The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients

Social functioning as an outcome variable in family interventions with schizophrenic patients has been a relatively neglected area. The requirements of a scale of social functioning to measure the efficacy of family interventions include: the measurement of skill/behaviour relevant to the impairments and the demography of this group; the ability to yield considerable information with an economy of clinical time; and the establishment of 'comparative' need through comparison between subscales and with appropriate reference groups. Results from three samples show that the Social Functioning Scale is reliable, valid, sensitive and responsive to change.

Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms

BACKGROUND

The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms.

METHOD

Of 117 patients with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months.

RESULTS

Both groups showed a decline in positive symptoms but this was more marked in the CT group (P < 0.001). At 9 months 5% of the CT group, v.56% of the control group, showed moderate or severe residual symptoms.

CONCLUSION

CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.

The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population

To determine whether participating in physical activity affects psychological well-being in an adolescent population, 147 adolescents completed self-reports of exercise and psychological stress and well-being. Analysis revealed that those who reported greater physical activity also reported less stress and lower levels of depression. Adolescents who experienced a higher incidence of life events also demonstrated a strong association between stress and anxiety/depression/hostility. To investigate the effects of exercise training on psychological well-being, adolescents were assigned to either high or moderate intensity aerobic training, flexibility training or a control group. The training groups met twice per week for 25-30 min. Aerobic fitness levels, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of the high intensity aerobic exercise and between groups differences for physiological and some psychological measures were found. Subjects undergoing high intensity exercise reported significantly less stress than subjects in the remaining three groups. The relationship between stress and anxiety/depression/hostility for the high intensity group was considerably weakened at the end of the training period. For the remaining subjects, however, this relationship was, if anything, strengthened. This experiment provides evidence to suggest that in an adolescent population, high intensity aerobic exercise has positive effects on well-being.

Microwave synthesis and characterization of Co-ferrite nanoparticles

Stable CoFe(2)O(4) nanoparticles have been obtained by co-precipitation using a microwave heating system. Transmission electron microscopy images analysis shows an agglomeration of particles with an average size of about 5 nm, and X-ray diffraction reveals the presence of a pure ferrite nanocrystalline phase. X-ray photoelectron spectroscopy and thermal gravimetric analysis show the presence of organic matter in the range of about 16 wt%. The magnetic response in DC fields is typical for an assembly of single-domain particles. The measured saturation magnetization is slightly larger than the bulk value, probably due to the presence of small amounts of Co and Fe. AC magnetization data indicate the presence of magnetic interactions between the nanoparticles.

Mental hospital admission rates of immigrants to England: a comparison of 1971 and 1981

The present study compares admissions to mental hospitals in England in 1981 with comparable figures obtained for 1971. Patients were classified by place of birth and the two data sets reveal interesting similarities a decade apart. With schizophrenia the trend in 1981, as in 1971, is for the foreign born to have higher rates of admission in comparison to the native born; and as in 1971 the groups with the highest rate of admission are the Irish born and those born in the Caribbean and Poland. Overall rates of admission in 1981 for immigrants from India, Pakistan, Germany and Italy (like 1971) are lower than the native born rates. As in 1971 the Irish and Scots have extremely high rates of alcohol and drug related disorders, and although they also have high rates of personality disorders they are not as high as the 1971 rates. Those born in the Caribbean continue to show relatively low rates of admission for alcohol, drug and personality disorders. For Indian born males the 1981 figure for alcohol related admissions is twice that of 1971. There is an apparent increase in the rates of depression in 1981 compared to 1971 across all the groups which is affected by changes in recording procedures. There are other findings which are peculiar to only one sub-group, such as the very low re-admission rates for Pakistani women compared to the other groups. This paper provides some possible explanations to account for these variations in rates of admission.

The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being

To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.

Cognitive therapy and recovery from acute psychosis: a controlled trial. II. Impact on recovery time

BACKGROUND

A trial of CT in acute psychosis conducted by the authors has shown a significant impact on the rate and degree of recovery of positive symptoms, the focus of the intervention. This paper seeks to determine whether these effects generalise to other features of acute psychosis including dysphoria, insight and "low level' psychotic thinking which were not directly targeted.

METHOD

Measures of dysphoria, insight and psychotic thinking were taken over a six-month period following presentation for acute psychosis. Using survival analysis, time to recovery from psychosis using three definitions of increasing stringency was compared between the CT and control group.

