Journal of Dementia Care, 19(2), March 2011, p.38.
Publisher:
Hawker
Briefly reports on an eight week support groups for people with newly diagnosed with dementia organised by Ashton, Wigan and Leigh Memory Service. The positive outcomes for those attending, which included a decrease in anxiety and depression, are also discussed.
Briefly reports on an eight week support groups for people with newly diagnosed with dementia organised by Ashton, Wigan and Leigh Memory Service. The positive outcomes for those attending, which included a decrease in anxiety and depression, are also discussed.
British Journal of Psychiatry, 191(Supplement), August 2007, pp.s52-s57.
Publisher:
Cambridge University Press
As understanding of the pathobiology of schizophrenia increases, the challenge is to relate such measures to outcome at a functional level. Critical appraisal of recent evidence on structural and functional imaging, neurological evaluation, early neurodevelopmental indices, genomics, proteomics, metabolomics and apoptotic mechanisms in relation to outcome. Studies conducted prospectively from the first episode of schizophrenia are generating more reliable findings but currently lack predictive power. Prediction of transition from `high-risk' status to first episode has proved somewhat more fruitful, but the gain has been modest and circumscribed. The current level of understanding does not yet allow the generation of predictive models on an individual patient basis. Genomic and metabolomic studies hold particular potential for generating clinically meaningful `biomarkers' but considerable further work is necessary.
As understanding of the pathobiology of schizophrenia increases, the challenge is to relate such measures to outcome at a functional level. Critical appraisal of recent evidence on structural and functional imaging, neurological evaluation, early neurodevelopmental indices, genomics, proteomics, metabolomics and apoptotic mechanisms in relation to outcome. Studies conducted prospectively from the first episode of schizophrenia are generating more reliable findings but currently lack predictive power. Prediction of transition from `high-risk' status to first episode has proved somewhat more fruitful, but the gain has been modest and circumscribed. The current level of understanding does not yet allow the generation of predictive models on an individual patient basis. Genomic and metabolomic studies hold particular potential for generating clinically meaningful `biomarkers' but considerable further work is necessary.
British Journal of Psychiatry, 189(3), September 2006, pp.241-246.
Publisher:
Cambridge University Press
... randomly selected from those with current major depression and 300 from those with no lifetime history. Participants were re-interviewed after 18-62 months to ascertain current diagnosis, psychological symptoms, disability and use of health services. Of participants with major depression at baseline 26% also met criteria for major depression at follow up. Mortality ratio standardised for age and gender
The outcome and impact of major depression in developing countries are not clear. The aim was to describe the outcome of major depression and compare the disability and patterns of service use among different outcome groups. In a case cohort study, nested within a population-based survey of 68 000 participants using the Composite International Diagnostic Interview (CIDI), 300 participants were randomly selected from those with current major depression and 300 from those with no lifetime history. Participants were re-interviewed after 18-62 months to ascertain current diagnosis, psychological symptoms, disability and use of health services. Of participants with major depression at baseline 26% also met criteria for major depression at follow up. Mortality ratio standardised for age and gender was 3.55 (95% C11.97 to 6.39). All indices of measure of disability were significantly higher in the persistently depressed group compared with the completely recovered group. Participants who had recovered partially resembled participants with persistent depression. Two-thirds of those with persistent depression had not sought any help. Major depression was associated with mortality and disability. Those with residual symptoms remained disabled. Help-seeking was unusual
Journal of Intellectual and Developmental Disability, 46(3), 2021, pp.272-280.
Publisher:
Taylor and Francis
Background: Early diagnosis of Fetal Alcohol Spectrum Disorder (FASD) is known to improve outcomes in children. It is less clear if diagnosis in adulthood also conveys benefits. This study investigated long-term outcomes for individuals diagnosed with FASD after 18 years of age. Method: Twenty adults aged 18–45 years at FASD diagnosis were interviewed. Pre-diagnosis information was compared recommendation and 75% enacted two. Most (75%) reported having a diagnosis was beneficial, providing better adaptation and self-understanding. Conclusion: An FASD diagnosis in adulthood can benefit individuals through more access to supports/services and greater personal understanding and adaptation.
