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IX. Concluding Remarks

Published online by Cambridge University Press:  06 August 2018

Eve C. Johnstone
Affiliation:
Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA1 3UJ University Department of Psychiatry, The Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF
C. D. Frith
Affiliation:
Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA1 3UJ
J. Leary
Affiliation:
Division of Psychiatry, Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA1 3UJ
D. G. C. Owens
Affiliation:
Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA1 3UJ

Abstract

This report concerns 532 patients with schizophrenia. Many items of information have been recorded and the results have been quickly drawn together for publication. It is likely that more detailed analyses of the data will be conducted in time, but this publication reports the central facts derived from this extensive investigation. They can be simply stated. The disorder remains very common. Five hundred and thirty-two individuals with schizophrenia as defined by the Feighner criteria were discharged from Harrow services over 10 years. It was possible to trace the great majority of these patients. In many cases the illness was clearly associated with recurrent or persistent problems. The mean number of admissions required was 5.37 (Fig. 1) and on average patients spent 13.7 of the 120 months between 1975 and 1985 in hospital (Fig. 2).

Type
Research Article
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Allebeck, P. & Wistedt, B. (1986) Mortality in schizophrenia. Archives of General Psychiatry, 43, 650653.Google Scholar
Allen, H. A. & Frith, C. D. (1983) Selective retrieval and free emission of category exemplars in schizophrenia. British Journal of Psychology, 74, 481490.Google Scholar
Alstrom, C. H. (1942) Mortality in mental hospitals with especial regard to tuberculosis. Acta Psychiatrica et Neurologica Scandinavica (suppl. 24).Google Scholar
Ammons, R. B. & Ammons, C. H. (1962) Quick Test. Missoula, MT: Psychological Test Specialists.Google Scholar
Baldwin, J. A. (1979) Schizophrenia and physical disease. Psychological Medicine, 9, 611618.Google Scholar
Battig, W. E. F. & Montague, W. E. (1969) Category norms for verbal items in 56 categories. Journal of Experimental Psychology Monographs, 80, 146.Google Scholar
Bech, P., Rafaelsen, P., et al (1978) The mania rating scale: scale construction and inter-observer agreement. Neuropharmacology, 17, 430431.Google Scholar
Berry, G. (1983) The analysis of mortality by subject-years method. Biometrics, 39, 173184.Google Scholar
Black, D. W. & Winokur, G. (1988) Age, mortality and chronic schizophrenia. Schizophrenia Research, 1, 267272.Google Scholar
Calev, A., Venables, P.H. & Monk, A. F. (1983) Evidence for distinct verbal memory pathologies in severely and mildly disturbed schizophrenic patients. Schizophrenia Bulletin, 9, 247264.Google Scholar
Cheadle, A. J., Freeman, H. L. & Korer, J. R. (1978) Chronic schizophrenic patients in the community. British Journal of Psychiatry, 132, 221227.Google Scholar
Cochrane, R. (1977) Mental illness in immigrants to England and Wales. Social Psychiatry, 12, 2535.Google Scholar
Cooper, B. (1961) Social class and prognosis in schizophrenia. British Journal of Preventive and Social Medicine, 15, 1721.Google Scholar
Crawford, J. R. (1989) Estimation of premorbid intelligence: a review of recent developments. In Developments in Clinical and Experimental Neuropsychology (eds Crawford, J. R. & Parker, D. M.), pp. 5574. London: Plenum.Google Scholar
Creer, C., Sturt, E. & Wykes, T. (1982) The role of relatives. In Long Term Community Care Experience in a London Borough (ed. J. K. Wing). Psychological Medicine (monograph suppl. 2).Google Scholar
Department of Health and Social Security (1981) Care in the Community: A Consultative Document on Moving Resources for Care in England. London: DHSS.Google Scholar
de Silva, W. P. & Hemsley, D. R. (1977) The influence of contact on language perception in schizophrenia. British Journal of Social and Clinical Psychology, 16, 337345.CrossRefGoogle Scholar
