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Biomedical subjects

D J Done

Publications and source records attributed to D J Done.

At least 19 recordsLinked to original sources
PubMed2005

Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study.

BACKGROUND: There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services. METHOD: In a randomized controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. RESULTS: We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. CONCLUSIONS: Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.

Adolescent↗
PubMed2004

Can disorganisation of semantic memory account for the abnormalities of thought in schizophrenia-a controlled experimental study.

BACKGROUND: Disorganisation of semantic memory could provide a cognitive explanation for the disturbances of thinking and reasoning in schizophrenia. In this study, we directly test this explanation by identifying patients with disorganised semantic categories and then examine how they use their knowledge about these same categories in an inductive reasoning task. METHOD: Experiment 1 utilised a semantic category-sorting task to identify patients with disorganisation of semantic memory. In Experiment 2, the patients with disorganised categories carried out a category-based inductive reasoning task. Accurate performance on this task requires access to well-organised semantic knowledge about the objects and categories used in Experiment 1. RESULTS: Patients with disorganised semantic categories in Experiment 1 did not demonstrate any difficulties or unusual responses when reasoning about the same categories in Experiment 2. CONCLUSION: Disorganisation of semantic memory may not be the primary cause of disturbed reasoning or thought in schizophrenia. Patients with schizophrenia tend to generate ad hoc categories, which are unsuited to the current context. Impaired performance on semantic memory tasks can arise from a misunderstanding of social context.

Adult↗
PubMed2002

Adult psychosis, common childhood infections and neurological soft signs in a national birth cohort.

BACKGROUND: Neurological soft signs preceding adult-onset schizophrenia suggest a neurodevelopmental origin and could reflect physical illness in childhood. AIMS: To investigate possible associations of adult-onset psychosis with neurological soft signs and common infectious illnesses in childhood. METHOD: Using data from the UK National Child Development Study, a longitudinal general population sample, odds ratios were calculated for clinical diagnoses of common childhood viral illnesses and later adult psychotic illness, childhood epilepsy and a range of neurological soft signs. RESULTS: The number of illnesses per individual did not relate either to the number of soft signs, or to any particular adult outcome. Schizophrenia, affective psychosis and epilepsy were not associated with common childhood illness but were associated with neurological soft signs and an increased, but small, frequency of previous meningitis and tuberculosis. CONCLUSIONS: Overall the data support the notion of neurological soft signs as markers of disordered neurodevelopment in schizophrenia (but the early neurological abnormalities are not caused by infectious illness) and an association between meningitis or tuberculosis in childhood and a small proportion of cases of epilepsy, affective psychosis and schizophrenia.

Adult↗
PubMed2001

Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet.

The objective of the study was to evaluate whether a short training workshop in communication techniques is more effective than an information booklet for improving communication skills in informal carers of people suffering from dementia. 30 informal carers were allocated to the workshop sessions and 15 to the booklet. Outcome measures included awareness of communication strategies; perceived frequency of communication breakdown at home, and the associated level of distress; general stress; and consumer satisfaction. At six week follow-up, the workshop group demonstrated a significantly greater awareness of communication strategies than the booklet-only group. Both groups reported some reduction in the frequency of communication problems at home, and a reduction in the associated level of distress. The frequency of other problem behaviours remained stable. Satisfaction with the workshop indicated that training was helpful but depended on the stage of illness of the partner.

Activities of Daily Living↗
PubMed2000

No association between breast-feeding and adult psychosis in two national birth cohorts.

BACKGROUND: It has been proposed that breast-feeding might have a protective effect against the development of adult schizophrenia. AIMS: To test this hypothesis. METHOD: Using prospective data from two UK national birth cohorts, the feeding histories of those who later developed schizophrenia were compared with the remaining population at risk. Analyses in each cohort were considered to be independent tests of the hypothesis. RESULTS: There were no differences in feeding histories. In the 1946 birth cohort (n = 4447) 30 cases of DSM-III-R schizophrenia arose by age 43; 24.1% of cases v. 23.6% of controls were entirely bottle-fed; 17.3% v. 12.3% were breast-fed for under 1 month; 58.6% v. 64.1% were breast-fed beyond 1 month. In the 1958 cohort (n = 18,856), 40 cases of CATEGO nuclear schizophrenia arose by age 28; 24.1% of cases v. 31.7% of controls were entirely bottle-fed; 27.6% v. 24.9% were breast-fed for under 1 month; 48.3% v. 43.4% were breast-fed beyond 1 month. CONCLUSIONS: These findings provide no evidence of any effect of breast-feeding in protecting against the risk of later schizophrenia.

