Biomedical subjects

T Wykes

Publications and source records attributed to T Wykes.

At least 19 recordsLinked to original sources

PubMed1995

The social disablement of men in hostels for homeless people. I. Reliability and prevalence.

BACKGROUND: Studies of mental health problems of homeless people have used diagnosis as the sole measure of these problems. In this study, the feasibility and reliability of measuring social disablement in the psychiatric assessment of homeless people was investigated. METHOD: A random sample of 101 homeless men living in four long-stay hostels were assessed for their social disablement by the Social Behaviour Schedule (SBS). The prevalence of SBS problems in these men and the interobserver reliability were assessed. RESULTS: The results show that the SBS is a reliable screening instrument which is relatively easy to use. The most frequent SBS problems were 'Other problems', 'Hostility' and 'Depression". Less than 10% of the hostel sample had disablement items similar to those of patients in long-stay wards. CONCLUSIONS: The SBS is a useful and reliable tool in the psychiatric assessment of men in hostels for the homeless.

Activities of Daily Living↗

PubMed1995

The social disablement of men in hostels for homeless people. II. A comparison with patients from long-stay wards.

BACKGROUND: Some authors have argued that hostels for homeless people are increasingly taking over the role of psychiatric long-stay wards, and that this creates a problem. We set out to test this hypothesis. METHOD: The social disablement of a random sample of 101 homeless men, described in Part 1, was compared with that of a sample of 66 psychiatric patients from a long-stay ward. RESULTS: The study sample rated significantly lower for social disablement than the long-stay ward sample. Thirteen subjects of the hostel sample had psychotic social behaviour problems. These had no history of being long-stay psychiatric patients. CONCLUSIONS: The hostel sample differ significantly in their social disablement from the chronic psychiatric patients. There is a small proportion of severely disturbed residents who might have been over-represented in previous non-random surveys.

Activities of Daily Living↗

PubMed1995

The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness.

BACKGROUND: People with severe mental illness often have a complex mixture of clinical and social needs. The Camberwell Assessment of Need (CAN) is a new instrument which has been designed to provide a comprehensive assessment of these needs. There are two versions of the instrument: the clinical version has been designed to be used by staff to plan patients' care; whereas the research version is primarily a mental health service evaluation tool. The CAN has been designed to assist local authorities to fulfil their statutory obligations under the National Health Service and Community Care Act 1990 to assess needs for community services. METHOD: A draft version of the instrument was designed by the authors. Modifications were made following comments from mental health experts and a patient survey. Patients (n = 49) and staff (n = 60) were then interviewed, using the amended version, to assess the inter-rater and test-retest reliability of the instrument. RESULTS: The mean number of needs identified per patient ranged from 7.55 to 8.64. Correlations of the inter-rater and test-retest reliability of the total number of needs identified by staff were 0.99 and 0.78 respectively. The percentage of complete agreement on individual items ranged from 100-81.6% (inter-rater) and 100-58.1% (test-retest). CONCLUSIONS: The study suggests that the CAN is a valid and reliable instrument for assessing the needs of people with severe mental illness. It is easily learnt by staff from a range of professional backgrounds, and a complete assessment took, on average, around 25 minutes.

Adult↗

PubMed1994

Global function scales.

There is a close relationship between impairment of global functioning and mental illness. However valid measurement of global functioning is difficult, and there is no perfect scale. The instruments reviewed in this paper illustrate a range of different approaches. Despite the inherent difficulties the measurement of functioning is a critical domain in mental health evaluative research.

Activities of Daily Living↗

PubMed1994

Violence in psychiatric hospitals: are certain staff prone to being assaulted?

The study reported here investigates (a) whether certain staff in psychiatric hospitals are more prone to being assaulted; (b) whether such proneness can be defined in terms of fixed attributes of these individuals (e.g. sex, personality); and (c) whether staff and patients with certain attributes are regularly combined in violent incidents. The characteristics of 65 nurses and 22 patients involved in 100 consecutive violent incidents were examined. A quarter of hospital staff were assaulted over 3 months but few were assaulted repeatedly. Those who were assaulted more than once were usually assaulted by the same patient, indicating problematic relationships rather than problematic individuals. Only two variables (age and grade) varied significantly between the assaulted and control group staff. It is argued that future research should focus on staff and patient behaviour in violent incidents rather than the characteristics of each.