RESULTS

CT was associated with a 25-50% reduction in recovery time depending on the definition used.

CONCLUSION

The impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and "low level' psychotic thinking. Nevertheless this kind of "clinical' recovery required a median of 20 weeks to complete. Implications for clinical models of acute care are discussed.

Families coping with schizophrenia: coping styles, their origins and correlates

An analysis of the coping styles adopted by relatives of schizophrenic patients has been identified by many reviewers as essential to an understanding of the complex interactions between patient and caregiver and to the origins of relatives' expressed emotion (EE). This study reports a taxonomy of coping behaviour derived from interviews with relatives of schizophrenic patients. It was found that relatives adopted broad styles of coping across all areas of patients' behaviour change. Relationships were uncovered between the styles and (a) relatives perceived control, burden and stress, (b) patients' social functioning, severity of behavioural disturbance and progress of the illness. It is suggested that advising relatives of changes in their coping styles in the course of family intervention must be tempered by an understanding of their origins in patients' behaviour. Further research is recommended to identify the coping styles associated with the high EE/low EE research classification.

The influence of ethnicity and family structure on relapse in first-episode schizophrenia. A comparison of Asian, Afro-Caribbean, and white patients

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

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.

Performance on tests of frontal lobe function reflect general intellectual ability

Recent studies have indicated that performance on tests of frontal lobe function are highly associated with general intellectual ability (g). Some authors have even claimed that the available evidence does not support a more specific account of frontal lobe function than to provide a general intellectual function for the performance of goal directed tasks. We examined the relationship between performance on the WAIS-R (as a measure of g) and performance on standard tests of frontal lobe function in 123 healthy individuals. Our results demonstrate that in healthy individuals (i) performance on the most popular tests of frontal lobe function shares significant variance, and (ii) a large proportion of that shared variance is highly associated with performance on the Wechsler Adult Intelligence Scales-Revised (WAIS-R), so that the tests are similar to the extent that they measure g. Performance on the Modified Card Sorting Test (MCST), however, is not related to g. The results support the claim that many tests of frontal lobe function measure primarily a non-specific intellectual function but also indicate that some tests, like the MCST, may be assessing more specific cognitive operations.

Mental health care for Asian, black and white patients with non-affective psychoses: pathways to the psychiatric hospital, in-patient and after-care

BACKGROUND

This UK-based study compares the pathways to the psychiatric hospital and the provision of in-patient and after-care for Asian, black and white patients with non-affective psychoses.

METHODS

Two overlapping samples of 120 patients, 40 from each ethnic group, were drawn; one on admission and the other at discharge. In addition to socio-demographic data, details were obtained on the pathways to care and the in-patient episode. An assessment of needs and service provision was undertaken 3 months post-discharge. Patient satisfaction was ascertained at each stage.

RESULTS

Asian and especially black patients experienced more complex pathways and had higher levels of both involvement with the police and compulsory detention than their white counterparts. They were less likely to perceive themselves as having a psychiatric problem or as needing to go into hospital and expressed less satisfaction with the admission process. Black patients, as compared to Asian but especially white patients, were more often detained in hospital against their will, confined to the ward and treated within a secure environment. However, there were few differences in satisfaction with hospital care. Likewise, perceptions of unmet need, provision of after-care and satisfaction with services were similar across the ethnic groups.

CONCLUSIONS

The implications of these findings are discussed. The potential of early intervention programmes and home treatment services to address the ethnic differentials identified in this study merit consideration.

A mediational model of quality of life for individuals with severe mental health problems

BACKGROUND

Despite the increasing importance of quality of life in the mental health field, the theoretical conceptualization of the construct remains poorly developed. A proposed mediational model of quality of life, which links subjective quality of life with self-related constructs, is examined with a group of long-term psychiatric hostel residents. The present study aims to develop a measure of quality of life based on the proposed model, to explore the data and their implications for service development and finally to conduct a preliminary analysis of the model's predictions.

METHODS

A cross-sectional research design was employed. Quality of life interviews, using a modified version of Lehman's Quality of Life Interview, were carried out with 54 psychiatric residents in Greece. The model's predictions were examined by using a series of regression analyses.

RESULTS

The results indicate that perceived improvements in lifestyle, greater autonomy and positive self-concept are significantly and directly associated with better quality of life. In contrast, a direct relationship between objective indicators and subjective quality of life was not found.

