Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1996 Apr;46(405):231–237.

Community care of patients with schizophrenia: the role of the primary health care team.

M King 1, I Nazareth 1
PMCID: PMC1239607  PMID: 8703526

Abstract

Schizophrenia is a severe, chronic mental disorder that usually begins in early adulthood. Recurrent relapse leading to long-term psychological and social disability means that patients may require intensive community support. Despite a recent fall in the overall numbers of patients consulting their general practitioner with mental disorders, presentations by those suffering from severe mental disorders have risen. This review encompasses the role of general practitioner in the management of schizophrenia, considering in turn drug and psychological therapies, family interventions, innovations in care, the effects of community care developments, and the liasion between primary health care and mental health professionals. There is a need for further research in the area of family-practice-based interventions involving general practitioners and the practice team.

Full text

PDF
232

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allebeck P. Schizophrenia: a life-shortening disease. Schizophr Bull. 1989;15(1):81–89. doi: 10.1093/schbul/15.1.81. [DOI] [PubMed] [Google Scholar]
  2. Bailey J. J., Black M. E., Wilkin D. Specialist outreach clinics in general practice. BMJ. 1994 Apr 23;308(6936):1083–1086. doi: 10.1136/bmj.308.6936.1083. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bamrah J. S., Freeman H. L., Goldberg D. P. Epidemiology of schizophrenia in Salford, 1974-84. Changes in an urban community over ten years. Br J Psychiatry. 1991 Dec;159:802–810. doi: 10.1192/bjp.159.6.802. [DOI] [PubMed] [Google Scholar]
  4. Bebbington P., Kuipers L. The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med. 1994 Aug;24(3):707–718. doi: 10.1017/s0033291700027860. [DOI] [PubMed] [Google Scholar]
  5. Benton M. K., Schroeder H. E. Social skills training with schizophrenics: a meta-analytic evaluation. J Consult Clin Psychol. 1990 Dec;58(6):741–747. doi: 10.1037//0022-006x.58.6.741. [DOI] [PubMed] [Google Scholar]
  6. Brooker C. G. A description of clients nursed by community psychiatric nurses whilst attending English National Board Clinical Course No. 811: clarification of current role? J Adv Nurs. 1990 Feb;15(2):155–166. doi: 10.1111/j.1365-2648.1990.tb01796.x. [DOI] [PubMed] [Google Scholar]
  7. Brown L. M., Tower J. E. Psychiatrists in primary care: would general practitioners welcome them? Br J Gen Pract. 1990 Sep;40(338):369–371. [PMC free article] [PubMed] [Google Scholar]
  8. Chadwick P. D., Lowe C. F. Measurement and modification of delusional beliefs. J Consult Clin Psychol. 1990 Apr;58(2):225–232. doi: 10.1037//0022-006x.58.2.225. [DOI] [PubMed] [Google Scholar]
  9. Davis J. M., Schaffer C. B., Killian G. A., Kinard C., Chan C. Important issues in the drug treatment of schizophrenia. Schizophr Bull. 1980;6(1):70–87. doi: 10.1093/schbul/6.1.70. [DOI] [PubMed] [Google Scholar]
  10. Earll L., Kincey J. Clinical psychology in general practice: a controlled trial evaluation. J R Coll Gen Pract. 1982 Jan;32(234):32–37. [PMC free article] [PubMed] [Google Scholar]
  11. Essex B., Doig R., Renshaw J. Pilot study of records of shared care for people with mental illnesses. BMJ. 1990 Jun 2;300(6737):1442–1446. doi: 10.1136/bmj.300.6737.1442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Glazer W. M., Morgenstern H., Doucette J. T. Predicting the long-term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications. J Clin Psychiatry. 1993 Apr;54(4):133–139. [PubMed] [Google Scholar]
