Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-04T19:48:55.618Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 April 2011

Domenico Semisa ,
Massimo Casacchia ,
Walter Di Munzio ,
Giovanni Neri ,
Giacinto Buscaglia ,
Lorenzo Burti ,
Cristina Pucci ,
Giuseppe Corlito ,
Maurizio Bacigalupi  and
Roberto Parravani
...Show all authors
Domenico Semisa*
Affiliation:
Dipartimento di Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
Massimo Casacchia
Affiliation:
Dipartimento di Scienze della Salute, Sezione di Psichiatria, Università de L'Aquila, L'Aquila
Walter Di Munzio
Affiliation:
Dipartimento Salute Mentale Salerno/1, Centro di Salute Mentale Nocera Inferiore
Giovanni Neri
Affiliation:
Dipartimento Salute Mentale Modena
Giacinto Buscaglia
Affiliation:
Dipartimento Salute Mentale 2 Savonese, Centro di Salute Mentale Albenga
Lorenzo Burti
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Cristina Pucci
Affiliation:
Dipartimento Salute Mentale, MOM-SMA 8, Azienda USL 10, Firenze
Giuseppe Corlito
Affiliation:
Dipartimento Salute Mentale Grosseto
Maurizio Bacigalupi
Affiliation:
Dipartimento Salute Mentale Roma/B, Centro di Salute Mentale, Roma
Roberto Parravani
Affiliation:
Dipartimento Salute Mentale Roma/B, Centro di Salute Mentale, Roma
Rita Roncone
Affiliation:
Dipartimento di Scienze della Salute, Sezione di Psichiatria, Università de L'Aquila, L'Aquila
Doriana Cristofalo
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Antonio Lora
Affiliation:
Dipartimento Salute Mentale, Azienda Ospedaliera di Vimercate, Vimercate (Milano)
Mirella Ruggeri
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
*
Address fo correspondence: Dr. D. Semisa, Dipartimento di Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti, Via Nicola Carnevale 7, 70021 Acquaviva delle Fonti (Bari). Fax: +39-080-3077082 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Aims – 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.

Keywords

clinical guidelinesschizophreniarecovery of patients with severe mental illnessquality of care evaluationcommunity mental health services
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 331 - 348
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

Bond, G. R., Drake, R. E., Mueser, K. T. & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services 48, 335–346.Google ScholarPubMed
Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., Bell, M. D. & Blyler, C. R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services 52, 313–322.CrossRefGoogle ScholarPubMed
Brooker, C., Tarrier, N., Barrowclough, C., Butterworth, A. & Goldberg, D. (1992). Training community psychiatric nurses for psychosocial intervention. Report of a pilot study. British Journal of Psychiatry 160, 836–844.CrossRefGoogle ScholarPubMed
Brooker, C., Falloon, I., Butterworth, A., Goldberg, D., Graham-Hole, V. & Hillier, V. (1994). The outcome of training community psychiatric nurses to deliver psychosocial intervention. British Journal of Psychiatry 165(2), 222–230.CrossRefGoogle ScholarPubMed
Brown, S., Inskip, H. & Barraclough, B. (2000). Causes of the excess mortality of schizophrenia. British Journal of Psychiatry 2, 177–217.Google Scholar
Burns, T. (2007). Evolution of outcome measures in schizophrenia. British Journal of Psychiatry 191, Suppl. 50, s1–s6.Google ScholarPubMed
Burns, T., Catty, J., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschbach, J., White, S. & Wiersma, D. for the EQOLISE Group (2007). The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 370, 1146–1152.CrossRefGoogle ScholarPubMed
