentally ill living in their neighbourhood. CONCLUSIONS: Any intervention aimed at changing attitudes to mentally ill people in the community should be targeted at people with children and non-Caucasians, as these groups are more likely to object.

Adolescent↗

PubMed1996

Community knowledge of mental illness and reaction to mentally ill people.

BACKGROUND: We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge. METHOD: A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness. RESULTS: Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account, age had no effect on Social Control, and the effect of social class and ethnic origin was diminished. Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness. CONCLUSIONS: The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.

Adolescent↗

PubMed1996

Public education for community care. A new approach.

BACKGROUND: The findings from a controlled study of the effect of a public education campaign on community attitudes to mentally ill people are presented. METHOD: A census of neighbours' attitudes toward mental illness was conducted in two areas before the opening of supported houses for the mentally ill. In one area an educational campaign was conducted. The attitude survey was then repeated in both areas and patients' social contact with neighbours was recorded. RESULTS: Respondents exposed to the didactic component of the campaign showed only a small increase in knowledge about mental illness but there was a lessening of fearful and rejecting attitudes in the experimental area and not in the control area. Neighbours in the experimental area were more likely to make social contact with both staff and patients. It was social contact which was directly associated with improved attitudes rather than education per se. Patients in the experimental area made contact and even friendships with neighbours whereas those in the control area did not. CONCLUSIONS: The public education campaign did not lead to significant change in neighbours' knowledge of mental illness. However, their attitudes improved and patients' social integration was enhanced.

Activities of Daily Living↗

PubMed1996

The TAPS project. 36: the most difficult to place long-stay psychiatric in-patients. Outcome one year after relocation. Team for the Assessment of Psychiatric Services.

BACKGROUND: The clinical and social outcomes were evaluated of "difficult to place" (DTP) patients discharged from hospital to alternative facilities. METHOD: In the course of a reprovision programme for a psychiatric hospital, 72 long-stay patients were considered to be too problematic to live within the usual range of community placements. Their clinical and social state was assessed shortly before the hospital closed. Severe, persistent behavioural problems were recorded for each subject at baseline. One year after being relocated, patients were reassessed. RESULTS: Clinical and social measures were stable over time. The profile of severe behavioural problems changed over time, with one-third of the total problems subsiding and a similar number of new problems emerging. There was a significant reduction in physical aggression. One of the settings provided an environment as free of restrictions as the usual community homes. CONCLUSIONS: The most difficult patients to reprovide for can be contained in a relatively non-restrictive care environment. There is some indication that aggressive behaviour can improve, raising the possibility that some DTP patients can move on to the usual community homes.

Activities of Daily Living↗

PubMed1996

First-contact incidence rates of schizophrenia in Trinidad and one-year follow-up.

BACKGROUND: Incidence rates of schizophrenia among UK African-Caribbeans have been reported as high. Various explanations including selective migration and genetic vulnerability have been proposed. METHOD: In one calendar year, all new cases of psychosis presenting to various psychiatric services in two clearly defined geographical catchment areas in Trinidad-one in the rural south and the other an urban area-were studied. Standardised diagnostic instruments were applied and information collected using WHO screening and measurement instruments. RESULTS: A total of 56 cases were collected, giving an incidence rate of 2.2/1000 of broad schizophrenia with a rate of 1.6 for S+ schizophrenia. CONCLUSION: These rates are similar to those from the WHO study in Honolulu and Aarhus, and much lower than the rates for African-Caribbeans in London. The cases were followed up for one year and the poor outcome rate for schizophrenia was 19%. The findings are discussed in a cross-cultural context and suggestions for future research made.

Adult↗

PubMed1996

Morbid risk of schizophrenia in first-degree relatives of white and African-Caribbean patients with psychosis.

BACKGROUND: The high rate of schizophrenia among the second-generation African-Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African-Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients. METHOD: We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African-Caribbean psychotic probands. The latter comprised 35 first-generation (born in the Caribbean) and 38 second-generation (born in Britain) probands. RESULTS: The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African-Caribbean patients, and for the parents of the second-generation African-Caribbean probands. However, the siblings of second-generation African-Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P = 0.007); similarly, the siblings of second-generation African-Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P = 0.05). CONCLUSIONS: These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African-Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.

Adult↗