Nigel McKenzie - Academia.edu (original) (raw)
Papers by Nigel McKenzie
The British Journal of Psychiatry, 2005
Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base i... more Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base is limited. To compare outcomes of crises before and after introduction of a CRT. A new methodology was developed for identification and operational definition of crises. A quasi-experimental design was used to compare cohorts presenting just before and just after a CRT was established. Following introduction of the CRT, the admission rate in the 6 weeks after a crisis fell from 71% to 49% (OR 0.38, 95% CI 0.21-0.70). A difference of 5.6 points (95% CI 2.0-8.3) on mean Client Satisfaction Questionnaire (CSQ-8) score favoured the CRT. These findings remained significant after adjustment for baseline differences. No clear difference emerged in involuntary hospitalisations, symptoms, social functioning or quality of life. CRTs may prevent some admissions and patients prefer them, although other outcomes appear unchanged in the short term.
Psychotherapy and psychosomatics
Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. ... more Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. Identifying predisposing factors in PTSD compared to anxiety disorders may help to clarify the classification of PTSD as a diagnostic entity. Retrospective case note study of 87 PTSD patients who participated in an RCT, and 51 PTSD patients and 87 agoraphobics treated routinely in outpatients. Compared to agoraphobics, PTSD patients had significantly less family history of anxiety disorder but not mental illness in general. They also had significantly less personal history of mental illness prior to the index episode. Trauma precipitated PTSD in subjects who had significantly fewer premorbid predisposing factors than did agoraphobics. Such factors may predispose agoraphobics to become psychiatrically ill after more minor trauma. Research is needed to systematically compare the events which precipitate PTSD as opposed to agoraphobia and other anxiety disorders.
Psychiatric Bulletin, 2009
Suicide and Life-Threatening Behavior, 2007
Suicide rates in prisons are high. Our aim was to investigate the contribution of imitative suici... more Suicide rates in prisons are high. Our aim was to investigate the contribution of imitative suicide to the prison suicide rate. We used Knox tests for space-time clustering in a case register of natural and self-inflicted deaths in prisons in England and Wales and model simulations to estimate the effect size. We found significant space-time clustering among 657 self-inflicted deaths in 90 prisons over 10 years but no space-time clustering among 430 deaths from natural causes in 87 prisons over this period. Model simulations with an imitation rate of 5.8% (CI 1%-11%) reproduced the observed space-time clustering.
Psychotherapy and Psychosomatics, 2003
Background: Though research trials have to rate clinical outcome, few units monitor outcome of th... more Background: Though research trials have to rate clinical outcome, few units monitor outcome of their routine care over many years. We report such monitoring to evaluate therapy over time and under changing operating and economic conditions. Method: Clinical outcome data were collected routinely over 11 years in a behavioural psychotherapy unit whose residential patients mostly had severe, chronic obsessive-compulsive disorder
The British Journal of Psychiatry, 2005
Most previous investigations of imitative suicide have reported suicide clustering in the general... more Most previous investigations of imitative suicide have reported suicide clustering in the general population, either temporal clustering following media reporting of suicide or case studies of geographically localised clusters. To determine whether space - time and space-time-method clustering occur in a national case register of those who had recent contact with mental health services and had died by suicide and to estimate the suicide imitation rate in this population. Knox tests were used for space-time and space-time-method clustering. Model simulations were used to estimate effect size. Highly significant space-time and space-time-method clustering was found in a sample of 2741 people who died by suicide over 4 years who had had recent contact with one of 105 mental health trusts. Model simulations with an imitation rate of 10.1% (CI 4-17) reproduced the observed space-time-method clustering. This study provides indirect evidence that imitative suicide occurs among people with mental illnesses and may account for about 10% of suicides by current and recent patients.
The British Journal of Psychiatry, 1999
Regular assessment of mood is often important for treatment but traditional measures can be time-... more Regular assessment of mood is often important for treatment but traditional measures can be time-consuming. A quick'litmus test' is needed. To test the reliability and validity of a single-item scale for mood. Mood was measured repeatedly in 812 patients (258 in-patients, 554 out-patient) being treated in an anxiety disorders unit. Patients had self- and clinician ratings of a single-item depression scale and also rated the 21-item Beck Depression Inventory (BDI-21). Their single-item scores were compared with BDI-21 scores and with outcome measures. The single-item depression scores correlated 0.71 to 0.78 with the BDI-21 scores. Clinically useful cut-off points were identified. Depression scores at discharge, but not pre-treatment, correlated significantly with improvement in the main problem. The quick single-item depression scale, whether rated by patient or by clinician, is a reasonable rough guide to mood in anxiety disorders and saves time for the patient and the clinician compared to longer measures.
