Nithsdale Schizophrenia Surveys 24: sexual dysfunction. Case-control study.

BACKGROUND: That sexual dysfunction occurs in schizophrenia is not in doubt. Previous studies have had weaknesses such as the use of selected populations or the absence of a control group. AIMS: To measure rates of sexual dysfunction in people with schizophrenia compared with the general population. METHOD: Sexual dysfunction was assessed by a self-completed gender-specific questionnaire. Ninety-eight (73%) of 135 persons with schizophrenia and 81 (71%) of 114 persons recruited as controls returned the questionnaire. RESULTS: At least one sexual dysfunction was reported by 82% of men and 96% of women with schizophrenia. Male patients reported less desire for sex, were less likely to achieve and maintain an erection, were more likely to ejaculate more quickly and were less satisfied with the intensity of their orgasms. Female patients reported less enjoyment than the control group. Sexual dysfunction in female patients was associated with negative schizophrenic symptoms and general psychopathology. There was no association between sexual dysfunction and type of antipsychotic medication. CONCLUSIONS: People with schizophrenia report much higher rates of sexual dysfunction than do the general population. Men and women with schizophrenia have a different pattern of sexual dysfunction.

Perspectives of collaboration/non-collaboration in a mental health inpatient setting.

Research investigating collaboration in health care has mainly taken place in general settings or has focused on the professional viewpoint. The initial aim of this study was an attempt to illuminate and explore 'collaboration' from the perspective of a person with a clinical diagnosis of schizophrenia using a hermeneutic-phenomenological approach. Through in-depth conversation, it became apparent that, rather than describing good examples of collaboration, the participant spontaneously drew attention to episodes of 'non-collaboration' and the difficulties he had experienced in joint decision-making in an inpatient mental health setting. Incorporated are extracts from a reflective journal to reveal the prejudices and preunderstandings of the researcher, who is a mental health nurse. The need for further research encompassing the views of those with a diagnosis of severe and enduring mental illness is underlined.

Nithsdale Schizophrenia Surveys. 20. Cognitive function in a catchment-area-based population of patients with schizophrenia.

BACKGROUND: Cognitive deficits are a core aspect of schizophrenia but there has been no study of cognitive function in a catchment-area-based population of patients with schizophrenia. AIMS: To assess cognitive function in a population of patients with schizophrenia, and relate it to community functioning. METHOD: All patients with schizophrenia in Nithsdale, south-west Scotland, were identified (n = 182). Measures of assessment were: National Adult Reading Test (NART), Mini-Mental State Examination (MMSE), Rivermead Behavioural Memory Test (RBMT), Executive Interview (EXIT), FAS Verbal Fluency and Health of the Nation Outcome Scales (HoNOS). RESULTS: We assessed 138 patients, mean age 48 years (standard deviation (s.d.) 15). Only 14% were in-patients. The mean premorbid IQ as assessed by NART was 98 (s.d. 14); 15% of patients had significant global cognitive impairment (MMSE); 81% had impaired memory (RBMT); 25% had executive dyscontrol (EXIT); and 49% had impaired verbal fluency (FAS). Scores on the functional impairment sub-scale of HoNOS correlated with all measures of cognitive impairment. CONCLUSIONS: Cognitive dysfunction is pervasive in a community-based population of patients with schizophrenia.

Nithsdale schizophrenia surveys 21: a longitudinal study of National Adult Reading Test stability.

BACKGROUND: The stability of the National Adult Reading Test (NART) as a measure of pre-morbid intelligence in schizophrenia has not yet been satisfactorily established despite the widespread use of the NART in schizophrenia research. METHOD: We examined NART stability in a diverse group of 45 schizophrenic patients in a prospective longitudinal study over 6.5-7.5 years. RESULTS: The results showed that NART performance does not decline significantly with increasing duration of schizophrenic illness and that test-retest reliability, even over 6.5-7.5 years, is extremely high. DISCUSSION: Our results provide the necessary evidence that the NART can be used as a stable measure of pre-morbid intelligence in schizophrenia.

Depot neuroleptics, schizophrenia and the role of the nurse: is practice evidence based? A review of the literature.

Nurses are expected to justify their practice with research based evidence. Community psychiatric nurses (CPNs) are under pressure to concentrate more on the 'seriously mentally ill', particularly those with a diagnosis of schizophrenia. Neuroleptic medicines are a recommended therapy in schizophrenia. The administration and monitoring of these drugs is a central part of the CPN's role. The CPN also often assumes an important position as patient advocate in relation to prescribing practices. Neuroleptics are commonly given in depot form to promote compliance, prevent relapse and be of benefit to the patient. This literature review considers the research evidence that these aims are achieved through current practice and reflects on the implications for nursing. In the absence of definitive research work, it may be that important decisions are based on received wisdom rather than research evidence. Whilst the data supporting the use of depots are inconclusive, there is an increasing body of knowledge demonstrating the efficacy of nursing approaches to drug therapy which seek to empower the patient.

Sexuality, sexual abuse. Omissions in admissions?

The main focus of this paper is to highlight the evidence relating long-term effects of childhood sexual abuse to presenting complaints on acute admission wards and to explore how sexuality, as an aspect of nursing concern, is broached by mental health nurses. There are few nursing articles on sexual abuse issues which are research-based, this literature has to be drawn from a wider field. Several authors recognize this paucity highlighting the need for future research in this area. The evidence from the literature review (1985-1995) makes it clear that the environment, the perceived interpersonal skills of the nurse and a general lack of definition of the nurse's role has a large influence on whether or not these issues are addressed. Following discussion about these findings, recommendations are made for inclusion of teaching on sexuality and sexual abuse, interpersonal skills training and illumination of assessment practice, with space for personal growth and development, in pre- and post-registration nurse education. This theme is developed further by considering how these recommendations could be introduced on acute admission wards.