CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud

More documents

Recommendations

Info

RCT (1-) There are signs that indicate that integrated clinical services and supported housing approach is more favourable than standard treatment in “homeless” patients with diagnosis of SMI and/or substance abuse, in results of substance consumption at 36 months, using a multiple imputation system for handling lost data (use of alcohol p = 0.047; intoxications p= 0.053; consumption days p = 0.028; spending on alcohol and drugs p = 0.048 212 . The integrated clinical service and supported housing approach appears to be more favourable too compared with case management and with standard treatment in “homeless” patients with diagnosis of SMI and/or substance abuse, with a shorter stay in institutions ( p < 0.05) 212 . Summary of evidence 1+ 1+ 1- 1- 1- There are no differences between long-term integrated treatment (36 months) and standard treatment (that included the same interventions, except for Assertive Community Treatment, which were not developed and coordinated by the same team, but by different teams) with respect to the use of substances 52 . There are no differences between long-term integrated treatment (36 months) and standard treatment with respect to abandonment of treatment and rehospitalisations 52 . There are no differences between integrated assertive community treatment (ACT) and standard ACT with respect to satisfaction and housing stability at 24 months, although there is between both interventions when compared with standard treatment 211 . The integrated clinical services and supported housing approach improves the consumption of substances when compared with standard treatment, in homeless patients with diagnosis of SMI and/or substance abuse at 36 months 212 . Integrated clinical services and supported housing approach seems to be more favourable compared with CM and with standard treatment in “homeless” patients with diagnosis of SMI and/or substance abuse, respect to a shorter stay in the institutions 212 . Recommendations B B C People with SMI with dual diagnosis must follow psychosocial intervention programmes and drug-dependent treatment programmes, both in an integrated manner and parallel. The treatment programmes offered to people with SMI with dual diagnosis must have a multi-component nature, be intensive and prolonged. For people with SMI and dual diagnosis and in a homeless situation, the treatment programmes should incorporate sheltered housing as a service. When the care for people with SMI and dual diagnosis is provided in parallel, it is necessary to guarantee continuity in the care and coordination among the different health and social levels. 104 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
5.4.2. “Homeless” with SMI The term “homeless” refers to the mixture of states that includes those who literally have no roof (rooflessness), those that have no stable home (houselessness) or those who live in precarious or inadequate conditions 214 . The prevalence of schizophrenia in homeless people is variable although higher quality studies have established the prevalence in this population within a range of between 4% and 16%, with an average of 11%. The highest rates corresponded to the younger subgroups, to women and to the chronically homeless. In 2002, one review concluded that schizophrenia is 7 to 10 times more frequent in homeless people than in the population with stable housing 215 . Data are included in this review from a Spanish study that offers figures situated within a lower range 216 . A more recent review 217 offers greater heterogeneity in its results, with figures of 12% average prevalence of psychotic disorders in a range of 2.8% to 42.3%. Another important fact is that, of this population, only one third receives treatment 214 . The attention to “homeless” people and who have SMI, is based on the combination of the services that provide housing and those that provide clinical care; this combination has two approaches: the traditional approach, called the continuum housing model in Anglo-Saxon literature, which is based on the offer of a range of housing provided by the same team that provides the clinical care, favouring the users’ progression towards more independent housing as they gain clinical stability. More modern approaches (supported housing) propose considering housing separately from clinical stability, based on normalised community housing and independent clinical services that give support when required 147 . On the other hand, there are proposals that give preference to housing (housing first), with no prior clinical stability requirements or no drug consumption 218 . The clinical care for the subgroup of “homeless” patients can be structured into three overlapping programmes and interventions 219 : • Outreach services aimed at “homeless” people who resist looking for treatment by themselves. • Case