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

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1- 1- 1+ 1- 1- 1- 1- 1- 1- 1+ 1+ 1+ 1- 1- 1- There is no evidence of improvement in symptoms when CBT is compared with other psychological interventions at the end of the treatment and 9 to 12 months after it has ended 8 . There is no evidence that indicates that CBT reduces persistent symptoms after 9 months’ follow-up, when compared with ST 8 . CBT, when compared with ST, improves the mental state (persistent symptomatology) after treatment 8 . There is limited evidence that indicates that CBT produces an improvement in social functioning of people with SMI and diagnosis of schizophrenia or related disorders 8 . When CBT is compared with other treatment, greater benefit is found in the reduction of positive symptoms in patients with acute episodes than in chronic patients 46 . Social skills training in people with SMI and a diagnosis of schizophrenia and related disorders There is no clear evidence that indicates that, when social skills training is compared with ST or with other treatments, it reduces relapses or readmissions 47 . It is impossible to determine that social skills training, when compared with ST, improves the quality of life 33 or when compared with other treatments 47 . There is no evidence that indicates that social skills training, when compared with ST, improves social functioning 33 . There are no differences between social skills training vs. ST with respect to the improvement of the mental state 33 . Training in social skills produces an improvement in the daily living skills, social functioning, negative symptoms and relapses, when compared with other active therapies 48 . Problem-solving in people with SMI and a diagnosis of schizophrenia and related disorders No differences were detected between problem-solving and standard treatment with respect to the ability to solve problems, aggressive behaviour, interaction with professional staff and with companions 51 . No differences were detected either between problem-solving and coping skills in connection with the number of admissions and reduction of the score in the BPRS scale after treatment 51 . Motivational interview in CBT When the motivational interview is included in CBT and compared with standard treatment, no differences were found between either of the two interventions in the consumption of substances in people who consume drugs 3 months or 6 months after the intervention 57 . No improvement in the mental state in either of the two groups was also found. 56 However, when the motivational interview alone is compared with standard treatment in people with SMI, the motivational interview appears to be efficient in alcohol abstinence 6 months after the intervention 53 and there is greater follow-up after the intervention 55 . There are differences between the motivational interview alone and standard treatment in the improvement of mental state 54 . 48 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
People with SMI and a diagnosis of bipolar disorder There are no differences between CBT and ST regarding prevention of maniac relapses, 1+ but there are differences when avoiding depressive relapses in favour of CBT (30 months follow-up period) 61 . 1- There are no differences between CBT and ST in the reduction of hospital readmissions 59 . 1+ 1+ When comparing CBT + ST with ST alone, no differences have been found that determine which intervention is more effective in connection with social functioning at 6 60,61 , 18 or 24 61 months’ follow-up. When CBT + ST are compared only with ST, it improves the readmissions and relapses at 6 61 , 12 60,61 and 30 61 months after starting the treatment. Recommendations C C C B In people with SMI, cognitive behavioural treatment can used combined with standard treatment to reduce positive symptomatology, mainly hallucinations. People with SMI and persistent positive symptomatology can be offered a specific cognitive behavioural-orientated psychological intervention for this pathology, lasting for a prolonged period of time (more than one year), in order to improve the persistent symptomatology. Incorporate cognitive therapy into the strategies aimed at preventing relapses of depressive symptomatology in people with SMI and diagnosis of bipolar disorder. When the main objective of the intervention in people with SMI is to improve their social functioning, it is advisable to incorporate social skills training. There is not sufficient evidence to make recommendations in the problem-solving area for people with SMI and a diagnosis of schizophrenia and related disorders. 5.1.2. Psychodynamic psychotherapies and psychoanalytical approach In individual therapy, psychoanalytical principles are applied that have evolved from basic theoretic-technical principles of psychoanalytical treatment, so normally, the treatment is called psychodynamic psychotherapy or psychoanalytical counselling. The central part of these treatments is the analysis of the transfer that arises in the relationship between the patient and the therapist, the observation of the countertransference reactions and the processes related to this phenomenon. The studies must be orientated towards the patients’ needs, and the starting point must be the patient’s needs and not the investigator’s needs 65 In the article by Bachmann et al 66 on psychological treatment for psychosis, it indicates that psychodynamic and psychoanalytical approaches have common fields even though they are different. There are three main models in psychodynamic approach: the concept of conflict-defence, the concept of ego impairment and the concept of self-object representations. Currently there is agreement in the following aspects: 1. Psychotherapy is possible in psychosis. 2. The classical psychoanalytical framing is contraindicated. 3. Greater emphasis must be placed on the present than on the past. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 49
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 and 48: In the systematic review by Kurtz a
Page 49: Summary of evidence 1- 1- 1- 1- 1-
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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