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

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Group psychoeducation for relations of people with SMI and a diagnosis of bipolar disorder RCT (1+) RCT (1-) Patients whose family members followed a group psychoeducational programme presented a significantly longer period of time until any recurrence, than those of the control group (p=0.044). When the analysis described the type of relapse, only the time until hypomaniac or maniac relapse was significant (P=0.015) but not for depressive relapses 104 . Furthermore, 42% of the patients whose family members followed a group psychoeducational programme presented relapses compared with 66% in the control group after 12 months’ follow-up (p=0.011). In a detailed analysis, this difference was exclusively due to the lower percentage of hypomaniac and maniac relapses in the experimental group (37.5% p=0.017) 104 . Family intervention vs. multi-family intervention In a study performed when the patient was in an acute phase, individual family intervention has not been found to be more effective than multifamily intervention with respect to the improvement in symptoms at the end of the treatment (28 months) (n = 92; RR = 0.67; 95% CI: between 0.34 and 1.32) 95 . Family intervention vs. non-intervention RCT (1-) RCT (1-) RCT (1-) RCT (1-) No differences are found in the clinical improvement between the two groups (at the end of treatment) (n = 26; RR = 0.49; 95% CI: between 0.10 and 2.4), nor after 6 months’ follow-up (n = 26; RR = 0.73; 95% CI: between 0.05 and 10.49) 101 . People from the family intervention group presented an increase in anxiety levels, compared with the group that did not receive any intervention (n = 39; WMD = 0.69; 95% CI between 0.05 and 1.34) 102 . No differences are found between the family psychoeducation intervention groups for carers caregivers and non-intervention in the relationships in the family environment (expressiveness, cohesion and conflict). Expressiveness (n = 45; WMD = -0.03; 95% CI: between -0.65 and 0.59); cohesion (n = 45; WMD = 0.10; 95% CI; between -0.52 and 0.72), and conflict (n = 45; WMD = -0.33; 95% CI: between -0.95 and 0.29) 103 . Van Gent & Zwart 102 indicate that there are no differences between the marital psychoeducation family intervention groups for couples vs. no intervention (n = 45; WMD = -0.33; 95% CI: between -0.95 and 0.29). There are no differences, either, between either of the two groups with respect to treatment adherence at the end of the study (12 months) (n = 36; RR = 1.06, 95% CI: between 0.73 and 1.54). RCT (1-) With respect to the recovery of the person at the end of the study (28 months), no differences have been found between multi-family group psychoeducation intervention and no intervention (n = 59; RR = 1.49, 95% CI: between 0.76 and 2.95) or in people with mania (n = 45; RR = 1.57, 95% CI: between 0.67 and 3.68) 100 . 62 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
Family intervention vs. other psychosocial interventions There are no differences in the recovery ratios between systemic family therapy focused on problem-solving and multi-family psychoeducational group therapy at the end of the study (28 months) in all the people (n = 63; RR=1.72; 95% CI: between 0.91 and 3.25) or in people with mania (n = 47; RR = 1.57; IC between 0.67 and 3.68) 100 . RCT (1-) Summary of evidence People with SMI and a diagnosis of schizophrenia and related disorders 1+ Family intervention in people with schizophrenia reduces relapses 8 . 1- Family intervention reduces persistent symptoms after 12 months’ treatment 79 . 1- 1- 1+ 1- 1- Family intervention of less than 5 sessions, or of unknown number, reduces relapses after one year’s treatment, after 1, 3 and 10 years’ follow-up 80 . Family intervention of more than 5 sessions reduces hospitalisations after 18 months’ follow-up 80 . There are no differences between family intervention and standard intervention in the reduction of hospital readmissions 2 years after finishing the treatment 8 . There is better compliance with the pharmacological treatment when the family intervention is more than 5 sessions 80 . Family intervention of more than 5 sessions represents a significant reduction of the burden perceived by family carers. 81,82 1- Family intervention of more than 5 sessions reduces the expressed emotion levels within families 80 . 1- Patients who have received family intervention have a higher quality of life 83 . 1- 1- 1+ 1+ 1- 1- 1- 1- There are no differences that determine that family intervention reduces negative symptom levels of people with schizophrenia 79 or improves social functioning 78,79 . The evidence found is not sufficient to determine if family intervention reduces suicide rates 80 . Family intervention of 6 months or more, or more than 10 scheduled sessions, reduces relapses at 4 to 15 months’ follow-up after treatment. There are no differences between multi-family intervention and single-family intervention in connection with relapses at 13 to 24 months 8 . There are no differences between multi-family intervention and single-family intervention related to pharmacological treatment adherence 84 . People with schizophrenia who received single-family intervention compared with those who received multi-family intervention, can lead a more independent life 85 . Individual family therapy with a behavioural approach improves the results of social functioning, doses of antipsychotic medication and psychotic symptoms compared with group family therapy 88 . There is no difference between behavioural family intervention and family supportive intervention of more than 5 sessions with respect to hospital re-admissions 86 . CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 63
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 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: After two years’ treatment, and b
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
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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
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
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86 Schooler NR, Keith SJ, Severe JB
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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
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225 Hurley AD. Individual psychothe
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