Perceptions of learning disability nurses and support staff towards people with a diagnosis of schizophrenia

WHAT IS KNOWN ABOUT THE SUBJECT?: People with learning disability are more likely than the general population to develop schizophrenia. Personal recovery philosophies are based on positive attitudes and an optimism that recognizes and values people and their strengths and capacity to achieve goals. Little is known from previous studies about the illness perceptions of learning disability practitioners who work with people that experience both a learning disability and schizophrenia. The illness beliefs of learning disability practitioners about schizophrenia may mediate the potential for social exclusion and limit recovery outcomes. WHAT THIS STUDY/PAPER ADDS TO EXISTING KNOWLEDGE?: The findings show that the illness beliefs of learning disability practitioners and support workers regarding schizophrenia are pessimistic in terms of the consequences for people with schizophrenia and learning disability and their relatives as well as the chronic course of the illness. WHAT ARE THE IMPLICATIONS FOR CLINICAL PRACTICE?: This study identifies the nature of LD practitioner perceptions about schizophrenia and provides guidance about how personal recovery philosophies can be applied to the management of LD and schizophrenia. The beliefs of learning disability practitioners and support workers regarding schizophrenia need to be reframed to support better recovery outcomes and social inclusion for this group. The findings from this study can inform the development of training in bio-psycho-social models of schizophrenia, recovery approaches, family/carer interventions, clinical supervision, mentorship and reflection on clinical practice, which could be potentially useful strategies to help facilitate a reframing of beliefs.

ABSTRACT

Background and purpose of study The prevalence of schizophrenia in people with learning disability is 3-4%. This is the first study to investigate the illness perceptions of learning disability (LD) practitioners towards people with schizophrenia. Methods Learning disability practitioners (n = 210) that work with people with LD and schizophrenia completed a modified version of the Illness Perception Questionnaire Schizophrenia Carers Version (IPQ-SCV). Descriptive and correlational analyses were conducted for all of the IPQ-SCV subscales. Results A significant positive correlation was found between consequences relative and consequences patient (0.495, P < 0.001), and a negative correlation was found between timeline episodic and timeline chronic (-0.243, P < 0.001) subscales. Discussion Consistent with previous evidence found regarding negative staff attitudes to schizophrenia recovery outcomes, course and chronicity, the current investigation has extended and confirmed these observations to staff working with individuals with comorbid schizophrenia and learning disability. Implications for practice This study identifies the nature of LD practitioner perceptions about schizophrenia and contributes to the development of the recovery philosophy in relation to the management of LD and schizophrenia. The findings inform the design of training modules in bio-psycho-social models of schizophrenia, recovery approaches, family intervention, clinical supervision and reflection. These can help LD practitioners to reframe their schizophrenia/LD illness beliefs.

An examination and appreciation of the dimensions of locus of control in psychosis: issues and relationships between constructs and measurement

Internal locus of control is associated with better psychological outcomes in comparison with external locus of control. Individuals experiencing a psychotic episode have a more external orientation, an externalizing bias for negative events and associations between paranoid delusions and external locus of control. The concept of multidimensional locus of control as measured by the Multidimensional Health Locus of Control (MHLC) scale may provide important information about the nature and course of psychotic symptoms. This narrative review explored the relationship between the orientation of locus of control and psychosis. Few studies have used the scale in samples with people experiencing psychotic symptoms and so there is limited evidence about the psychometric properties of the MHLC scale within this client group, although the findings from studies that have explored the properties of this tool in other groups suggest it could be a valuable instrument for use in psychosis. Further research is required to determine both the relationship between locus of control and psychosis in terms of therapeutic factors and outcome, and also the veracity of the MHLC scale as an instrument of choice in this group.

From classical psychodynamics to evidence synthesis: the motif of repression and a contemporary understanding of a key mediatory mechanism in psychosis

