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

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1++ 1- In homeless people with SMI, ACT reduces the psychiatric symptoms when compared with standard Case management 221 . Living in group improves the executive functions, especially in patients with no substance abuse 223 . Recommendations A C C For homeless people with SMI who require psychiatric care and psychosocial intervention, it is advisable for both to be supplied together via integral programmes where residential programme/housing is offered. When there is no active substance abuse, it would be advisable to provide grouped accommodation to homeless people with SMI included in integral intervention programmes. When it is not possible to use accommodation and support programmes in the integral psychosocial intervention of homeless people with SMI, the intervention of assertive community treatment team should be offered. 5.4.3. SMI and low IQ/mental retardation There seems to be general agreement about the high prevalence of mental disorders in people with intellectual disability or mental retardation (understood as a person whose intellectual coefficient is 70 or below) 224 , at the same time as less access to specialised mental health services. Several factors may be interfering with this, one of which may be the perception by professionals that psychological interventions may be inefficient due to the cognitive deficits and verbal limitations 225 . On the other hand, the correct diagnosis of the symptoms, syndromes and nosological entities in this population may be limited by the use of the current diagnostic classification criteria. More specifically, the diagnosis of psychotic disorders (schizophrenia and related disorders, included in SMI) is hindered by the problem of distinguishing real hallucinations from other nonpathological behaviours, such as talking to themselves or to imaginary friends. Added to this is a high prevalence of symptomatology, but limited detection capacity (lack of diagnostic criteria and adapted and validated instruments for this population) of greater psychiatric disorders. The use of diagnostic criteria and instruments adapted to mental retardation has been proposed therefore 226 as a way of improving the reliability of the diagnoses in this population. Question to be answered • Which psychosocial treatment is more effective in people with SMI and a low IQ? To be able to answer this question the RCT by Martin et al 227 has been included, which compares the efficacy of the ACT model with the standard community treatment, to treat mental illness in light to moderate mental retardation (MR) and SMI. Due to the little evidence found, which could also answer this question, a series of cases by Haddock 228 (n = 5) have been included, where the people that are described, suffer from light MR and schizophrenia (they are being treated with antipyschotics) and chronic and resistant sensoper- 108 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
ceptive disorders. This series of cases describes the reliability of cognitive-behavioural therapy adapted to this population, including 2 cases where family intervention was integrated. Little volume and quality of evidence have been found, regarding the number of studies and types of interventions to be compared. Assuming that the productive symptomatology in people with SMI and learning disabilities (light MR) may be disruptive, chronic and resistant to treatment, the application of effective psychosocial interventions may provide clear benefits, especially when the learning disabilities variable is often a criterion for exclusion when creating programmes, services and studies. In our context and at the present time, the basic conditions do not exist to be able to apply cognitive-behavioural techniques and assertive programmes to the SMI population with learning disabilities. No differences were found between ACT and standard treatment. Favourable results have been observed in both treatments with respect to covering needs and improving the burden of care and the functioning level of this population. Regarding the quality of life, the results were even favourable for standard treatment, compared with ACT (adjusted difference of standard means vs. ACT -5.27 IC95%: between -9.7 and -0.82; p = 0.023) 227 . Adapted, individual cognitive-behavioural therapy or with family intervention is effective in population with learning disabilities andschizophrenia and can be efficient as a supplementary therapy in treatment of chronic psychotic symptomatology resistant to antipsychotic treatment 228 . RCT (1+) Cases series (3) Summary of evidence 1+ 1+ 3 ACT and standard treatment improve the burden of care and functioning levels in people with SMI and learning disbailities 227 . The results appear to be more favourable in standard treatment, compared with ACT, respect to quality of life 227 . Adapted, individual cognitive-behavioural therapy or with family intervention is effective in population with learning disbilities and schizophrenia and may be efficient as a complementary therapy in the treatment of chronic psychotic symptomatology resistant to antipsychotic treatment 228 . Recommendations B For people with SMI and a low IQ, and when there is a presence of persistent productive symptoms, it is recommendable to indicate cognitive behaviour therapy adapted to that condition. To improve the diagnosis of psychiatric disorders included within the concept of SMI in people with a low IQ, adapted criteria and specific and validated instruments must be used. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 109
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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
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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 and 108: 5.4.2. “Homeless” with SMI The
Page 109: Patients who access housing with no
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
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