Showing papers by "Robin M. Murray published in 1988"

The long-term outcome of Maudsley depressives.

Abstract: Eighty-nine consecutive admissions with primary depressive illness were prospectively ascertained and diagnosed in 1965-66 by R. E. Kendell, who also allocated each a position on a neurotic-psychotic continuum on the basis of previous discriminant function analysis. In 1983-84, 94% of the survivors were personally interviewed by a psychiatrist blind to index admission data. Operational outcome criteria were employed and longitudinal data were established for 98% of the series. Mortality risk was doubled overall, and increased sevenfold for women under 40 years at index admission. Less than one-fifth of the survivors had remained well, and over one-third of the series suffered unnatural death or severe chronic distress and handicap. Patients whose index episode marked their first psychiatric contact had a 50% chance of readmission within their lifetime, but those with previous admissions had a 50% chance of readmission within three years. Readmissions occurred even after 12 years of being symptom-free, and conversely patients recovered after as long as 15 years of illness. There was a high incidence of other disorders (schizoaffective disorder, alcoholism, schizophrenia), and only four patients showed pure recurrent unipolar histories. Patients at the psychotic end of the continuum were more likely to be readmitted and to have very poor outcomes.

Obstetric complications and schizophrenia: a computed tomographic study

Abstract: All patients aged 16-50 years who had been discharged from the Maudsley Hospital over a 4-year period with a diagnosis of schizophrenia were ascertained retrospectively. Case records were rated blindly for a history of obstetric complications (OCs). Sixty-one patients who satisfied the RDC for schizophrenia had undergone CT scanning. Those with a definite history of OCs presented at an earlier age. In this group widening of cortical sulci and fissures was more strongly correlated with VBR than in subjects without OCs. Moreover, large VBRs when accompanied by widened cortical sulci and fissures occurred more commonly in subjects with OCs than in those without. These results support the hypothesis that OCs, or a factor associated with them, lead to brain damage of aetiological significance in some cases of schizophrenia.

Prevalence of familiality, obstetric complications, and structural brain damage in schizophrenic patients.

Abstract: Schizophrenic in-patients with and without a family history were identified prospectively. The two groups did not differ with respect to clinical variables, ventricular enlargement, prevalence of cortical sulcal widening, or a history of obstetric complications, even when a variety of definitions of familiality were used.

Response to drugs in schizophrenia: the influence of family history, obstetric complications and ventricular enlargement

Abstract: A prospective study of antipsychotic drug treatment showed no difference in response between schizophrenic in-patients with or without a familial predisposition to the illness (N = 53). All patients received at least 600 mg chlorpromazine equivalents antipsychotic medication for 6 weeks. Ventricle brain ratios, ratings of cortical sulcal widening and a history of obstetric complications also failed to account for the variability, but early age of onset was associated with unsatisfactory response.

The Bethlem and Maudsley Hospital item sheets (B-MIS): The development and reliability of an instrument for routine collection of summary clinical data

Abstract: The Bethlem and Maudsley Hospital item sheets (B-MIS) are summaries in coded form which are completed for every patient admitted or readmitted to the joint hospitals. The Part 1 item sheet contains information which is included in the Part 1 case summary, as described in Notes on Eliciting and Recording Clinical Information, and is completed at the same time as the summary is prepared; that is, usually within a fortnight of the patient entering hospital. Similarly, the Part 2 item sheet contains information normally found in the discharge summary, and is completed at the same time that this summary is prepared; shortly after the patient has left hospital. The item sheets are restricted to pieces of information which can be readily coded by the registrar. Thus, of necessity, they concentrate on relatively ‘hard’ data.

Neurodevelopmental Model of Schizophrenia

Abstract: —We agree 1,2 with Weinberger that it is more appropriate to regard some schizophrenias as a remote consequence of an early brain lesion with subsequent neurodevelop mental deviance rather than as the result of an adult onset of a neurodegenerative disorder. However, we would like to discuss two points. 1. An early brain lesion is probably only one of a number of routes to the syndrome we currently call schizophrenia. To claim that it underlies all schizophrenia is to run the risk that the hypothesis will be discounted because not all schizophrenics conform to its predictions. The neurodevelopmental model is certainly compatible with recent neuropathologic findings and with those computed tomographic (CT) scan studies that demonstrate an association between a complicated pregnancy and birth, later schizophrenia, and enlarged cerebral ven tricles. 1,3,4 It also provides an explanation for the deviant childhood behavior found in a proportion of schizophrenics and for