Bustillo, J. R., Lauriello, J., Horan, W. P. & Keith, S. J. (2001). The psychosocial treatment for schizophrenia: an update. American Journal of Psychiatry 158, 163–175.CrossRefGoogle ScholarPubMed
Carrà, G., Barale, F. & Marinoni, A. (Eds.) (2004). Schizofrenia. Linee GuidaCliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. Il Pensiero Scientifico Editore: Roma.Google Scholar
Casacchia, M. & Roncone, R. (1999). I trattamenti psicoeducativi familiari nella schizofrenia: esterofilia o applicazione di interventi basati sull'evidenza? Epidemiologia e Psichiatria Sociale 8(3), 183–189.CrossRefGoogle Scholar
Casacchia, M. & Roncone, R. (2007). Riabilitazione psicosociale e modelli di intervento. In Trattato Italiano di Psichiatria, Volume VI, La Schizofrenia, 3.ed. (ed. Pancheri, P.), pp. 417–453.Elsevier Masson: Milano.Google Scholar
Catty, J., Lissouba, P., White, S., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschbach, J., Wiersma, D. & Burns, T. for the EQOLISE Group (2008). Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial. British Journal of Psychiatry 192, 224–231.CrossRefGoogle ScholarPubMed
de Girolamo, G., Picardi, A., Santone, G., Semisa, D. & Morosini, P. per il Gruppo Nazionale PROGRES (2004). Le Strutture Residenziali e i Loro Ospiti: I Risultati della Fase2 del Progetto Nazionale PROGRES. Epidemiologia e Psichiatria Sociale, Monograph Supplement No. 7.Google Scholar
Dixon, L., Postrado, L., Delahanty, J., Fischer, P. J. & Lehman, A. (1999). The association of medical comorbidity in schizophrenia with poor physical and mental health. Journal of Nervous and Mental Disease 187, 502.CrossRefGoogle ScholarPubMed
Dixon, L., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., Mueser, K., Miklowitz, D., Solomon, P. & Sondheimer, D. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services 52, 903–910.CrossRefGoogle ScholarPubMed
Donatello, M. & Michielin, P. (2003). Lavoro e Oltre. Inserimento Lavorativo e Sociale delle Persone con Disabilità. McGraw-Hill: Milano.Google Scholar
Fadden, G. (1997). Implementation of family interventions in routine clinical practice following staff training programs: a major cause for concern. Journal of Mental Health 6, 599–612.CrossRefGoogle Scholar
Falloon, I. (1993). Intervento Psicoeducativo Integrato in Psichiatria. Guida al Lavoro con le Famiglie. Erickson Edizioni: Trento.Google Scholar
Fava, G. A. (1997). La ricerca in psicoterapia: perchè in Italia è così poca? Epidemiologia e Psichiatria Sociale 6(2), 81–83.CrossRefGoogle Scholar
Garety, P. A., Fowler, D. G., Freeman, D., Bebbington, P., Dunn, G. & Kuipers, E. (2008). Cognitive-behavioural therapy and family intervention for relapse prevention and symptomreduction in psychosis: randomised controlled trial. British Journal of Psychiatry 192, 412–423.CrossRefGoogle Scholar
Grilli, R. & Taroni, F. (2004). Governo Clinico. Il Pensiero Scientifico Editore: Roma.Google Scholar
Harris, E. C. & Barraclough, B. (1998). Excess mortality of mental disorder. British Journal of Psychiatry 173, 11–53.CrossRefGoogle ScholarPubMed
Harrow, M. & Jobe, T. H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medication: A 15-year mul-tifollow-up study. Journal of Nervous and Mental Disease 195, 406–414.CrossRefGoogle Scholar
Jeste, D. V., Gladsjo, J. A., Lindamer, L. A. & Lacro, J. P. (1996). Medical comorbidityin schizophrenia. Schizophrenia Bulletin 22, 430.CrossRefGoogle Scholar
Jones, P. B., Barnes, T. R. E. & Davies, L. (2006). Randomized controlled trial of the effect on quality of life of second vs. first-generation anti-psychotic drugs in schizophrenia. Cost utility of the latest antipsy-chotic drugs in schizophrenia study (Cutlass 1). Archives of General Psychiatry 63, 1079–1087.CrossRefGoogle Scholar
