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Biomedical subjects

G Hutchinson

Publications and source records attributed to G Hutchinson.

At least 19 recordsLinked to original sources
PubMed2006

Minor physical anomalies across ethnic groups in a first episode psychosis sample.

Minor physical anomalies (MPAs) are more prevalent amongst individuals with psychosis, supporting a neurodevelopmental model for psychotic disorders. The aim of this study was to investigate the possibility that neurodevelopmental adversity contributes to the excess of psychosis found in some ethnic groups in the UK. Subjects with first onset psychosis and healthy neighbourhood controls were enrolled in the AESOP study in South East London and Nottingham between 1997 and 1999. MPA rates were estimated in four broad ethnic groupings (White, African Caribbean, Black African and Other). Patients (n=245) had a higher mean total MPA score than healthy controls (n=158). This held true across each of the four ethnic groupings. The results of this study suggest that neurodevelopmental factors play a role in the aetiology of psychosis across all ethnic groups.

Adult↗
PubMed2006

Grey matter correlates of minor physical anomalies in the AeSOP first-episode psychosis study.

BACKGROUND: Minor physical anomalies are more prevalent among people with psychosis. This supports a neurodevelopmental aetiology for psychotic disorders, since these anomalies and the brain are both ectodermally derived. However, little is understood about the brain regions implicated in this association. AIMS: To examine the relationship between minor physical anomalies and grey matter structure in a sample of patients with first-episode psychosis. METHOD: Sixty patients underwent assessment of minor physical anomalies with the Lane scale. High-resolution magnetic resonance images and voxel-based methods of image analysis were used to investigate brain structure in these patients. RESULTS: The total anomalies score was associated with a grey matter reduction in the prefrontal cortex and precuneus and with a grey matter excess in the basal ganglia, thalamus and lingual gyrus. CONCLUSIONS: Minor physical anomalies in a sample of patients with first-episode psychosis are associated with regional grey matter changes. These regional changes may be important in the pathogenesis of psychotic disorder.

Adolescent↗
PubMed2005

Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission. Report from the AESOP study.

BACKGROUND: Many studies have found high levels of compulsory admission to psychiatric hospital in the UK among African-Caribbean and Black African patients with a psychotic illness. AIMS: To establish whether African-Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres. METHOD: All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (AESOP) study. For this analysis we included all White British, other White, African-Caribbean and Black African patients from the AESOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes. RESULTS: African-Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African-Caribbean men were the most likely to be compulsorily admitted. CONCLUSIONS: These findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African-Caribbean and Black African patients.

Adolescent↗
PubMed2005

Pathways to care and ethnicity. 2: Source of referral and help-seeking. Report from the AESOP study.

BACKGROUND: Previous research has found that African-Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres. METHOD: We included all White British, other White, African-Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes. RESULTS: Compared with White British patients, general practitioner referral was less frequent for both African-Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders. CONCLUSIONS: These findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

Adolescent↗
PubMed2005

HIV mania as a marker for clinical deterioration in AIDS.

HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Variation of homicidal and suicidal behaviour within Trinidad and Tobago and the associated ecological risk factors.

Self destructive behaviour may not occur consistently across a population. Identification of variations in homicidal and suicidal behaviour within a country can enable specific prevention and public health strategies to be adopted. This is significant because morbidity and mortality associated with these behaviour patterns is preventable and the affected population is increasingly young adults with potentially productive lives. The author sought to identify some of the associated risk factors with the behaviours in Trinidad and Tobago, a developing island-state in the English-speaking Caribbean, by disaggregating the homicide and suicide data available from Police records for distinct geographical regions. Spearman rank correlation was used to determine whether any of the variations observed could be attributed to social or demographic factors. Homicide and suicide were inversely related in many areas of the country. They were both low in Tobago. Homicide was positively associatedwith high population density, low marriage rates, African ethnicity and showed a trend toward association with school drop-out rates. For suicide, low population density, low income, East Indian ethnicity and alcohol consumption were significantly correlated. These findings underline the benefit of disaggregating national data and suggest specific interventions to diminish the occurrence of these harmful behaviour patterns in Trinidad and Tobago with possible extension to other similar developing countries.

Adolescent↗
PubMed2004

Social and health determinants of well being and life satisfaction in Jamaica.

