Showing papers by "Graham Thornicroft published in 2009"
TL;DR: The nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia is described, which suggests measures such as disability discrimination laws might not be effective without interventions to improve self-esteem of people with mental illness.
1,034 citations
TL;DR: The SLAM BRC Case Register represents a 'new generation' of this research design, built on a long-running system of fully electronic clinical records and allowing in-depth secondary analysis of both numerical, string and free text data, whilst preserving anonymity through technical and procedural safeguards.
Abstract: Case registers have been used extensively in mental health research. Recent developments in electronic medical records, and in computer software to search and analyse these in anonymised format, have the potential to revolutionise this research tool. We describe the development of the South London and Maudsley NHS Foundation Trust (SLAM) Biomedical Research Centre (BRC) Case Register Interactive Search tool (CRIS) which allows research-accessible datasets to be derived from SLAM, the largest provider of secondary mental healthcare in Europe. All clinical data, including free text, are available for analysis in the form of anonymised datasets. Development involved both the building of the system and setting in place the necessary security (with both functional and procedural elements). Descriptive data are presented for the Register database as of October 2008. The database at that point included 122,440 cases, 35,396 of whom were receiving active case management under the Care Programme Approach. In terms of gender and ethnicity, the database was reasonably representative of the source population. The most common assigned primary diagnoses were within the ICD mood disorders (n = 12,756) category followed by schizophrenia and related disorders (8158), substance misuse (7749), neuroses (7105) and organic disorders (6414). The SLAM BRC Case Register represents a 'new generation' of this research design, built on a long-running system of fully electronic clinical records and allowing in-depth secondary analysis of both numerical, string and free text data, whilst preserving anonymity through technical and procedural safeguards.
375 citations
TL;DR: A randomised, double-blind, placebo-controlled trial of Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction and the results are published on behalf of the BEAUTIFUL Investigators.
215 citations
TL;DR: A new series in PLoS Medicine that reviews the evidence for packages of care for ADHD, alcohol misuse disorders, dementia, depression, epilepsy, and schizophrenia in low- and middle-income countries is introduced.
Abstract: In a Perspective article, Vikram Patel and Graham Thornicroft introduce a new series in PLoS Medicine on mental health disorders in low- and middle-income countries that reviews the evidence for packages of care for ADHD, alcohol misuse disorders, dementia, depression, epilepsy, and schizophrenia.
208 citations
TL;DR: Public attitudes towards people with mental illness in England and Scotland became less positive during 1994– 2003, especially in 2000–2003, and to a greater extent in England.
Abstract: Background
Understanding trends in public attitudes towards people with mental illness informs the assessment of ongoing severity of stigma and evaluation of anti-stigma campaigns.
Aims
To analyse trends in public attitudes towards people with mental illness in England and Scotland using Department of Health Attitudes to Mental Illness Surveys, 1994–2003.
Method
We analysed trends in attitudes for 2000 respondents in each survey year (6000 respondents in 1996 and 1997) using quota sampling methods and the adapted Community Attitudes Toward the Mentally Ill scale.
Results
Comparing 2000 and 2003, there was significant deterioration for 17/25 items in England and for 4/25 items in Scotland. Neither country showed significant improvements in items between 2000 and 2003.
Conclusions
Public attitudes towards people with mental illness in England and Scotland became less positive during 1994–2003, especially in 2000–2003, and to a greater extent in England. The results are consistent with early positive effects for the `see me' anti-stigma campaign in Scotland.
199 citations
TL;DR: This editorial summarises what is known about accelerating the transfer of discoveries in the health sciences into implementation in routine clinical practice in three phases: adoption in principle, early implementation, and persistence of implementation.
Abstract: This editorial summarises what is known about accelerating the transfer of discoveries in the health sciences into implementation in routine clinical practice. Three phases are described: adoption in principle, early implementation, and persistence of implementation. Facilitators and barriers to the implementation across these phases are discussed.
142 citations
TL;DR: Five main reasons for recruitment difficulties in trials involving patients with severe mental illness include issues that occur in trials in general, but others are more specific to these patients.
123 citations
TL;DR: In the third in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Jair Mari and colleagues discuss the treatment of schizophrenia.
Abstract: In the third in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Jair Mari and colleagues discuss the treatment of schizophrenia.
89 citations
TL;DR: Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives.