Adult↗

PubMed1994

An observational study of associations between nurse behaviour and violence in psychiatric hospitals.

A cyclical model of violence to psychiatric nurses is proposed in this paper and a partial test of the model is reported. The model suggests that stress induced by exposure to violence leads to impaired staff performance and adoption of behaviours which make the re-occurrence of violence more likely. We tested the proposal that certain staff behaviours (e.g. expressing verbal hostility) are associated with an increased risk of assault by observing nurse-patient interaction on 12 psychiatric wards (n = 103 nurses). The verbal and physical interaction of (1) assaulted staff, (2) staff on violent wards, and (3) staff in grades which experience high levels of assault, were compared with those of respective low risk groups. There was some evidence of an association between interaction patterns and violence. We conclude this paper by discussing the implications of the model for psychiatric nursing practice.

Female↗

PubMed1994

Predicting symptomatic and behavioural outcomes of community care.

BACKGROUND: Many studies of community care show little overall improvement in patient functioning. This study investigated whether cognitive impairment mediates the effect of the increased opportunities offered by the community. METHOD: Behaviour, symptoms, sociodemographic variables and information processing of a random sample of chronic psychiatric patients were examined. Six years later, social and behavioural outcomes were measured. RESULTS: The overall change in the group was negligible. Individual variation can be accounted for by two factors: time since transfer to the community, and initial information processing problems. Patients transferred for at least three years showed significant improvements. Schizophrenic patients without information processing problems improved, but those with deficits got worse. CONCLUSIONS: The identification of mediating factors should allow better rehabilitation plans, and alleviate the toxic effects that transfer has on some patients' functioning.

Chronic Disease↗

PubMed1993

The homeless mentally ill: myths and realities.

This literature review summarises the historical background of homelessness. It suggests that the current view of homeless people as chronic mentally ill is the latest phase in a series of the different ways in which society has perceived and labelled the homeless. We have argued that homelessness is a product of the lack of housing provision to the poorest section of society and that the psychiatric needs of many of the homeless might be a direct result of poverty and homelessness. This review also highlights difficulties in interpreting data produced by surveys of homeless people. These difficulties include the multiple definitions of homelessness used and also the major methodological errors which limit the usefulness of their findings. In particular sampling methods used may have overestimated the more visible part of the homeless population, overestimating the levels of psychiatric morbidity. Even if these limitations are ignored the data produced by these studies do not allow planning of effective mental health services for homeless people as their results depend mainly on diagnostic classification rather than disability or need. What is required is a study of needs where the appropriateness of particular services is defined, the sampling method is explicit and the definitions of homelessness are precise and consistent.

Cross-Cultural Comparison↗

PubMed1993

Stress incubation and the onset of affective disorders.

Incubation is the process by which life events influence the onset of psychiatric disorder after an appreciable delay. It has long been recognised clinically. In this paper we use data from the Camberwell Collaborative Depression Study to see whether incubation effects can be demonstrated in depressive illness. We used a novel adaptation of survival analysis for this purpose. The results suggest that incubation does occur in depressive disorder, that it is much less important than the effect of life events close to onset, that it is apparent in women but not in men, and that it is no more evident preceding endogenous than neurotic symptom patterns.

Adaptation, Psychological↗

PubMed1992

Cognitive deficit and the prediction of rehabilitation success in a chronic psychiatric group.