Donovan, C. M. (1982) Problems of psychiatric practice in community mental health centers. American Journal of Psychiatry, 139, 456460.Google Scholar
Feighner, J. P., Robins, E., Guze, S., et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5762.Google Scholar
Fink, P. J. & Weinstein, S. P. (1979) Whatever happened to psychiatry? The deprofessionalisation of community health centers. American Journal of Psychiatry, 136, 406409.Google Scholar
Foerster, A., Lewis, S. & Owen, M. (1991) Pre-morbid adjustment and personality in psychosis. Effects of sex and diagnosis. British Journal of Psychiatry, 158, 171176.Google Scholar
Furlong, R. (1987) The care of the very sick – the role of the institution. In Schizophrenia (ed. Herbst, K. G.), pp. 5762. London: Mental Health Foundation.Google Scholar
Garmezy, N. (1978) Attentional processes in adult schizophrenia and children at risk. Journal of Psychiatric Research, 14, 334.Google Scholar
Gessler, S., Cutting, J., Frith, C. D., et al (1989) Schizophrenic inability to judge facial emotion: a controlled study. British Journal of Clinical Psychology, 28, 1929.Google Scholar
Goldberg, E. M. & Morrison, S. L. (1963) Schizophrenia and social class. British Journal of Psychiatry, 109, 785802.CrossRefGoogle ScholarPubMed
Guy, W. (1976) ECDEU Manual for Psychopharmacology, pp. 534537. Washington, DC: DHEW.Google Scholar
Hammond, T. (1987) When they are not in hospital, where should they be? In Schizophrenia (ed. Herbst, K. G.), pp. 6374. London: Mental Health Foundation.Google Scholar
Harrison, G., Owens, D., Holton, A., et al (1988) A prospective study of severe mental disorder in Afro Caribbean patients. Psychological Medicine, 18, 643657.Google Scholar
Harrison, G., Holton, A., Neilson, D., et al (1989) Severe mental disorder in Afro Caribbean patients: some social demographic and service factors. Psychological Medicine, 19, 683696.Google Scholar
Harvey, I. & Murray, R. M. (1990) Why Kraepelin was wrong: the neurodevelopmental view of dementia praecox. In Psychiatry: A World Prospective Vol. I (ed. Stephanis, C. N. et al), pp. 223233. Amsterdam: Elsevier.Google Scholar
Hemsley, D. R. (1982) Cognitive impairment in schizophrenia. In The Pathology and Psychology of Cognition (ed. Burton, A.), pp. 169203. London: Methuen.Google Scholar
Her Majesty's Stationery Office (1980) Classification of Occupations of the Registrar General. London: HMSO.Google Scholar
Herrman, H. E., Baldwin, J. A. & Christie, D. (1983) A record linkage study of mortality and general hospital discharge in patients diagnosed as schizophrenic. Psychological Medicine, 13, 581593.Google Scholar
Hill, I. D. (1972) Computing man years at risk. British Journal of Social and Preventative Medicine, 26, 132134.Google ScholarPubMed
Hogarty, G. E. (1988) Resistance of schizophrenic patients to social and vocational rehabilitation. In Treatment Resistance in Schizophrenia (eds Dencker, S. J. & Kulhanek, F.), pp. 8397. Wiesbaden: Dencker & Kulhanek.Google Scholar
Innes, G. & Millar, W. M. (1970) Mortality among psychiatric patients. Scottish Medical Journal, 15, 143148.Google Scholar
Jablensky, A., Schwartz, R. & Tomov, T. (1980) WHO collaborative study of impairments and disabilities associated with schizophrenic disorders. A preliminary communication. Objectives and methods. Acta Psychiatrica Scandinavica (suppl. 285), 152163.Google Scholar
Janowsky, J. S., Shimamura, A. P. & Squire, L. R. (1989) Source memory impairment in patients with frontal lobe lesions. Neuropsychologia, 27, 10431056.Google Scholar
Johnstone, E. C. (1990) Chronic schizophrenia: can one do anything about persistent symptoms? In Difficulties and Dilemmas in the Management of Psychiatric Patients (eds Hawton, K. & Cowan, P.). Oxford: Oxford University Press.Google Scholar
Johnstone, E. C., Owens, D. G. C., Gold, A., et al (1981) Institutionalisation and the defects of schizophrenia. British Journal of Psychiatry, 139, 195203.Google Scholar
Johnstone, E. C., Owens, D. G. C., Gold, A. et al (1984) Schizophrenic patients discharged from hospital: a follow up study. British Journal of Psychiatry, 145, 586590.Google Scholar