The stress vulnerability model has proven to be a politically important model for two reasons. It has provided the framework that defines a temporal and dynamic process whereby a person's uniquely determined biopsychosocial vulnerability to schizophrenia symptoms interacts with his or her capacity to manage stress and the amount and type of stress experienced in such a way that the person experiences schizophrenia symptoms. Second, the development of this framework promoted the notion of inherited and acquired vulnerability. Implicit was that vulnerability was individually determined and that there was a role for psychosocial factors in the development/maintenance of schizophrenia symptoms. This proved to be a catalyst for the development of studies implicating psychosocial factors in the etiology of schizophrenia symptoms. Studies derived from cognitive-behavioral theories have proven the most successful in identifying thinking patterns, emotional disturbances, and neurocognitive and defensive vulnerability factors inherent in the development of schizophrenia symptoms. Historically, within the psychoanalytic school there has been debate regarding the role of repressive coping mechanisms in schizophrenia development. Psychoanalytic theories have always appeared incapable of providing etiologic explanations of schizophrenia symptoms, with the possible exception of Melanie Klein, than other more salient psychosocial schools. Mechanisms within the process of repressive coping are consistent with evidence and mechanisms supporting the stress vulnerability models and existing cognitive-behavioral theories regarding development of paranoid delusions. These mechanisms are less consistent with social cognitive explanations of schizophrenia symptoms.

Genes and schizophrenia: a pseudoscientific disenfranchisement of the individual

The biological model of schizophrenia remains the dominant model within mental health services. It has a powerful influence on the culture of mental health services; providing the structure for the delivery and selection of mental health treatments. There is widespread acceptance of a genetic cause for schizophrenia. Acceptance of a genetic cause is inconsistent with a person-centred recovery-orientated approach. The following paper provides a rigorous review of the underpinning research that supports the genetic argument. Appraisal of family, twin and adoption studies uncovers serious flaws in the methodologies and statistical analyses used in studies. These flaws not only artificially inflate the genetic contribution to schizophrenia but also invalidate many of the findings. More recent micro-imaging techniques have also failed to find replicable and consistent findings indicating a clear genetic pathway to schizophrenia. Freed from the implied pessimism of an unmodifiable genetic cause for schizophrenia, mental health nurses can confidently work to instil hope with people that have a diagnosis of schizophrenia.

The utility of the Illness Perception Questionnaire in the evaluation of mental health practitioners' perspectives on patients with schizophrenia

RATIONALE, AIMS, OBJECTIVES: The Illness Perception Questionnaire (IPQ) was designed as a measure of illness perception and has been used extensively for measuring the perceptions of people with physical illness. Latterly modified versions of the IPQ have been used to measure the illness perceptions of people with mental health problems and their carers. This study examined the utility of a modified version of the IPQ to measure changes in mental health practitioners' illness perceptions about schizophrenia after undertaking psychosocial intervention training.

METHOD

A total of 245 mental health practitioners who undertook psychosocial intervention training completed a modified version of the IPQ before and after training. The structure of the questionnaire was tested using confirmatory factor analysis. The internal consistency of sub-scales embedded in the instrument was also examined.

RESULTS

The hypothesized structure failed to account for the data. Model fit indices revealed a poor fit to the data across all models evaluated. Cronbach's alpha revealed a number of sub-scales in the instrument to have mediocre internal consistency characteristics.

CONCLUSIONS

The modified version of the IPQ is not suitable for evaluating the impact of psychosocial intervention training on changes in illness perceptions of schizophrenia in mental health practitioners. However, the study has highlighted the need to develop a valid and reliable measure to assess the illness perceptions health professionals have of patients in their care.

A preliminary investigation into the experience of symptoms of psychosis in mental health professionals: implications for the psychiatric classification model of schizophrenia

The psychiatric classification system regarding the discrete category of schizophrenia remains controversial. Key concerns regarding the legitimacy of the classification system for this presentation focus on issues of study design, the relevance and inter-relationship between symptom clusters and the lack of a coherent model of aetiology. A defining summary feature of the psychiatric model is the distinctiveness of psychotic symptoms in those with a diagnosis of schizophrenia compared with non-clinical samples. The current study sought to challenge the prevailing psychiatric system by exploring the occurrence and experience of psychotic symptoms in mental health practitioners who routinely engage in therapeutic work with clients with a primary diagnosis of schizophrenia. A total of 16% (n = 19) of the sample indicated that they experienced voice hearing while 21% (n = 26) indicated they experienced delusions as assessed by validated assessment tools. The findings are indicative of a continuum model of psychotic symptom experience and run counter to the contemporary model of psychiatric classification of this disorder. The direction of future research is indicated.

