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

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Supportive therapy vs. any other psychological or psychosocial therapy RCT (1-) There are insufficient data to determine if supportive therapy or counselling improves the relapse rates at the end of the treatment period (n = 361; RR = 1.33; 95% CI: between 0.80 and 2.21) or after a non-specified follow-up period (n = 154; RR = 1.21: 95% CI: between 0.89 and 1.66) 8 . These results concur with those reviewed by Buckley et al 74 , which indicate that there are no differences between either of the two interventions with respect to relapses (5 RCT; n = 270; RR = 1.18; 95% CI: between 0.91 and 1.53). There is evidence that indicates that supportive therapy or counselling leads to an improvement in the mental state at the end of the treatment (BPRS/PANSS/CPRS: n = 316; WMD = 0.02; 95% CI: between -0.20 and 0.24) or after a non-specified follow-up period (BPRS/PANSS/CPRS: n = 284; WMD = 0.20; 95% CI: between -0.03 and 0.44) 8 . Supportive therapy or counselling does not produce a reduction of the positive symptoms of schizophrenia at the end of the treatment (BPRS positive symptoms: n = 59; RR = 1.27; 95% CI: between 0.95 and 1.70), or after a follow-up period (the period is not indicated in the review) once the treatment has ended (CPRS positive symptoms: n = 90; RR = 1.66; 95% CI: between 1.06 and 2.59) 8 . It is impossible to determine that supportive therapy or counselling reduces the cases of death at the end of the treatment and after a follow-up period once the treatment has ended (the follow-up period is not indicated) (n = 281; RR = 2.86; 95% CI: between 0.12 and 69.40) 8 . Summary of evidence 1- 1- 1- There is no evidence that the use of supportive therapy or counselling, when compared with standard treatment, improves the hospitalisation ratios 74 relapses, mental state and death 8 . When supportive therapy or counselling is compared with CBT, the results are positive in favour of CBT with respect to general functioning 74 . There are insufficient data to determine if supportive therapy or counselling when compared with any other psychological or psychosocial therapy, improves the rate of relapses and mental state, reduces positive symptoms or decreases the cases of death 8 . Recommendations Sufficient evidence has not been found to make recommendations related to supportive therapy or counselling in the treatment of people with SMI. 54 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
5.1.5. Family interventions There appears to be general consensus about the fact that SMI has a considerable effect on the family relations of people who suffer from it, and that family relations can also, in some way or another, affect the course of the disease. Some studies show that people with schizophrenia that come from families with high levels of “expressed emotion”, in other words, that show high levels of over-protection, criticism and hostility, are more likely to suffer relapses than those people with the same type of pathology but with lower levels of “expressed emotion” within the family 8 . Nowadays, there is a great variety of methods to help people with mental diseases and their families manage the disease in a more effective manner. These interventions are designed to improve the relationships between family members, reduce the levels of “expressed emotion” and, in some way, reduce the relapse ratios and improve the quality of life both of the patient and of the families. Pyschosocial interventions have been reviewed as well as the evidence that exists about their efficiency in people with SMI with respect to their isolated application compared with standard treatment or other interventions. However, studies have been found in the review where the experimental group receives two or more interventions. The question of how these interventions must be combined, not only together but also added to other types of interventions, is directly related to the need to integrate treatments and to the debate on the artificial delimitation between treatment and rehabilitation. No specific question has been contemplated in this CPG to define which combination of psychosocial interventions is more efficient. It is, however, considered advisable to indicate that there are studies that propose the application of interventions that combine family therapy and other therapies. For some authors there is an international agreement about the need to offer a combination of three essential interventions in the treatment of patients with schizophrenia and related disorders: optimal doses of antipsychotic medication, education of users and their caregivers to cope more effectively with environmental stress, and Assertive Community Treatment that helps resolve social needs and crisis, including symptomatic exacerbation 75 . Despite the evidence that supports this, there are very few mental health plans that foresee these programmes in a routine manner. However, for other authors, it is the combination of family treatment, social skills training and pharmacological treatment that can be the appropriate treatment to avoid relapses 76 . A combined psychosocial treatment project started up in 1994, which included family intervention and other psychosocial interventions (Optimal Treatment Project, OTP). It was multicentre (in 21 countries and with 35 venues) and its aim was to assess costs and benefits of applying evidence-based optimal psychosocial and biomedical strategies, to treat schizophrenia and other non-affective psychosis, through the implementation and assessment of optimal therapeutic interventions in ordinary mental health resources –not investigators- after the adequate training of multidisciplinary professionals teams and with a 5-year follow-up period 77 . Although the project proposed incorporating patients as soon as possible after the onset of the disease (in the first ten years), some venues incorporated patients with more than 10 years’ evolution, where the treatment was focused on improving their quality of life through social and occupational skills training, and on providing pharmacological and psychosocial strategies for persistent symptoms. The interventions included pharmacological strategies, psychoeducation of patients and caregivers, Assertive Community Treatment, social skills training, pharmacological and psychosocial handling of persistent and residual symptoms. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 55
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 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: weekly or fortnightly sessions. The
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
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7. Recommendations for Future Resea
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Appendices
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Appendix 2. Information obtained fr
Page 122 and 123:
Appendix 4. Information for people
Page 124 and 125:
4. Regulatory and legal framework 1
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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
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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
Page 146 and 147:
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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