The Nithsdale schizophrenia surveys. An overview

The Nithsdale surveys over a ten year period have examined a community of schizophrenic patients. Although almost three-quarters of patients were living outside hospital, social and psychiatric disability was considerable, with flattening of affect and social withdrawal most prominent. The majority probably cause little disturbance to most people in the community. Only 13% of the total Nithsdale schizophrenic population were living in a high contact/high Expressed Emotion family, the family structure believed to be most conducive to schizophrenic relapse. An attempt at family intervention found it difficult to engage relatives in treatment; however, where such intervention did take place, there was a fall in the total number of relapses. Reassessment found that the level of EE was stable in most relatives over a five year period. Patients who lived in a high or fluctuating EE home, and who relapsed, did so more often than those who lived in a low EE home. Assessment of the prevalence of motor disorders secondary to antipsychotic medication found a point prevalence of parkinsonism of 27%, of tardive dyskinesia (TD) 29%, and of akathisia or pseudoakathisia 23%. Only 44% had no movement disorder. Eight percent had persistent TD. Parkinsonism was associated with a history of obstetric complications and TD with left-handedness. An obstetric history obtained from mothers of schizophrenic patients found there was no difference in the proportion of schizophrenic patients and their sibs who had at least one definite obstetric complication.