  13. Goldberg D., Jackson G. Interface between primary care and specialist mental health care. Br J Gen Pract. 1992 Jul;42(360):267–269. [PMC free article] [PubMed] [Google Scholar]
  14. Gournay K., Brooking J. Community psychiatric nurses in primary health care. Br J Psychiatry. 1994 Aug;165(2):231–238. doi: 10.1192/bjp.165.2.231. [DOI] [PubMed] [Google Scholar]
  15. Grol R. Development of guidelines for general practice care. Br J Gen Pract. 1993 Apr;43(369):146–151. [PMC free article] [PubMed] [Google Scholar]
  16. Gunderson J. G., Frank A. F., Katz H. M., Vannicelli M. L., Frosch J. P., Knapp P. H. Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment. Schizophr Bull. 1984;10(4):564–598. doi: 10.1093/schbul/10.4.564. [DOI] [PubMed] [Google Scholar]
  17. Haines A., Feder G. Guidance on guidelines. BMJ. 1992 Oct 3;305(6857):785–786. doi: 10.1136/bmj.305.6857.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Harrison G., Bartlett P. Supervision registers for mentally ill people. BMJ. 1994 Sep 3;309(6954):551–552. doi: 10.1136/bmj.309.6954.551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hirsch S. R., Puri B. K. Clozapine: progress in treating refractory schizophrenia. BMJ. 1993 May 29;306(6890):1427–1428. doi: 10.1136/bmj.306.6890.1427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hoult J. Community care of the acutely mentally ill. Br J Psychiatry. 1986 Aug;149:137–144. doi: 10.1192/bjp.149.2.137. [DOI] [PubMed] [Google Scholar]
  21. Jackson G., Gater R., Goldberg D., Tantam D., Loftus L., Taylor H. A new community mental health team based in primary care. A description of the service and its effect on service use in the first year. Br J Psychiatry. 1993 Mar;162:375–384. doi: 10.1192/bjp.162.3.375. [DOI] [PubMed] [Google Scholar]
  22. Jolley A. G., Hirsch S. R., Morrison E., McRink A., Wilson L. Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients: clinical and social outcome at two years. BMJ. 1990 Oct 13;301(6756):837–842. doi: 10.1136/bmj.301.6756.837. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kendrick T., Burns T., Freeling P. Randomised controlled trial of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. BMJ. 1995 Jul 8;311(6997):93–98. doi: 10.1136/bmj.311.6997.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kendrick T., Burns T., Freeling P., Sibbald B. Provision of care to general practice patients with disabling long-term mental illness: a survey in 16 practices. Br J Gen Pract. 1994 Jul;44(384):301–305. [PMC free article] [PubMed] [Google Scholar]
  25. Kendrick T., Sibbald B., Addington-Hall J., Brenneman D., Freeling P. Distribution of mental health professionals working on site in English and Welsh general practices. BMJ. 1993 Aug 28;307(6903):544–546. doi: 10.1136/bmj.307.6903.544. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Kendrick T., Sibbald B., Burns T., Freeling P. Role of general practitioners in care of long term mentally ill patients. BMJ. 1991 Mar 2;302(6775):508–510. doi: 10.1136/bmj.302.6775.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. King M. B. Management of patients with schizophrenia in general practice. Br J Gen Pract. 1992 Aug;42(361):310–311. [PMC free article] [PubMed] [Google Scholar]
  28. Kingdon D. G., Turkington D. The use of cognitive behavior therapy with a normalizing rationale in schizophrenia. Preliminary report. J Nerv Ment Dis. 1991 Apr;179(4):207–211. doi: 10.1097/00005053-199104000-00005. [DOI] [PubMed] [Google Scholar]
  29. Kuipers L., Bebbington P. Expressed emotion research in schizophrenia: theoretical and clinical implications. Psychol Med. 1988 Nov;18(4):893–909. doi: 10.1017/s0033291700009831. [DOI] [PubMed] [Google Scholar]
