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Biomedical subjects

N Smeeton

Publications and source records attributed to N Smeeton.

26 records · Page 2Linked to original sources
PubMed1989

The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics.

Longitudinal studies of schizophrenia based on at least 70 subjects and a minimum five-year follow-up period are reviewed in respect of the requirements of adequate method. A cohort of 121, PSE-diagnosed, schizophrenic admissions from a defined population was identified. The sex-distribution of the subjects was almost equal. Forty per cent were first admissions; 65% of the men and 24% women were unmarried; the mean age of onset for men was 28.6 years, for women 33.2 years. Almost half (48%) were continuously employed (including house and child care) for 2 years prior to admissions. First rank symptoms of schizophrenia were present in 79% of the men and 86% of the women. Comprehensive, standardized assessments of clinical state and social function were made on discharge from hospital and at follow-up by home interview of patient and relative(s). Outcome was also assessed by duration and frequency of readmission and by duration of employment. First admissions were analysed separately from the whole cohort. There were 49 first admissions generating an incidence of 7.4 per 100,000 general population per annum. Sixty-nine per cent of men and 13% of women were unmarried. The mean age of admission for men was 30.8 years, women 40.3 years and the mean age of onset 30.7 and 38.6 respectively. After 5 years first rank symptoms were present in 46% of the males and 35% of the females. The proportion showing depressive symptoms fell from 39% at intake to 22% at five years. In terms of a combination of symptoms and readmissions there was a good outcome in 50% of men and 65% of women, a trend comparable to that found in the whole cohort. For the whole cohort a combination of the number of symptoms and admissions disclosed a good outcome for 48%. The mean total duration of readmissions during the five years for men was 76 weeks and for women 27 weeks. Depressive symptoms were present in 38% at intake and 21% after 5 years. An overall rating of social functioning at 5 years showed no more than mild impairment for 47% of men and 74% of women, although individual items were more impaired. However, 38% of the group showed no more than mild impairment in any aspect of social functioning rated. Clinical and social outcome were, in general, closely correlated. The difference in outcome between men and women and the relations between clinical and social outcome are discussed. By means of an application of measures of association between independent and dependent variables to the onset data the clinical and social categories of pathology and impairment at 5 years were forecast.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1988

Consultation for physical illnesses by patients diagnosed and treated for psychiatric disorders by a general practitioner: 20 year follow up study.

Patterns of consultation for physical illness were analysed in a body of consultation data covering a continuous 20 year period from a single general practitioner in south London. Three groups of adult patients were identified: patients with a psychiatric disorder and a new prescription for a psychotropic drug; patients with a psychiatric disorder but no new prescription for a psychotropic drug; and a control group without psychiatric disorder. The percentages of patients having one or more consultation for physical illnesses were stable over the years studied, being roughly 90%, 85%, and 60% respectively. For groups identified in 1972 their patterns of consultation for physical illness were examined in 1957, 1962, and annually from 1967 to 1976. In every year studied except 1957 the group with a psychiatric disorder and a new prescription for a psychotropic drug exceeded both other groups in the percentage of patients having one or more consultations for physical illnesses. Both groups with psychiatric disorders had an excess of consultations over the control group; this excess halved in about four years for the group with a new prescription and in about one year for the group without a new prescription. Mental health care by general practitioners for patients with psychiatric disorders does not seem to have an offset effect on general health care of these patients.

Adult↗
PubMed1988

Classification of mental disorder in primary care.

This monograph describes a study designed to test how far the two major international systems of disease classification, International Classification of Diseases (ICD) and International Classification of Health Problems in Primary Care (ICHPPC), can be consistently applied by General Practitioners (GPs) to mental disorder presenting in primary care, and to identify sources of observer variation occurring at different stages of clinical judgement. A group of 27 senior GPs was exposed to a series of real life general practice consultations, either in the form of videotape or written case-vignette material, chosen to reflect a wide range of minor psychiatric problems, differing not only in respect of phenomenology but also of their associations with social stresses and supports, physical illness and personality features. The findings clearly indicate that neither ICD nor ICHPPC can be applied consistently by GPs. However, while the overall diagnostic concordance using ICD and ICHPPC proved to be disappointingly low, agreement on individual observations relating to psychological, physical, personality and social features was moderately good. It was also noted that participants, when given the opportunity, tended to incorporate several domains into their diagnostic conclusions, aiming for a multidimensional formulation, to which neither ICD nor ICHPPC lend themselves. It is, therefore, not surprising that if the principal diagnostic schemata are neither adequate in themselves nor readily applicable to primary care, then GPs are more likely to resort to symptomatic treatment and evade diagnosis when confronted with minor psychiatric morbidity. The consequence of this approach for National Morbidity Surveys and drug trials are discussed. The historical development of multiaxial schemata of classification is briefly traced, the problems associated with DSM-III are discussed, and a comprehensive model of classification is proposed which incorporates the notions of severity and duration as well as of category on the four dimensions of psychological illness, social stresses and supports, personality and physical illness.

Adjustment Disorders↗
PubMed1988

The identification of clustering in parasuicide.

A straightforward test for detecting clustering in patterns of parasuicide in individual patients is described and applied to data from the Edinburgh Regional Poisoning Treatment Centre.

Adolescent↗
PubMed1985

A study of the classification of mental ill-health in general practice.

An outline is provided of an experimental study of the classification of mental ill-health presented to general practitioners (GPs). Videotaped real-life consultations were assessed by 27 GPs for the purpose. A high degree of inter-observer variation was recorded. Some of the implications of the findings are discussed.

Family Practice↗
PubMedDate not supplied

Coronary bypass grafting in South Thames: the correlation between clinical scores and waiting times.

To determine waiting times before surgery and their correlation with clinical need, we examined the files of 1049 patients on the waiting list for coronary bypass grafting in 1996. The total waiting time to bypass grafting was 279 (SD 209) days (range 1-1579 days). Waiting time to specialist consultation was 36 (SD 43) days, and time on the waiting list for coronary angiography was 85 (SD 89) days. The mean time on the surgical waiting list was 133 (SD 134) days. Patients with a Birmingham clinical score below 10 waited between 27 and 879 days, and patients with scores above 35 waited between 3 and 282 days. Total waiting time was weakly associated with the priority score (Pearson correlation = -0.51). We conclude that waiting times were long with wide variation at every stage between referral and coronary bypass grafting. There was little correlation between clinical scores and waiting times.

Adult↗