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New Schizophrenia Treatment Guidelines from the UK

by on May 6, 2014
 

There are new schizophrenia treatment guidelines that have been published and you can review them here in either web-format or PDF format. I think every family, caregiver or person who suffers from schizophrenia should review these new treatment guidelines to help you understand what the state of the art is as far as treatment for schizophrenia.

(Note – there are also a set of different guidelines for the treatment of schizophrenia and psychosis in young children available, but that was updated last year).

These new treatment guidelines are from the UK-based National Institute for Health and Care Excellence (or NICE for short), which is the UK body that is part of their National Health System (NHS) that researches and decides upon the best treatment approaches for different healthcare issues.  NICE publishes guidelines in for clinical practice (guidance on the appropriate treatment and care of people with specific diseases and conditions). These appraisals are based primarily on evaluations of efficacy and cost–effectiveness in various circumstances.

NICE is renowned for producing impartial and evidence-based clinical guidelines, with a rigorous development process leading to reliable and cost-effective recommendations. There is a similar schizophrenia treatment guideline put out in Canada but I don’t believe it gets updated as regularly as the UK’s.  There isn’t an equivalent body in the USA because the US healthcare system is largely driven by the for-profit industry and so you have a more fractured approach, with the American Psychiatric Association (funded by the Pharmaceutical Companies) publishing and selling their their guidelines for use by psychiatrists, and the American Psychological Association sometimes funding their own treatment guidelines that they sell to psychologists – but they don’t make these guidelines available to the public and they are not freely available. Additionally there is no (or few) integrated delivery of services (i.e. medication and psychological); the approach that is universally recognized as the approach that produces the best outcomes for people.

Some things that I find really positive about these new recommendations are the following sections:

1. The specific emphasis on care-givers (family members who are helping person with schizophrenia)

1.1.5.1Offer carers of people with psychosis or schizophrenia an assessment (provided by mental health services) of their own needs and discuss with them their strengths and views. Develop a care plan to address any identified needs, give a copy to the carer and their GP and ensure it is reviewed annually. [new 2014]

2. Peer Support Emphasis:

Consider peer support for people with psychosis or schizophrenia to help improve service user experience and quality of life. Peer support should be delivered by a trained peer support worker who has recovered from psychosis or schizophrenia and remains stable. Peer support workers should receive support from their whole team, and support and mentorship from experienced peer workers. [new 2014]

3. A focus on early intervention and preventing psychosis:

If a person is distressed, has a decline in social functioning and has:

  • transient or attenuated psychotic symptoms or
  • other experiences or behaviour suggestive of possible psychosis or
  • a first-degree relative with psychosis or schizophreniarefer them for assessment without delay to a specialist mental health service or an early intervention in psychosis service because they may be at increased risk of developing psychosis. [new 2014]

Early intervention in psychosis services should be accessible to all people with a first episode or first presentation of psychosis, irrespective of the person’s age or the duration of untreated psychosis. [new 2014]

4. Comprehensive Treatment Approaches:

For people with first episode psychosis offer:

  • oral antipsychotic medication (see sections 1.3.5 and 1.3.6) in conjunction with
  • psychological interventions (family intervention and individual CBT) (cognitive behavioral therapy), delivered as described in section 1.3.7). [new 2014]

 

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