  30. Leff J., Berkowitz R., Shavit N., Strachan A., Glass I., Vaughn C. A trial of family therapy versus a relatives' group for schizophrenia. Two-year follow-up. Br J Psychiatry. 1990 Oct;157:571–577. doi: 10.1192/bjp.157.4.571. [DOI] [PubMed] [Google Scholar]
  31. Leff J., Kuipers L., Berkowitz R., Sturgeon D. A controlled trial of social intervention in the families of schizophrenic patients: two year follow-up. Br J Psychiatry. 1985 Jun;146:594–600. doi: 10.1192/bjp.146.6.594. [DOI] [PubMed] [Google Scholar]
  32. Leff J. Working with the families of schizophrenic patients. Br J Psychiatry Suppl. 1994 Apr;(23):71–76. [PubMed] [Google Scholar]
  33. Lewis G., Appleby L., Jarman B. Suicide and psychiatric services. Lancet. 1994 Sep 17;344(8925):822–822. doi: 10.1016/s0140-6736(94)92379-5. [DOI] [PubMed] [Google Scholar]
  34. Liddle P., Carpenter W. T., Crow T. Syndromes of schizophrenia. Classic literature. Br J Psychiatry. 1994 Dec;165(6):721–727. doi: 10.1192/bjp.165.6.721. [DOI] [PubMed] [Google Scholar]
  35. Lieberman J. A. Understanding the mechanism of action of atypical antipsychotic drugs. A review of compounds in use and development. Br J Psychiatry Suppl. 1993 Dec;(22):7–18. [PubMed] [Google Scholar]
  36. Low C. B., Pullen I. Psychiatric clinics in different settings. A case register study. Br J Psychiatry. 1988 Aug;153:243–245. doi: 10.1192/bjp.153.2.243. [DOI] [PubMed] [Google Scholar]
  37. Macdonald A. 'Suicide prevention' by GPs? Br J Psychiatry. 1992 Oct;161:574–574. doi: 10.1192/bjp.161.4.574a. [DOI] [PubMed] [Google Scholar]
  38. Marks I. M., Connolly J., Muijen M., Audini B., McNamee G., Lawrence R. E. Home-based versus hospital-based care for people with serious mental illness. Br J Psychiatry. 1994 Aug;165(2):179–194. doi: 10.1192/bjp.165.2.179. [DOI] [PubMed] [Google Scholar]
  39. McFarlane W. R., Dunne E., Lukens E., Newmark M., McLaughlin-Toran J., Deakins S., Horen B. From research to clinical practice: dissemination of New York State's family psychoeducation project. Hosp Community Psychiatry. 1993 Mar;44(3):265–270. doi: 10.1176/ps.44.3.265. [DOI] [PubMed] [Google Scholar]
  40. Merson S., Tyrer P., Onyett S., Lack S., Birkett P., Lynch S., Johnson T. Early intervention in psychiatric emergencies: a controlled clinical trial. Lancet. 1992 May 30;339(8805):1311–1314. doi: 10.1016/0140-6736(92)91959-c. [DOI] [PubMed] [Google Scholar]
  41. Michel K., Valach L. Suicide prevention: spreading the gospel to general practitioners. Br J Psychiatry. 1992 Jun;160:757–760. doi: 10.1192/bjp.160.6.757. [DOI] [PubMed] [Google Scholar]
  42. Miles C. P. Conditions predisposing to suicide: a review. J Nerv Ment Dis. 1977 Apr;164(4):231–246. doi: 10.1097/00005053-197704000-00002. [DOI] [PubMed] [Google Scholar]
  43. Mitchell A. R. Psychiatrists in primary health care settings. Br J Psychiatry. 1985 Oct;147:371–379. doi: 10.1192/bjp.147.4.371. [DOI] [PubMed] [Google Scholar]
  44. Muijen M., Cooney M., Strathdee G., Bell R., Hudson A. Community psychiatric nurse teams: intensive support versus generic care. Br J Psychiatry. 1994 Aug;165(2):211–217. doi: 10.1192/bjp.165.2.211. [DOI] [PubMed] [Google Scholar]
  45. Nazareth I. D., King M. B. Controlled evaluation of management of schizophrenia in one general practice: a pilot study. Fam Pract. 1992 Jun;9(2):171–172. doi: 10.1093/fampra/9.2.171. [DOI] [PubMed] [Google Scholar]
  46. Nazareth I., King M., Davies S. Care of schizophrenia in general practice: the general practitioner and the patient. Br J Gen Pract. 1995 Jul;45(396):343–347. [PMC free article] [PubMed] [Google Scholar]