Abstract: Background Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years. Aims Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations. Method National cross-sectional survey of alternatives to standard acute in-patient care. Results We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions. Conclusions Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.
75 citations
Journal Article•
TL;DR: Overall the SF-6D appears more suitable as a measure of utility in this patient group due to its normal distribution and lack of ceiling effect and the sensitivity of these measures to changes in an established measure of symptomatology.
Abstract: Economic evaluations of healthcare interventions increasingly measure outcomes using quality-adjusted life years (QALYs). The SF-6D and the EQ-5D are alternative ways of generating utility scores for use in QALY estimations. This study compares these measures in a sample of patients with schizophrenia. Mean utility scores were very similar at baseline (EQ-5D 0.68, SF-6D 0.67) and follow-up (EQ-5D 0.71, SF-6D 0.68). The SF-6D scores followed a normal distribution whilst the EQ-5D scores were negatively skewed with a clustering at 1.00. There were few differences in sensitivity to change between the EQ-5D and SF-6D. From an analytical perspective the SF-6D has advantages over the EQ-5D due to its normal distribution and lack of ceiling effect. However, both measures produce similar mean utility scores. Overall the SF-6D appears more suitable as a measure if utility in this patient group.
72 citations
TL;DR: JCPs empower their holders to obtain their preferred care and treatment in a crisis, and the best supported hypothesis was that participants felt more in control of their mental health problem.
Abstract: Introduction
We report participants’ and case managers’ use of and views on the value of Joint Crisis Plans (JCPs), shown to reduce compulsory hospitalisation and violence.
TL;DR: Caregiver consequences of depression and schizophrenia are very similar and differences reflect the context in which caregiving takes place: In schizophrenia mostly elderly mother caring for their ill (adult) child, in depression mostly spouses caring for a partner.
Abstract: Attention to caregiver consequences has been mainly restricted to caregivers of patients with schizophrenia. The few studies done in depression were conducted on small samples and/or with non-validated instruments. Caregiver consequences in depression and schizophrenia were measured with the validated Involvement Evaluation Questionnaire (IEQ). IEQ scores of caregivers of 252 mainly outpatients with depression and caregivers of 151 mainly outpatients with schizophrenia were compared. IEQ scores were quite similar for depression and schizophrenia. Caregivers of patients with schizophrenia worry more and have more nursing tasks; in case of depression caregivers experience more tension between spouses. In case of many consequences caregivers live close to a patient who has more acute symptoms. They have more additional expenses on behalf of the patient, and report higher distress scores. In case of depression caregivers report less social support, and less coping abilities. Caregiver consequences of depression and schizophrenia are very similar. Differences reflect the context in which caregiving takes place: In schizophrenia mostly elderly mother caring for their ill (adult) child, in depression mostly spouses caring for their partner. Caregivers of patients with depression should be given more attention and support by professionals.
TL;DR: Factors that may positively affect adherence in terms of compliance with prescribed medication regimens may not affect patients’ views on adherence, and this should be taken into consideration when planning and negotiating treatment modalities with each individual patient suffering from schizophrenia.
Abstract: Background: Factors influencing patient and clinician perspectives in the assessment of medication adherence have never been compared. Method: This study used bas
TL;DR: Overall, findings indicate that at present, there is no plausible explanatory model of adherence and this has consequences for clinical practice since there are no compelling evidence on how to intervene effectively to improve adherence in people with schizophrenia.
Abstract: This study examined the relationship over time of adherence to anti-psychotic medication and quality of life in people with schizophrenia, taking into account effects of mediating variables. Data on on adherence, quality of life, attitude towards medication, side effects, symptom severity, and level of functioning at baseline and 1-year follow-up were obtained from 373 participants in a multi-centre trial. Participants randomised to the intervention group were offered eight sessions of adherence therapy. Data were analysed via block recursive graphical modelling. Direct links between adherence and quality of life and effects across time were scarce and weak if present. However, indirect effects could be identified, i.e. adherence at baseline affected quality of life at follow-up via symptom severity and medication side effects. These findings underline associations between "traditional" clinical outcome parameters and quality of life. Adherence might have an impact on some of these clinical outcome dimensions, and this might indirectly affect quality of life across time. Overall, findings indicate that at present, there is no plausible explanatory model of adherence. This also has consequences for clinical practice since there is no compelling evidence on how to intervene effectively to improve adherence in people with schizophrenia.
