Frequency and predictors of adverse events. PRISM Psychosis Study 3

Department of Psychiatry and Behavioural Sciences, University College London Medical School.
The British Journal of Psychiatry (Impact Factor: 7.99). 12/1998; 173(5):376-84. DOI: 10.1192/bjp.173.5.376
Source: PubMed


Community care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim.
Best available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals.
Twenty-eight natural and II unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors.
Rates of adverse events and 'slipping through the net' are relatively low among individuals receiving community-based services, whether intensive or standard care.

Download full-text


Available from: Til Wykes, Jul 02, 2014
  • Source
    • "xi) Any incidents of suicidal behaviour, violence or aggression in the previous year were recorded using a proforma based on the one used by Johnson and colleagues [34]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Art Therapy has been promoted as a means of helping people who may find it difficult to express themselves verbally engage in psychological treatment. Group Art Therapy has been widely used as an adjunctive treatment for people with schizophrenia but there have been few attempts to examine its effects and cost effectiveness has not been examined. The MATISSE study aims to evaluate the clinical and cost effectiveness of group Art Therapy for people with schizophrenia. The MATISSE study is a three-arm, parallel group, pragmatic, randomised, controlled trial of referral to group Art Therapy plus standard care, referral to an attention control 'activity' group plus standard care, or standard care alone. Study participants were recruited from inpatient and community-based mental health and social care services at four centres in England and Northern Ireland. Participants were aged over 18 years with a clinical diagnosis of schizophrenia, confirmed by an examination of case notes using operationalised criteria. Participants were then randomised via an independent and remote telephone randomisation service using permuted stacked blocks, stratified by site. Art Therapy and activity groups were made available to participants once a week for up to 12 months. Outcome measures were assessed by researchers masked to allocation status at 12 and 24 months after randomisation. Participants and care givers were aware which arm of the trial participants were allocated to. The primary outcomes for the study are global functioning (measured using the Global Assessment of Functioning scale) and mental health symptoms (measured using the Positive and Negative Syndrome Scale) assessed at 24 months. Secondary outcomes were assessed at 12 and 24 months and comprise levels of group attendance, social function, satisfaction with care, mental wellbeing, and costs. We believe that this is the first large scale pragmatic trial of Art Therapy for people with schizophrenia. Current Controlled Trials ISRCTN46150447.
    BMC Psychiatry 08/2010; 10(1):65. DOI:10.1186/1471-244X-10-65 · 2.21 Impact Factor
  • Source
    • "One of these was younger long-stay patients, aged 18 -34, who were predominantly single men with schizophrenia; 43% of this group had a history of serious violence, dangerous behaviour, or admission to a Special Hospital. Amongst community care patients with psychotic illnesses in the UK (Johnson et al. 1998), rates of serious violence and imprisonment were "relatively low." "

  • Source
    • "One study found that 20% of people with a psychotic illness were compulsorily admitted within a 3-year period (Johnson et al, 1998). Less clear is the impact of compulsory admission on the patient, although Wall et al (1999) quote unpublished data that compulsion is experienced as coercive. "

Show more