  47. Nazareth I., King M., Haines A., Rangel L., Myers S. Accuracy of diagnosis of psychosis on general practice computer system. BMJ. 1993 Jul 3;307(6895):32–34. doi: 10.1136/bmj.307.6895.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Nazareth I., King M., Haines A., Tai S. S., Hall G. Care of schizophrenia in general practice. BMJ. 1993 Oct 9;307(6909):910–910. doi: 10.1136/bmj.307.6909.910. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Pickar D. Prospects for pharmacotherapy of schizophrenia. Lancet. 1995 Mar 4;345(8949):557–562. doi: 10.1016/s0140-6736(95)90469-7. [DOI] [PubMed] [Google Scholar]
  50. Pullen I. M., Yellowlees A. J. Scottish psychiatrists in primary health-care settings. A silent majority. Br J Psychiatry. 1988 Nov;153:663–666. doi: 10.1192/bjp.153.5.663. [DOI] [PubMed] [Google Scholar]
  51. Robson M. H., France R., Bland M. Clinical psychologist in primary care: controlled clinical and economic evaluation. Br Med J (Clin Res Ed) 1984 Jun 16;288(6433):1805–1808. doi: 10.1136/bmj.288.6433.1805. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Roy A. Suicide in chronic schizophrenia. Br J Psychiatry. 1982 Aug;141:171–177. doi: 10.1192/bjp.141.2.171. [DOI] [PubMed] [Google Scholar]
  53. Rutz W., von Knorring L., Wålinder J. Long-term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatr Scand. 1992 Jan;85(1):83–88. doi: 10.1111/j.1600-0447.1992.tb01448.x. [DOI] [PubMed] [Google Scholar]
  54. Schooler N. R., Levine J., Severe J. B., Brauzer B., DiMascio A., Klerman G. L., Tuason V. B. Prevention of relapse in schizophrenia. An evaluation of fluphenazine decanoate. Arch Gen Psychiatry. 1980 Jan;37(1):16–24. doi: 10.1001/archpsyc.1980.01780140018002. [DOI] [PubMed] [Google Scholar]
  55. Silverstone T., Smith G., Goodall E. Prevalence of obesity in patients receiving depot antipsychotics. Br J Psychiatry. 1988 Aug;153:214–217. doi: 10.1192/bjp.153.2.214. [DOI] [PubMed] [Google Scholar]
  56. Stein L. I., Test M. A. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980 Apr;37(4):392–397. doi: 10.1001/archpsyc.1980.01780170034003. [DOI] [PubMed] [Google Scholar]
  57. Strathdee G., King M. B., Araya R., Lewis S. A standardized assessment of patients referred to primary care and hospital psychiatric clinics. Psychol Med. 1990 Feb;20(1):219–224. doi: 10.1017/s0033291700013398. [DOI] [PubMed] [Google Scholar]
  58. Strathdee G., Williams P. A survey of psychiatrists in primary care: the silent growth of a new service. J R Coll Gen Pract. 1984 Nov;34(268):615–618. [PMC free article] [PubMed] [Google Scholar]
  59. Tarrier N., Barrowclough C., Vaughn C., Bamrah J. S., Porceddu K., Watts S., Freeman H. Community management of schizophrenia. A two-year follow-up of a behavioural intervention with families. Br J Psychiatry. 1989 May;154:625–628. doi: 10.1192/bjp.154.5.625. [DOI] [PubMed] [Google Scholar]
  60. Teasdale J. D., Fennell M. J., Hibbert G. A., Amies P. L. Cognitive therapy for major depressive disorder in primary care. Br J Psychiatry. 1984 Apr;144:400–406. doi: 10.1192/bjp.144.4.400. [DOI] [PubMed] [Google Scholar]
  61. Thomas R. V., Corney R. H. A survey of links between mental health professionals and general practice in six district health authorities. Br J Gen Pract. 1992 Sep;42(362):358–361. [PMC free article] [PubMed] [Google Scholar]
  62. Warner R. W., Gater R., Jackson M. G., Goldberg D. P. Effects of a community mental health service on the practice and attitudes of general practitioners. Br J Gen Pract. 1993 Dec;43(377):507–511. [PMC free article] [PubMed] [Google Scholar]
  63. Weller M. P., Tobiansky R., Hollander D. Destitution at the festive season. Lancet. 1989 Jan 28;1(8631):220–220. doi: 10.1016/s0140-6736(89)91237-3. [DOI] [PubMed] [Google Scholar]
  64. Wilkinson G. Can suicide be prevented? Better treatment of mental illness is more appropriate aim. BMJ. 1994 Oct 1;309(6958):860–861. doi: 10.1136/bmj.309.6958.860. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES