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Biomedical subjects

Morven Leese

Publications and source records attributed to Morven Leese.

At least 37 records · Page 2Linked to original sources
PubMed2005

Needs and quality of life among patients with schizophrenia in five European centres: what is the impact of global functioning scores?

BACKGROUND: Global assessment of functioning, quality of life (QOL) and patient needs have been discussed as inter-related domains important for care planning and outcome assessment in care for the severely mentally ill. The study was conducted to investigate relationships of functioning level, subjective QOL and unmet needs in a cross-sectional study of 404 patients with schizophrenia spectrum disorders in five European centres with a focus on the patient group with low function scores. METHODS: Patient groups with low, medium and high function scores were compared with regard to subjective QOL and unmet needs. QOL variability was assessed in subgroups according to function scores. Regression analyses were used to examine the impact of illness-related and other unmet patient needs on QOL. The influence of individual needs in the low and medium/high function score subgroup was compared. RESULTS: QOL increased and unmet needs decreased from the low to high function score subgroup. There was greater QOL variability in patients with low function scores compared to those with medium and high function scores, with some low-function score patients having relatively high QOL. In the low function score subgroup, both illness-related and other needs had an impact on QOL, whereas non-illness needs influenced QOL in medium and high function score patients. CONCLUSION: Scores of functioning level, in people with schizophrenia spectrum disorders, are related to QOL in a complex way, and types of unmet need impinge on the relationship. In order to improve QOL in people with low function scores, both illness-related and other needs should be met.

Adult↗
PubMed2005

A comparison of two methods of collecting economic data in primary care.

BACKGROUND: There have been few attempts to assess alternative methods of collecting resource use data for economic evaluations. OBJECTIVE: This study aimed to compare two methods of collecting resource use data in primary care: GPs' case records and a self-complete postal questionnaire. METHODS: 303 primary care attenders were sent a postal survey, incorporating a questionnaire designed to collect service utilisation information for the previous six months. Data were also collected from GP case records. The reporting of GP visits between the two methods, and estimates of costs associated with those visits, were compared. RESULTS: There was good agreement between the number of GP visits recorded on GP case records (mean 3.03) and on the CSRI (mean 2.99) (concordance correlation coefficient = 0.756). In contrast, estimates of average costs of visits from CSRI data were higher and had greater variance compared to case record-based costs (54.63 pound sterling versus 42.37 pound sterling; P = 0.003). This may be explained by differences in average visit length (11.66 versus 9.36 minutes). CONCLUSIONS: This study shows good agreement between GP case records and a self-complete questionnaire for the reporting of GP visits. However, differences in costs associated with those visits arose due to differences in the method used for calculating length of visit.

Adolescent↗
PubMed2005

Perceived coercion at admission to psychiatric hospital and engagement with follow-up--a cohort study.

BACKGROUND: Measures of perceived coercion at psychiatric hospital admission have been developed. We aimed to investigate predictors of perceived coercion in subjects admitted to psychiatric hospital in the UK, and to test the hypothesis that high perceived coercion at admission predicts poor engagement with community follow-up. METHOD: A cohort of consecutively admitted subjects were interviewed at admission and before discharge, and were followed prospectively for 10 months. Service use and compliance with care were rated from case notes and by clinicians. RESULTS: One hundred interviews were obtained from 118 consecutive admissions (85%). Compulsory admission was strongly associated with perceived coercion, but one-third of voluntary patients felt highly coerced, and two-thirds were not certain they were free to leave hospital. Greater age, less insight, and non-white ethnicity were associated with high perceived coercion. Perceived coercion did not predict engagement with follow-up. CONCLUSIONS: Services recognise provision of care in the least restrictive setting as a key objective. Perceived coercion should be regarded as an important outcome measure in service evaluation.

Adult↗
PubMed2005

Routine use of mental health outcome assessments: choosing the measure.

BACKGROUND: There is little consensus about which outcome measures to use in mental healthcare. AIMS: To investigate the relationship between the items in four staff-rated measures recommended for routine use. METHOD: Correlation analysis of total scores and factor analysis using combined data from the Health of the Nation Outcome Scales (HoNOS). The Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Threshold Assessment Grid (TAG) and the Global Assessment of Functioning (GAF) were performed. Procrustes analysis on factors and scales, and Ward's cluster analysis to group the items, were applied. RESULTS: The total scores of the measures were moderately correlated. The Procrustes analysis, factor analysis and cluster analysis all agreed on better coverage of the patients' problems by HoNOS and CANSAS. CONCLUSIONS: A global severity factor accounts for 16% of the variance, and is best measured with TAG or GAF. The CANSAS and HoNOS each provide a detailed characterisation of the patient; only CANSAS provides information about met needs.

