The Nithsdale Schizophrenia Surveys

McCreadie, Robin Graeme (1992) The Nithsdale Schizophrenia Surveys. DSc thesis, University of Glasgow.

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Abstract

A generation of schizophrenic patients has grown up since the introduction in the 1950's of community care and antipsychotic medication, and over the past two decades many have been exposed to long term maintenance antipsychotic drug treatment. However, there have been very few studies describing the impact of these developments on a community of schizophrenic patients. The Nithsdale surveys over a 10 year period have tried to do this. The studies fall into three broad groups: the mental state, behaviour and social adjustment of the patient; the family life of the patient, with special reference to relatives' expressed emotion; and the motor disorders produced by antipsychotic medication. Most recently, the frequency of obstetric complications in schizophrenic patients has been examined. THE PATIENT The first census in 1981 of all known schizophrenic patients in Nithsdale, Dumfries and Galloway Region, Scotland identified 133 patients, a point prevalence of 2.38 per 1,000 of the total population. Only three percent of the cohort had no abnormality in mental state or behaviour; negative schizophrenic symptoms were prominent. Only one quarter were inpatients. Patients' and their relatives' assessment of the patient's overall social adjustment correlated very closely, thus suggesting a schizophrenic patient can satisfactorily describe his own adjustment. The patients were less well adjusted than a normal community population in all areas except the parental role. FAMILY LIFE: A repeat census in 1985 found that 50 percent of patients were living with relatives or friends. The family atmosphere, that is, the relatives' level of expressed emotion (EE), was assessed through the Camberwell Family Interview. Thirty two percent of patients living with relatives or friends had high face-to-face contact with a relative showing high EE; put another way, 87% of all Nithsdale schizophrenic patients were not living in a high contact/high EE family. Parents were more critical than spouses, and more showed emotional overinvolvement. A prospective 12 month follow-up identified relapsing patients. There was no difference in relapse rates in patients living on their own, with low EE or with high EE relatives. Amount of contact with high EE relatives did not affect relapse rates. A further census in 1987 identified 77 patients living at home with relatives or friends. Sixty three relatives of 52 of these patients were offered a package of treatments by professionals working in an everyday NHS setting: educational seminars, relatives' groups and family meetings. Thirty two relatives refused intervention. Of the 31 relatives who agreed, 14 attended neither the educational seminars nor the relatives' groups. Seventeen relatives had a mean of 10 treatment sessions but there was little change in their level of EE after intervention. The number of patients who relapsed was the same in the 18 months before and after intervention, although the total number of relapses fell after intervention. By 1990 30 relatives and 30 schizophrenic patients had lived together continuously for five years. The relatives had had their level of EE assessed on three separate occasions over the five years, namely in 1985, 1987 and 1990. In the majority of relatives (63%) the level of EE was stable over time. Patients who relapsed were evenly spread throughout those living in a consistently high, consistently low or fluctuating EE home. However, patients living in low EE homes who did relapse did so significantly less often than those who relapsed and were living in high or fluctuating EE homes. MOTOR DISORDERS: The prevalence of abnormal movements, side effects of the antipsychotic drugs, was examined in the 1981 cohort. Thirty one percent of patients had parkinsonism and 31% tardive dyskinesia (TD). Patients with TD were significantly older than those without TD and more showed flattening of affect and social withdrawal. A repeat census in 1989 identified 161 patients, 146 of whom were assessed for the presence of akathisia (18%), pseudoakathisia (5%), TD (29%) and parkinsonism (27%). Forty four percent had no movement disorder, 36% one and 20% more than one movement disorder. The presence of TD had also been assessed in 61 of the 146 patients in 1981 and 1984. Only 8% showed TD on all three occasions. There was no relationship between plasma antipsychotic drug levels and akathisia, parkinsonism or TD. More non-righthanded than right-handed patients showed TD. Patients with parkinsonism or receiving an antiparkinsonian drug more often had a history of at least one definite obstetric complication. OBSTETRIC COMPLICATIONS: Fifty one mothers of 54 patients of the 1989 cohort were interviewed to obtain obstetric histories of patients and their sibs. There was no statistically significant difference in the proportion of schizophrenic patientss (35%) and sibs (29%) who had at least one definite obstetric complication. There was also no evidence that patients with a history of obstetric complications were less likely to have a first degree relative with a history of psychiatric illness leading to inpatient care. There was a trend for TD to be more common in those patients with no obstetric complications, but a family history of schizophrenia.

Item Type: Thesis (DSc)
Qualification Level: Doctoral
Keywords: Medicine, Biostatistics, Quantitative psychology
Date of Award: 1992
Depositing User: Enlighten Team
Unique ID: glathesis:1992-76367
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 15:21
Last Modified: 19 Nov 2019 15:21
URI: http://theses.gla.ac.uk/id/eprint/76367

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