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

defined as “standard care” or “discussion groups”. The studies included varied with respect to the
duration of the treatment (from 4 weeks to 2 years), follow-up (from 6 months to 2 years), place
of treatment (outpatients, hospitalised, day or mixed), and sex of the participants (mixed or all the
participants were males). All the studies come from the Anglo-Saxon field.
The Kurtz and Mueser 48 review was also taken into account, which assesses the effects of
social skills on people with schizophrenia or schizoaffective disorders and they are compared
with other active therapies or standard intervention. Social skills training, to be considered an intervention,
must include behavioural techniques such as instructions on skills, role play, training,
and positive or negative feedback.
23 randomised studies (n = 1599) are included in this review and the effects magnitudes are
differentiated for different proximal (such as the execution of trained skills), intermediate (such
as social functioning) or distal (such as relapses) measurements.
There seems to be a divergence among the studies chosen regarding the force of the recommendation
or the effect magnitude. This leads to divergences as occurs in the case of the data
provided by the NICE Schizophrenia CPG 8 , which does not detect any evidence to support this
intervention that is advised in the PORT criteria49. Kurtx and Mueser 48 argue that the Pilling et
al 47 study, which the NICE Schizophrenia CPG 8 is based upon, is more restrictive and mixes distal
measurements with proximal measurements, thus making it more difficult to find significant
effects. Furthermore, the Kurtz and Mueser 48 review is later than the NICE Schizophrenia CPG 8
and includes more studies.
Measuring isolated symptoms is not sufficient to reflect significant results. To assess longterm
results, it is essential to have information on the social situation of the people; namely, assess
how they live, how they function in society and how they undertake their different roles, placing
importance on distant (distal) and costly results compared with nearer (proximal) psychopathological
results 50 .
The development group of this CPG chose to include both studies as it considered that they
are congruent and complementary in many aspects due to the varied measurement approach they
offer. The impact of this intervention is determined on the one hand by the low effect on distal
measurements detected and by the population it addresses. The impact may be low if the intention
is for it to be an intervention aimed at preventing relapses because the target population may
present other types of problems, and the impact may be higher if the intention is to improve the
psychosocial functioning.
Problem-solving therapy in people with SMI and a diagnosis of schizophrenia and related
disorders
The problem-solving therapy is considered as a brief and focused form of psychotherapy. It involves
holding a few practical sessions where the therapist organises a process with the patients to
identify their more immediate problems and they design agreed tasks and ways of solving them.
Problem-solving therapy has a cognitive and behavioural component, it tries to establish a link
initially between the symptoms and the practical difficulties to be developed in several stages (explanation
about the therapy and its fundamentals, identification and breakdown of the problem,
establishing accessible objectives, generating solutions, assessing them, implementing them and
assessing the result of the solution implemented).
The main objectives of the therapy are to make the people have a better understanding about
the relationship between their symptoms and their problems, increasing their capacity to define
CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 39