Johnstone, E. C., Owens, D. G. C., Frith, C. D., et al (1985) Institutionalisation and the outcome of functional psychoses. British Journal of Psychiatry, 146, 3644.Google Scholar
Johnstone, E. C., Crow, T. J., Johnson, A. L., et al (1986) The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission. British Journal of Psychiatry, 148, 115120.Google Scholar
Johnstone, E. C., Owens, D. G. C., Frith, C. D., et al (1987) The relative stability of positive and negative features in chronic schizophrenia. British Journal of Psychiatry, 150, 6064.Google Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D., et al (1988) The Northwick Park ‘Functional’ Psychosis Study: diagnosis and treatment response. Lancet, ii, 119126.Google Scholar
Johnstone, E. C., Macmillan, J. F., Frith, C. D., et al (1990) Further investigation of the predictions of outcome following first schizophrenic episodes. British Journal of Psychiatry, 157, 182189.Google Scholar
Johnstone, E. C., Frith, C. D., Crow, T. J., et al (1991) The Northwick Park ‘Functional’ Psychosis Study: diagnosis and outcome. Psychological Medicine (in press).Google Scholar
Jones, K. & Poletti, A. (1985) Understanding the Italian experience. British Journal of Psychiatry, 146, 341347.Google Scholar
Jones, K. & Poletti, A. (1986) The Italian experience reconsidered. British Journal of Psychiatry, 148, 144150.Google Scholar
Kane, L. M., Woerner, M. & Lieberman, J. (1985) Tardive dyskinesia: prevalence incidence and risk factors. In Dyskinesia – Research and Treatment (eds Casey, D. E., Chase, T. N., Christiansen, A. V., et al), pp. 7278. Berlin: Springer-Verlag.Google Scholar
Krawiecka, M., Goldberg, D. & Vaughan, M. (1977) A standardised psychiatric assessment for rating chronic psychotic patients. Acta Psychiatrica Scandinavica, 55, 299308.Google Scholar
Lancet (1985) Psychiatry – a discipline that lost its way. Lancet, i, 731732.Google Scholar
Liddle, P. F. & Morris, D. L. (1991) Schizophrenic syndromes and frontal lobe performance. British Journal of Psychiatry, 158, 340345.Google Scholar
Littlewood, R. (1986) Ethnic minorities and the Mental Health Act: problems of explanation. Bulletin of the Royal College of Psychiatrists, 10, 306308.CrossRefGoogle Scholar
Macmillan, J. F., Crow, T. J., Johnson, A. L., et al (1986) The Northwick Park Study of First Episodes of Schizophrenia. British Journal of Psychiatry, 148, 128133.Google Scholar
May, P. R. A., Dencker, S. J., Hubbard, J. W., et al (1988) A systematic approach to treatment resistance in schizophrenic disorders. In Treatment Resistance in Schizophrenia (eds Denker, S. J. & Kulhanek, F.). Wiesbaden: Braunschweig.Google Scholar
McClintock, F. H. & Avison, N. H. (1968) Crime in England & Wales. London: Heinemann.Google Scholar
McGovern, D. & Cope, R. V. (1987) The compulsory detention of males of different ethnic groups with special reference to offender patients. British Journal of Psychiatry, 150, 502512.Google Scholar
Milner, B. (1964) Some effects of frontal lobectomy in man. In The Frontal Granular Cortex and Behaviour (eds Warren, J. M. & Alcert, K.). New York: McGraw-Hill.Google Scholar
Montgomery, S. A. & Asberg, M., (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 383389.Google Scholar
Morice, R. (1990) Cognitive inflexibility and prefrontal dysfunction in schizophrenia and mania. British Journal of Psychiatry, 157, 5054.Google Scholar
National Schizophrenia Fellowship (1979) Home Sweet Nothing: The Plight of Sufferers from Chronic Schizophrenia. London: NSF.Google Scholar
Nelson, H. E. & O'Connell, A. (1978) Dementia: the estimation of premorbid intelligence using the New Adult Reading Test. Cortex, 14, 234244.Google Scholar
Nelson, H. E., Pantelis, C., Carruthers, K., et al (1990) Cognitive functioning and symptomatology in chronic schizophrenia. Psychological Medicine, 20, 357365.Google Scholar
North West Thames Regional Health Authority (1985) Draft Regional Strategy. London: NWTRHA.Google Scholar
Owens, D. G. C. & Johnstone, E. C. (1980) The disabilities of chronic schizophrenia – their nature and the factors contributing to their development. British Journal of Psychiatry, 136, 384395.Google Scholar