Kendall, P. C. & Chambless, D. L. (Eds) (1998). Empirically supported psychological therapies. Journal of Consulting and Clinical Psychology 66, 3–167.CrossRefGoogle ScholarPubMed
Kingdon, D. G. & Kirschen, H. (2006). Who does not get cognitive-behavioral therapy for schizophrenia when therapy is readily available? Psychiatric Services 57(12), 1792–1794.CrossRefGoogle Scholar
Kuipers, E. (2000). Psychological treatments for psychosis: evidence but unavailable. Psychiatric Rehabilitation Skills 4, 249–258.CrossRefGoogle Scholar
Lambert, J. R., Velakoulis, E. & Pantelis, C. (2003). Medical comorbidity in schizophrenia. Medical Journal of Australia 178, Suppl., S67–S70.Google ScholarPubMed
Lawrence, D. M., Holman, C. D., Jablensky, A. V. & Hobbs, M. S. (2003). Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998. British Journal of Psychiatry 182, 31–36.CrossRefGoogle ScholarPubMed
Lieberman, J. A., Stroup, T. S. & McEvoy, J. P. for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 1209– 1223.Google Scholar
Lora, A., Cosentino, U., Gandini, A. & Zocchetti, C. (2007). Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiologia e Psichiatria Sociale 16(4), 330–338.CrossRefGoogle ScholarPubMed
Lora, A, Corlito, G., Miceli, M., Di Munzio, W., Lasalvia, A., Tanini, A., Mari, L., Casacchia, M., Cristofalo, D., Magnani, N., Semisa, D. & Ruggeri, M. per il Gruppo SIEP-DIRECT's (2008). The treatment of acute psychotic episode: discrepancy between routine practice andevidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 319–330.CrossRefGoogle Scholar
Magliano, L. & Fiorillo, A. (2007). Gli interventi psicoeducativi familiari per la schizofrenia: questioni relative alla loro diffusione nei servizi di salute mentale. Psichiatria di Comunità 6(2), 80–84.Google Scholar
Magliano, L., Fadden, G., Madianos, M., de Almeida, J. M., Held, T., Guarneri, M., Marasco, C., Tosini, P., & Maj, M. (1998). Burden on the families of patients with schizophrenia: results of the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology 33, 405–412.CrossRefGoogle ScholarPubMed
Magliano, L., Marasco, C., Fiorillo, A., Marangone, C., Guarneri, M., Maj, M. & Working Group of the Italian National Study on Families of Persons with Schizophrenia (2002). The impact of professional and social support on the burden of families of patients with schizophrenia in Italy. Acta Psychiatrica Scandinavica 106, 291–298.CrossRefGoogle ScholarPubMed
Magliano, L., Fiorillo, A., Fadden, G., Gair, F., Economou, M., Kallert, T., Schellong, J., Xavier, M., Pereira, M. G., Torres-Gonzales, F., Palma Crespo, A. & Maj, M. (2005a). Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: preliminary results of a study funded by the European Commission. World Psychiatry 4, 45–49.Google ScholarPubMed
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., Favata, G., Sasso, A., Prezioso, M., Pezzenati, L., Gentile, F., Casale, L., Bondi, E., Test, G. R., Di Lella, M., Biscussi, E., Degl'Innocenti, F., Bellini, R., Di Nunzio, R., Matrella, L., Salmeri, R., Cantone, R., Gargiulo, L., Esposito, A., Delcuratolo, V., Giannini, M., Maresca, L., Cavaliere, G., Scandone, B., Folla, M., Raffaeli, M., Innocente, P., Dagianti, F., Lucania, S., Scorsino, A., Bardicchia, F., Cerullo, G., Curreli, R., Miscali, S., Scordato, M., Campo, G., Mameli, C., Sodde, C., Dunyer, X., Bigger, J. T. Jr, Friedman, A., Kleinberg, D., Yevich, S. J., Davis, B. & Shon, S. (2004). Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry 161, 1334–1349.Google Scholar