Adolescent↗
PubMed1998

Relative hand skill predicts academic ability: global deficits at the point of hemispheric indecision.

Population variation in handedness (a correlate of cerebral dominance for language) is in part genetic and, it has been suggested, its persistence represents a balanced polymorphism with respect to cognitive ability. This hypothesis was tested in a sample of 12,770 individuals in a UK national cohort (the National Child Development Study) by assessing relative hand skill (in a square checking task) as a predictor of verbal, non-verbal, and mathematical ability and reading comprehension at the age of 11 years. Whereas some modest decrements were present in extreme right handers the most substantial deficits in ability were seen close to the point of equal hand skill ('hemispheric indecision'). For verbal ability females performed better than males, but the relationship to relative hand skill was closely similar for the two sexes; for reading comprehension males close to the point of equal hand skill showed greater impairments than females. Analysed by writing hand the relationship of ability to hand skill appeared symmetrical about the point of 'hemispheric indecision'. The variation associated with degrees of dominance may reflect the operation of continuing selection on the gene (postulated to be X-Y linked) by which language evolved and speciation occurred.

Achievement↗
PubMed1998

Linguistic performance in children who develop schizophrenia in adult life. Evidence for normal syntactic ability.

BACKGROUND: Less syntactically complex speech in patients with schizophrenia has been thought to represent a premorbid dysfunction, of possible prognostic value and indicative of a neurodevelopmental origin for schizophrenia. METHOD: Narratives written at age 11 by children who then developed psychiatric disorders in adult life (using PSE CATEGO diagnoses), especially schizophrenia, were compared with matched controls on syntactic complexity, syntactic maturity, grammatical deviance and spelling ability. RESULTS: Children who later developed either schizophrenia, affective psychosis or a neurotic type of disorder in adulthood did not differ from normal controls on any of the measures of syntactic production, grammatical errors or spelling. CONCLUSIONS: It is probable that previous reports of reduced syntactic complexity in schizophrenic speech are a consequence of being in a psychotic state and do not represent a premorbid deficit.

Adolescent↗
PubMed1996

Cerebral lateralization is delayed in children who later develop schizophrenia.

The origins of schizophrenia are obscure. One suggestion is that it represents a component of the genetic variation associated with the establishment of dominance in one or other cerebral hemisphere, a mechanism that has been crucial in the evolution of language. Indices of cerebral hemispheric dominance (hand, foot and eye preference, speed of checking squares) recorded on the 16,980 children in the UK National Child Development Study cohort were examined in relation to psychiatric admission by the age of 28 years. Diagnoses were established by the application of Present State Examination criteria to case notes. Pre-schizophrenic children (n = 34-36) were more likely (p < 0.0003) to be rated by their mothers as ambidextrous at the age of 7 years, and at 11 years were less (p < 0.01) strongly right-handed than their peers in the cohort population on a test of relative hand skill: children who later developed affective psychosis (n = 25) or neurosis (n = 60) did not differ significantly from controls. Delay in establishing dominance in one hemisphere could be the critical factor that predisposes to schizophrenia.

Adolescent↗
PubMed1996

Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case-control studies.

On the basis of previous findings, we used meta-analyses to consider whether births to parents with schizophrenia have an increased risk of obstetric complications. Meta-analyses were based on published studies satisfying the following selection criteria. The schizophrenic diagnosis could apply to either parent: parents with non-schizophrenic psychoses were not included: only normal controls were accepted. In all, 14 studies provided effect sizes or data from which these could be derived. Studies were identified by data searches through MEDLINE, PSYCLIT and through references of papers relating to the subject. Births to individuals with schizophrenia incur an increased risk of pregnancy and birth complications, low birthweight and poor neonatal condition. However, in each case the effect size is small (mean r = 0.155; 95% CI = 0.057). The risk is greater for mothers with schizophrenia and is not confined to mothers with onset pre-delivery or to the births of the children who become schizophrenic themselves.

Adult↗
PubMed1995

Childhood precursors of psychosis as clues to its evolutionary origins.

