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

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In the study by Tsemberis et al 220 (n = 225) the sample to be studied is assigned either to the continuity of care group (housing and clinical care following continuum model) or housing with no clinical conditioning factors (housing fi rst model). The systematic review by Coldwell & Bender 221 , where 6 RCTs and 4 observational studies are assessed (940 and 4854 patients, respectively), ACT is compared with standard Case Management or standard treatment in “homeless” people. Nelson et al 222 carries out another SR with 16 assessments of controlled studies on housing and support for people who have been homeless. In this study, ACT, Case Management and supported housing are compared with each other. No information is provided about the magnitude of the effect. Caplan et al 223 (n = 112) randomise the sample (all receive ICM) and assign it to an individual residential housing programme without clinical personnel or housing with 6 to 10 residents with individual room and assigned clinical personnel. There are several problems regarding the generalisation and application of the results of these studies, which have been conducted in Anglo-Saxon countries: • The variability in the prevalence of psychotic disorders in the homeless population, already mentioned. • The differences in social and health support between the different areas where they are conducted, with a greater degree of protection in European countries. • Derived from the above, the problem of the homeless population has determined the need to create specific teams to care for them in certain contexts; this may create differences regarding the comparative intervention and the generalisation of the results to settings such as ours, where the existence of these resources is not so usual. • Most of the studies focus on the greater efficiency of the ACT compared with CM. In our context there are a few ACT teams disseminated in certain autonomous communities, compared with the absence of teams that focus on the traditional CM model (broker), due mainly, once again, to the different social support and health systems. • With respect to the housing provision systems, the prevailing model in our context is similar to the model of housing + supporting (assisted flats), whilst the housing in parallel to the clinical care model is difficult to find as there are no agencies that provide economically accessible individual or group housing for people with SMI. As there are differences between the social environment and the support of homeless people in our context and that of the countries where the studies have been conducted, there will also be differences in the need to develop and/or adapt resources for them. Therefore, the relevance of the intervention for the Spanish social and health system is linked to the prevalence of homeless with SMI, possibly not as high as that of the Anglo-Saxon countries. However, there is a benefit derived from the application of programmes in a group for which the only alternative is conventional treatment. The necessary resources to start up integrated housing and care programmes for homeless people are multiple and involve the start-up of assertive community treatment teams, only available today in some health sectors of some autonomous communities. People with SM and “homeless” RCT (1++) Patients who are in an integrated housing system (housing + clinical services) spend less time homeless (p
Patients who access housing with no prior conditioning factors (housing first model) drop more quickly in the rates of staying in the “homeless” status and stay in stable housing for longer than those who have gone through a period of soberness and treatment acceptance (p < 0.001), although there are no significant differences between both groups with respect to psychiatric symptoms and evolution in time (p = 0.85) 220 . RCT (1+) Housing stability Assertive Community treatment (ACT) reduces the “homeless” state in 37% (p = 0.0001) compared with standard Case Management 221 . The best results in housing stability are obtained by programmes that include housing and support (ES = 0.67), followed by ACT (ES = 0.47) 222 . SR (1++) SR (1-) Hospitalisation Assertive Community treatment does not reduce hospitalisation when compared with standard Case Management in “homeless” population (10% reduction) (`= 0.024)” 221 . SR (1++) Symptomatology and cognition In homeless people with SMI, assertive community treatment reduces the psychiatric symptoms compared with standard Case Management (p = 0.006) 221 . Living in a group improves the executive functions (measured in agreement with perseverance in WCST), especially in patients with no substance abuse, with an interaction between type of housing, evolution in time and abuse of substances or not (p
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Clinical Practice Guidelines for Ps
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This CPG is an aid for decision mak
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Table of Contents Presentation 7 Au
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Presentation Healthcare practice is
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Authorship and collaborators CPG de
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José Manuel Lalana Cuenca. Special
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c) SERVICE LEVEL INTERVENTIONS •
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A B A A B B B C Psychosocial inter
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B B B C A C C 5.3. SERVICE LEV
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20 CLINICAL PRACTICE GUIDELINES IN
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independence, quality of life, pers
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This guideline is aimed at mental h
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Figure 1. Search Strategy Search fo
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The highest evidence level found wa
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4. Characteristics of the CPG 4.1.
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The main focus of rehabilitation is
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5. Psychosocial type rehabilitation
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From another point of view, social
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defined as “standard care” or
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General global state In the short r
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Specific symptoms: when CBT was com
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In the systematic review by Kurtz a
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Summary of evidence 1- 1- 1- 1- 1-
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People with SMI and a diagnosis of
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5.1.3. Interpersonal therapy The li
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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 and 106: Finally, in the RCT by Cheng et al
Page 107: 5.4.2. “Homeless” with SMI The
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
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225 Hurley AD. Individual psychothe
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