McCreadie, R., Kelly, C., Connolly, M., Williams, S., Baxter, G., Lean, M. & Paterson, J. R.(2005). Dietary improvement in people with schizophrenia. British Journal of Psychiatry 187, 346–351.CrossRefGoogle ScholarPubMed
Morosini, P. & Michielin, P. (2001). Efficacia delle psicoterapie. In La Salute Mentale: Contro il Pregiudizio il Coraggio delle Cure (Cassano, G.B. et al.). Il Pensiero Scientifico Editore: Roma.Google Scholar
Munk-Jorgensen, P., Mors, O., Mortensen, P. B. & Ewald, H. (2000). The schizophrenic patient in the somatic hospital. Acta Psychiatrica Scandinavica 102, 96–99.CrossRefGoogle Scholar
Nathan, P. E., Gorman, J. M. & Salkind, N. J. (1999). Treating Mental Disorders: A Guide to What Works Oxford University Press: New York.Google Scholar
National Collaborating Centre for Mental Health (2003). Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Gaskell: London.Google Scholar
National Institute of Clinical Excellence (2002). Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. In: Technology Appraisal No. 43. National Institute for Clinical Excellence: London.Google Scholar
Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G. & Morgan, C. (2002). Psychological treatments in schizophrenia: I.Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine 32(5), 763–782.CrossRefGoogle ScholarPubMed
Roth, A. & Fonagy, P. (1996). What Works for Whom: A Critical Review of Psychotherapy Research. Guilford Press: New York.Google Scholar
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium? Epidemiologia e Psichiatria Sociale 17(4), 270–277.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lora, A. & Semisa, D. on behalf of the SIEP-DIRECT's Group (2008a). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of the main findings and the practical implications for the future of community based mental health services. Epidemiologia e Psichiatria Sociale 17(4), 358–368.CrossRefGoogle ScholarPubMed
Ruggeri, M., Bacigalupi, M., Casacchia, M., Miceli, M., Morganti, C., Scavo, V., Allevi, L., Lupoi, S., Cristofalo, D., Lasalvia, A., Lora, A. & Semisa, D., peril Gruppo, SIEP-DIRECT's (2008b). Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 305–318.CrossRefGoogle Scholar
Semisa, D, Lora, A, Morosini, P & Ruggeri, M. (2008a). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence in the treatment of schizophrenia. The design, the indicators, and the methodology of the study (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 278–290.CrossRefGoogle Scholar
Semisa, D., Lasalvia, A., Miceli, M., Dall'Agnola, R. B., Pucci, C., Bissoli, S., Visani, E., Pismataro, C. P., Vanetti, M., Pioli, R., Ruggeri, M. & Lora, A. per il Gruppo SIEp-DIRECT's (2008b). The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental health. The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 291–304.CrossRefGoogle ScholarPubMed
Sistema Nazionale, Linee Guida (2007). Linea Guida: Gli Interventi Precoci nella Schizofrenia. Ministero della Salute: Roma. Retrieved August 5, 2008, from http://www.snlg-iss.it/node/405Google Scholar
Tansella, M. (2004). Psichiatria bipolare, linee guida sui trattamenti, valutazione degli esiti. In Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica (ed. Carrà, G., Barale, F. e Marinoni, A.). Il Pensiero Scientifico Editore: Roma.Google Scholar
Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J. & Mehta, R. (2006). Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia. British Journal of Psychiatry 189, 36–40.CrossRefGoogle ScholarPubMed
World Psychiatric Association (2001). Schizofrenia e Cittadinanza. Edizione italiana a cura di Casacchia, M., Pioli, R., e Rossi, G.Il Pensiero Scientifico Editore: Roma.Google Scholar