TL;DR: These findings show that whether the primary long-term condition is presenting as physical or as mental disorder, the practitioner should ensure that the full range of physical, mental and social problems is assessed and treated.
Abstract: Purpose
To investigate whether people with long term conditions, whatever their specific nature, need to be assessed and treated for the full range of mental, physical and social problems. Main question investigated: that rheumatoid arthritis and schizophrenia will be associated with significantly greater impairment across the subscores of the SF36 scale than in reference general population samples. Specific hypothesis tested: while rheumatoid arthritis and schizophrenia will impair both physical and mental functioning, when comparing the two groups there will be a greater difference between the physical component scores than there will be between the mental/emotional component scores of the short form health survey (SF-36).
TL;DR: This paper illustrates the process of constructing, selecting and applying simple measures in order to empirically derive patterns of course of psychotic episodes in schizophrenia.
Abstract: Objective: This paper illustrates the process of constructing, selecting and applying simple measures in order to empirically derive patterns of course of psychotic episodes in schizophrenia.
Method: Data were collected with a composite instrument constructed for a multi-centre, follow-up randomized controlled trial of adherence therapy for people with schizophrenia. The instrument included a retrospective weekly assessment of psychotic/non-psychotic status, which was used to derive the measures, and the DSM-IV course specifiers.
Results: The measures discriminated well between different course patterns and identified homogeneous clusters of subjects which correlated with the groups derived from the DSM-IV course specifiers.
Conclusions: The new measures provide an empirical basis to identify specific patterns of course and to differentiate patients according to pre-defined criteria. They can be used in follow-up studies as measures of outcome, to investigate correlations between variables and to identify potential predictors of outcome. Copyright © 2009 John Wiley & Sons, Ltd.
TL;DR: A sizeable proportion of people with severe mental illness would consider working full-time, potentially overcoming the benefits trap in achieving this, contrary to the commonly held belief that such clients only want part-time work.
Abstract: Background: Most people with severe mental illness are not in paid employment. The cost is high, economically and in terms of social exclusion.Aim: To investigate the number of weekly hours that such people want to be in competitive paid employment and the reasons why.Methods: Baseline clinical and demographic data were analysed for 219 people with severe mental illness participating in an RCT of supported employment in London, England.Results: Self-esteem, quality of life, symptom severity and general level of functioning did not largely explain wanting part or full-time work. The latter was significantly associated with having more unmet needs (p = 0.01) and not receiving Incapacity Benefit and/or Income Support (p = 0.04). However, 31% (55/178) of those receiving these benefits did want full-time work, desiring a significantly higher rate of pay than those wanting to work up to 16 hours or 17 to 34 hours per week (p < 0.001 and p = 0.001, respectively).Conclusions: A sizeable proportion of people with ...
TL;DR: Muitas pessoas com esquizofrenia ex-perimentam estigma causado pelo conhecimento, atitudese comportamento de outras pssoas; isto pode levar aoempobreciment, marginalizacao social e baixa qualida-de de vida as mentioned in this paper.
Abstract: Muitas pessoas com esquizofrenia ex-perimentam estigma causado pelo conhecimento, atitudese comportamento de outras pessoas; isto pode levar aoempobrecimento, marginalizacao social e baixa qualida-de de vida. Pretendemos descrever a natureza, direcao egravidade da discriminacao experimentada e antecipadarelatada por pessoas com esquizofrenia.
TL;DR: A needs assessment procedure specifically designed to assess the needs of the elderly is required for the lower rate of schizophrenia in the elderly mentally ill compared to the younger community patients and asylum mentally ill.
Abstract: Background: Previous studies on the elderly mentally ill (graduates) have been undertaken in mental hospital settings and on populations being resettled from hospitals. This paper aims to assess the characteristics and service needs of an epidemiological sample of elderly mentally ill.Aims: The aim of this study was to identify the characteristics, problems, service utilization and needs of a sample of elderly patients with functional psychosis in a defined epidemiological area.Method: Data collected by PRiSM on psychotic patients who lived in two districts of Maudsley Hospital's catchment area were analyzed using the characteristics, problems and the needs for mental health services of those patients who were over the age of 64. These patients were compared with younger patients using the same data.Results: The elderly patients differed significantly in their characteristics and problems from the younger mentally ill persons. The needs assessment procedure (Camberwell Assessment of Needs, CAN) was less s...