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

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This CPG development group considers that the impact of the implementation of ACT teams must be high because it would improve the care of patients who, if this service did not exist, would not be attended by the system (they are left outside), and would permit providing more efficient care for those patients who overload the short-stay units. People with SMI constitute a relatively small population but they represent a considerable burden for the Spanish NHS and for their families. The specific problems of the design of this type of studies to assess the service level interventions are related to the following difficulties: • The difficulty in defining these interventions with precision. • Variations relating to the application of one same model (or fidelity to the model). • Variations between different settings and different moments, with respect to standard care with respect to what it is compared with. • The frequency with which some interventions and others overlap depending on the place. 5.3.1. Day Centres and/or Psychosocial Rehabilitation Centres No randomised clinical trials have been found that assess these services 206 5.3.2. Community Mental Health Centres (CMHC) CMHC vs. ST Use of services SR (1-) In the NICE schizophrenia CPG 8 , it indicates that there is insufficient evidence to determine if the CMHCs reduce hospital admissions when compared with standard treatment (n = 100; RR = 0.711; 95% CI: between 0.42 to 1.19 and n = 155; RR = 0.88; 95% CI: between 0.76 and 1.01) These results agree with those found in the SR by Malone et al 204 (n= 587; 3 RCT; RR = 0.81; 95% CI: between 0.7 and 1.0). No differences have been found, either, with respect to the use of emergency services (n = 587; 3 RCT; RR = 0.86; 95% CI: between 0.7 and 1.1) or respect to the reduction of contacts with Primary Care (n = 587; 3 RCTs; RR = 0.94, 95% CI: between 0.8 and 1.1) 204 . Deaths SR (1-) There is not sufficient evidence to determine if the CMHC are associated with a reduction in the death ratios (n = 100; RR = 0.54, 95% CI: between 0.5 and 5.78; and n = 155; RR = 0.89; 95% CI: between 0.06 and 13.98) 8 . It has not been found either in the SR by Malone et al 204 (n = 587; 3 RCT; RR = 0.47; 95% CI: between 0.2 and 1.3) in the medium term assessment (3 to 12 months). 96 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
Loss of contact With respect to the risk of loss of contact in the population cared for in CMHC compared with ST, it seems to indicate that there is insufficient evidence to determine this association (n = 100; RR = 1.24; 95% CI: between 0.49 and 3.16 and n = 155; RR = 1.04; 95% CI: Between 0.60 and 1.79) 8 . Similar results to those obtained in the study by Malone et al. 204 (n = 253; RR = 1.10; 95% CI: between 0.7 and 1.8). SR (1-) Mental state In the data indicated in the NICE Schizophrenia CPG, which are those provided by the study by Merson et al. 202 respect to the evolution of the mental state in the population cared for in CMHC compared with ST, no differences are observed between the two interventions (n = 100; WMD = - .80; 95% CI between -5.74 and 4.14). RCT (1-) Social functioning There is no evidence to determine if the CMHC is associated with an improvement of social functioning according to the Social Functioning Questionnaire scale (n = 100; WMD = 0.70; 95% CI: between -1.18 and 2.58) 8 . SR (1-) Service satisfaction In the CMHC group there was a smaller number of people who were dissatisfied compared with the participants who received ST (n = 87; RR=0.37; 95% CI: between 0.2 and 0.8) 204 . SR (1-) 5.3.3. Assertive Community Treatment (ACT) ACT vs. Standard treatment (ST) Use of services Patients who receive ACT have more probabilities of remaining in contact with services than those that receive community ST (number of losses in follow-up: n = 1757; RR = 0.62; 95% CI: between 0.52 and 0.74) 8 and the probabilities of admission also decreases compared with ST (n = 1047; RR = 0.71; 95% CI: between 0.52 and 0.97; NNT = 7; 95% CI: between 4 and 100) 8 . The ACT decreases the probabilities of hospital admission compared with rehabilitation based in the hospital (n = 185; RR = 0.47; 95% CI: between 0.33 and 0.66; NNT = 3; 95% CI: between 3 and 5) 8 . SR (1-) CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 97
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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
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defined as “standard care” or
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General global state In the short r
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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 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: • The satisfaction data originati
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
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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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CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud