The tertiary service for psychosis: Holistic recommendations for people with complex psychosis

Abstract

Objective To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. Method Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. Results Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73–100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. Conclusions Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.

Commando care for individuals living with severe mental illness: Equally Well goes beyond metabolic health alone

“…TRSP is a statewide publicly funded consultation-liaison service that works with adult mental health teams across NSW to improve the lives of individuals living with psychotic illness through a holistic approach to care (Davies et al., 2023). Individuals referred to TRSP typically have severe and enduring psychosis, marked social and functional impairment, and experience multiple complicating factors, including physical health conditions, cognitive impairments, intellectual disabilities and substance misuse.…”

“…Recommendations may also be given to review treatment plans if there is lack of evidence of effectiveness of current treatments. An audit of TRSP assessments conducted over the past 2.5 years identified that 91.5% of individuals received recommendations focused on their physical health (Davies et al., 2023). Most received multiple physical health recommendations, highlighting the complexity and need for ongoing review.…”