J Piachaud

Imperial College London, London, ENG, United Kingdom

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Publications (17)62.18 Total impact

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    ABSTRACT: Aggressive challenging behaviour in people with intellectual disability (ID) is frequently treated with antipsychotic drugs, despite a limited evidence base. A multi-centre randomised controlled trial was undertaken to investigate the efficacy, adverse effects and costs of two commonly prescribed antipsychotic drugs (risperidone and haloperidol) and placebo. The trial faced significant problems in recruitment. The intent was to recruit 120 patients over 2 years in three centres and to use a validated aggression scale (Modified Overt Aggression Scale) score as the primary outcome. Despite doubling the period of recruitment, only 86 patients were ultimately recruited. Variation in beliefs over the efficacy of drug treatment, difficulties within multidisciplinary teams and perceived ethical concerns over medication trials in this population all contributed to poor recruitment. Where appropriate to the research question cluster randomised trials represent an ethically and logistically feasible alternative to individually randomised trials.
    Journal of Intellectual Disability Research 08/2009; 54(1):17-25. · 1.88 Impact Factor
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    ABSTRACT: The purpose of this paper is to describe long-term outcomes for patients discharged over a 12-year period from a medium secure service for people with intellectual disabilities (ID). A cohort study using case-notes analysis and a structured interview of current key informants. Eleven per cent of the sample was reconvicted. Fifty-eight per cent of the sample showed offending-like behaviour that did not lead to police contact. Twenty-eight per cent of the sample was currently detained in hospital under the Mental Health Act. The presence of a personality disorder, a history of theft or burglary, and young age increased the risk of reconviction. Contact with the police was less likely in those with schizophrenia. Re-admission to hospital was associated with the presence of offending-like behaviours, rather than any specific diagnosis. In terms of reconviction, these results are good compared with those from general forensic services; however, behavioural problems continue for many years and are managed without recourse to the criminal justice system. There is a borderline group whose needs are poorly defined and serviced. Declaration of interests Horizon National Health Service Trust, the managing authority of the service, gave the grant for this study; the corresponding author was working in the service.
    Journal of Intellectual Disability Research 05/2006; 50(Pt 4):305-15. · 1.88 Impact Factor
  • Journal of Intellectual Disability Research 09/2005; 49(Pt 8):635. · 1.88 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Journal of Intellectual Disability Research 08/2005; 49(Pt 7):507-15. · 1.88 Impact Factor
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    Sujeet Jaydeokar, Jack Piachaud
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    ABSTRACT: All people with learning disabilities should be able to choose from a variety of residential placements as a way of achieving greater community integration. However, many are still placed away from their borough of origin, resulting in complex consequences for them, and their families and for clinicians. This article explores the nature of the problem, defining the current issues, and examining the role of the stakeholders and the implications for psychiatrists working in this field.
    Advances in Psychiatric Treatment 01/2004; 10(2):116-123.
  • Jack Piachaud
    Medicine Conflict and Survival 10/2003; 19(4):335-6.
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    Evidence-Based Mental Health 06/2003; 6(2):37-9.
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    ABSTRACT: BACKGROUND: In an era of evidence-based medicine, practice is constantly monitored for quality in accordance with the needs of clinical governance (Oyebode et al. 1999). This is likely to lead to a dramatic change in the treatment of those with intellectual disability (ID), in which evidence for effective intervention is limited for much that happens in ordinary practice. As Fraser (2000, p. 10) has commented, the word that best explains "the transformation of learning disability practice in the past 30 years is 'enlightenment'." This is not enough to satisfy the demands of evidence, and Fraser exhorted us to embrace more research-based practice in a subject that has previously escaped randomized controlled trials (RCTs) of treatment because of ethical concerns over capacity and consent, which constitute a denial of opportunity which "is now at last regarded as disenfranchising". CONCLUSIONS: The present paper describes the difficulties encountered in setting up a RCT of a common intervention, i.e. assertive community treatment, and concludes that a fundamental change in attitudes to health service research in ID is needed if proper evaluation is to prosper.
    Journal of Intellectual Disability Research 06/2002; 46(Pt 4):340-5. · 1.88 Impact Factor
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    ABSTRACT: This survey describes the socio-demographic, clinical and forensic variables of all patients referred to a medium secure unit in the psychiatry of learning disability. Of the sample, 67.5% were referred following an index offence and 76.6% had at least one previous conviction. Just over half (50.6%) came from either prisons, special hospitals or medium secure units and the remainder from mental health/learning disability hospitals or community resources. The majority (91.7%) had prior contact with a mental health or learning disability team. Most (81.5%) had a mild or ‘borderline’ learning disability, 46.8% had either a psychosis or major mood disorder, 58.4% had personality disorders and 56.6% had a history of illicit substance abuse. Of the 79 referrals 29.1% were accepted for admission. Arson as an index offence and a previous conviction for arson were significantly associated with being accepted for admission.