Adult↗
PubMed2005

Patient-rated mental health needs and quality of life improvement.

BACKGROUND: Patient-rated unmet need is cross-sectionally associated with quality of life. Its longitudinal relationship has not been established. AIMS: To test the hypotheses that: (a) higher patient-rated unmet need is associated with lower individual quality of life assessments by a patient over time; and (b) reduction in patient-rated unmet need precedes improvement in quality of life. METHOD: One hundred and one individuals using adult mental health services were asked to complete 6-monthly questionnaires, comprising quality of life (Manchester Short Assessment of Quality of Life, MANSA) and unmet need (Camberwell Assessment of Need Short Appraisal Schedule, CANSAS) assessments. RESULTS: Seventy-three participants provided 240 separate pairs of consecutive assessments. Random effects regression models indicated an impact on current quality of life for both average level of unmet need (B= -0.23, 95% CI -0.29 to -0.17) and change in unmet need over the past month (B= -0.04, 95% CI -0.02). CONCLUSIONS: Changes in patient-rated unmet needs may cause changes in quality of life.

Adult↗
PubMed2005

Redeveloping secure psychiatric services for women.

Historically, a substantial proportion of women have been unduly detained in conditions of high security in England due to the lack of suitable alternative facilities. There have been no studies that have comprehensively examined the individual needs of these women in relation to their placement needs. A cross sectional survey was undertaken of the individual and placement needs of all females detained in the three high security psychiatric hospitals (HSPHs) in England on 18th October 1999. Whilst there are clearly differences in accommodation needs among the women, those requiring lower secure services are significantly less likely to have needs in relation to violence (OR 0.29, 95% CI 0.14-0.62) and drugs (OR 0.29, 95% CI 0.12-0.67) when length of stay is taken into account. They also have lower security, treatment and dependency needs than women still requiring HSPH treatment. A significant reorganisation of services is required. There is a need to gain further understanding of the relationships between traumatic histories, clinical presentation and antisocial behaviour and how these impact on assessed risk, treatment and care needs and outcome. The special needs of these women should be considered a priority when developing treatment and care packages.

Adult↗
PubMed2004

The psychosocial outcome of pregnancy in women with psychotic disorders.

OBJECTIVE: To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life. METHOD: Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996-1998 (199 cases and 787 controls). RESULTS: Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45-2.96, p<0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services. CONCLUSIONS: Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families.

Adolescent↗
PubMed2004

The personal impact of schizophrenia in Europe.

The personal impact of schizophrenia is poorly described in the scientific literature. The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) study compared representative treated prevalence cohorts of patients with schizophrenia in five European countries, to assess unmet needs, impact on caregivers, quality of life, satisfaction with services, symptoms and disability. Of the 404 patients, 79% undertook no work of any kind, and 65% were single. Low quality of life was associated with: anxiety, depression, psychotic symptoms, more previous psychiatric admissions, alcohol abuse, having no reliable friends nor daily contact with family, being unemployed, and having few leisure activities. The most frequently occurring unmet needs among the patients were: daytime activities, company and intimate relationships, psychotic symptoms, psychological distress, and information. The most common worries of relatives were about the patient's health, and their own future, safety and financial position. Psychiatric services were therefore largely ineffective in managing the personal impact of schizophrenia, especially upon work, home and family life. Research, clinical practice and disability policy developments need to address a wider range of consequences of the disorder than symptoms alone.

Activities of Daily Living↗
PubMed2004

Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial.

OBJECTIVE: To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment. DESIGN: Single blind randomised controlled trial, with randomisation of individual patients. The investigator was blind to allocation. SETTING: Eight community mental health teams in southern England. PARTICIPANTS: 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years. INTERVENTION: The joint crisis plan was formulated by the patient, care coordinator, psychiatrist, and project worker and contained contact information, details of mental and physical illnesses, treatments, indicators for relapse, and advance statements of preferences for care in the event of future relapse. MAIN OUTCOME MEASURES: Admission to hospital, bed days, and use of the Mental Health Act over 15 month follow up. RESULTS: Use of the Mental Health Act was significantly reduced for the intervention group, 13% (10/80) of whom experienced compulsory admission or treatment compared with 27% (21/80) of the control group (risk ratio 0.48, 95% confidence interval 0.24 to 0.95, P = 0.028). As a consequence, the mean number of days of detention (days spent as an inpatient while under a section of the Mental Health Act) for the whole intervention group was 14 compared with 31 for the control group (difference 16, 0 to 36, P = 0.04). For those admitted under a section of the Mental Health Act, the number of days of detention was similar in the two groups (means 114 and 117, difference 3, -61 to 67, P = 0.98). The intervention group had fewer admissions (risk ratio 0.69, 0.45 to 1.04, P = 0.07). There was no evidence for differences in bed days (total number of days spent as an inpatient) (means 32 and 36, difference 4, -18 to 26, P = 0.15 for the whole sample; means 107 and 83, difference -24, -72 to 24, P = 0.39 for those admitted). CONCLUSIONS: Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness. The reduction in overall admission was less. This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services.

