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

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Appendix 4. Information for people with SMI and their families 1. What is a Clinical Practice Guideline? This document is an essential part of the composition of a Clinical Practice Guideline (CPG), it includes those contents that the authors believe may be important for the people interested, in order to be able to have information and help cope with and in this health problem. A CPG is a scientific instrument, comprised of a series of systematically developed recommendations, based on the best evidence available, in order to help clinicians and patients take decisions. Its purpose is to reduce the variability of clinical practice, providing summarised information. Each recommendation is based on the scientific quality of the studies and publications, the professionals’ experience and the users’ preferences. Deciding which questions on psychosocial interventions in SMI are pertinent and require an answer, searching for information, summing up data and agreeing to the final content have been the work of the Guideline development group over the last few months. This CPG has been funded through the agreement signed by the Carlos III Health Institute an organisation pertaining to the Ministry of Science and Innovation, and the Aragon Health Sciences Institute , within the framework of collaboration provided for in the Quality Plan for the National Healthcare System. The CPG is not a substitute for scientific knowledge and the life-long training of professionals on the topic, but rather it is a part of this, another tool for decision-making when doubts arise. For users and families it is a tool that can help them discover the characteristics of the different interventions. Sometimes, our intuitions, practical knowledge and common sense do not coincide with the conclusions of the guideline. This may be due to a lack of knowledge in this area of knowledge or simply to the absence of good quality studies designed to be able to answer our problems. The application of our knowledge to those problems where there is no proof or evidence of the efficacy of the interventions is where the clinician and the user must decide which decisions to make concerning a specific health problem, in a specific scenario or with specific conditions and with respect to one single person. The preparation of this guideline on Psychosocial Interventions in Severe Mental Illness (SMI) presents additional difficulties as it does not respond to the needs for knowledge on one single and defined mental disorder, due to the lack of consensus about the meaning of the techniques and activities included as Pyschosocial Interventions and the different definitions of the concept of Severe Mental Illness. The majority of the documents and scientific evidence found refer to affective and non-affective psychotic disorders, schizophrenia and related disorders, bipolar disorders and severe and persistent affective disorders; thus they are all specifically defined or framed within the concept of Severe Mental Illness. There are other CPGs that deal with specific psychiatric disorders and can be found at http:// portal.guiasalud.es/web/guest/home 120 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
2. What is SMI When we refer to Severe Mental Illness (SMI) we are referring to a series of clinical diagnoses that fall within the group of psychoses (mainly Schizophrenia and Bipolar Disorder), but also other related diagnoses. For the people with these diagnoses to be considered as pertaining to the group of SMI, they must also satisfy two requirements: persistence in time (2 years by consensus) and present serious difficulties in personal and social functioning due to this illness. Thus, it can be stated that not all people who have been diagnosed with a psychosis (such as, for instance, schizophrenia) enter the group of SMI and that not all people with SMI suffer from schizophrenia. As indicated, apart from the diagnosis, the persistence of the disorder in time and the existence of a disability are required. 3. Why do we talk about a bio-psycho-social approach The main treatment for people with SMI has been pharmacological interventions since its introduction in the 50s. However, the partial and limited control of the symptomatology with the medication, the difficulties for certain patients to adapt to the pharmacological patterns, the need to work in areas such as awareness of the illness, the short and long term side effects, the difficulties in co-existence and the difficulty to carry out a productive activity and be independent, among others, pose the need to use a more far-reaching approach than pharmacological treatment, an approach that permits including biological, psychological and social aspects of the treatment (“bio-psycho-social approach”). So, other psychotherapeutic and psychosocial interventions must be incorporated which, in many aspects, are included in the psychosocial rehabilitation concept. The sole objective of these interventions and this approach is to improve the personal and social functioning and the quality of life of people with SMI, as well as support their integration. This means doing more than just controlling symptoms and considering overcoming the illness; in other words, foster the possibility of people with SMI to lead a significant and satisfactory life, being able to define their own objectives and finding help to develop them in the professionals. This concept has been called recovery in scientific literature and at the same it becomes a channel and an objective to work with each patient. These programmes, framed within a bio-psycho-social approach and aiming towards recovery have their maximum expression in Community Mental Health, whose aim is to care for patients in their normal environment, contrary to hospital (psychiatric hospital) care. As referred to in other chapters of this manual, this community model is the direct consequence of the changes in mental illness care over the last few decades and that foster a shift from the psychiatric hospital to the community and which have been reflected in, among other documents, the General Law on Health and the Strategies document of the Spanish NHS. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 121
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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
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In the RCT carried out by Hogarty e
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A family intervention of more than
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After two years’ treatment, and b
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Family intervention vs. other psych
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1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
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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 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 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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