The British Journal of Psychiatry, 2005
Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base i... more Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base is limited. To compare outcomes of crises before and after introduction of a CRT. A new methodology was developed for identification and operational definition of crises. A quasi-experimental design was used to compare cohorts presenting just before and just after a CRT was established. Following introduction of the CRT, the admission rate in the 6 weeks after a crisis fell from 71% to 49% (OR 0.38, 95% CI 0.21-0.70). A difference of 5.6 points (95% CI 2.0-8.3) on mean Client Satisfaction Questionnaire (CSQ-8) score favoured the CRT. These findings remained significant after adjustment for baseline differences. No clear difference emerged in involuntary hospitalisations, symptoms, social functioning or quality of life. CRTs may prevent some admissions and patients prefer them, although other outcomes appear unchanged in the short term.
Psychotherapy and psychosomatics
Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. ... more Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. Identifying predisposing factors in PTSD compared to anxiety disorders may help to clarify the classification of PTSD as a diagnostic entity. Retrospective case note study of 87 PTSD patients who participated in an RCT, and 51 PTSD patients and 87 agoraphobics treated routinely in outpatients. Compared to agoraphobics, PTSD patients had significantly less family history of anxiety disorder but not mental illness in general. They also had significantly less personal history of mental illness prior to the index episode. Trauma precipitated PTSD in subjects who had significantly fewer premorbid predisposing factors than did agoraphobics. Such factors may predispose agoraphobics to become psychiatrically ill after more minor trauma. Research is needed to systematically compare the events which precipitate PTSD as opposed to agoraphobia and other anxiety disorders.
Psychiatric Bulletin, 2009
Suicide and Life-Threatening Behavior, 2007
Suicide rates in prisons are high. Our aim was to investigate the contribution of imitative suici... more Suicide rates in prisons are high. Our aim was to investigate the contribution of imitative suicide to the prison suicide rate. We used Knox tests for space-time clustering in a case register of natural and self-inflicted deaths in prisons in England and Wales and model simulations to estimate the effect size. We found significant space-time clustering among 657 self-inflicted deaths in 90 prisons over 10 years but no space-time clustering among 430 deaths from natural causes in 87 prisons over this period. Model simulations with an imitation rate of 5.8% (CI 1%-11%) reproduced the observed space-time clustering.
Psychotherapy and Psychosomatics, 2003
Background: Though research trials have to rate clinical outcome, few units monitor outcome of th... more Background: Though research trials have to rate clinical outcome, few units monitor outcome of their routine care over many years. We report such monitoring to evaluate therapy over time and under changing operating and economic conditions. Method: Clinical outcome data were collected routinely over 11 years in a behavioural psychotherapy unit whose residential patients mostly had severe, chronic obsessive-compulsive disorder
The British Journal of Psychiatry, 2005
Most previous investigations of imitative suicide have reported suicide clustering in the general... more Most previous investigations of imitative suicide have reported suicide clustering in the general population, either temporal clustering following media reporting of suicide or case studies of geographically localised clusters. To determine whether space - time and space-time-method clustering occur in a national case register of those who had recent contact with mental health services and had died by suicide and to estimate the suicide imitation rate in this population. Knox tests were used for space-time and space-time-method clustering. Model simulations were used to estimate effect size. Highly significant space-time and space-time-method clustering was found in a sample of 2741 people who died by suicide over 4 years who had had recent contact with one of 105 mental health trusts. Model simulations with an imitation rate of 10.1% (CI 4-17) reproduced the observed space-time-method clustering. This study provides indirect evidence that imitative suicide occurs among people with mental illnesses and may account for about 10% of suicides by current and recent patients.
The British Journal of Psychiatry, 1999
Regular assessment of mood is often important for treatment but traditional measures can be time-... more Regular assessment of mood is often important for treatment but traditional measures can be time-consuming. A quick'litmus test' is needed. To test the reliability and validity of a single-item scale for mood. Mood was measured repeatedly in 812 patients (258 in-patients, 554 out-patient) being treated in an anxiety disorders unit. Patients had self- and clinician ratings of a single-item depression scale and also rated the 21-item Beck Depression Inventory (BDI-21). Their single-item scores were compared with BDI-21 scores and with outcome measures. The single-item depression scores correlated 0.71 to 0.78 with the BDI-21 scores. Clinically useful cut-off points were identified. Depression scores at discharge, but not pre-treatment, correlated significantly with improvement in the main problem. The quick single-item depression scale, whether rated by patient or by clinician, is a reasonable rough guide to mood in anxiety disorders and saves time for the patient and the clinician compared to longer measures.