Adult↗
PubMed2004

Demographic, clinical, social and service variables associated with higher needs for care in community psychiatric service patients. The South Verona Outcome Project 8.

BACKGROUND: Mental health services should be provided on the basis of need. This study investigated a representative sample of patients attending a community-based psychiatric service. The aim was to identify the profile of patients with higher needs for care, by considering a full range of potential demographic, clinical, social and service correlates. METHODS: A total of 268 patients using mental health services in South Verona, Italy, had cross-sectional assessments of their needs (using the Camberwell Assessment of Need), symptomatology, disability, functioning, quality of life, service use and satisfaction with care analysed using linear regression. RESULTS: A model comprising being male, being unemployed, having high symptomatology and disability, having low functioning and self-reported quality of life, and a high number of outpatient and community contacts accounted for 67% of the variance in total level of need. CONCLUSIONS: Patients who meet any of these criteria may be more likely to have higher needs, which has implications for clinical practice and audit. Assessment of needs for care by using the CAN provides a good overall measure of the number and the severity of a patient's problems in several key areas of everyday life.

Adolescent↗
PubMed2004

Effect of a medication management training package for nurses on clinical outcomes for patients with schizophrenia: cluster randomised controlled trial.

BACKGROUND: Non-compliance attenuates the efficacy of treatments for physical and mental disorders. AIMS: To assess the effectiveness of a medication management training package for community mental health nurses (CMHNs) in improving compliance and clinical outcomes in patients with schizophrenia. METHOD: Pragmatic randomised controlled trial. Sixty CMHNs in geographical clusters were assigned randomly to medication management training or treatment as usual. Each CMHN identified two patients on their case-load who were assessed at baseline and again after 6 months by a research worker. The primary efficacy outcome of interest was psychopathology, measured using the Positive and Negative Syndrome Scale (PANSS). RESULTS: Nurses who had received medication management training produced a significantly greater reduction in patients'overall psychopathology compared with treatment as usual at the end of the 6-month study period (change in PANSS total scores: medication management -16.62, treatment as usual 1.17; difference -17.79; 95% CI -24.12 to -11.45; P<0.001). CONCLUSIONS: Medication management training for CMHNs is effective in improving clinical outcomes in patients with schizophrenia.

Adult↗
PubMed2004

Exploratory cluster randomised controlled trial of shared care development for long-term mental illness.

BACKGROUND: Primary care clinicians have a considerable amount of contact with patients suffering from long-term mental illness. The United Kingdom's National Health Service now requires general practices to contribute more systematically to care for this group of patients. AIMS: To determine the effects of Mental Health Link, a facilitation-based quality improvement programme designed to improve communication between the teams and systems of care within general practice. DESIGN OF STUDY: Exploratory cluster randomised controlled trial. SETTING: Twenty-three urban general practices and associated community mental health teams. METHOD: Practices were randomised to service development as usual or to the Mental Health Link programme. Questionnaires and an audit of notes assessed 335 patients' satisfaction, unmet need, mental health status, processes of mental and physical care, and general practitioners' satisfaction with services and beliefs about service development. Service use and intervention costs were also measured. RESULTS: There were no significant differences in patients' perception of their unmet need, satisfaction or general health. Intervention patients had fewer psychiatric relapses than control patients (mean = 0.39 versus 0.71, respectively, P = 0.02) but there were no differences in documented processes of care. Intervention practitioners were more satisfied and services improved significantly for intervention practices. There was an additional mean direct cost of pound 63 per patient with long-term mental illness for the intervention compared with the control. CONCLUSION: Significant differences were seen in relapse rates and practitioner satisfaction. Improvements in service development did not translate into documented improvements in care. This could be explained by the intervention working via the improvements in informal shared care developed through better link working. This type of facilitated intervention tailored to context has the potential to improve care and interface working.

