Alan Butler

PSYCHIATRIC ASPECTS OF EPILEPSY IN CHILDHOOD TREATED WITH CARBAMAZEPINE, PHENYTOIN OR SODIUM VALPROATE: A RANDOM TRIAL

Sixty‐four new cases of childhood epilepsy were randomly assigned to either carbamazepine, phenytoin or sodium valproate, and were assessed with behavioural measures before medication and after one and six months of treatment. Those treated with carbamazepine and sodium valproate had minor behavioural difficulties after a month of treatment, but these did not persist. Mothers of the epileptic children had unusually high levels of anxiety and depression two months, on average, after epilepsy was diagnosed.

The parents of school phobic adolescents – a preliminary investigation of family life variables

Parents were interviewed at home in a preliminary study of family life variables. Forty-eight had children admitted to an adolescent in-patient unit, 19 of them for school phobia and the remainder because of other psychiatric conditions. Difficulty in obtaining a comparable group from the normal school population resulted in only 12 such families being studied in addition. The psychiatric cases were reliably separated into school phobic and other problems. Practically all the school phobics had neurotic disorders. Contact of parents with relatives and friends, their leisure activities outside the home, their patterns of work and their management of domestic affairs, were looked at. It was thought that these aspects of family functioning might be distinctive where there was a school phobic youngster and that an abnormal pattern of family life might predispose a child to this disorder. In fact, no evidence emerged to suggest that parents of school phobic adolescents participate in, or make decisions about, family life activities in any way different from parents of other psychiatric cases or normal controls.

Teachers' perceptions of school phobic and truant behaviour and the influence of the youth tutor

Teachers are often initiators of referrals to either statutory or theraputic agencies. A perennial problem is that of non-school-attendance which can be schematically defined as school phobia and truancy. There is considerable evidence that this categorisation has some validity. Consequently it is important for teachers to be able to differentiate between the two conditions, as the child probably requires different regimes. This study examined a sample of teachers drawn from secondary schools in which there was a Youth Tutor present, and from schools who had no Youth Tutor. It was found that there were clear statistical significant differences in the perceptions of teachers of school phobia and truancy from the different type of schools. The teachers from the Youth Tutor Schools were more inclined to be child, parent, and socially orientated than their counterparts. The practical implications of the findings are discussed.

Social Work and Suicide

About 3,000 people take their own lives in England and Wales every year. Far more widespread is the phenomenon of attempted suicide. Incidence rates are always likely to be incomplete and at best may be viewed as estimates, but figures in the order of an annual rate of 200:10,000 for men aged over 15 and 300:10,000 for women over 15 years of age are widely quoted.

Minor Psychiatric Illness in Mothers of Young Children

A survey of minor psychiatric illness in women with young children was carried out in Harrogate, a non-industrial town in the North of England. They were patients of one group practice composed of three family practitioners with 2,000 patients each. Previous surveys have mostly involved industrial and socially disadvantaged areas in Britain and a high prevalence of minor psychiatric illness has been found linked to poor living conditions and having a large number of children (Brown and Harris 1978, Goldberg and Huxley 1980). In our survey it was considered important to look at age of mother, number and spacing of her children, social factors, interpersonal difficulties, life events and contact with medical services. Disturbance of the children was also studied. Harrogate is a reasonably affluent part of the country where severe social problems are rare.

Different Approaches to Work with Mentally Disordered People

Social casework is perhaps the most familiar method of intervention to social workers. However, it is only one of a number which rely upon some form of verbal interaction to bring about change within the client. Throughout this text we have advocated an eclectic approach — one which draws upon a number of influences for its strength. Lazarus, in his notion of multi-modal behaviour therapy, comes closest to our own thinking about interventive technique and practice. ln this chapter we intend to explore some of the different therapeutic models which are available to the social worker. Some of them are drawn upon quite heavily in our eclectic model, and allusion to them is made else where in the text. The object of this chapter is not to pass on a set of techniques, but rather to indicate some of the identifying features of alternative therapies which may be followed up by interested readers.

Drugs and Physical Treatment

Many social workers remain sceptical about the use of physical treatment of all kinds in psychiatry. Certainly history is on their side, since some practices, long held to be efficacious, have been abandoned as ineffective. However, regardless of one’s personal stance and beliefs the reality is that most people who suffer from psychiatric disorder in this country are going to be treated with some form of physical procedure, most usually drugs. It is important therefore for the social worker to gain some working knowledge of what these treatments entail, how they affect the client, what may be some of the likely side-effects, and how they are likely to affect the relationship between the client, the worker and his family.

What is Meant by Mental Illness

It may seem strange to start a book entitled Social Work and Mental Illness by trying to discuss what is meant by mental illness. It is not our intention to seek a definitive definition, nor to replicate what is widely available to standard psychiatric texts. Rather our aim is to suggest that there exist a diversity of views and theories and that the focus for the social worker should always be upon the consequences of a particular disorder rather than on its aetiology or detailed pathology. A working knowledge of these aspects of a disorder is obviously an advantage in helping the individual worker to understand his or her clients, appreciate their predicament, discuss issues with colleagues and communicate with others concerned, such as relatives. However, the emphasis must be upon the reality which confronts the client at the time.

Social Work and Schizophrenia: a Case Study

In this chapter our aim is to present a case as an example in order to illustrate the range of work that a social worker may be called upon to perform with a particular client, in this case, a young man suffering from schizophrenia. The techniques involved are common to social work in many settings and the presence of mental illness is only one facet of a case which might just as well have involved work with someone with a physical handicap or with a young offender about to leave institutional care.

Research Foundations for the Integrated Approach

In the previous chapter we outlined an assessment and intervention model which sought to integrate concepts and techniques from the behavioural and ego-dynamic schools. In this chapter we intend to review a number of evaluatory studies that indicate the effectiveness of interventions with the mentally ill involving social work or related techniques.