Review of psychotherapeutic interventions for people with schizophrenia

In recent years, various clinical practice guidelines have been developed for people with schizophrenia recommending different psychotherapeutic interventions. The objective of this study is to identify, review and compare the recommendations in these guidelines on the efficacy of psychotherapeutic interventions in schizophrenia. We conducted a computerized search of the main clinical practice guideline developers and repositories, identifying five different clinical practice guidelines. We extracted descriptive information from each and compared their recommendations on the efficacy of psychotherapeutic interventions. They were evidence-based consensus guidelines developed by multidisciplinary groups. Family intervention, cognitive behavioural therapy (CBT), social skills training, arts therapies, cognitive rehabilitation, psychoeducation, psychodynamic psychotherapy and counselling were recommended in the identified guidelines. There was strong consensus on the efficacy of CBT and family intervention and high-quality evidence supporting their use. When choosing psychotherapeutic interventions for people with schizophrenia, it is recommended that mental health professionals take clinical practice guidelines into account as well as the setting in which they are being applied, since implementation of health-care interventions is associated with the characteristics of the service system. Schizophrenia treatment should include biological, psychosocial and community intervention

Clinical Case Management for Patients with Schizophrenia with High Care Needs

The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effect

Revisión de intervenciones psicoterapéuticas para personas con esquizofrenia

In recent years, various clinical practice guidelines have been developed for people with schizophrenia recommending different psychotherapeutic interventions. The objective of this study is to identify, review and compare the recommendations in these guidelines on the efficacy of psychotherapeutic interventions in schizophrenia. We conducted a computerized search of the main clinical practice guideline developers and repositories, identifying five different clinical practice guidelines. We extracted descriptive information from each and compared their recommendations on the efficacy of psychotherapeutic interventions. They were evidence-based consensus guidelines developed by multidisciplinary groups. Family intervention, cognitive behavioural therapy (CBT), social skills training, arts therapies, cognitive rehabilitation, psychoeducation, psychodynamic psychotherapy and counselling were recommended in the identified guidelines. There was strong consensus on the efficacy of CBT and family intervention and high-quality evidence supporting their use. When choosing psychotherapeutic interventions for people with schizophrenia, it is recommended that mental health professionals take clinical practice guidelines into account as well as the setting in which they are being applied, since implementation of health-care interventions is associated with the characteristics of the service system. Schizophrenia treatment should include biological, psychosocial and community interventionsEn los últimos años han aparecido varias guías de práctica clínica para personas con esquizofrenia que recomiendan diversas intervenciones psicoterapéuticas. El objetivo de este estudio es identificar, revisar y comparar las recomendaciones sobre la eficacia de las intervenciones psicoterapéuticas en la esquizofrenia de estas guías. Se realizó una búsqueda electrónica sobre la esquizofrenia en los principales elaboradores y repositorios de guías de práctica clínica. Se identificaron cinco guías de práctica clínica. Se extrajeron datos descriptivos de cada una y se compararon sus recomendaciones sobre las intervenciones psicoterapéuticas. Las guías fueron desarrolladas por grupos multidisciplinarios, consensuadas y se basaban en la evidencia. El arte terapia, la terapia cognitivo-conductual (TCC), la rehabilitación cognitiva, el asesoramiento, la intervención familiar, la psicoterapia psicodinámica, la psicoeducación y entrenamiento en habilidades sociales se recomendaban en las guías identificadas. Hubo un alto consenso sobre la eficacia de la TCC y de la intervención familiar, así como evidencias de alta calidad que apoyaban su uso. Al elegir intervenciones psicoterapéuticas para personas con esquizofrenia, se recomienda que los profesionales de la salud mental tengan en cuenta las guías de práctica clínica y el contexto en el que se ofrecerán ya que las características del sistema están asociadas a la implementación de estas intervenciones. El tratamiento de la esquizofrenia debe incluir intervenciones biológicas, psicosociales y comunitaria

Current case management models

Case management is one of the principal components of service delivery in mental health services. Over time, it has evolved into new models, and various meta-analytic studies have been carried out to establish its effects. Those studies have yielded non-homogeneous results, which might be related in part to the progress of case management models. Therefore, there is a need to understand the relationship between CM models and CM effects. This paper deals with this issue by reviewing and updating the literature regarding case management models and effects in order to help understand its current role and suggest how CM could be reorganized. Assertive community treatment and any other case management model seem to have fused and turned into two models that differ mainly with regard to the intensity of care provided to patients. The results of the meta-analyses on the efficacy/effectiveness of case management are not homogeneous across all studies, which seems to be related to the case management model used and the strictness of the methodology followed. When the model of case management used is congruent with clinical practice, the results favor case management over standard care and show that intensive and non-intensive case management may be provided depending on the previous use of hospital resources. Our paper suggests that case management models could be reconfigured by offering an intensity of care based on patients'needs