Adult↗
PubMed2003

Patients' perspectives on electroconvulsive therapy: systematic review.

OBJECTIVE: To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy. DESIGN: Descriptive systematic review. DATA SOURCES: Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. STUDY SELECTION: Articles with patients' views after treatment with electroconvulsive therapy. DATA EXTRACTION: 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. DATA SYNTHESIS: The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. CONCLUSIONS: The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.

Attitude to Health↗
PubMed2003

Referred to high secure care: determinants of a bed offer/admission and placement after one year.

BACKGROUND: The admission process to high secure care ought to ensure that those admitted (a) receive mental health care that meets their needs and (b) that this is provided at an appropriate level of security. AIMS: A study was undertaken to test the effectiveness of the gate keeping process according to these two criteria. METHOD All referrals for admission to Rampton high security hospital over one year were examined and, in addition, all women, all Anglo-Caribbeans and a random 50% sample of the Caucasian male majority were selected for interview. Each case was followed up for 12 months following the panel decision to determine his/her placement at that time. RESULTS: Of 138 referred, 56 (41%) were initially offered a bed although nearly half (66) had been subsequently admitted by the end of the study period. Seriousness of mental disorder and offence were independently associated with admission. After one year, one third of those admitted were no longer in high secure care. CONCLUSIONS: The variables predictive of admission (i.e. seriousness of both mental disorder and offence) suggest that the decision-making process was valid. Placement at 12 months tended to endorse the decision not to offer a bed, but it is more difficult to interpret the reverse as short admissions to high security for those who left within 12 months may have been appropriate. There was no apparent advantage in having a panel reviewing the decision of the assessing clinician.

Admitting Department, Hospital↗
PubMed2003

People with schizophrenia in five countries: conceptual similarities and intercultural differences in family caregiving.

The European Psychiatric Services: Inputs Linked to Outcomes and Needs (EPSILON) study was a EU BIOMED-2-funded comparative, cross-national, cross-sectional study aimed (1) to produce standardized versions of five key research instruments in five languages, and (2) to compare the characteristics, needs, and life qualities of people with schizophrenia and their caregivers in these five countries. One of the key instruments was the Involvement Evaluation Questionnaire (IEQ), an instrument to assess caregiving consequences. In this article, the intercultural validity of the IEQ is described. It was concluded that the IEQ covers the same caregiving domains in all five countries: interpersonal tension, worrying, urging, and supervision. Differences in score levels between countries were found. When adjusted for variables known to correlate with IEQ scores (patient, caregiver, and relationship), these differences still persisted. It could not be determined how far the remaining variation could be explained by site-level characteristics, because only limited site-level data had been collected. This means that researchers must still resolve the question of whether levels of caregiver consequences that cannot be explained by the data presented here are caused by cultural factors or by differences in mental health care provision. As long as cultural bias cannot be ruled out, researchers are advised to compose their own national norm groups and use these as a local standard.

Adolescent↗
PubMed2003

Characteristics of subgroups of individuals with psychotic illness and a comorbid substance use disorder.

OBJECTIVES: The co-occurrence of severe mental illness and substance use disorder, or dual diagnosis, is prevalent and is associated with significant clinical and social problems. Most studies have treated persons with a dual diagnosis as a homogeneous population, grouping together different substances of misuse. This study investigated whether subgroups defined by their main substances of misuse were heterogeneous. The primary hypothesis was that users of stimulants, such as cocaine or amphetamines, would be characterized by especially high rates of inpatient admission, violence, and self-harm. METHODS: Case managers' ratings were used to identify individuals with serious mental illness and comorbid substance abuse or dependence who were being treated by 13 community mental health teams in South London. Standardized instruments were used to elicit sociodemographic, clinical, social, and service use data. RESULTS: A total of 233 cases of comorbid substance use disorder and psychotic illness were identified. On the basis of best available information, 78 (34 percent) patients were classified as alcohol misusers only, 52 (22 percent) as alcohol and cannabis users, 29 (12 percent) as users of cannabis only, and 55 (24 percent) as stimulant users; 19 patients (8 percent) were excluded from the analysis. No significant differences were found between subgroups in the use of inpatient services and lifetime history of self-harm, but there was a significant difference in lifetime history of violence, which was more frequent among stimulant users. The alcohol users were older and more likely to be white, but otherwise few differences between subgroups were suggested by exploratory analyses. CONCLUSIONS: Apart from differences in history of violence, little heterogeneity was found among subgroups of patients with different types of substance misuse.

Adult↗