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

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Motivational interview vs. standard treatment RCT (1-) RCT (1-) RCT (1-) However, when the motivational interview alone is compared with standard treatment in SMI people, it appears to be efficient in obtaining alcohol abstinence 6 months after the intervention (n = 28; RR = 0.36; 95% CI: between 0.2 and 0.8; NNT = 2) 53 With respect to the improvement of the mental state, no differences were found between the motivational interview alone and standard treatment (1 RCT; n = 30; WMD = -4.2; 95% CI: between -18.7 and -10.3) 54 The motivational interview appears to be more efficient than standard treatment in the achievement of a greater percentage of follow-ups after the intervention (n = 93; 58% vs. 84%; RR = 0.69; 95% CI: between 0.5 and 0.9; NNT = 4) 55 Cognitive-behavioural therapy (CBT) for people with SMI and a diagnosis of bipolar disorder (BD). Cognitive-behavioural therapy (BCT) vs. standard treatment (ST) RCT (1+) RCT (1-) Relapses In one RCT where there is a 30-month follow-up, no significant differences were found to prevent maniac relapses n = 103; OR = 0.48; 95% CI: between 0.21 and 1.13), but for depressive relapses, significant differences were found (OR = 0.32; 95% CI: between 0.13 and 0.74) 61 Readmissions No statistically significant differences have been found in the reduction of readmissions between either of the two interventions (n = 28; OR = 0.30; 95% CI: between 0.05 and 1.91) 59 Cognitive-behavioural therapy (BCT) + standard treatment (ST) vs. standard treatment (ST) RCT (1+) RCT (1+) RCT (1+) Social functioning Two studies by the same author found that there is no evidence that determines which intervention is more effective at 6 months’ follow-up (n = 103; WMD = -0.13; 95% CI: between -0.37 and 0.1) 60,61 . Nor at 18 months (n = 68; WMD = -0.3; 95% CI between -0.5 and -0.1), nor at 24 months (n = 71; WMD = -0.2; 95% CI: between -0.46 and 0.06) 61 Readmissions There is certain evidence in favour of CBT in connection with readmissions (n = 103; RR = 0.42; 95% CI: between 0.23 and 0.8) 12 months after having begun the treatment 61 Relapses There is moderate evidence in favour of CBT compared with standard treatment with respect to the presence of relapses 6 months after the start of treatment (n = 155; RR = 0.61; 95% CI between 0.41 and 0.91) 61 , 12 months after the start of the study (n = 180; RR = 0.62; 95% CI: between 0.39 and 0.98) 60,61 , and after 30 months (n = 103; RR = 0.79; 95% CI: between 0.63 and 0.99) 61 46 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
Summary of evidence 1- 1- 1- 1- 1- 1- 1- 1- 1- 1- 1- 1- 1- People with SMI and a diagnosis of schizophrenia and related disorders CBT + ST vs. ST does not reduce the rates of relapses or readmissions in the medium 38 or long term 32 . An improvement in the global state of people with SMI and a diagnosis of schizophrenia and related disorders is observed when they receive CBT in the short 32 and medium term 39 However, this effect is no longer significant in the long term 32 . The application of CBT together with standard treatment is more effective in the improvement of the clinical state than when only standard treatment is applied. However, this difference was no longer significant after one year’s treatment 32 . There are no differences between CBT + ST vs. ST in general symptoms in short 32 medium term 40 . However, there is an improvement after 18 months in favour of the CBT group 40 . In the case of hallucinations, CBT + ST vs. ST favours specific symptoms in the long term 34 . No effect was observed between CBT + ST vs. ST respect to the conviction of delusional beliefs 34 . There is a positive effect in favour of CBT + ST vs. ST in connection with positive and negative symptoms and global symptoms 32 . No significant differences have been found between CBT + ST vs. ST with respect to the improvement of quality of life 33 . There are no differences between CBT + ST vs. ST in the social functioning of people who suffer SMI and a diagnosis of schizophrenia and related disorders with respect to isolation, interpersonal behaviour, independence in performance and competence. However, there is a positive effect in favour of CBT for prosocial behaviours 41 . No differences have been observed between CBT + ST vs. Supportive psychotherapy + ST with respect to medium 42 or long 32 term relapse ratios. There are no differences between CBT + ST vs. Supportive psychotherapy + ST respect to clinical improvements in medium 38 or long term 32 . However, with respect to general symptoms, there are no significant differences in favour of CBT in the short term 35 , but there are in the medium term 37 . There are no differences between CBT + ST vs. supportive psychotherapy + ST in connection with the improvement of negative and positive symptoms in the short 64 or long 42 term. When CBT is compared with other psychological interventions, no improvement is observed in the specific symptoms with respect to delirium, but there is with respect to hallucinations 42 . 1+ There is not sufficient evidence to indicate that CBT when compared with ST reduces relapses during treatment, or 12 months or 2 years after finishing treatment. 1+ CBT programmes lasting for more than 3 months reduce relapses 8 . 1- CBT, when compared with ST, reduces the symptoms at the end of the treatment 8 . 1+ BT, when compared with ST, improves the mental state at the end of the treatment 8 . CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 47
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 and 36: The main focus of rehabilitation is
Page 37 and 38: 5. Psychosocial type rehabilitation
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: In the systematic review by Kurtz a
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
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 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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