Validation of the modified DUKE-UNC functional social support questionnaire in patients with schizophrenia

Abstract Purpose: The modified DUKE-UNC Functional Social Support Questionnaire (FSSQ) is considered an assessment tool for patients with schizophrenia. However, it has not been validated in this patient population. This issue is addressed here by examining the tool's psychometric properties in a clinical sample of patients with schizophrenia. Methods: Two hundred and forty-one patients from 10 Adult Mental Health Centres (AMHC) meeting the following inclusion criteria were included: 1) International Classification of Diseases-10 (ICD-10) diagnosis of schizophrenia; 2) Global Assessment of Functioning (GAF) scores ≤50; 3) Illness duration of more than 2 years; and 4) Clinical stability. Patients were evaluated at baseline and at one-year follow-up for clinical and psychosocial variables. Results: The factor analysis revealed two factors that explained 54.15% of the variance. Internal consistency was excellent for the total FSSQ (0.87 at baseline and 0.88 at one year follow-up) and ranged between adeq uate and excellent for FSSQ domains. Correlations between FSSQ scores and those of global functioning, psychiatric symptoms, disability and quality of life ranged between small and large. There were significant differences between groups of patients with schizophrenia in FSSQ scores. Patients with higher levels of somatic complaints and patients who were disabled scored significantly lower in some or all FSSQ scores. After one-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms. Conclusions: The FSSQ is a reliable and valid instrument for the assessment of perceived social support in patients with schizophrenia

Revisión de intervenciones psicoterapéuticas para personas con esquizofrenia

In recent years, various clinical practice guidelines have been developed for people with schizophrenia recommending different psychotherapeutic interventions. The objective of this study is to identify, review and compare the recommendations in these guidelines on the efficacy of psychotherapeutic interventions in schizophrenia. We conducted a computerized search of the main clinical practice guideline developers and repositories, identifying five different clinical practice guidelines. We extracted descriptive information from each and compared their recommendations on the efficacy of psychotherapeutic interventions. They were evidence-based consensus guidelines developed by multidisciplinary groups. Family intervention, cognitive behavioural therapy (CBT), social skills training, arts therapies, cognitive rehabilitation, psychoeducation, psychodynamic psychotherapy and counselling were recommended in the identified guidelines. There was strong consensus on the efficacy of CBT and family intervention and high-quality evidence supporting their use. When choosing psychotherapeutic interventions for people with schizophrenia, it is recommended that mental health professionals take clinical practice guidelines into account as well as the setting in which they are being applied, since implementation of health-care interventions is associated with the characteristics of the service system. Schizophrenia treatment should include biological, psychosocial and community interventionsEn los últimos años han aparecido varias guías de práctica clínica para personas con esquizofrenia que recomiendan diversas intervenciones psicoterapéuticas. El objetivo de este estudio es identificar, revisar y comparar las recomendaciones sobre la eficacia de las intervenciones psicoterapéuticas en la esquizofrenia de estas guías. Se realizó una búsqueda electrónica sobre la esquizofrenia en los principales elaboradores y repositorios de guías de práctica clínica. Se identificaron cinco guías de práctica clínica. Se extrajeron datos descriptivos de cada una y se compararon sus recomendaciones sobre las intervenciones psicoterapéuticas. Las guías fueron desarrolladas por grupos multidisciplinarios, consensuadas y se basaban en la evidencia. El arte terapia, la terapia cognitivo-conductual (TCC), la rehabilitación cognitiva, el asesoramiento, la intervención familiar, la psicoterapia psicodinámica, la psicoeducación y entrenamiento en habilidades sociales se recomendaban en las guías identificadas. Hubo un alto consenso sobre la eficacia de la TCC y de la intervención familiar, así como evidencias de alta calidad que apoyaban su uso. Al elegir intervenciones psicoterapéuticas para personas con esquizofrenia, se recomienda que los profesionales de la salud mental tengan en cuenta las guías de práctica clínica y el contexto en el que se ofrecerán ya que las características del sistema están asociadas a la implementación de estas intervenciones. El tratamiento de la esquizofrenia debe incluir intervenciones biológicas, psicosociales y comunitaria

Considering variables for the assignment of patients with schizophrenia to a case management programme

The elements and intensity of Case Management (CM) practices should be established according to patients' needs. Therefore, it is important to improve the knowledge of the needs of patients in such a community-based intervention. This paper deals with this issue by characterizing two groups of patients receiving CM or a Standard Treatment Programme (STP) and identifying the patients' characteristics associated with the provision of CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centers from Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical and non-intensive CM program with that of patients in a STP. CM patients showed a poorer profile. Community psychiatric visits, social services, education, physical health, needs and positive symptoms were significantly associated with the provision of CM services. This study may help in identifying patients' necessities and strengthen the CM programme

