Excerpt

This guideline has been developed to advise on the treatment and management of psychosis and schizophrenia in adults. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, people with psychosis and schizophrenia, their carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning highquality care for people with psychosis and schizophrenia while also emphasising the importance of the experience of care for people with psychosis and schizophrenia and their carers.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL CLINICAL GUIDELINES
  • 1.2. THE NATIONAL PSYCHOSIS AND SCHIZOPHRENIA GUIDELINE
• 2. PSYCHOSIS AND SCHIZOPHRENIA IN ADULTS
  • 2.1. THE DISORDER
  • 2.2. ASSESSMENT, ENGAGEMENT, CONSENT AND THE THERAPEUTIC ALLIANCE
  • 2.3. LANGUAGE AND STIGMA
  • 2.4. ISSUES FOR FAMILIES, CARERS AND FRIENDS
  • 2.5. TREATMENT AND MANAGEMENT OF PSYCHOSIS AND SCHIZOPHRENIA IN THE NHS
  • 2.6. ECONOMIC COST
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. CLINICAL REVIEW METHODS
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. LINKING EVIDENCE TO RECOMMENDATIONS
  • 3.8. STAKEHOLDER CONTRIBUTIONS
  • 3.9. VALIDATION OF THE GUIDELINE
• 4. CARERS’ EXPERIENCE
  • 4.1. INTRODUCTION
  • 4.2. CARERS’ EXPERIENCE (QUALITATIVE REVIEW)
  • 4.3. INTERVENTIONS TO IMPROVE CARERS’ EXPERIENCE
  • 4.4. HEALTH ECONOMICS EVIDENCE
  • 4.5. LINKING EVIDENCE TO RECOMMENDATIONS
  • 4.6. RECOMMENDATIONS
• 5. PREVENTING PSYCHOSIS AND SCHIZOPHRENIA: TREATMENT OF AT RISK MENTAL STATES
  • 5.1. INTRODUCTION
  • 5.2. CLINICAL REVIEW PROTOCOL FOR AT RISK MENTAL STATES FOR PSYCHOSIS AND SCHIZOPHRENIA
  • 5.3. PHARMACOLOGICAL INTERVENTIONS
  • 5.4. DIETARY INTERVENTIONS
  • 5.5. PSYCHOSOCIAL INTERVENTIONS
  • 5.6. HEALTH ECONOMIC EVIDENCE
  • 5.7. LINKING EVIDENCE TO RECOMMENDATIONS
  • 5.8. RECOMMENDATIONS
• 6. ACCESS AND ENGAGEMENT
  • 6.1. INTRODUCTION
  • 6.2. ACCESS AND ENGAGEMENT TO SERVICE-LEVEL INTERVENTIONS
• 7. INTERVENTIONS TO PROMOTE PHYSICAL HEALTH IN ADULTS
  • 7.1. INTRODUCTION
  • 7.2. BEHAVIOURAL INTERVENTIONS TO PROMOTE PHYSICAL ACTIVITY AND HEALTHY EATING
  • 7.3. INTERVENTIONS FOR SMOKING CESSATION AND REDUCTION
• 8. PEER-PROVIDED AND SELF-MANAGEMENT INTERVENTIONS
  • 8.1. INTRODUCTION
  • 8.2. PEER-PROVIDED INTERVENTIONS
  • 8.3. SELF-MANAGEMENT INTERVENTIONS
  • 8.4. LINKING EVIDENCE TO RECOMMENDATIONS
  • 8.5. RECOMMENDATIONS
• 9. PSYCHOLOGICAL THERAPY AND PSYCHOSOCIAL INTERVENTIONS
  • 9.1. INTRODUCTION
  • 9.2. ADHERENCE THERAPY
  • 9.3. ARTS THERAPIES
  • 9.4. COGNITIVE BEHAVIOURAL THERAPY
  • 9.5. COGNITIVE REMEDIATION
  • 9.6. COUNSELLING AND SUPPORTIVE THERAPY
  • 9.7. FAMILY INTERVENTION
  • 9.8. PSYCHODYNAMIC AND PSYCHOANALYTICAL THERAPIES
  • 9.9. PSYCHOEDUCATION
  • 9.10. SOCIAL SKILLS TRAINING
  • 9.11. PSYCHOLOGICAL MANAGEMENT OF TRAUMA IN PSYCHOSIS AND SCHIZOPHRENIA
  • 9.12. **2009**RECOMMENDATIONS (ACROSS ALL TREATMENTS)
• 10. PHARMACOLOGICAL INTERVENTIONS IN THE TREATMENT AND MANAGEMENT OF SCHIZOPHRENIA
  • 10.1. INTRODUCTION
  • 10.2. INITIAL TREATMENT WITH ANTIPSYCHOTIC MEDICATION
  • 10.3. ORAL ANTIPSYCHOTICS IN THE TREATMENT OF THE ACUTE EPISODE
  • 10.4. PROMOTING RECOVERY IN PEOPLE WITH SCHIZOPHRENIA THAT ARE IN REMISSION – PHARMACOLOGICAL RELAPSE PREVENTION
  • 10.5. PROMOTING RECOVERY IN PEOPLE WITH SCHIZOPHRENIA WHOSE ILLNESS HAS NOT RESPONDED ADEQUATELY TO TREATMENT
  • 10.6. TREATMENT WITH DEPOT/LONG-ACTING INJECTABLE ANTIPSYCHOTIC MEDICATION
