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Monitoring Psychosis in General Practice: A Controlled Trial

Published online by Cambridge University Press:  02 January 2018

Irwin Nazareth ,
Michael King  and
Sharon See Tai
Irwin Nazareth*
Affiliation:
Department of Primary Care and Population Sciences, University College Medical School
Michael King
Affiliation:
University Department of Psychiatry, Royal Free Hospital School of Medicine, London
Sharon See Tai
Affiliation:
Department of Primary Care and Population Sciences, University College Medical School
*
Dr Irwin Nazareth, Department of Primary Care and Population Sciences, University College Medical School, Whittington Hospital, Archway Site, London N19 2QG
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Abstract

Background

This trial evaluated the feasibility, acceptability and effectiveness of a structured approach to the management of schizophrenia in general practice.

Method

All patients with non-affective psychosis (mainly schizophrenia) in four inner-city general practices were recruited. A check-list and a set of outcome measures were used by the general practitioner and the practice nurses. Information on attendances at the general practice and psychiatric out-patient departments was also collected.

Results

Two practices took part in the intervention and two served as control practices. Sixty-seven patients with non-affective psychosis were identified. Thirty-three (81%) of the 41 patients in the two intervention practices attended the initial assessment by the doctor and nurse, but only 13 (32%) attended the first review assessment. The attendance for the second review, after six months, was six out of 15 (40%) in one practice, but rose to 16 out of 18 (89%) in the other practice. Significant improvements were recorded in the intervention group on the Global Assessment Scale (GAS) and the Behaviour, Speech and Other Syndromes (BSO) subscore of the Present State Examination (PSE). The absolute risk reduction and relative risk reduction as a result of the intervention as measured by the GAS scores, was 29% (95% CI 4% to 54%) and 36% (95% CI 5% to 66%), respectively, and in the case of the BSO subscores of the PSE, this was 23% (95% CI – 1.8% to 47.2%) and 28% (95% CI – 2.2% to 57%), respectively. For one patient to show an improvement in GAS and BSO scores 3.5 patients (95% CI 1.85 to 25) and 4.3 patients (95% CI – 55 to 2.1), respectively, would need to receive the intervention. There was a significant increase in consultation rates for patients in the intervention practices.

Conclusions

Health surveillance of patients with non-affective psychosis is possible in general practice.

Type
Papers
Information
The British Journal of Psychiatry , Volume 169 , Issue 4 , October 1996 , pp. 475 - 482
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Campbell, P. G., Taylor, J., Pantelis, C., et al (1989) Studies of schizophrenia in a large mental hospital proposed for closure and in two halves of an inner London borough served by the hospital. In International Perspectives in Schizophrenia; Biological, Social and Epidemiological Findings (ed. Weller, M.), pp. 185–203. London: John Libbey.Google Scholar
Carroll, K., Rounsaville, B. & Nich, C. (1994) Blind man's buff: effectiveness and significance of psychotherapy and pharmacotherapy blinding procedures in a clinical trial. Journal of Consulting and Clinical Psychology, 62, 276–280.CrossRefGoogle Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 30, 766–771.CrossRefGoogle Scholar
Guy, W. (1976) ECDEU Manual for Psychopharmacology, pp. 534–537. Washington, DC: NIMH.Google Scholar
Guyatt, G. S., Sackett, D. S. & Cook, D. J. (1994) Users' guide to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Journal of the American Medical Association, 271, 59–63.CrossRefGoogle ScholarPubMed
Kendrick, T., Burns, T. & Freeling, P. (1995) Randomised controlled trial of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. British Medical Journal, 311, 93–98.CrossRefGoogle ScholarPubMed
Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., et al (1979) Assessment of client/patient satisfaction: development of a general scale. Evaluation and Programme Planning, 2, 197–207.CrossRefGoogle ScholarPubMed
Muijen, M., Marks, M., Connolly, J., et al (1992) Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial. British Medical Journal, 304, 749–754.CrossRefGoogle ScholarPubMed
Nazareth, L., King, M., Haines, A., et al (1993a) Care of schizophrenia in general practice. British Medical Journal, 307, 910.CrossRefGoogle ScholarPubMed
Nazareth, L., King, M., Haines, A., et al (1993b) Accuracy of diagnosis of psychosis on a general practice computer system. British Medical Journal, 307, 32–34.CrossRefGoogle ScholarPubMed
Nazareth, L., King, M., & Myers, S. (1995) Care of schizophrenia in general practice – the general practitioner and the patient British Journal of General Practice, 45, 343–347.Google ScholarPubMed
Parloff, M. B., Kelman, H. C. Frank, J. D. (1954) Comfort, effectiveness and self-awareness as criteria of improvement in psychotherapy. American Journal of Psychiatry, 111, 343–351.CrossRefGoogle ScholarPubMed
Pocock, D. (1983) Clinical Trials – A Practical Approach. New York: John Wiley.Google Scholar
Robinson, R. (1993) Count down to community care: moving ahead–community care in Gwent. British Medical Journal, 306, 44–47.CrossRefGoogle Scholar
Royal College of Psychiatrists & Royal College of General Practitioners (1993) Shared Care of Patients with Mental Health Problems: Report of a Joint Royal College Working Group. London: RCGP/RCPsych.Google Scholar
Stewart, A. L., Hays, R. D. & Ware, J. E. (1986) The MOS short form general health survey. Medical Care, 26, 724–735.CrossRefGoogle Scholar
Strathdee, G., King, M., Araya, R., et al (1990) A standardised assessment of patients referred to primary care and hospital psychiatric clinics. Psychological Medicine, 20, 219–224.CrossRefGoogle ScholarPubMed
Tyrer, P. (1990) Personality disorder and social functioning. In Measuring Human Problems: A Practical Guide (eds Peck, D. F. & Shapiro, C. M.), pp. 119–142. Chichester John Wiley.Google Scholar
Weller, B. G. A., Weller, M. P. I., Coker, E., et al (1987) Crisis at Christmas. Lancet, i, 553–554.CrossRefGoogle Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: An Instruction Manual for PSE and Catego Systems. London: Camnbridge University Press.Google Scholar
Wojick, J. D., Gelenberg, A. G., Labrie, R. A., et al (1980) Prevalence of tardive dyskinesia in an outpatient population. Comparative Psychiatry, 21, 370–380.Google Scholar
World Health Organization (1978) The Ninth Revision of the International Classification of Diseases and Related Health Problems (9th edn) (ICD–9). Geneva: WHO.Google Scholar
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