BACKGROUND: Psychological well being and the degree of satisfaction with life are likely to affect a range of social behaviours and determine uptake of health and social services. It is important to identify the factors that inform these constructs. AIMS: We sought to identify the variables which best predicted psychological well being in the Caribbean country, Jamaica and also those associated with feelings of satisfaction with life. METHODS: Interviews were conducted on young adults aged 15-50 years as part of a sexual decision-making survey in Jamaica. Information was collected on a range of social, health and demographic variables and a measure of psychological well being--Centre for Epidemiological Studies of Depression (CES-D). Satisfaction with life was measured using a Likert scale in response to the question 'Are you satisfied with your life as a whole?' Multiple regression analyses were used to determine the predictors of psychological well being and satisfaction with life. RESULTS: There were 2580 respondents (1601 women and 979 men). The mean age was 29.7 years (standard deviation 9.2 years). Women had lower levels of psychological well being and satisfaction with life. Independent predictors of lower psychological well being were having an acute illness, having a chronic illness in women and high religious behaviour in men. Satisfaction with life was predicted by younger age, marital status and employment. CONCLUSIONS: Our findings suggest that health variables are more important for psychological well being while social circumstances are more significant for satisfaction with life. There are important gender differences in the mediation of psychological well being as well as age differences in the variables associated with satisfaction with life.

Adolescent↗
PubMed2003

Pregnancy and birth complications in patients with schizophrenia in Trinidad and London.

It has been shown that an excess of pregnancy and birth complications (PBCs) does not contribute to the excess rates of schizophrenia reported for the population of Caribbean origin in Britain compared with the native Caucasian British population. We therefore attempted to compare the rate of PBCs between a sample of schizophrenics in Britain with that of a sample from Trinidad where some of the Caribbean migrants to Britain originated. First contact patients with schizophrenia according to the CATEGO system diagnosis were identified in Trinidad and London. Their mothers, where available, were interviewed using the Lewis-Murray scale for pregnancy and birth complications. Data from Trinidad and Tobago concerning 56 patients were compared with those of the Caucasian (n = 61) and African-Caribbean (n = 50) patients in London. The rate of PBCs was similar for the Caucasian British patients (24.6%) and the patients in Trinidad and Tobago (21.7%). The rates were lowest in the African-Caribbean patients in London (14.0%), though this difference was not statistically significant. These findings suggest that pregnancy and birth complications are a risk factor for a substantial minority of patients with schizophrenia in Trinidad and London. It also confirms that the excess rates of schizophrenia reported for the Caribbean population in Britain are not due to these complications.

Adolescent↗
PubMed2003

Gender and ethnicity in first admissions to a psychiatric unit in Trinidad.

It has been recognized that there are gender disparities in the admission rates to psychiatric units. While the community prevalence of the major non-organic psychotic mental disorders are thought to have no gender bias, non-psychotic disorders such as depression are more commonly diagnosed in women. Gender differences in admission may indicate differences in severity or in presentation to psychiatric services and would have important implications for the targeting of preventative strategies. The case notes of all admissions to the psychiatric unit at the San Fernando General Hospital were obtained for the calendar year 1999. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses and gender were analysed to determine the distribution of diagnostic categories by gender. A total of 119 patients were admitted to the unit for the first time in the period under review, 72 were male (60.5%) and 47 were female (39.5%). There were no significant differences in age by gender. Substance use related admissions and psychotic illnesses (schizophrenia spectrum and affective psychoses) were significantly more common in men (p = 0.006; p = 0.03 respectively). These differences were especially marked for those of East Indian descent. Non-psychotic illnesses were more commonly diagnosed among women (p = 0.0008). These findings suggest that a larger proportion of males are admitted to the general hospital psychiatric unit among first time admissions. This is also true for re-admissions. Men are more likely to be diagnosed with substance use and psychotic disorders, while for women, major depression and non-psychotic illnesses are the main diagnoses. Community surveys are needed to determine whether this demographic pattern of admission reflects the population prevalence of these disorders. Reduction of admission rates will require interventions that are sensitive to gender differences in diagnosis among those admitted to psychiatric units.

Adolescent↗
PubMed2002

Making a diagnosis of adult attention deficit hyperactivity disorder.

