Nazareth, Irwin; (1997) The care of schizophrenia in general practice. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Schizophrenia, the most common form of psychosis, is a chronic disorder that usually develops in early adulthood and often leads to life long disability. Over the last decade, the transfer of patients with chronic schizophrenia from long stay hospitals to the community has had an impact on the extent of involvement of the general practitioners in the care of patients with schizophrenia. Little, however, is known about the role of the general practitioner in the management of patients with schizophrenia. The study described in this thesis tests the hypothesis that the diagnosis of psychosis recorded on a general practice computer system is accurate and that patients with schizophrenia present a high workload in general practice. The study also determines the views of patients and general practitioners about the services currently offered in a group of London general practices. Sixteen general practices in London consisting of 28 general practitioners and 72,000 registered patients were recruited to the study. After validation of the diagnoses of psychoses as entered on the general practice computers, a sample of patients and all the general practitioners involved in their care were interviewed to assess their views on the service provided. Lastly, a comparative assessment was made of the care offered to all patients with schizophrenia and age and sex matched controls. The diagnoses of schizophrenia and other related psychosis as entered on the practice computers was accurate. The overall prevalence of schizophrenia in these practice was 3.0 per 1000, with a higher prevalence in the inner city practices (3.75 per 1000) compared to suburban practices (2 per 1000) . The patients' views on the services offered to them were not always in accordance with those of the general practitioners. Patients with schizophrenia, attended the surgery as frequently as other patients with chronic physical diseases but significantly more often than patients randomly selected from the general practice age sex register. The care offered to patients with schizophrenia, was less structured than that provided to other patients with chronic physical diseases. General practitioners are increasingly involved in the care of patients with schizophrenia. There is a need, however, to consider a more structured approach to their management. General practice computers can be effectively used to identify patients. Before developing a practice based care plan, it is essential to identify the need of the patients and the professionals involved in their care. This study provides a detailed account of the management currently offered in general practice and will assist general practitioners and mental health professionals in developing a more structured approach to the care of patients with schizophrenia in general practice.

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