(Edited publisher abstract)
Background: Early diagnosis of Fetal Alcohol Spectrum Disorder (FASD) is known to improve outcomes in children. It is less clear if diagnosis in adulthood also conveys benefits. This study investigated long-term outcomes for individuals diagnosed with FASD after 18 years of age. Method: Twenty adults aged 18–45 years at FASD diagnosis were interviewed. Pre-diagnosis information was compared to follow-up information gathered between 1 and 11 years later. Results: Individuals reported high rates of mental health disorders (55%) and unemployment (85%). Pre-diagnosis, 10% received disability income and 15% were eligible for intellectual disability (ID) services. At follow-up, 90% received disability income and 85% were eligible for ID services. All (100%) enacted at least one assessment recommendation and 75% enacted two. Most (75%) reported having a diagnosis was beneficial, providing better adaptation and self-understanding. Conclusion: An FASD diagnosis in adulthood can benefit individuals through more access to supports/services and greater personal understanding and adaptation.
(Edited publisher abstract)
British Journal of Psychiatry, 193(11), November 2008, pp.416-421.
Publisher:
Cambridge University Press
Assesses in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement. Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients. Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level. The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
Assesses in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement. Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients. Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level. The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
Subject terms:
outcomes, patients, psychiatry, user participation, diagnosis;
British Journal of Psychiatry, 191(Supplement), August 2007, pp.s7-s14.
Publisher:
Cambridge University Press
Symptom rating scales are now well established in schizophrenia research but their scores are not the same as outcome. Literature on the use of the Brief Psychiatric Rating Scale (BPRS) the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) in schizophrenia research was studied. Results Scales were designed to make diagnoses, to categorise patients, syndromes or both, and to demonstrate antipsychotic efficacy, as well as to measure outcome. There is much redundancy both between and within scales. Early work suggests limited concurrent validity with external outcome variables. Data are at best ordinal and there are particular difficulties in equating outcome with percentage changes in scores. The concept of remission, which uses absolute item score thresholds with a duration criterion, is a promising outcome measure. Symptom rating scale scores can only comprise a limited part of outcome measurement. Standardised remission criteria may present advantages in outcome research.
Symptom rating scales are now well established in schizophrenia research but their scores are not the same as outcome. Literature on the use of the Brief Psychiatric Rating Scale (BPRS) the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) in schizophrenia research was studied. Results Scales were designed to make diagnoses, to categorise patients, syndromes or both, and to demonstrate antipsychotic efficacy, as well as to measure outcome. There is much redundancy both between and within scales. Early work suggests limited concurrent validity with external outcome variables. Data are at best ordinal and there are particular difficulties in equating outcome with percentage changes in scores. The concept of remission, which uses absolute item score thresholds with a duration criterion, is a promising outcome measure. Symptom rating scale scores can only comprise a limited part of outcome measurement. Standardised remission criteria may present advantages in outcome research.
This review addresses ten common questions arising from practitioners in the research in practice network by presenting messages from research, along with pointers to ongoing studies, further reading and practice examples. It aims to help practitioners consider a range of factors that can affect outcomes for adolescents and young people whose behaviour meets the criteria to diagnose conduct disorder, as classified by the World Health Organisation.
This review addresses ten common questions arising from practitioners in the research in practice network by presenting messages from research, along with pointers to ongoing studies, further reading and practice examples. It aims to help practitioners consider a range of factors that can affect outcomes for adolescents and young people whose behaviour meets the criteria to diagnose conduct disorder, as classified by the World Health Organisation.
Subject terms:
outcomes, young people, adolescence, behaviour problems, diagnosis;
British Journal of Psychiatry, 189(3), September 2006, pp.235-240.