CONCLUSIONS

The traditional two-part quality of life model that includes objective indicators of life circumstances and subjective indicators is extended to included the constructs of self-concept and perceived autonomy. The present extended mediational model of quality of life for individuals with long-term mental health problems appears to have important implications for the planning and delivery of mental health programmes.

Cognitive therapy and recovery from acute psychosis: a controlled trial. 3. Five-year follow-up

BACKGROUND

This paper describes the 5-year outcome of a cohort of patients who had received a cognitive therapy intervention during an acute episode of non-affective psychosis.

METHOD

Thirty-four out of the original 40 patients who had taken part in a randomised controlled trial of a cognitive intervention were assessed, using standardised instruments completed at entry into the study. In the original trial, half the patients received a cognitive therapy programme (CT group) and the other half received recreational activities and support (ATY group).

RESULTS

At follow-up no significant differences in relapse rate, positive symptoms or insight between the groups were found, although the CT group did show significantly greater perceived 'Control over illness' than the ATY group. For individuals who had experienced a maximum of one relapse in the follow-up period, self-reported residual delusional beliefs and observer-rated hallucinations and delusions were significantly less in the CT than in the ATY group.

CONCLUSION

Cognitive therapy applied in the acute phase of a psychotic disorder can produce enduring and significant clinical benefits if experience of relapse can be minimised.

Women, marriage, employment and mental health

This paper reviews explanations of sex differences in mental hospital admission rates, taking account of age and marital status effects. Six propositions derived from the review are tested on data from a nationwide community survey of 259 respondents, using a standardized symptom check list. Women report more psychological symptoms than men, but this is unrelated to marital status. It is suggested that being married acts to keep a potential patient out of hospital rather than to reduce symptoms. Whether or not a woman is in paid employment outside the home is a major predictor of symptom levels, especially in depression. Women with unemployed husbands are also particularly likely to report high levels of depression. However, there is no reciprocal effect of wives' employment status on the psychological well-being of their husbands.

Seasonal variations in hospital admissions for affective disorders by gender and ethnicity

Hospital admission statistics for depression and mania have shown significant seasonal patterns. The present investigation was conducted to establish the pervasiveness of the impact of seasons on mood disorder presentation at Birmingham (52 degrees North) by gender and ethnicity. Non-mood disorder admissions were examined as a control to determine the specificity of any seasonal variation to affective illness. Case notes for 992 admissions, during January-December 1995 inclusive, to an inpatient unit were reviewed retrospectively. Admission data were broken down by gender and into three ethnic groups: Asian, white and black. Seasonality in admissions for depression, bipolar disorder and non-mood disorders was tested by gender and ethnicity. Admission frequencies for depression showed significant seasonal pattern, with the incidence of depression being highest in winter. Total admissions, bipolar and non-mood disorders did not show any significant seasonal variability. A gender effect was evident on seasonality of admissions for affective illness, with significant winter peak for depression and summer peak for bipolar disorder in women only. The Asian group was the only ethnic group that showed significant seasonal variation in depression, with a greater number of depressive episodes in winter. Environmental variables were related significantly to the incidence of mood disorders. Specific seasonal effect for affective illness was evidenced by the non-existence of seasonality in other psychiatric disorders. The reverse seasonal pattern for depression and mania suggests a maladaptive response of vulnerable individuals to specific functions of seasons.

Psychological symptom levels in Indian immigrants to England--a comparison with native English

A national community survey of psychological symptom levels among samples of Indian immigrants and natives is reported. Using a quasi-random sampling procedure, a sample of 200 Indian-born residents of large towns in England was selected to match the age and sex structure of the total Indian immigrant population. An indigenous population, selected in the same way, was matched with the immigrants for comparison purposes. Psychological disturbance was measured with the Langner 22-Item Scale which has previously been specifically validated for use in this context. Other indices were constructed to test specific hypotheses. The pattern revealed by mental hospital admission statistics was strongly supported by the survey. Indian immigrants as a group experience far less psychological disorder than natives, despite the experiences of migration and of being an immigrant. On other measures Indians also manifested an adjustment superior to that of natives. Among the Indian sample stable psychological adjustment was related to being young at migration, being acculturated to life in England and being socially integrated. A subgroup of higher social status, Indian females who had been upwardly socially mobile, emerged as the only group with a higher than average symptom level. However, even this group was at least as well adjusted as its English counterpart.