This paper describes the diagnosis of adult attention deficit hyperactivity disorder (ADHD) in a 26-year-old female. Adult ADHD is being increasingly acknowledged as a cause of psychiatric morbidity particularly since the diagnosis is frequently missed in childhood. Greater recognition of this disorder is important because it can be a cause of low productivity and employment disruption as well as a risk factor for other psychiatric problems such as substance abuse and mood disorders.

Adult↗
PubMed2001

Evaluation of the chemotherapy patient monitor: an interactive tool for facilitating communication between patients and oncologists during the cancer consultation.

Effective communication between oncologists and patients with cancer is of paramount importance. The Chemotherapy Patient Monitor (CPM) is a novel tool designed to assist doctor-patient communication regarding patient concerns and side-effects. Initially, the CPM was assessed in a primary evaluation study of its use during consultations with 26 patients with advanced colorectal cancer (one consultation without, followed by two with, the CPM per patient). This led to a further dissemination/audit of 34 patients attending oncology centres in the UK, who had completed the survey prior to three consultations. The CPM contains a checklist of common side-effects of chemotherapy regimens used in advanced colorectal cancer, and other common concerns of patients with advanced colorectal cancer. The CPM records the presence of side-effects/concerns, the distress caused, whether patients wish to discuss them further, and actions taken as a result. Questionnaires explored the views of patients and oncologists in the UK and Spain regarding the effectiveness of consultations during a baseline visit conducted without the CPM, and then with the CPM in subsequent visits. These data were then complemented by the dissemination/audit study of the CPM across nine centres in the UK. All patients understood the CPM. The CPM was rated as useful by oncologists in 83% of consultations, and did not lengthen 82% of visits. Patients felt it had improved the visit in 95% of cases. Responses from patients (100%) and oncologists (84%) indicated willingness to use the CPM for at least some consultations in the future. The results of the dissemination/audit study supported these conclusions. We conclude that the CPM appears to be a useful new tool for improving patient-doctor communication during cancer consultations.

Antineoplastic Agents↗
PubMed2001

Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses.

BACKGROUND: Increased rates of schizophrenia continue to be reported among the African-Caribbean population in England. AIMS: To evaluate the competing biological, psychological and social explanations that have been proposed. METHOD: Literature review. RESULTS: The African-Caribbean population in England is at increased risk of both schizophrenia and mania; the higher rates remain when operational diagnostic criteria are used. The excess of the two psychotic disorders are probably linked: African-Caribbean patients with schizophrenia show more affective symptoms, and a more relapsing course with greater social disruption but fewer chronic negative symptoms, than White patients. No simple hypothesis explains these findings. CONCLUSIONS: More complex hypotheses are needed. One such links cultural variation in symptom reporting, the use of phenomenological constructs by psychiatrists and social disadvantage.

Attitude to Health↗
PubMed1999

Life events, ethnicity and perceptions of discrimination in patients with severe mental illness.

BACKGROUND: Whilst it is commonly believed that black and ethnic minority (B&EM) people living in the UK experience social disadvantage compared with the white British (WB) population, no study has specifically addressed this issue in patients with severe mental illness. We sought to test the hypothesis that B&EM patients experience more negative life events than their WB counterparts, and to examine the extent to which they attribute these events to discrimination. METHOD: Thirty-four WB, 78 African Caribbean (AC) and 35 other ethnic minority patients with psychotic illnesses, defined using Research Diagnostic Criteria, were asked to complete a Racial Life Event Questionnaire examining life events and perceptions of discrimination at baseline and 12 and 24 months later. RESULTS: African Caribbean patients experienced more 'Financial' life events across the study period, otherwise there were no significant differences between patient groups in number of life events experienced. The B&EM group collectively (n = 113), however, were significantly more likely than the WB group (n = 34) to attribute 'Assault', and 'Legal' life events to discrimination. The AC patient group were significantly more likely than the other two ethnic groups to attribute the 'Financial' and 'Health' life events they experienced to discrimination. The B&EM group was also significantly more likely, and particularly the AC patient group, to report that members of their own ethnic group are adversely affected by discrimination. Further analyses showed skin colour rather than ethnicity or nationality to be the major contributing factor to perception of discrimination; thus, the Irish (n = 11) had similar scores to the WB while Africans (n = 16) scored like the ACs. CONCLUSION: Our study shows that B&EM patients do not experience significantly more life events than WB patients; however, their perception of these events is clearly different, and significantly more often attributed to racism. It is reasonable to suppose that patients may be disinclined to utilise services they believe to be prejudiced against them on the basis of their skin colour, and service providers need to be aware of this in order to create health care services that B&EM patients feel confident to use.