    British Journal of Forensic Practice 01/2002; 4(2):29-33.
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    R. T. Alexander, J. Piachaud, I. Singh
    British Journal of Developmental Disabilities 07/2001; 47(93). · 0.38 Impact Factor
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    ABSTRACT: Little research has been carried out on the benefits of intensive case management (ICM) for people with borderline IQ and severe mental illness. To compare outcome and costs of care of patients with severe psychotic illness with borderline IQ to patients of normal IQ and to assess whether ICM is more beneficial for the former than for the latter. The study utilises data from the UK700 multi-centre randomised controlled trial of case management. The main outcome measure was the number of days spent in hospital for psychiatric reasons. Secondary outcomes were costs of care and clinical outcome. ICM was significantly more beneficial for borderline-IQ patients than those of normal IQ in terms of reductions in days spent in hospital, hospital admissions, total costs and needs and increased satisfaction. ICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits.
    The British Journal of Psychiatry 03/2001; 178:166-71. · 6.61 Impact Factor
  • European Psychiatry - EUR PSYCHIAT. 01/2000; 15.
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    ABSTRACT: Background: Intensive case management is said to be a highly effective model of community care for patients with severe mental illness. However recent studies have failed to show clear advantage of intensive versus standard care for the majority of severely mentally ill patients. Aims: To explore the outcome and costs incurred by patients with severe mental illness and borderline intelligence over a period of three years. Method: The study utilises data from the UK700 project, a multicentre randomised controlled trial. 104 patients with psychosis and borderline intelligence were recruited into the standard and intensive case management arms (54 and 50 respectively) of trial. The main outcome measures were bed use, relapse rates, clinical symptoms and social function. Service costs were also calculated. Results: At three years those in the intensive case management showed: a reduction in number of hospital admissions (p = 0.004) and days spent in hospital (p = 0.003) though only marginal difference was observed in total costs for the two groups (p = 0.06). Other results showed an increase in total number of needs (p = 0.006) and increased satisfaction with the service @ = 0.006) Conclusion: The evidence which has emerged from the study suggests that intensive case management can be effective for a sub-group of severely mentally ill patients who have cognitive and other deficits. Assertive community treatment may increase effective engagement of patients who may be high service users.
    Hassiotis, A. and Ukoumunne, O. and Byford, S. and Tyrer, P. and Harvey, K. and Piachaud, J. and Gilvarry, C. (2000) Outcome of patients with severe mental illness and borderline intellectual functioning. European Psychiatry, 15 (Supplement 2). pp.291S - 291S. ISSN 09249338. 01/2000;
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    ABSTRACT: Patients with recurrent psychotic disorder and borderline learning disability who were randomly assigned intensive case management spent less than half the subsequent time in hospital than those who were assigned standard case management.
    The Lancet 10/1999; 354(9183):999-1000. · 39.21 Impact Factor
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    ABSTRACT: Low cognitive ability and developmental delays have been implicated in the causation of mental illness. To examine the prevalence, socio-demographic characteristics, psychopathology and social functioning profiles of people with low intelligence and recurrent psychotic illness. A multi-centre randomised controlled trial of case management provided the opportunity to explore associations between mental illness and borderline intellectual functioning (assessed using the National Adult Reading test). Overall prevalence of borderline intelligence was 18%. Significant positive associations were shown with: being Black Caribbean; having a father who worked in a manual occupation; lower educational achievement; having had special education; longer course of illness. Those with borderline intelligence had greater disability and were more likely to suffer extrapyramidal side-effects and show evidence of negative symptoms. Educational achievement, history of special education and social class were the best socio-demographic predictors of intellectual level. Many patients who attend generic psychiatric services have considerable intellectual deficits. This may lead to difficulties in other domains of adaptive functioning, and merits further investigation as well as clinical vigilance.
    The British Journal of Psychiatry 09/1999; 175:135-40. · 6.61 Impact Factor
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    ABSTRACT: Patients with recurrent psychotic disorder and borderline learning disability who were randomly assigned intensive case management spent less than half the subsequent time in hospital than those who were assigned standard case management.
    Tyrer, P. and Hassiotis, A. and Ukoumunne, O. and Piachaud, J. and Harvey, K. (1999) Intensive case management for psychotic patients with borderline intelligence. The Lancet, 354 (9183). pp.999 - 1000. ISSN 01406736. 01/1999;
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