Psychological Treatments for Psychosis: Evidence Based but Unavailable?

Kuipers, Elizabeth

doi:10.1080/10973430008408409

Cited by 11 publications

(6 citation statements)

References 31 publications

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“…The data yielded by the SIEP-DIRECT'S project also revealed an infrequent use of 1) psychoeducational intervention for families and 2) continuative and structured family support activities aimed at involving family members more directly in the therapeutic process, that both have been proved effective in decreasing patient relapse rates (Pilling et al, 2002). To date, however, it is generally acknowledged that the practice does not occur frequently -either in Italy or abroad (Kuipers, 2000;Magliano et al, 2002;Dixon et al, 2001) -and the data presented herein provide further confirmation of this phenomenon. We found that the main reason for this form of service "inertia" might reside in the low number of workers that are trained and skilled in these approaches, also with reference to nursing personnel.…”

Section: Training and Implementation Of Individual Psychological Intesupporting

confidence: 68%

The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

Ruggeri

Lora²,

Semisa³

2008

Epidemiol Psychiatr Sci

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SUMMARYAims– To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT's Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and c) evaluating their actual application in Italian MHSs.Methods– The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management.Results– The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementingspecific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process.Conclusions– The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocationprocesses that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.Declaration of Interest: None.

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Section: Training and Implementation Of Individual Psychological Intesupporting

confidence: 68%

The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

Ruggeri

Lora²,

Semisa³

2008

Epidemiol Psychiatr Sci

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“…Sulla base dei nostri dati, tuttavia, gli interventi psicoeducativi familiari sembrano essere ancora sottoutilizzati e non trovare una diffusa applicazione nei Servizi partecipanti. Ciò appare in linea, peraltro, con la difficoltà complessiva nel ricorso agli interventi "efficaci" riscontrata nella pratica dei Servizi di salute mentale e non solo in Italia (Kuipers, 2000) e, in modo specifico, con i dati nazionali (Magliano et al, 2002), europei (Magliano et al, 1998) e statunitensi (Dixon et al, 2001) sullo scarso ricorso ad interventi psicoeducativi strutturati in favore di famiglie con pazienti affetti da schizofrenia.…”

Section: Attività Rivolta Alla Famigliaunclassified

Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project

Semisa¹,

Casacchia

Munzio³

et al. 2008

Epidemiol Psychiatr Sci

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SUMMARYAims– The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT's Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia.Methods– Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations. The data required by most of the indicators were obtained from the psychiatric informative system or from the Direction of the MHD. Moreover, specific research was carried out on the clinical records and on representative patient samples. Furthermore, for 14 indicators, there was requested an assessment by the part of “multidisciplinary” or “specialistic” focus groups who then attributed a score according to a defined “ad hoc” scale.Results– According to the data obtained, although the mental health services seem to care about the physical condition of their patients, they do not routinely examine principle parameters such as blood pressure, glycaemia etc., and collaboration with general practitioners is often complex or not uniformly practiced. Most psychiatrists and psychologists possess the basic communication skills but not enough competences in cognitive-behavioural treatments; such treatments, and every other form of structured individual psychotherapy, are seldom carried out and seem to have become marginal activities within the Services. Also family psycho-educational interventions are under-used. The Services are very active in the care of multi-problem schizophrenia patients, who make up a large percentage (almost a quarter, on average) of the patients in their care. These patients are offered specific and integrated treatment plans with the involvement of other health services and social agencies operating in the territory. The strategies adopted by the services for the pharmacological treatment in the prevention of relapses and for patients with frequent crises or with treatment-resistant schizophrenia are all in line with the NICE recommendations. Finally, the Services promote activities of vocational training and supported employment, but the outcomes of these are often unsatisfactory.Conclusions– The results of the study show a picture of the Italian mental health services with bright yet also dark areas as regards recovery promotion activities. The Services seem to guarantee adequate pharmacological evidence-based treatments, an integrated assistance and good management of multi-problem patients. They have difficulty, however, with respect to the monitoring of the physical health of the patients, psychotherapeutic activities, including those for families, and the promotion of supported employment. Moreover, they still show problems regarding the structuring and formalizing of care processes. To improve this situation, they should make greater use of professional guidelines, protocols and written procedures.Declaration of Interest:None.

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“…It had the advantage of collaborative relationship and shared formulation of the patient's problem based on common sense. Cognitive behavioural and family work could all be woven into the work with the individual (Kuipers, 2000). Cognitive behavioural and family work could all be woven into the work with the individual (Kuipers, 2000).…”

Section: Cognitive Behaviour Therapymentioning

confidence: 99%