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Biomedical subjects

A Jablensky

Publications and source records attributed to A Jablensky.

At least 19 recordsLinked to original sources
PubMed1992

The International Pilot Study of Schizophrenia: five-year follow-up findings.

A five-year follow-up of the patients initially included in the International Pilot Study of Schizophrenia was conducted in eight of the nine centres. Adequate information was obtained for 807 patients, representing 76% of the initial cohort. Clinical and social outcomes were significantly better for patients in Agra and Ibadan than for those in the centres in developed countries. In Cali, only social outcome was significantly better.

Activities of Daily Living↗
PubMed1992

Politics and mental health I.

The origins and evolution of psychiatry as a medical discipline since the end of the 18th century have been influenced by society's beliefs about the 'nature of man', the dominant forms of social organisation, and the level of technology which could be mobilised to modify human behaviour. These are also the themes from which politics develop. Throughout the past two centuries and up to the present day, two distinct streams can be traced in the political history of psychiatry: first, psychiatry as social control of deviance; and secondly, psychiatry as advocacy of the 'right to be different'. The 'third psychiatric revolution' which is now in progress in many parts of the world has been inspired by the second set of beliefs. It has already produced positive effects on the quality of life of many patients but is also experiencing certain setbacks. The extent to which the new approach to mental health care delivery will benefit patients and society depends not so much on psychiatry as a discipline as on the perceptions and actions of politicians.

Cross-Cultural Comparison↗
PubMed1991

The national mental health programme in the United Republic of Tanzania. A report from WHO and DANIDA.

This is the terminal report on the pilot implementation phase of the national mental health programme in the United Republic of Tanzania which was carried out as a cooperative venture between the Government of Tanzania, the Danish International Development Agency (DANIDA), and the World Health Organization (WHO). Although Tanzania had already achieved wide coverage of its population through a decentralized and easily accessible system of primary health care facilities providing the most essential services, its mental health services were poorly staffed and concentrated in a few custodial-type institutions and out-patient departments hardly capable of ensuring even one contact per year to about one-fifth of the estimated 100,000 severely mentally ill adults and 37,000 children in need of care at any given point in time. The programme design, developed jointly by the three parties involved, aimed to take full advantage of Tanzania's existing primary health care infrastructure by integrating mental health into the general health services of the country, including the 'grassroot' level of the services in the village and the district. The objectives guiding the new programme were: (i) to create an infrastructure for mental health care provision which should meet the requirements of both adequate population coverage and quality of service; (ii) to raise the community's awareness of mental health issues (including informing the community on the availability of effective means to deal with specific problems) and thus enlist its support and participation. The essential features of the adopted strategy were as follows. 1. Mental health care provision was conceived as a sub-system within the health care system, extending from rural health posts and dispensaries through rural health centres to district and regional hospitals. While full integration of mental health care within the general functions of the health workers was sought at the village and dispensary level (first echelon of care), relative differentiation and identity of mental health services were considered necessary at the district and regional levels (the second echelon). Tasks appropriate to each level of care were defined in operational terms and referral pathways were designated to enable the unobstructed access of the patient to more specialized diagnostic or therapeutic services if the problem was not within the competence of the more peripheral level. These pathways were also used in reverse when, following assessment or treatment, a patient was discharged back to the rural service with appropriate instructions about maintenance treatment and aftercare.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1990

Relatives' expressed emotion and the course of schizophrenia in Chandigarh. A two-year follow-up of a first-contact sample.

A two-year follow-up was conducted of a subsample of the Chandigarh cohort of first-contact schizophrenic patients from the WHO Determinants of Outcome project. The patients were those living with family members who had been interviewed initially to determine their levels of expressed emotion (EE). The interview was repeated for 74% of the relatives at one-year follow-up. A dramatic reduction had occurred in each of the EE components and in the global index. No rural relative was rated as high EE at follow-up. Of the patients included in the one-year follow-up, 86% were followed for two years. In contrast to the one-year findings, the global EE index at initial interview did not predict relapse of schizophrenia over the subsequent two years. However, there was a significant association between initial hostility and subsequent relapse. The better outcome of this cohort of schizophrenic patients compared with samples from the West is partly attributable to tolerance and acceptance by family members.