Those who as adults will be admitted to a psychiatric ward with a psychotic illness can be distinguished (on the basis of group differences) from others by their behaviour and academic performance at the ages of 7 and 11 years. Pre-schizophrenic boys are anxious and hostile towards adults and peers at the age of 7 years and show poor concentration. By age 11 years these boys are also rated as depressed, and pre-schizophrenic girls as depressed and withdrawn. Pre-affective psychotic boys show minor changes (for example an increase in hostility and restlessness) at age 7 years, although these features are not obvious at age 11 years. Abnormalities that in some respects resemble those in pre-schizophrenic boys are present at age 11 years in a group of females who will be admitted to psychiatric units with non-psychotic diagnoses by the age of 28 years. Academic impairments (including speech and reading difficulties) at ages 7, 11 and 16 years are more severe in pre-schizophrenics than in the other groups. Schizophrenics-to-be are slow to develop continence and show poor coordination and vision at age 7 years, and are rated clumsy at age 16 years. Psychosis reflects a disturbance of aspects of central nervous system function that are time-dependent and in certain respects gender specific. It is argued that the psychoses represent extremes of variation in a gene (or genes) that differs between sexes and controls the timing of development of the two cerebral hemispheres.(ABSTRACT TRUNCATED AT 250 WORDS)

Achievement↗
PubMed1995

Antecedents of schizophrenia and affective illness. Obstetric complications.

BACKGROUND: This exploratory study seeks to generate new hypotheses about the relationship between obstetric complications and schizophrenia. METHOD: The British Perinatal Mortality Survey represents 98% of all births during one week in March 1958 in Great Britain. Present State Examination (PSE), Catego diagnoses of narrowly defined schizophrenia (n = 49), broadly defined schizophrenia (n = 79), affective psychosis (n = 44) and neurosis (n = 93) were derived from case notes for all cohort members. The remainder of the cohort, surviving the perinatal period, acted as controls (n = 16 812). Variables in the British Perinatal Mortality Survey were grouped into five categories: the physique/lifestyle of the mother (including demographic characteristics), her obstetric history, the current pregnancy, the delivery and the condition of the baby. RESULTS: There were 7/17 significant differences in maternal physique/lifestyle and obstetric history between the births of schizophrenics and controls, compared to 4/40 comparisons of somatic variables relating to pregnancy, birth and the condition of the baby. This compares with 4/17 and 7/40 for affective psychotics and a total of 4/57 differences for all categories of variables when neurotics were contrasted with controls. CONCLUSIONS: The purported increased risk of obstetric complications in schizophrenics may result from the physique/lifestyle of their mothers.

Affective Disorders, Psychotic↗
PubMed1994

Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11.

OBJECTIVE: To investigate the social adjustment in childhood of people who as adults have psychiatric disorders. DESIGN: Subjects in a prospectively followed up cohort (the national child development study) who had been admitted as adults to psychiatric hospitals were compared with the rest of the cohort on ratings of social behaviour made by teachers at the ages of 7 and 11 years. SUBJECTS: 40 adult patients with schizophrenic illnesses, 35 with affective psychoses, and 79 with neurotic illness who had been admitted for psychiatric reasons by the age of 28. 1914 randomly selected members of the cohort who had never been admitted for psychiatric treatment. MAIN OUTCOME MEASURES: Overall scores and scores for overreaction (externalising behaviour) and underreaction (internalising behaviour) with the Bristol social adjustment guide at ages 7 and 11. RESULTS: At the age of 7 children who developed schizophrenia were rated by their teachers as manifesting more social maladjustment than controls (overall score 4.3 (SD 2.4) v 3.1 (2.0); P < 0.01). This was more apparent in the boys (5 (2.6)) than the girls (3.4 (1.8)) and related to overreactive rather than underreactive behaviour. At both ages prepsychotic (affective) children differed little from normal controls. By the age of 11 preneurotic children, particularly the girls, had an increased rating of maladjustment (including overreactions and underreactions). CONCLUSION: Abnormalities of social adjustment are detectable in childhood in some people who develop psychotic illness. Sex and the rate of development of different components of the capacity for social interaction are important determinants of the risk of psychosis and other psychiatric disorders in adulthood.

Adult↗
PubMed1992

The Northwick Park 'Functional' Psychosis Study: diagnosis and outcome.

Three hundred and twenty-six consecutively admitted patients with functional psychotic illnesses to which no diagnostic classification had been applied were followed up after 2.5 years. They were examined in social, clinical and psychological terms and the CATEGO programme and DSM-III criteria were applied to data concerning the index episode to derive diagnostic classifications. The deterioration in occupational functioning and the hospital careers of patients with diagnostic classifications of schizophrenia were worse than those in the other groups and positive and negative features were also more severe in patients with a classification of schizophrenia. By contrast, no differences in psychological test performance were found between the groups based upon diagnostic classification. Impaired psychological test performance was found and it was strongly related to concurrent mental state abnormalities, particularly negative symptoms. It is concluded that the diagnostic classifications used were of limited value in predicting outcome in functional psychosis.

