CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud
CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud
CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
ceptive disorders. This series of cases describes the reliability of cognitive-behavioural therapy<br />
adapted to this population, <strong>in</strong>clud<strong>in</strong>g 2 cases where family <strong>in</strong>tervention was <strong>in</strong>tegrated.<br />
Little volume and quality of evidence have been found, regard<strong>in</strong>g the number of studies<br />
and types of <strong>in</strong>terventions to be compared. Assum<strong>in</strong>g that the productive symptomatology <strong>in</strong><br />
people with SMI and learn<strong>in</strong>g disabilities (light MR) may be disruptive, chronic and resistant<br />
to treatment, the application of effective psychosocial <strong>in</strong>terventions may provide clear benefits,<br />
especially when the learn<strong>in</strong>g disabilities variable is often a criterion <strong>for</strong> exclusion when creat<strong>in</strong>g<br />
programmes, services and studies. In our context and at the present time, the basic conditions do<br />
not exist to be able to apply cognitive-behavioural techniques and assertive programmes to the<br />
SMI population with learn<strong>in</strong>g disabilities.<br />
No differences were found between ACT and standard treatment. Favourable<br />
results have been observed <strong>in</strong> both treatments with respect to cover<strong>in</strong>g needs<br />
and improv<strong>in</strong>g the burden of care and the function<strong>in</strong>g level of this population.<br />
Regard<strong>in</strong>g the quality of life, the results were even favourable <strong>for</strong><br />
standard treatment, compared with ACT (adjusted difference of standard<br />
means vs. ACT -5.27 IC95%: between -9.7 and -0.82; p = 0.023) 227 .<br />
Adapted, <strong>in</strong>dividual cognitive-behavioural therapy or with family <strong>in</strong>tervention<br />
is effective <strong>in</strong> population with learn<strong>in</strong>g disabilities andschizophrenia<br />
and can be efficient as a supplementary therapy <strong>in</strong> treatment of chronic psychotic<br />
symptomatology resistant to antipsychotic treatment 228 .<br />
RCT (1+)<br />
Cases series (3)<br />
Summary of evidence<br />
1+<br />
1+<br />
3<br />
ACT and standard treatment improve the burden of care and function<strong>in</strong>g levels <strong>in</strong> people<br />
with SMI and learn<strong>in</strong>g disbailities 227 .<br />
The results appear to be more favourable <strong>in</strong> standard treatment, compared with ACT,<br />
respect to quality of life 227 .<br />
Adapted, <strong>in</strong>dividual cognitive-behavioural therapy or with family <strong>in</strong>tervention is effective<br />
<strong>in</strong> population with learn<strong>in</strong>g disbilities and schizophrenia and may be efficient as a<br />
complementary therapy <strong>in</strong> the treatment of chronic psychotic symptomatology resistant<br />
to antipsychotic treatment 228 .<br />
Recommendations<br />
B<br />
<br />
For people with SMI and a low IQ, and when there is a presence of persistent productive<br />
symptoms, it is recommendable to <strong>in</strong>dicate cognitive behaviour therapy adapted to that<br />
condition.<br />
To improve the diagnosis of psychiatric disorders <strong>in</strong>cluded with<strong>in</strong> the concept of SMI<br />
<strong>in</strong> people with a low IQ, adapted criteria and specific and validated <strong>in</strong>struments must be<br />
used.<br />
CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 109