Management and ACT Services that are based on personalised relations as a means of accessing the services. • Housing and community work to facilitate stability in housing. Assertive community treatment is worth a special attention as a way of addressing the problem. In this section reference will be made to the specific ACT modalities aimed at dealing with “homeless” people. These ACT programmes often present modifications with respect to the original programme to address the specific need of this patient subgroup 218 . Question to be answered • Which intervention is more efficient in people with SMI and “homeless”? In the RCT by McHugo et al 147 (n = 121) 2 community ICM (Intensive Case Management) programmes are analysed, that differ in the way they approach the housing intervention (integrated vs. parallel). CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 105
Page 1:
Clinical Practice Guidelines for Ps
Page 4 and 5:
This CPG is an aid for decision mak
Page 7 and 8:
Table of Contents Presentation 7 Au
Page 9 and 10:
Presentation Healthcare practice is
Page 11 and 12:
Authorship and collaborators CPG de
Page 13:
José Manuel Lalana Cuenca. Special
Page 16 and 17:
c) SERVICE LEVEL INTERVENTIONS •
Page 18 and 19:
A B A A B B B C Psychosocial inter
Page 20 and 21:
B B B C A C C 5.3. SERVICE LEV
Page 22 and 23:
20 CLINICAL PRACTICE GUIDELINES IN
Page 24 and 25:
independence, quality of life, pers
Page 26 and 27:
This guideline is aimed at mental h
Page 28 and 29:
Figure 1. Search Strategy Search fo
Page 30 and 31:
The highest evidence level found wa
Page 33 and 34:
4. Characteristics of the CPG 4.1.
Page 35 and 36:
The main focus of rehabilitation is
Page 37 and 38:
5. Psychosocial type rehabilitation
Page 39 and 40:
From another point of view, social
Page 41 and 42:
defined as “standard care” or
Page 43 and 44:
General global state In the short r
Page 45 and 46:
Specific symptoms: when CBT was com
Page 47 and 48:
In the systematic review by Kurtz a
Page 49 and 50:
Summary of evidence 1- 1- 1- 1- 1-
Page 51 and 52:
People with SMI and a diagnosis of
Page 53 and 54:
5.1.3. Interpersonal therapy The li
Page 55 and 56: weekly or fortnightly sessions. The
Page 57 and 58: 5.1.5. Family interventions There a
Page 59 and 60: In the RCT carried out by Hogarty e
Page 61 and 62: A family intervention of more than
Page 63 and 64: After two years’ treatment, and b
Page 65 and 66: Family intervention vs. other psych
Page 67 and 68: 1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
Page 69 and 70: Question to be answered • Are pys
Page 71 and 72: Summary of evidence Pyschoeducation
Page 73 and 74: with schizophrenia and that the tre
Page 75 and 76: With reference to the type of train
Page 77 and 78: would normally receive and which in
Page 79 and 80: Hypnosis vs. relaxation No improvem
Page 81 and 82: Supervised fl ats are a community h
Page 83 and 84: 3 Programmes directed to leisure an
Page 85 and 86: SMI (schizophrenia, affective schiz
Page 87 and 88: When PVT is compared with standard
Page 89 and 90: Patients included in the individual
Page 91 and 92: 1+ 1+ 1++ 1+ 1+ 1+ 1+ The people in
Page 93 and 94: Music therapy Music therapy + stand
Page 95 and 96: A series of Case Management systems
Page 97 and 98: • The satisfaction data originati
Page 99 and 100: Loss of contact With respect to the
Page 101 and 102: There is not sufficient evidence, e
Page 103 and 104: 1+ 1+ 1+ 1+ Respect to ICM teams or
Page 105: Finally, in the RCT by Cheng et al
Page 109 and 110: Patients who access housing with no
Page 111: ceptive disorders. This series of c
Page 115 and 116: 7. Recommendations for Future Resea
Page 117: Appendices
Page 120 and 121: Appendix 2. Information obtained fr
Page 122 and 123: Appendix 4. Information for people
Page 124 and 125: 4. Regulatory and legal framework 1
Page 126 and 127: Several protocols have been publish
Page 128 and 129: The coordination of these resources
Page 130 and 131: Social protection systems Pursuant
Page 132 and 133: Specifi c regulation • (SPANISH)
Page 134 and 135: Service Management: The first anti-
Page 136 and 137: on Mental Health and the future Eur
Page 138 and 139: Spanish Society of Legal Psychiatry
Page 140 and 141: Appendix 5. Abbreviations ACT Asser
Page 142 and 143: Appendix 6. Glossary Therapy adhere
Page 144 and 145: Appendix 7. Declaration of interest
Page 146 and 147: 15 Rossler W. Psychiatric rehabilit
Page 148 and 149: 53 Graeber DA, Moyers TB, Griffi th
Page 150 and 151: 86 Schooler NR, Keith SJ, Severe JB
Page 152 and 153: 117 Sohlberg MM, Mateer CA. Effecti
Page 154 and 155: 154 López M, García-Cubillana P,
Page 156 and 157:
190 Bond GR, Drake RE. Predictors o
Page 158 and 159:
225 Hurley AD. Individual psychothe
show all

CPG for Psychosocial Interventions in Severe Mental ... - GuÃ­aSalud

Create successful ePaper yourself

Delete template?

Save as template?

CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud