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

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4.4. Research into psychosocial interventions The preparation of quality randomised control trials to be able to determine the possible effectiveness of the different interventions and psychosocial formats is complicated. This may be due in part to the type and complexity of the actual interventions referred to and to the ethical implications entailed. When a research study is proposed in this specific area, these limitations should be taken into account, considering the execution of good quality observational studies, which, although they fall below the RCTs in the evidence pyramid, can provide evidence about the effectiveness of some interventions, bearing in mind the limitations of these designs. The use of qualitative research techniques, which are widely used in the field of social sciences and to a lesser extent, in health sciences, should also be considered, as they cover the compilation, analysis and interpretation of data that are difficult to reduce to numbers. This type of techniques permit studying contexts and interventions, which, due to their nature, are difficult to prove with quantitative techniques as is the case of some psychosocial interventions addressed in this CPG. 34 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
5. Psychosocial type rehabilitation interventions As indicated by Gisbert et al 11 the aim of psychosocial rehabilitation interventions as part of the integral care of people with SMI is to overcome or compensate for the psychosocial and social integration difficulties that these people undergo, giving them support in their daily lives in the community in the most independent and decent manner, as well as in undertaking and handling the different roles and demands represented by living, working and mixing in different community environments. This type of intervention focuses on the functioning of persons, improving their personal and social skills and providing support to the different roles undertaken in their social and community lives. All in all, they aim to improve the quality of life of people affected and their families, supporting their social participation in the community in the most active, normalised and independent possible way. They are organised through an individualised process that combines, on the one hand, training and development of the skills and competences that each person requires to effectively function in the community and on the other hand, actions on the environment. It includes several aspects that vary from pyschoeducation and advice to families to the development of social supports aimed at offering the necessary aid to compensate or strength the level of psychosocial functioning of chronic mental patients 21 . Psychosocial interventions in rehabilitation have gained in operativity and efficiency with the incorporation of different extrapolated strategies, adapted from the field of psychology, social learning, behaviour modification, social intervention and human resources, including, among others: training and development of personal and social skills, pyschoeducational and psychosocial intervention strategies with families and users, development of social networks, social support, etc. This series of psychosocial intervention strategies have proved to be efficient in improving the psychosocial functioning of people with SMI and in their adaptation and maintenance in the community 11 . 5.1. Psychological interventions 5.1.1. Cognitive-behavioural therapys Cognitive-behavioural therapy (CBT) is a psychological intervention that is based on the hypothesis that cognitive activity determines behaviour. Many differences can be found when approaching the cognitive aspects, as some of them focus on structures, beliefs or basic cases as the main causal entities of emotions and behaviour 22,23 , whilst others focus on processes such as problemsolving, cognitive distortions or thought content: self-instructions, automatic thoughts, etc. 23,25 In addition, there are important differences in the intervention strategies. Despite these differences, the following characteristics, which they all have in common, can be pointed out: CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 35
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: The main focus of rehabilitation is
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
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When PVT is compared with standard
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Patients included in the individual
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1+ 1+ 1++ 1+ 1+ 1+ 1+ The people in
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Music therapy Music therapy + stand
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A series of Case Management systems
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• The satisfaction data originati
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Loss of contact With respect to the
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There is not sufficient evidence, e
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1+ 1+ 1+ 1+ Respect to ICM teams or
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Finally, in the RCT by Cheng et al
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5.4.2. “Homeless” with SMI The
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Patients who access housing with no
Page 111:
ceptive disorders. This series of c
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7. Recommendations for Future Resea
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Appendices
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Appendix 2. Information obtained fr
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Appendix 4. Information for people
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4. Regulatory and legal framework 1
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Several protocols have been publish
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The coordination of these resources
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Social protection systems Pursuant
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Specifi c regulation • (SPANISH)
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Service Management: The first anti-
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on Mental Health and the future Eur
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Spanish Society of Legal Psychiatry
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Appendix 5. Abbreviations ACT Asser
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Appendix 6. Glossary Therapy adhere
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Appendix 7. Declaration of interest
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15 Rossler W. Psychiatric rehabilit
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53 Graeber DA, Moyers TB, Griffi th
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86 Schooler NR, Keith SJ, Severe JB
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117 Sohlberg MM, Mateer CA. Effecti
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154 López M, García-Cubillana P,
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190 Bond GR, Drake RE. Predictors o
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225 Hurley AD. Individual psychothe
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