The World Health Organization Short Disability Assessment Schedule: a validation study in patiens with schizophrenia

Purpose: The World Health Organization Short Disability Assessment Schedule (DAS-s) is used for patients with schizophrenia even though no validation is available. This paper addresses this issue by dealing with its psychometric properties in a clinical sample of patients with schizophrenia. Methods: Two hundred forty-one patients from 10 Adult Mental Health Care Centres (AMHCC) meeting the following inclusion criteria were included: 1) International Classification of Diseases-10 or ICD-10 diagnosis o schizophrenia; 2) Global Assessment of Functioning scores or GAF ≤50; 3) Illness duration of more than 2 years; and 4) Clinical stability at assessment time. Patients were evaluated at baseline and at one-year follow-up regarding disability, socio-demographic and clinical variables, psychosocial measures and use of mental health services. Results: The factor analysis revealed a single factor that explained 60.57% of the variance. Internal consistency values were appropriate for the DAS-s total (0.78 at baseline and 0.78 at one year follow-up). Correlations between DAS-s scores and those of global functioning, psychiatric symptoms, social support and quality of life ranged between small and moderate (range: 0.13-0.39). There were significant differences between groups of patients with schizophrenia in the DAS-s. Patients who were unemployed, with lower global functioning, with cognitive impairment and lacking social support scored significantly lower in DAS-s scores. After one year follow-up, there was a non-significant decrease in DAS-s scores and patients improved significantly in overall functioning and psychiatric symptoms. Discussion: This study shows that the DAS-s has good reliability and validity, and suggests that it is suitable for the assessment of disability in patients with schizophrenia

The World Health Organization Quality of Life Scale Brief Version: a validation study in patiens with schizophrenia

Purpose The World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) is used for patients with schizophrenia although no validation is available. This work addresses this issue by dealing with its psychometric properties in a clinical sample of patients with schizophrenia. Methods Two hundred forty-one patients from 10 Adult Mental Health Care Centers (AMHCC) meeting the following inclusion criteria were included: (1) International Classification of Diseases-10 or ICD-10 diagnosis of schizophrenia, (2) Global Assessment of Functioning scores or GAF ≤ 50, 3) Illness duration of more than 2 years and (4) Clinical stability at assessment time. Patients were evaluated at baseline and at one-year follow-up regarding quality of life (QOL), clinical variables and other psychosocial measures. Results Internal consistency was excellent for the total WHOQOL-BREF (0.88 at baseline and 0.89 at follow-up) and adequate (0.65-0.78 at baseline; 0.66-0.79 at one-year follow-up) for the WHOQOL-BREF domains. Correlations between WHOQOL-BREF scores and those of global functioning, psychiatric symptoms, disability and social support ranged between small and large. There were significant differences between groups of patients with schizophrenia in the WHOQOL-BREF. Patients who were anxious, disabled, lacked social support and used more social services scored significantly lower in some or all WHOQOL-BREF domains. Changes in WHOQOL-BREF scores were positively associated with changes over time in global functioning, social support and use of health services, and negatively with psychiatric symptoms and disability (correlation coefficients between small and moderate). After one-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms. Conclusions This study shows that the WHOQOL-BREF has good reliability and validity, and suggests that it is suitable for the assessment of QOL in patients with schizophrenia

Evaluación de dos años de funcionamiento de un servicio de apoyo y atención emocional en centros educativos de alta complejidad del Plan de Barrios de la ciudad de Barcelona

El servicio de apoyo y atención emocional (SAAE) de 27 centros educativos del Plan de Barrios de Barcelona tiene la finalidad de mejorar el desarrollo integral del niño en el marco escolar, mediante un abordaje que incluya las dimensiones emocionales, sociales, físicas e intelectuales. Este artículo describe el SAAE y presenta un análisis de su implementación, tras dos años de funcionamiento, teniendo en cuenta: 1) los cambios asociados al servicio; 2) los facilitadores y barreras encontrados; y 3) algunas propuestas de mejora y de futuro. Se han examinado las memorias de centro siguiendo la metodología de análisis de documentos. Del análisis se desprende que el SAAE garantiza el desarrollo de competencias socioemocionales y la cohesión y convivencia en las aulas. Los facilitadores y barreras identificados son amplios e incluyen factores al nivel de toda la comunidad educativa. Se sugieren propuestas de mejora y de futuro en la interrelación de: a) la filosofía y valores de centro; b) el encaje, la coordinación y la colaboración entre profesionales; y c) la definición, funcionamiento y evaluación de las intervenciones. Este servicio podría extenderse a otros centros educativos con características o necesidades distintas