Adult↗
PubMed1992

Prenatal exposure to influenza does not cause schizophrenia.

Claims have been made that maternal infection with influenza during pregnancy is a cause of schizophrenia in the child. These assertions are based upon some apparently significant associations between the timing of influenza epidemics in the general population and birth rates of people who later suffered from schizophrenia. Such associations have not been present in studies of the 1919 and 1957 epidemics, with sample sizes larger than those on which the claims were made. More decisively, in an investigation of the subsequent psychiatric admissions of people born a few months after the 1957 epidemic, it was found that the children of 945 mothers who actually suffered from influenza during the second trimester of pregnancy were at no greater risk of developing schizophrenia than children of mothers who were not infected. In contrast to the predictions of the influenza hypothesis of 26.5 extra cases by broad diagnostic criteria and 15.8 cases by narrow criteria, the numbers observed in children of mothers exposed to influenza in the second trimester were 3 and 1 cases respectively, close to the expected rate. It is concluded that prenatal influenza and schizophrenia are unrelated.

Adolescent↗
PubMed1991

Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British perinatal mortality survey sample.

OBJECTIVE: To evaluate whether events occurring at or around the time of birth contribute to the onset of psychotic illness in adult life. DESIGN-Pregnancy and birth complications as possible causes of adult mental illness were studied in the population sample of the British perinatal mortality survey. Subsequent psychiatric admissions were independently identified through the Mental Health Enquiry and records of regional and special health authorities. Logistic regression was used to compare data on perinatal deaths with those on survivors to determine factors independently associated with perinatal death, and this equation was then used to calculate the risk of perinatal death for each survivor. SUBJECTS: 16,980 people born in a single week in 1958 (the British perinatal mortality survey sample), including 252 patients admitted to psychiatric care; case notes of 235 patients were supplied. MAIN OUTCOME MEASURES AND RESULTS: Patients with a schizophrenic illness (whether defined by "broad" (n = 57) or "narrow" (n = 35) diagnostic criteria) did not have a greater mean risk of perinatal death than the population in general, but there was some evidence of increased liability (relative risk 2.43; 95% confidence interval 1.17 to 5.05) for those with affective psychosis (n = 32). Specific high risk variables for affective psychosis were decreased gestation time (273.9 v 281.2 days; mean difference 7.3 days, 95% confidence interval 3.1 to 11.5; p less than 0.002) and prescription of vitamin K to the child in the first week of life (19% of patients v 5% of controls, p = 0.016). CONCLUSIONS: The findings give no support to theories that factors predicting perinatal mortality contribute significantly to causation of schizophrenic illness. Further investigation of decreased gestation length in relation to affective disorder is required.

Adult↗
PubMed1990

A "mock up" of schizophrenia: temporal lobe epilepsy and schizophrenia-like psychosis.

Schizophrenia-like psychoses occur more frequently than expected in patients with chronic temporal lobe epilepsy. We have analyzed pathological and clinical data from a series (n = 249) of temporal lobectomies to determine the factors that may relate to the development of schizophrenia-like psychosis. Schizophrenia-like psychoses did not occur at random; they were significantly associated with lesions that (1) originated in the fetus or perinatally, (2) affected neurons in the medial temporal lobe, and (3) gave an early age of first fit. Gangliogliomas--developmental lesions of the medial temporal lobe containing aberrant neurons--were disproportionately (p less than 0.001) associated with risk of psychosis. Schizophrenia-like psychoses arising preoperatively occurred more often (p = 0.1) with left-sided lesions. Asymmetry of lesion was not present in cases with postoperative psychoses. These findings are of interest in relation to recent studies suggesting that the structural abnormalities found in the brains of schizophrenics arise during fetal brain development.

Adult↗
PubMed1990

Combination tricyclic antidepressant and lithium maintenance medication in unipolar and bipolar depressed patients.

In a small study of up to 3 years' duration comparison of the value of amitriptyline alone versus amitriptyline + lithium in unipolar cases (27 patients) and of that of lithium alone versus amitriptyline + lithium in bipolar cases (13 patients) showed no advantage for the combination treatments in terms of efficacy in reducing depressive relapses. There was no effect of treatment, developing depression or developing hypothyroidism upon the psychological tests which were conducted during this prolonged study. Observer and self ratings detected an increase in depression before relapse was clearly present, but of the various psychological assessments conducted only arousal showed changes in association with developing and definite relapse. The prescription of lithium but not amitriptyline + lithium or amitriptyline alone was associated with significant increases in blood pressure.

Adult↗