This paper describes the second stage (years 4, 5 and 6) of a prospective follow-up of a sample of chronic patients which was designed to investigate the in service use. It also tested the relative predictive power of variables which included demographic, symptomatic and behavioural factors as well as a novel reaction time variable which reflects response processing time. During the six years of the study 91% of the patients in the sample changed either the degree of their day and/or night care. Many moved to more independence but, a number did also become more dependent on psychiatric services. There were no differences in outcome between a schizophrenic group and patients with other diagnoses. These results suggest a level of flexibility in outcome even in a severely disabled chronic group. The main predictor of future service use at each stage of the follow-up for the whole group was chronicity at entry to the study. But, when the group was divided into schizophrenic patients and 'others', the response processing measure was a significant predictor of service use in the schizophrenic group and accounted for between 17% and 30% of the variance. For the 'other' diagnostic group, the age of the patient seemed to be the major determinant of care. The reaction time variable seems to be an extra class correlate of a strict diagnosis of schizophrenia. It may also be a stable or episodic vulnerability factor, but as well as these promising hypotheses, which have yet to be justified, this measure does seem to have pragmatic value in predicting outcome in a rehabilitation network.

Activities of Daily Living↗

PubMed1992

Staff strain and social support in a psychiatric hospital following assault by a patient.

Attacks by patients are acknowledged as an important source of stress for psychiatric staff which has ramifications for patients and the nurses' employers as well. Twenty-three psychiatric nurses and one doctor who had been assaulted by a patient at work were interviewed within 72 hours of the incident and twice more within 2 weeks. The levels of strain they experienced and the amount of support provided for them in the time between interviews were measured and correlated. Some subjects reported high levels of strain which persisted well beyond the incident. Support was usually provided on an informal basis and was concentrated in the period immediately after the incident.

Burnout, Professional↗

PubMed1992

Antidepressants may not assist recovery in practice: a naturalistic prospective survey.

A total of 130 people attending psychiatric hospitals within 6 months of onset or relapse of an episode of depressive disorder were interviewed about their symptoms and treatment at the time of their initial contact. After a mean 4-month interval, 119 were reassessed to test the hypothesis that patients treated with antidepressants would be significantly more likely to be clinically improved compared with those untreated. Severity and duration of the episode emerged as the only significant clinical predictors of clinical improvement. Patients on treatment with antidepressants at the start of the study showed a nonsignificant trend for a lesser degree of clinical improvement, even when clinical severity and compliance were taken into account. Those who were not commenced on treatment until later in the study also fared no better than those who were never prescribed antidepressants. The effect of low doses of antidepressants (almost always a tricyclic) appeared to be less beneficial than either higher doses or clinical management without antidepressant drugs. The need for further experimental and naturalistic studies conducted over various periods of time and the implications for clinical practice, medical audit and the appropriate use of health outcome indicators are discussed.

Antidepressive Agents, Tricyclic↗

PubMed1992

Abnormalities of response processing in a chronic psychiatric group. A possible predictor of failure in rehabilitation programmes?

This study attempted to identify, in a mixed group of chronic patients, a specific measure of cognitive processing that may be of use in predicting dependence on psychiatric care. The measures investigated are derived from reaction-time tasks. Difficulties of response processing seem to account for the largest amount of variance in current service use. When compared with other variables shown to have some predictive power (e.g. social behaviour, symptoms and chronicity), the reaction time measures fare well. Functions derived from discriminant analyses using all the variables correctly classified 90% of those requiring day care and 95% of those requiring night care. Stepwise methods produced lower classification rates but always included reaction-time measures in the predictor set. Patients with continuing cognitive difficulties are likely to remain in more supportive psychiatric settings despite rigorous rehabilitation procedures.

Chronic Disease↗

PubMed1991

Attitudes of relatives of Afro-Caribbean patients: do they affect admission?