Undetected gynaecological disorders in women with renal disease

Women with chronic renal disease (CRD) who are on dialysis or have a functioning renal transplant are typically stoical in their attitude towards other health problems. We undertook a prospective study of 100 women with CRD to assess the prevalence of gynaecological disorders in this group of patients. Assessment included the measurement of follicle stimulating hormone, luteinizing hormone, prolactin and oestradiol concentrations, cervical cytology and a pelvic ultrasound scan. We found that gynaecological problems are highly prevalent and frequently unrecognized. Of these women, 58% had a menstrual disorder, with uncontrolled menorrhagia being a significant problem when it aggravated the chronic anaemia of renal disease, and 35% were menopausal, including seven women under the age of 40 years. Menopausal symptoms were undertreated. We identified a 14-fold increase in premature ovarian failure secondary to CRD and the use of cyclophosphamide therapy. In all, 22% of the women were subfertile and 10% had an abnormal smear, with cervical dyskariosis being significantly increased because of long-term immunosuppression. Contraceptive advice had often been absent or inappropriate. We conclude that formal gynaecological review should be routinely available for women with CRD.

A comparative evaluation of the Symptom Rating Test and the Langner 22-item Index for use in epidemiological surveys

A systematic evaluation was made of the reliability, validity and psychometric properties of the Symptom Rating Test and Langner 22-Item Scale in order to determine whether they are suitable for use in community surveys of psychiatric epidemiology. On the basis of studies on several samples (total N = 846), both scales were shown to be suitable for this purpose. Although the subscale structure of the Symptom Rating Test was not confirmed, it appeared superior in most respects to the Langner Scale.

Maternal and child psychological sequelae in paediatric burn injuries

It is a commonly held belief that many children suffer psychological sequelae following burn injury. This six month controlled, prospective, follow up study was designed to investigate psychological sequelae in children and their mothers following paediatric burn injury. The study employed a sample of 40 children with burn injuries, and their mothers with three control groups, each of 40 children and their mothers: an acutely ill group, a fracture group and a non ill/injured group. Measures at initial contact and 6 month follow up included the Child Behaviour Checklist and the Hospital Anxiety and Depression Scale. The results demonstrated higher initial maternal anxiety scores in the burn, compared to the fracture and non ill/injured groups, which remained comparatively high 6 months later even though they decreased over time. Children with burn injuries, of the type included in this study, did not appear to develop significant psychological or behavioural sequelae. Following paediatric burn injury mothers appear to be at higher risk than children for developing psychological sequelae, which may have longer term implications for the child's outcome such as affecting compliance with treatment.

Seasonal changes in affective state measured prospectively and retrospectively

BACKGROUND

The study was designed to investigate whether seasonal mood and behavioural changes are detectable prospectively in a non-clinical population in the way they have been reported in retrospective studies. The specificity of any seasonal fluctuation in affective state was also investigated by measuring anxiety as well as depression.

METHOD

To measure seasonal fluctuations in affect and behaviour prospectively, 25 women were interviewed every month for one year using four scales (depression, anxiety, stress, and behavioural change). Retrospective accounts of mood and behaviour at the end of the year were collected with the Seasonal Pattern and Assessment Questionnaire (SPAQ).

RESULTS

Seasonal depression peaked in winter as did atypical behaviour when measured either prospectively or retrospectively, but the difference between winter and summer was much more pronounced in the retrospective data. No seasonal effect was found for anxiety or psychosocial stressors.

CONCLUSIONS

The results obtained by retrospective techniques have limited reliability. In the future, more prospective studies with unbiased, standardised instruments are recommended to measure seasonal variations in affect and behaviour.

Psychological and behavioural disturbance in West Indians, Indians and Pakistanis in Britain: a comparison of rates among children and adults

Data are presented from four studies which compare rates of psychological disturbance for three groups of immigrants to Britain and natives respectively. Children of West Indian and Asian parents are compared to native British children on the Rutter Teachers' Questionnaire and on rates of admission to psychiatric hospitals. Asian children have lower rates of behavioural deviance and mental hospital admissions than do British children. Children of West Indian immigrants show no more behavioural deviance in schools than do British children, but have considerably higher rates of admission to mental hospitals. The pattern for adults is remarkably similar to that shown by children, even though different definitions of psychological disturbance are used. The findings are discussed in the context of previous studies of immigrants to Britain and contemporary theories of immigrant adjustment.