Publisher:
Cambridge University Press
There has been controversy as to whether early intervention in psychosis can improve the outcome of the disorder. The aim was to establish if there is an association between duration of untreated psychosis and the 4-year outcome of persons with a first episode of psychosis. Prospective naturalistic follow-up study of the outcome of consecutive first presentations with DSM-IV psychosis attending a community-based psychiatric service. A longer duration of untreated psychosis was associated with a significantly poorer functional and symptomatic outcome 4 years later. For schizophrenia and schizophreniform disorder, each increment in duration of untreated psychosis was associated with a 7.8 point decrease in global functioning and an increase in positive symptoms scores by 1.9 points. This study extends the findings of short-term follow-up studies by confirming an association between duration of untreated psychosis and `mid-term' outcome
There has been controversy as to whether early intervention in psychosis can improve the outcome of the disorder. The aim was to establish if there is an association between duration of untreated psychosis and the 4-year outcome of persons with a first episode of psychosis. Prospective naturalistic follow-up study of the outcome of consecutive first presentations with DSM-IV psychosis attending a community-based psychiatric service. A longer duration of untreated psychosis was associated with a significantly poorer functional and symptomatic outcome 4 years later. For schizophrenia and schizophreniform disorder, each increment in duration of untreated psychosis was associated with a 7.8 point decrease in global functioning and an increase in positive symptoms scores by 1.9 points. This study extends the findings of short-term follow-up studies by confirming an association between duration of untreated psychosis and `mid-term' outcome
Subject terms:
long term conditions, outcomes, psychoses, research methods, diagnosis;
British Journal of Psychiatry, 189(1), July 2006, pp.79-80.
Publisher:
Cambridge University Press
Studies have assessed the association between a longer duration of untreated symptoms and outcome for psychoses in specialist care. The authors investigated the effect of longer duration on the outcome of common psychiatric disorders in primary care, where most patients are treated. Patients presenting to primary care for new episodes in 10 countries were recruited into a prospective cohort study. Information on duration of untreated symptoms and psychosocial status was collected for 351 individuals using standardised instruments and this was repeated 1 year later. At 1-year follow-up, longer duration was associated with worse psychiatric outcome even after controlling for potential confounders.
Studies have assessed the association between a longer duration of untreated symptoms and outcome for psychoses in specialist care. The authors investigated the effect of longer duration on the outcome of common psychiatric disorders in primary care, where most patients are treated. Patients presenting to primary care for new episodes in 10 countries were recruited into a prospective cohort study. Information on duration of untreated symptoms and psychosocial status was collected for 351 individuals using standardised instruments and this was repeated 1 year later. At 1-year follow-up, longer duration was associated with worse psychiatric outcome even after controlling for potential confounders.
Subject terms:
outcomes, patients, primary care, psychoses, diagnosis;
British Journal of Psychiatry, 187(Supplement 48), August 2005, pp.s19-s23.
Publisher:
Cambridge University Press
A major reason for interest in early intervention for psychotic disorders is the hypothesised relationship between longer duration of untreated psychosis (DUP) and poorer outcome of treatment. The aim was to critically examine the evidence concerning DUP being related to treatment outcome and possible mediators of any such relationship. A systematic review of studies in which DUP is assessed and its relationship to treatment outcome is examined. In addition, studies relevant to possible neurotoxic effects of DUP were reviewed. The research is entirely of a correlational nature and, therefore, firm conclusions regarding causation are not possible. There is, however, substantial evidence of DUP being an independent predictor of treatment outcome, particularly remission of positive symptoms, over the first year or so of treatment. Findings regarding the possible neurotoxic effects of DUP are inconsistent. There continues to be evidence consistent with DUP influencing aspects of treatment outcome. Non-correlational studies, such as quasi-experimental designs, could provide stronger evidence regarding causality.
A major reason for interest in early intervention for psychotic disorders is the hypothesised relationship between longer duration of untreated psychosis (DUP) and poorer outcome of treatment. The aim was to critically examine the evidence concerning DUP being related to treatment outcome and possible mediators of any such relationship. A systematic review of studies in which DUP is assessed and its relationship to treatment outcome is examined. In addition, studies relevant to possible neurotoxic effects of DUP were reviewed. The research is entirely of a correlational nature and, therefore, firm conclusions regarding causation are not possible. There is, however, substantial evidence of DUP being an independent predictor of treatment outcome, particularly remission of positive symptoms, over the first year or so of treatment. Findings regarding the possible neurotoxic effects of DUP are inconsistent. There continues to be evidence consistent with DUP influencing aspects of treatment outcome. Non-correlational studies, such as quasi-experimental designs, could provide stronger evidence regarding causality.
Subject terms:
medical treatment, outcomes, psychoses, diagnosis, early intervention;