Gyles Glover

Schizophrenia after prenatal exposure to 1957 A2 influenza epidemic

The birth dates of schizophrenic inpatients in eight health regions in England and Wales were reviewed for any effect of the 1957 A2 influenza epidemic. 5 months after the peak infection prevalence, the number of births of individuals who later developed schizophrenia was 88% higher than the average number of such births in the corresponding periods of the 2 previous and the next 2 years. This finding is in accordance with a study from Helsinki and with clinical and neuropathological evidence of aberrant fetal brain development in the pathogenesis of schizophrenia.

The feasibility of routine outcome measures in mental health.

Background: Standardised outcome measures are not being used in routine mental health care. Method: The importance of routine use of standardised outcome measures is argued, and reasons for their lack of use suggested. Results: One reason for standardised outcome measures not being used routinely is the lack of appropriate instruments. This property of being suitable for routine use is often called feasibility, but there is no consensus about the meaning of feasibility, or how it should be measured. We propose a definition of feasibility as a psychometric property of a standardised outcome measure, provide criteria for assessing feasibility, and then present a framework for changing practice to increase the routine use of standardised outcome measures. Conclusions: If mental health care is to maximise outcome, then more attention needs to be paid both to the process of developing and to facilitating the routine clinical use of feasible outcome measures.

Does prenatal influenza divert susceptible females from later affective psychosis to schizophrenia

We examined the relationship between influenza epidemics and the number of schizophrenic and affective psychotic individuals born each month between 1938 and 1965 in England and Wales. Increased death rates from influenza were followed 5 months later by a significant increase in schizophrenic births and a concurrent fall in the number of births of affective psychotic individuals. When the sexes were examined separately, both the positive effect of influenza on schizophrenic births and its negative effect on affective psychotic births were evident for females but not for males. Furthermore, during February to June in high influenza years, there was an inverse relationship between the number of female schizophrenic and affective psychotic births. The explanation for these surprising findings may be that prenatal exposure to influenza impairs the neurodevelopment of some females with a predisposition to affective psychosis, in such a way that their later illness shows schizophrenic rather than affective features.

The pattern of psychiatric admissions of Caribbean-born immigrants in London

SummaryData from the mental health enquiry and the 1981 census are used to describe the age/sex specific pattern of first and total admissions of West Indian born patients to psychiatric hospitals in two Thames Regions. By contrast to native Britons, more young men, but not young women, appear to be admitted but the readmission rate for young patients of both sexes is high. Older West Indians of both sexes have a similar first admission rate to the native British. Older men but not older women have a low overall admission rate. Time trends suggest that there is a cohort of young men of whom the oldest are now in their early thirties who are at particular risk.

The “transition cliff” in the administrative prevalence of learning disabilities in England

Purpose – The aim of this paper is to report on the age‐specific administrative prevalence of learning disabilities in England.Design/methodology/approach – The papers approach is secondary analysis of data from national education, health and social care agencies.Findings – There is an abrupt decline in the age‐specific administrative prevalence of learning disabilities at the point of transition to adult services.Research limitations/implications – The results highlight the existence of a “hidden majority” of adults with learning disabilities.Originality/value – The data in this paper have implications for commissioning better health services for people with learning disabilities. First, health information systems should incorporate better ways of identifying patients with mild and moderate learning disabilities. Second, consideration should be given to the extension of annual health checks to include all young people who have had a Statement of Special Educational Needs.

Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study

BACKGROUND People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID. METHODS We did a longitudinal cohort study that used data from The Health Improvement Network primary care database. We did multivariate logistic regression to assess associations between various characteristics and whether or not practices had opted in to the incentivised scheme. FINDINGS We assessed data for 8692 patients from 222 incentivised practices and those for 918 patients in 48 non-incentivised practices. More blood tests (eg, total cholesterol, odds ratio [OR] 1·88, 95% CI 1·47-2·41, p<0·0001) general health measurements (eg, smoking status, 6·0, 4·10-8·79, p<0·0001), specific health assessments (eg, hearing, 24·0, 11·5-49·9, p<0·0001), and medication reviews (2·23, 1·68-2·97, p<0·0001) were done in incentivised than in non-incentivised practices, and more health action plans (6·15, 1·41-26·9, p=0·0156) and secondary care referrals (1·47, 1·05-2·05, p=0·0256) were made. Identification rates were higher in incentivised practices for thyroid disorder (OR 2·72, 95% CI 1·09-6·81, p=0·0323), gastrointestinal disorders (1·94, 1·03-3·65, p=0·0390), and obesity (2·49, 1·76-3·53, p<0·0001). INTERPRETATION Targeted annual health checks for people with ID in primary care could reduce health inequities. FUNDING National Institute for Health Research.

From commitment to reality: early intervention in psychosis services in England

Aim:  To evaluate the extent to which Government plans for early intervention in psychosis services have been realized in England, the UK.

A needs index for mental health care in England based on updatable data.

Abstract.Background:Mathematical models relating rates of mental health care use to population characteristics such as social deprivation are widely used in both planning and researching mental health services. The models currently in wide use in England are based on data mostly derived from the 10-yearly population censuses. These are perceived to be out of date many years before new census data are available for their replacement. A new set of government deprivation monitoring statistics based mainly on annually updatable data has recently been developed. This study set out to produce a mental illness needs index based on these new data.Methods:A series of regression models were tested using individual domain scores from the DETR Index of Multiple Deprivation and the Office of National Statistics area-type classification as independent variables to predict 1998/9 psychiatric admission rates for broad diagnostic groups for 8251 of the 8414 electoral wards in England as dependent variables.Results:The distribution of admission numbers in wards showed a pattern of over-dispersion with an excessive number of zero values for conventional regression approaches. A two-stage ‘hurdle’ model was, thus, adopted, predicting first the likelihood that wards would produce any admissions and second the probable number. This produced satisfactory predictive power, with residual variance showing strong geographical patterns associated with administrative areas, probably arising from differential resourcing or idiosyncratic clinical practice.Conclusions:A website providing data on the various indicators has been provided and its uses are indicated.

Use of medication for challenging behaviour in people with intellectual disability

This editorial discusses the use of antipsychotic medications to manage challenging behaviour in people with intellectual disability, and suggests a national audit programme to address the concerns this raises.

Mortality of People with Intellectual Disabilities in England: A Comparison of Data from Existing Sources

BACKGROUND At present, there is limited statistical information about mortality of people with intellectual disabilities in England. This study explores the data that are currently available. MATERIALS AND METHODS Four recent sources of data about mortality of people with intellectual disabilities in England are reviewed: the Confidential Inquiry into Premature Deaths of People with intellectual disabilities (CIPOLD); the 2013 Joint Health and Social Care Intellectual Disability Self-assessment Exercise; local registers of people with intellectual disability; and analysis of Cause of Death certificates. RESULTS Available data confirm that people with intellectual disability have a shorter lifespan and increased risk of early death when compared with the general population. The standardized mortality rate for people with intellectual disabilities is approximately twice that of the general population in England, with little indication of any reduction in this over time. CONCLUSIONS Comprehensive data about mortality of people with intellectual disabilities that take account of the age and sex distribution of the population are currently lacking in England. Existing data suggest persistent inequalities between people with intellectual disabilities and the general population. There is an urgent need for better monitoring mechanisms and actions to address these.