Owens, D. G. C., Johnstone, E. C., & Frith, C. D. (1982) Spontaneous involuntary disorders of movement: their prevalence, severity and distribution in chronic schizophrenics with or without treatment with neuroleptics. Archives of General Psychiatry, 39, 452461.Google Scholar
Owens, D. G. C., Harrison-Read, P. E. & Johnstone, E. C. (1990) L-Dopa in very impaired schizophrenic patients. Clinical Neuropharmacology, 13 (suppl. 2 ), 174175.Google Scholar
Papeschi, R. (1985) The denial of the institution: a critical review of Franco Basaglia's writing. British Journal of Psychiatry, 146, 247254.Google Scholar
Rabkin, J. G. (1979) Criminal behaviour of discharged mental patients: a critical appraisal of the research. Psychological Bulletin, 86, 127.Google Scholar
Richardson, J. T. E., Frith, C. D., Scott, E., et al (1984) The effects of intravenous diazepam and hyoscine upon recognition memory. Behavioural Brain Research, 14, 193199.Google Scholar
Sartorius, N., Jablensky, A., Korte, A., et al (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909928.Google Scholar
Sartorius, N., Jablensky, A., Enrberg, G., et al, (1987) Course of schizophrenia in different countries: some results of a WHO international comparative 5 year follow up study. In Search for the Causes of Schizophrenia (eds Häfner, H., Gattaz, W. F. & Janzarik, W.). Berlin: Springer Verlag.Google Scholar
Scharfstein, S. S. (1978) Will community mental health survive in the 1980's? American Journal of Psychiatry, 135, 13631365.Google Scholar
Stevens, B. C. (1972) Dependence of schizophrenic patients on elderly relatives. Psychological Medicine, 2, 1732.Google Scholar
Sturt, J. & Waters, H. (1985) Role of the psychiatrist in community based mental health care. Lancet, i, 507509.Google Scholar
Taylor, P. J. (1987) Social implications of psychosis. British Medical Bulletin, 43, 718740.Google Scholar
Taylor, P. J. & Gunn, J. (1984) Violence and psychosis I – risk of violence among psychotic men. British Medical Journal, 288, 19451949.Google Scholar
Teggin, A. F., Elk, R., Ben-Avie, O., et al (1985) A comparison of catego class ‘S’ schizophrenia in three ethnic groups’ psychiatric manifestations. British Journal of Psychiatry, 147, 683687.Google Scholar
Teplin, L. A. (1985) The criminality of the mentally ill: a dangerous misconception. American Journal of Psychiatry, 142, 593599.Google Scholar
Tidmarsh, D. (1990) Schizophrenia. In Principles and Practice of Forensic Medicine (eds Bluglass, R. & Bowden, P.), pp. 321343. London: Churchill Livingstone.Google Scholar
Tooth, G. C. & Brooke, E. M. (1961) Trends in the mental hospital population and their effect of future planning. Lancet, i, 710713.Google Scholar
Tsuang, M. T. & Woolson, R. F. (1977) Mortality in patients with schizophrenia, mania, depression and surgical conditions: a comparison with general population mortality. British Journal of Psychiatry, 130, 162166.Google Scholar
Tuma, A. H. & May, P. R. A. (1979) And if that doesn't work what next …? A study of treatment failures in schizophrenia. Journal of Nervous and Mental Disease, 167, 566571.Google Scholar
Wallace, M. (1983) Bedsit despair of the mental hospital outcasts. Sunday Times, 20 November.Google Scholar
Weller, M. P. I. (1985) Friern Hospital: Where have all the patients gone? Lancet, i, 569571.Google Scholar
Winslow, W. W. (1979) The changing role of the psychiatrist in community mental health centers. American Journal of Psychiatry, 136, 2427.Google Scholar
Wojcik, J. D., Gelenberg, A. G., Labrie, R. A., et al (1980) Prevalence of tardive dyskinesia in an outpatient population. Comparative Psychiatry, 21, 370380.Google Scholar
World Health Organization (1975) Schizophrenia: A Multinational Study. Public Health Paper 63. Geneva: WHO.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. Geneva: WHO.Google Scholar
Zitrin, A., Hardesty, A. S., Burdock, E. I., et al (1976) Crime and violence among mental patients. American Journal of Psychiatry, 133, 142149.Google Scholar
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