Attitude to Health↗
PubMed1988

Is schizophrenia universal?

The question whether schizophrenia occurs in similar forms in different populations and cultures was first raised by Kraepelin at the turn of the century. However, methodological difficulties have impeded for decades the development of comparative cross-cultural research, and it was not until the 1960s that investigations of the kind Kraepelin envisaged became feasible. A major role in launching multi-centre clinical and epidemiological studies of schizophrenia in over 20 countries in different parts of the world has been played by the World Health Organization. The WHO studies have demonstrated that: (I) syndromes of schizophrenia occur in all cultures and geographical areas investigated; (II) their rate of incidence is very similar in the different populations; (III) the course and prognosis of schizophrenia is extremely variable, but outcome is significantly better in the developing countries. These findings have fundamental implications for the conceptualization of schizophrenia and for designing strategies of new research.

Cross-Cultural Comparison↗
PubMed1987

Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization.

This study reports on the findings from a WHO sponsored cross-national investigation of life events and schizophrenia. Data are presented from a series of 386 acutely ill schizophrenic patients selected from nine field research centers located in developing and developed countries (Aarhus, Denmark; Agra, India; Cali, Colombia; Chandigarh, India; Honolulu, USA; Ibadan, Nigeria; Nagasaki, Japan; Prague, Czechoslovakia; Rochester, USA). On a methodological level, the study demonstrates that life event methodologies originating in the developed countries can be adapted for international studies and may be used to collect reasonably reliable and comparable cross-cultural data on psychosocial factors affecting the course of schizophrenic disorders. Substantive findings replicate the results of prior studies which conclude that socioenvironmental stressors may precipitate schizophrenic attacks and such events tend to cluster in the two to three week period immediately preceding illness onset.

Adolescent↗
PubMed1986

Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders.

In a context of a WHO collaborative study, 12 research centres in 10 countries monitored geographically defined populations over 2 years to identify individuals making a first-in-lifetime contact with any type of 'helping agency' because of symptoms of psychotic illness. A total of 1379 persons who met specified inclusion criteria for schizophrenia and other related non-affective disorders were examined extensively, using standardized instruments, on entry into the study and on two consecutive follow-ups at annual intervals. Patients in different cultures, meeting the ICD and CATEGO criteria for schizophrenia, were remarkably similar in their symptom profiles and 49% of them presented the central schizophrenic conditions as defined by CATEGO class S+. However, the 2-year pattern of course was considerably more favourable in patients in developing countries compared with patients in developed countries, and the difference could not be fully explained by the higher frequency of acute onsets among the former. Age- and sex-specific incidence rates and estimates of disease expectancy were determined for a 'broad' diagnostic group of schizophrenic illness and for CATEGO S+ cases. While the former showed significant differences among the centres, the differences in the rates for S+ cases were non-significant or marginal. The results provide strong support for the notion that schizophrenic illnesses occur with comparable frequency in different populations and support earlier findings that the prognosis is better in less industrialized societies.

Adolescent↗
PubMed1986

Epidemiology of schizophrenia: a European perspective.

Since its inception, the concept of dementia praecox and, later, of schizophrenia has been one of the most disputed entities in modern medicine. Schizophrenia was, and still is, defined by its clinical symptoms and their characteristic evolution over time. No external validating criteria for the diagnosis have been established, in spite of a host of suggestive biological findings, among which the genetic data carry most weight. This absence of clear-cut substrate markers and indicators underscores the importance of the epidemiological perspective in the study of the disorder. The European contributions to the epidemiological description and understanding of schizophrenic morbidity are numerous. They range from community surveys and studies of pedigrees to case-control designs for assessment of risk factors and long-term followup investigations of course and outcome. This review focuses on epidemiological approaches to schizophrenia that have attempted to highlight the essential attributes of a disease: its incidence and prevalence, ecology, and associated features. It is difficult to generalize about European epidemiological research in schizophrenia, because of the coexistence of a variety of "schools," traditions, and approaches. It is nevertheless possible to discern several clear trends in European epidemiological investigations of schizophrenia that can, to some extent, be contrasted to North American developments.

Adolescent↗