User:Earlypsychosis/sandbox

based on treatment guidelines and pending NICE publication

patient expectations of treatment best predictor of treatment outcome

''Evidence-based treatment for schizophrenia.Lehman AF, Buchanan RW, Dickerson FB, Dixon LB, Goldberg R, Green-Paden L, Kreyenbuhl J. Department of Psychiatry University of Maryland School of Medicine, 701 West Pratt Street, Suite 388, Baltimore, MD 21201, USA. alehman@psych.umaryland.edu

Taken together, the research on what treatments help people with schizophrenia point to the value of treatment programs that combine medications with a range of psychosocial services. Provision of such packages of services likely reduces the need for crisis-oriented care hospitalizations and emergency room visits and enables greater recovery. For most people with schizophrenia, the combination of psychopharmacological and psychosocial interventions improves outcomes. Several psychosocial treatments have demonstrated efficacy. These include family intervention, supported employment, assertive community treatment, skills training, and CBT. In the same way that psychopharmacologic management must be tailored individually to the needs and preferences of the patient, so too should the selection of psychosocial treatments. At the very least, all people with schizophrenia should be provided with education about their illness. Beyond illness education, all of the recommended psychosocial interventions would be used rarely during any one phase of illness for an individual. Some psychosocial treatments share treatment components, and patients have different clinical and social needs at different points in their illness course. Knowledge regarding how best to combine treatments to optimize outcomes is scarce.

[PubMed - indexed for MEDLINE''

''Evidence-based treatment of schizophrenia.Drake RE, Mueser KT, Torrey WC, Miller AL, Lehman AF, Bond GR, Goldman HH, Leff HS. Psychiatric Research Center, Dartmouth Medical School, 2 Whipple Place, Suite 202, Lebanon, NH 03766, USA. robert.e.drake@dartmouth.edu

People with schizophrenia can be helped greatly with pharmacologic and psychosocial interventions that are known to be effective. Several interventions are now supported by research: use of medications following specific guidelines, training in illness self-management, case management based on principles of assertive community treatment, family psychoeducation, supported employment, and integrated substance abuse treatment. However, few patients actually receive these evidence-based interventions because they are not provided in routine mental health settings. Therefore, implementing effective treatments in mental health treatment programs is a critical challenge for the field. We review the six areas of evidence-based treatment of schizophrenia, as well as knowledge regarding implementation of mental health programs in routine practice settings.

[PubMed - indexed for MEDLINE]''











Treatment of mental disorders in clinical practice settings is not is not routinely determined by diagnosis alone.

Prognosis and Recovery
leave in as it stands

Specific treatments
distinct between levels of clinical acuity (acute vs in remision) and different stages of condition (see clinical staging) (initial presentation, in-remission, recurring symtpoms, inadequate response to treatment)

Vocational rehabilation and Supported employement
Research on the individual placement and support model of supported employment.Drake RE, Becker DR, Clark RE, Mueser KT. Dartmouth Medical School, Lebanon, NH, USA.

'''This paper reviews research on the Individual Placement and Support (IPS) model of supported employment for people with severe mental illness. Current evidence indicates that IPS supported employment is a more effective approach for helping people with psychiatric disabilities to find and maintain competitive employment than rehabilitative day programs or than traditional, stepwise approaches to vocational rehabilitation. There is no evidence that the rapid-job-search, high-expectations approach of IPS produces untoward side effects. IPS positively affects satisfaction with finances and vocational services, but probably has minimal impact on clinical adjustment. The cost of IPS is similar to the costs of other vocational services, and cost reductions may occur when IPS displaces traditional day treatment programs. Future research should be directed at efforts to enhance job tenure and long-term vocational careers.

[PubMed - indexed for MEDLINE]'''