Showing papers by "Max Birchwood published in 1992"

The Influence of Ethnicity and Family Structure on Relapse in First-Episode Schizophrenia: A Comparison of Asian, Afro-Caribbean, and White Patients

Abstract: There is overwhelming evidence that the outcome for people with schizophrenia in Western industrialised countries is inferior to that of those living in the Third World. Extended family structures, greater opportunities for social reintegration, and more positive constructions of mental illness have been offered as possible explanations for this effect. The Asian community in the UK retains many of these features as well as strong links with native cultures of origin. The issue arises as to whether similar differences in outcome may be observed in the UK. An exploratory study was undertaken, examining the early progress of schizophrenia in a first-episode sample (n = 137), and based on systematic examination of case-note data. A lower rate of relapse/readmission in the first 12 months after discharge was found in the Asian (16%) as compared with white (30%) and Afro-Caribbean (49%) patients. Available evidence suggested that speed of access to care, living with a family, and employment may account for this effect. Medication compliance may have contributed to differences in relapse between white and Afro-Caribbeans but was not a factor influencing the low rate among Asians. The limitations and strengths of case-note studies are discussed at length, and it is concluded that a prospective study is warranted and would be highly instructive.

Specific and non-specific effects of educational intervention for families living with schizophrenia. A comparison of three methods.

Abstract: Three methods of delivering an educational intervention to families living with a schizophrenic relative were compared in terms of their efficacy in improving understanding and promoting family and patient well-being. Relatives receiving education in a group acquired more information than relatives receiving information by post or on video, but these differences were not maintained at six-month follow-up. The inclusion of homework assignments did not significantly affect gains in knowledge or any of the non-specific effects observed. The intervention overall led to considerable gains in knowledge, increased optimism concerning the family's role in treatment, and reductions in relatives' stress, which were maintained at follow-up. Fear was reduced in the short-term. Significant improvements in social function were observed at follow-up. The results suggest that the delivery of information, rather than the mode of delivery, is the crucial element in the intervention; however, the additional contextual factors operating in a group may be important if the full potential of education is to be realised.

Early intervention in schizophrenia: Theoretical background and clinical strategies

Abstract: Clinical observation and retrospective studies have provided considerable information as to the nature of decompensation into acute schizophrenic illness These themes have been further developed in studies designed to reduce overall exposure to neuroleptics whilst maintaining adequate prophylaxis against relapse This review extracts from the literature information which could be harnessed to prevent, abort or ameliorate florid schizophrenic relapse Emphasis is laid upon the coordination of psychological and medical approaches, describing in some detail both the theoretical background and practical intervention strategies in development, and exploring their implications for the role of clinical psychologists

Informing people with schizophrenia about their illness: The effect of residual symptoms

Abstract: An educational intervention for individuals with schizophrenia is described and evaluated in two groups of subjects: those with residual symptoms (n=18) and those without (n=10). Its impact was monitored on a number of variables including information assimilation, insight and attitude to medication compliance. Significant knowledge gains were observed in both groups in all information areas except aetiology; the greatest gains were in information about demography and coping. The ‘symptom-free’ group had consistently higher pre and post knowledge scores than the symptom group. The residual symptom group absorbed less information about symptoms than did the symptom group, suggesting a selectivity of information assimilation according to their pre-existing constructions of their illness. No significant changes in insight or medication compliance scores were observed for either group. The clinical significance of these findings and their implication for further research are discussed.

Innovations in the psychological management of schizophrenia : assessment, treatment and services

Abstract: Part 1 Assessment: Assessment of symptoms and behaviour, Philippa Garety vulnerability models - the assessment and prediction of relapse, Keith Clements and Graham Turpin monitoring recovery from acute psychosis, Valerie Drury. Part 2 Treatment: interventions with families, Christine Barrowclough and Nicholas Tarrier teaching social and coping skills, Jerome Vaccaro and Liza Roberts early intervention, Max Birchwood et al management and modification of residual positive psychotic symptoms, Nicholas Tarrier management of long-term impairments and challenging behaviour, Lorna Hogg and John Hall. Part 3 Services: models of continuing are, Tony Lavender and Frank Holloway family interventions - service implications, Jo Smith the balance of care, Mattijs Muijen service organisation and planning, Kate Woof the future of psychological treatments, Nick Tarrier and Max Birchwood.

Predicting and controlling relapse in schizophrenia: early signs monitoring

Abstract: A consultant psychiatrist working in The Mental Health services in the UK may expect to see perhaps eight to twelve new cases of schizophrenia in a year: however the known individuals suffering from schizophrenia may number 100 to 120 for a catchment area of 45 000. In some settings, characteristically that of a deprived inner city area, this number may be greatly exceeded. The service provision for this group may have to be flexible to accommodate a broad range of age, disability, and social settings. Although there is a marked tendency for the deficits associated with schizophrenia to increase with duration of illness (Owens and Johnstone, 1980) there will be individuals for whom youth is no protection from severe disability, and some aging individuals whose disabilities may be less than expected.