Adult↗
PubMed1999

Fertility and marital rates in first-onset schizophrenia.

BACKGROUND: Many studies have demonstrated that in schizophrenia there are decreased rates of marriage, fertility and marital fertility. However, it is not clear whether this finding occurs as a social consequence of having the illness or is an inherent part of the illness. One would expect it to vary across cultures if it were being mediated by social and cultural factors. METHOD: We investigated this by reviewing the marital and fertility data from a multi-ethnic first-contact group of patients in London with CATEGO broadly defined schizophrenia, and comparing this with similar data from a group of controls who were matched for age, gender and ethnicity. RESULTS: Our sample comprised 38 White British, 38 Caribbean and 24 Asian subjects. The Asian group were significantly older (mean age 38, P < 0.003) and had a greater percentage of females (50%). When compared to controls, the White and Caribbean patients, but not the Asians, had decreased marital and stable relationship rates. There was also decreased fertility and marital fertility as evidenced by number of children among the Whites and Caribbeans, but again significantly not among the Asians. Marital status did not predict fertility rates, particularly among the Caribbeans. Regression analysis demonstrated an effect for age on the number of children but not on marital status. CONCLUSIONS: These findings suggest that marital and reproductive behaviour are reduced in schizophrenia, but this effect may be mediated by social and cultural factors and therefore not apply consistently across ethnicity. Further research is needed to prospectively investigate populations to determine whether impairments of this nature are inherent or consequential to the illness.

Adolescent↗
PubMed1999

The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population.

BACKGROUND: African-Caribbean patients have less desirable routes of entry into the psychiatric services than other ethnic groups in Britain but this may not apply to the first contact with services. METHODS: Patients' pathways to care, type of admission or referral and sectioning details were recorded for all first contact patients presenting to south London psychiatric services over a 2-year period. We also conducted a retrospective analysis of data from the Camberwell Register, comparing rates of compulsory admission between 'Whites' and 'African-Caribbeans' for first and readmissions, over a 20-year period. RESULTS: Our first contact sample comprised 38 White, 38 African-Caribbean and 24 Asian patients with CATEGO defined broad schizophrenia. GP referral was found to be the most common mode of contact and there were no significant differences between the ethnic groups with regard to compulsory admission. Similarly, data from the Camberwell Register showed no significant difference in rates of compulsory admission between first admission White and African-Caribbean patients. However, when all readmissions were examined, African-Caribbeans were more likely to be admitted involuntarily. CONCLUSIONS: Our findings suggest that reports of less desirable routes of entry for African-Caribbean patients into the psychiatric service do not apply to their first admission but are likely to develop over time and repeated contact with the services.

Adolescent↗
PubMed1999

Factor analysis of symptoms in schizophrenia: differences between White and Caribbean patients in Camberwell.

BACKGROUND: The incidence of schizophrenia among African-Caribbeans living in Britain has been frequently reported to be increased. We sought to determine whether the symptom profile in schizophrenic patients from this group differed from that of their White counterparts. METHODS: Factor analysis was applied to symptom data obtained by the Present State Examination (PSE) from a group of White (N = 96) and Afro-Caribbean (N = 64) patients who satisfied Research Diagnostic Criteria criteria for broad schizophrenia. We identified six symptom dimensions: mania, depression, first-rank delusions, other delusions, hallucinations and one which comprised both manic and catatonic symptoms. RESULTS: The only difference between the two ethnic groups was seen on the mixed mania-catatonia dimension with the Afro-Caribbean group being over-represented. There were no other significant differences between the groups. Discriminant analysis, however, revealed no significant differences between the groups in any dimension. CONCLUSIONS: These results indicate that there are no differences between White and African-Caribbean patients with schizophrenia in terms of the core symptoms of the disorder, however, the African-Caribbean patients may present with more symptoms of a mixed affective nature.

Adolescent↗