  • 10.7. SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATION
  • 10.8. EFFECTIVENESS OF ANTIPSYCHOTIC MEDICATION
  • 10.9. HEALTH ECONOMICS
  • 10.10. LINKING EVIDENCE TO RECOMMENDATIONS
  • 10.11. RECOMMENDATIONS
• 11. ECONOMIC MODEL - COST EFFECTIVENESS OF PHARMACOLOGICAL INTERVENTIONS FOR PEOPLE WITH SCHIZOPHRENIA
  • 11.1. INTRODUCTION
  • 11.2. ECONOMIC MODELLING METHODS
  • 11.3. RESULTS
  • 11.4. DISCUSSION OF FINDINGS - LIMITATIONS OF THE ANALYSIS
  • 11.5. CONCLUSIONS
• 12. TEAMS AND SERVICE-LEVEL INTERVENTIONS
  • 12.1. INTRODUCTION
  • 12.2. INTERFACE BETWEEN PRIMARY AND SECONDARY CARE
  • 12.3. NON-ACUTE COMMUNITY MENTAL HEALTHCARE
  • 12.4. ALTERNATIVES TO ACUTE ADMISSION
• 13. VOCATIONAL REHABILITATION
  • 13.1. INTRODUCTION
  • 13.2. CLINICAL EVIDENCE REVIEW – VOCATIONAL REHABILITATION INTERVENTIONS
  • 13.3. HEALTH ECONOMICS EVIDENCE
  • 13.4. LINKING EVIDENCE TO RECOMMENDATIONS
  • 13.5. RECOMMENDATIONS
• 14. SUMMARY OF RECOMMENDATIONS
  • 14.1. CARE ACROSS ALL PHASES
  • 14.2. PREVENTING PSYCHOSIS
  • 14.3. FIRST EPISODE PSYCHOSIS
  • 14.4. SUBSEQUENT ACUTE EPISODES OF PSYCHOSIS OR SCHIZOPHRENIA AND REFERRAL IN CRISIS
  • 14.5. PROMOTING RECOVERY AND POSSIBLE FUTURE CARE
  • 14.6. RESEARCH RECOMMENDATIONS
• 15. REFERENCES
• Appendices
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GUIDELINE DEVELOPMENT GROUP MEMBERS
  • APPENDIX 3. STAKEHOLDERS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULATATION DRAFT OF THE GUIDELINE
  • APPENDIX 4A. SPECIAL ADVISORS
  • APPENDIX 4B. EXPERT REVIEWERS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED OR SOON-TO-BE PUBLISHED STUDIES
  • APPENDIX 6. REVIEW QUESTIONS AND PROTOCOLS
  • APPENDIX 7. DATA EXTRACTION FORMS
  • APPENDIX 8. METHODOLOGY CHECKLIST TEMPLATE FOR CLINICAL STUDIES AND REVIEWS
  • APPENDIX 9. METHODOLOGY CHECKLIST TEMPLATE FOR ECONOMIC STUDIES
  • APPENDIX 10. RESEARCH RECOMMENDATIONS
  • APPENDIX 11. 2009 SCHIZOPHRENIA IN ADULTS METHODS CHAPTER
  • APPENDIX 12. CHANGES MADE TO THE 2009 GUIDELINE
  • APPENDIX 13. 2014 SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL EVIDENCE
  • APPENDIX 14. 2014 SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMIC EVIDENCE
  • APPENDIX 15A. 2014 STUDY CHARACTERISTICS TABLES FOR QUANTITATIVE STUDIES
  • APPENDIX 15B. 2014 METHODOLOGY CHECKLIST: QUALITATIVE STUDIES
  • APPENDIX 16. 2014 CLINICAL EVIDENCE FOREST PLOTS
  • APPENDIX 17. 2014 GRADE EVIDENCE PROFILES
  • APPENDIX 18. 2014 HEALTH ECONOMIC EVIDENCE - COMPLETED METHODOLOGY CHECKLISTS
  • APPENDIX 19. 2014 HEALTH ECONOMIC EVIDENCE- EVIDENCE TABLES OF PUBLISHED STUDIES
  • APPENDIX 20. 2009 SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL STUDIES
  • APPENDIX 21. 2009 ANALYTIC FRAMEWORK AND CLINICAL QUESTIONS
  • APPENDIX 22. 2009 STUDY CHARACTERISTICS FOR CLINICAL EVIDENCE
  • APPENDIX 23. 2009 CLINICAL EVIDENCE FOREST PLOTS AND/OR DATA TABLES
  • APPENDIX 24. 2009 SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMICS EVIDENCE
  • APPENDIX 25. 2009 EVIDENCE TABLES FOR ECONOMIC STUDIES
  • APPENDIX 26. 2009 WINBUGS CODES USED FOR MIXED TREATMENT COMPARISONS IN THE ECONOMIC MODEL OF PHARMACOLOGICAL TREATMENTS FOR RELAPSE PREVENTION
  • APPENDIX 27. 2009 THE FULL SCHIZOPHRENIA IN ADULTS GUIDELINE
  • APPENDIX 28. QUALITY CHECKLIST FOR ECONOMIC STUDIES

This guideline should be read in conjunction with ‘Service User Experience in Adult Mental Health’, NICE Clinical Guidance 136