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

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5.2.5. Other therapeutic interventions: art therapy and music therapy Music therapy and art therapy are creative interventions, used together with other more common treatments, in the rehabilitation process and treatment of people with Severe Mental Illnesses. There is still a lively debate about whether the curative aspect of this type of interventions lies in the process of making music or art, or in the actual relationship that is established between the therapist and the patient, or in an interaction between both elements. Music therapy for people with SMI Music therapy is “a systematic intervention process where the therapist helps promote the patient’s health via musical experiences and the relationships that are developed by means of such experiences, as dynamic forces of change” 191 . It is often perceived as a psychotherapeutic method in the sense that it addresses intra- and inter-psychic processes through the interaction with music as a means of communication and expression. The objective of therapy is to help people with severe mental illnesses develop relationships and address questions that they may not be able to develop or address by words. There is a SR by Gold et al 192 (4 RCTs, n = 321) 193-196 , which examines the effects of music therapy on people with schizophrenia, in the short term (duration of less than 20 sessions) and medium term (20 or more sessions). The treatment varies between 7 and 78 sessions. Art therapy for people with SMI According to the British Association of Art Therapists, artistic materials for self-expression and reflection are used in art therapy, in the presence of a trained art therapist. The general objective of the professionals is to enable the patient to make a change and grow up on a personal level, using artistic materials and in a safe and facilitating atmosphere 197 . Art therapy allows patients to explore their interior world in a non-threatening manner, through a therapeutic relationship and the use of artistic materials. It was carried out mainly in psychiatric units for adults and was designed to work with people with whom verbal psychotherapy would be impossible. Ruddy et al 198 , in the SR carried out by them, compare art therapy and standard treatment with standard care alone, in people with schizophrenia. Only 2 studies (n = 137) satisfied the inclusion criteria in this review. These studies did not include sufficient participants so as for the results to be significant, and clear conclusions could not be drawn with respect to benefits or harm of art therapy based on them. It is difficult to estimate the availability of this intervention; however, there are descriptions for its use in people with schizophrenia, individually or in groups, in outpatients and hospitals, as well as in the private sector 199. Question to be answered • Do therapeutic interventions, such as art therapy and music therapy, improve the evolution of the illness and the quality of life of people with SMI? 90 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
Music therapy Music therapy + standard treatment (ST) vs. ST Music therapy as a complement to standard treatment is superior to ST only in the medium term with respect to the improvement of the global state (n = 72, RR = 0.10; 95% CI between 0.03 to 0.31) 193 . In an intervention of less than 20 sessions, no significant differences are found in favour of music therapy with respect to the mental state in the medium term (n = 69); average final score in the PANSS scale, WMD = -0.36; 95% CI: between -0.85 and 0.12) 194 ; however, when the intervention includes more than 20 sessions, there are differences in favour of music therapy (1 RCT; n = 70; average final score in the BPRS scale, WMD = -1.25; 95% CI: between -1.77 and -0.73) 193 . Music therapy favours the improvement of negative symptoms (3 RCTs, n = 180); average final score in the SANS scale (WMD = -0.86, 95% CI: between -1.17 and -0.55) 193,195,196 . There is no improvement of social functioning in the music therapy group when 20 or more sessions are applied (1 RCT; n = 70; average final score in the SDSI scale, WMD = -0.78; 95% CI: between -1.27 and -0.28) 193 . No differences are found in favour of music therapy with respect to the patient’s satisfaction in the medium term (less than 20 sessions) ( 1 RCT; n = 69; average score of the CSQ scale, WMD = 0.32; 95% CI: between -0.16 and 0.80) 194 . Music therapy does not improve the quality of life (measured with the SPG) with an intervention of less than 20 sessions (1 RCT; n = 31; WMD = 0.05; 95% CI between -0.66 and 0.75) when compared with ST alone 196 . RCT (1-) RCT (1-) Art therapy The mental state measured with the SANS scale slightly improved in favour of the art therapy group (n = 73; 1 RCT; WMD = -2.3; 95% CI: between -4.10 and -0.5) 198 . Social functioning (measured with the SFS scale) in the short term, did not show any clear differences between the groups in final scores (n = 70; 1 RCT; WMD = 7.20; 95% CI: between -2.53 and 16.93); and quality of life, measured with the Perc Qol scale, did not indicate the effects of art therapy (n = 74; 1 RCT; WMD = 0.1; 95% CI: between -2.7 and 0.47) 198 . SR (1-) Summary of evidence 1- Music therapy as a complement to ST improves the global state in the medium term 193 . 1- 1- Music therapy produces a positive effect on the improvement of the negative symptoms of people with schizophrenia 193,195,196 . Interventions of music therapy with more than 20 sessions improve the mental state and social functioning of people with schizophrenia 193 . CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 91
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Clinical Practice Guidelines for Ps
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This CPG is an aid for decision mak
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Table of Contents Presentation 7 Au
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Presentation Healthcare practice is
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Authorship and collaborators CPG de
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José Manuel Lalana Cuenca. Special
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c) SERVICE LEVEL INTERVENTIONS •
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A B A A B B B C Psychosocial inter
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B B B C A C C 5.3. SERVICE LEV
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20 CLINICAL PRACTICE GUIDELINES IN
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independence, quality of life, pers
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This guideline is aimed at mental h
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Figure 1. Search Strategy Search fo
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The highest evidence level found wa
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4. Characteristics of the CPG 4.1.
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The main focus of rehabilitation is
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5. Psychosocial type rehabilitation
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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 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: 1+ 1+ 1++ 1+ 1+ 1+ 1+ The people in
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
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Appendix 6. Glossary Therapy adhere
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Appendix 7. Declaration of interest
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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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