This pilot study explored suggestions made in the literature that high rates of Afro-Caribbean patients compulsorily admitted to hospital can be explained by the attitudes of relatives. In particular relatives who hold negative attitudes towards psychiatric services and adopt non-medical explanations for the onset of illness might delay in contacting hospital services. This could delay the process of admission and make a compulsory admission more likely. The attitudes and experiences of relatives of 15 patients admitted compulsorily and 10 admitted informally were compared. The relatives' attitudes did not differ between the two groups. There was also no difference in the severity of current symptoms or the relative's assessment of dangerousness. Neither group was characterised by the sorts of attitudes to illness that had been hypothesised. In fact the group were very similar to the relatives of white psychiatric patients. The data suggest that future research should concentrate on the interaction between families and the services. In particular attention needs to be paid to the possibility that compulsory admissions are occurring because relatives' need for help is not being met and because there is an over-expectation of dangerousness on the part of the services.

Adolescent↗

PubMed1990

The relation between life events and social support networks in a clinically depressed cohort.

Life events and supportive social networks are often treated as separate independent variables in their relations with supposed dependent variables such as depressive disorder. It is important therefore to establish that they are independent of one another. One hundred and twenty one men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact by a research psychiatrist and a week later by a non-clinical research worker who enquired about life events (LEDS) and about social networks (IMSR). One hundred and eleven patients were successfully followed up in the same manner, typically 4 months later. Social networks were very stable over time. Where they did change, this could not be explained in terms of losses of social contact due to events such as death of a primary group member. The rating of threatening events and difficulties was also unrelated to the quality of social support networks. Institutional rearing in childhood was associated with substantially smaller adult primary networks. It was concluded that over short periods of time, measures based on the LEDS and IMSR are independent, but that major social disruptions may have life long effects on social support networks.

Adaptation, Psychological↗

PubMed1990

Gender, social support and recovery from depressive disorders: a prospective clinical study.

One hundred and thirty men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact. After a mean four month interval, 119 were reassessed in order to test the hypothesis that initial levels of social support predict clinical improvement even when other potential risk factors such as age, sex, diagnosis and severity of depression are controlled. Severity and duration of the episode emerged as the only significant background predictors of recovery. The explained variance in recovery from depression due to social support was equal in men and women, and was not diminished by the background clinical predictors. According to subset analyses however, the aspects of personal relationships and perceived support that predict recovery in men and in women appear to be different. The available multiple regression models of outcome favoured a main effect of social support and provided persuasive if inconclusive evidence for a statistical interaction effect with sex. The implications for further research and for theory are discussed.

Adult↗

PubMed1990

The prediction of rehabilitative success after three years. The use of social, symptom and cognitive variables.

A three-year follow-up study of 49 psychiatric patients, representative of those found in long-stay care, tested whether behavioural, symptom and demographic variables as well as response-processing difficulties could predict levels of psychiatric care. The researchers were blind to the criteria for allocating patients to particular forms of care and the staff responsible for care had no access to information collected by the research team. Not only was it possible, using only these few factors, to predict the form of care, but one factor, response processing, was related to whether patients moved to more independent forms of psychiatric care.

Achievement↗

PubMed1988

The Camberwell Collaborative Depression Study. I. Depressed probands: adversity and the form of depression.

The Camberwell Collaborative Depression Study is an investigation of a series of 130 patients (76 female; 54 male) attending the Maudsley Hospital Services with unipolar depression of recent onset (the probands), and of their first-degree relatives. This paper describes the first element of the study, the investigation of the index cases or probands, which was carried out by members of the MRC Social Psychiatry Unit over the period 1982-1985. A description of the methods of the study is followed by an analysis of life events in relation to the symptomatic pattern of the depressive state. An 'endogenous' group was defined as cases of depression falling within Catego classes D and R, and compared with a 'neurotic' group conforming to classes N and A. The hypothesis that the 'endogenous' group of disorders would be relatively independent of prior life stress was not confirmed. Depressed women were more likely to have experienced life events or difficulties than their male counterparts, and there was some evidence that sex, but not age or social class, influenced the relationship between adversity and the type of depression. Examination of the timing of life events was strongly suggestive of a causal effect, with a pronounced rise in the month before onset. This was not limited to the most severe events. Differences between the 'endogenous' and 'neurotic' groups in the temporal patterning of events before onset are discussed. The findings are interpreted in terms of the literature on the topic.

Adult↗