Effects of varying scoring rules of the Clinician Administered PTSD Scale (CAPS) for the diagnosis of PTSD after acute burn injury

The Clinician Administered Posttraumatic Stress Disorder Scale (CAPS) enables quantification of the severity of each of the 17 posttraumatic stress disorder (PTSD) symptoms. Blanchard and colleagues (1995) have documented variation in rates of PTSD among survivors of motor vehicle accidents depending on the CAPS scoring rule used. This report examines the effects of varying the scoring rules of the CAPS on rates of acute PTSD symptoms in hospitalized burn patients. Changing from the most liberal to the most conservative scoring rule resulted in a change in diagnosis of acute PTSD from 25% of 32% of the sample. The variation documented in this study and others has implications for a range of issues, including rates of PTSD in epidemiological studies, treatment outcome research, and forensic evaluations.

A telemedicine consultative service for the evaluation of patients with urolithiasis

OBJECTIVES

A 6-month pilot teleconsultative project linking Georgetown University Medical Center (GUMC) in Washington, DC, and City Hospital in Martinsburg, West Virginia, 90 miles away, was designed to assess the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis.

METHODS

The telemedicine system designed and tested for this project was based on a PC-based platform. Videoconferencing and review of the patient's imaging studies were performed over an Integrated Service Digital Network (ISDN) with 3 Basic Rate (BRI) ISDN lines providing a 336-kilobytes/s bandwidth through an Inverse Multiplexor (IMUX). Treatment options were recorded for the clinical trial group and a simulated study group by the consulting urologist after the initial telephone consultation, after the telemedicine consultation, and after examination of those patients transferred to GUMC.

RESULTS

A total of 32 telemedicine consultations were performed: 14 in the clinical trial group and 18 in the simulated study group. The recommendation of the consulting urologist at the tertiary center was altered in 12 patients (37.5%) after the telemedicine consultation compared with the recommended treatment after the initial telephone consultation.

CONCLUSIONS

In the evaluation of patients with urolithiasis, this telemedicine application enhanced the clinical decision-making process by allowing for improved quality of care through immediate access and effective transfer of information between the referring urologist, the patient, and the stone center specialist.

Association of Campylobacter jejuni with enteritis in dogs and cats

Campylobacter jejuni was recovered from 59 of 505 (11.7 per cent) dogs with diarrhoea as compared with only two of 122 (1.6 per cent) dogs without diarrhoea. However, there was no significant difference between campylobacter isolations from 142 cats with and without diarrhoea. C jejuni infections were commonly associated with chronic diarrhoea in both species and appropriate therapy abolished clinical signs and excretion of the organism in faeces in most cases. C jejuni may be responsible for some forms of enteritis in dogs and cats and is a zoonosis in which the companion animal may be the vector.

Biphasic enteritis in imported cynomolgus (Macaca fascicularis) monkeys infected with Shigella, Salmonella and Campylobacter species

Epidemic enteritis in approximately 10 000 newly-imported Macaca fascicularis was common and fell into 2 distinct phases. During the 1st month of quarantine Shigella organisms, often antibiotic resistant, posed a threat to life of the animals. Later, Campylobacter jejuni/coli appeared to be the main organism in infectious enteritis. The clinical syndrome was complicated at all stages by the presence of helminths, virus infections such as measles and pathogenic protozoa, but salmonellae were not usually an important feature. Normal quarantine procedures did not guarantee freedom from either shigellae or salmonellae and serial tests were done in individual cases to ensure this. It was not possible to eradicate Campylobacter jejuni/coli from the colony.

Trimethoprim-resistance and its transferability in E. coli isolated from calves treated with trimethoprim-sulphadiazine: a two year study

Regular examination of rectal swabs revealed the presence of very low numbers of trimethoprim resistant Escherichia coli in the faeces of 10 batches of calves successively reared in the same shed and none of these strains transferred trimethoprim resistance to E. coli K12. All the calves had received oral doses of 30 mg/kg day of trimethoprim-sulphadiazine for 5 consecutive days. From two subsequent batches of calves reared in the same shed, however, several isolations were made of E. coli with transmissible R factors determining trimethoprim and streptomycin resistance. Shortly before these strains were detected, isolations of E. coli with similar properties had been made from other calves, in a different shed, which had been fed much higher doses of trimethoprim-sulphadiazine. Serological evidence indicated that all the E. coli isolated carrying this R factor belonged to the same strain, which had apparently spread from the second shed to the first. No evidence of ;in vivo' transfer of the R factor to other enteric bacteria was obtained.

Trimethoprim resistance determined by R factors

R factors conferring a high level of resistance to trimethoprim have been identified in one strain of Escherichia coli and one of Klebsiella aerogenes, both isolated from infected urines.