This guideline on Schizophrenia, commissioned by NICE and
developed by the National Collaborating Centre for Mental Health,
sets out clear, evidence- and consensus-based recommendations for
healthcare staff on how to manage and treat schizophrenia in
adults.
This guideline is an update of the previous guidance (full
guideline published 2003), which was the first guideline that NICE
ever produced and which was judged to be superior to other
schizophrenia guidelines in an international survey.
This updated guideline provides new clinical and economic evidence
about the use of psychological and psychosocial interventions and
antipsychotic drugs and new reviews of early intervention services,
primary care and treatment for physical health problems. There are
also new chapters on access and engagement for minority ethnic
groups and on service user and carer experience of treatment and
care for schizophrenia.
List of the other NICE mental health
guidelines
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"The original NICE
schizophrenia guideline was of remarkable superiority in its
methodological quality compared with other national treatment
guidelines throughout the world. This updated version of the
guideline is yet again of exceptional quality, demonstrating rigour
in its development, clarity in its presentation and noticeable
breadth in its coverage. Whether dealing with drug and psychosocial
treatments, patient experience, ethnic minorities or health
economics, based on current evidence the guideline opens up new
vistas on the best treatments available for people with
schizophrenia. A landmark of schizophrenia practice
guidelines."
- Professor Wolfgang
Gaebel, Professor of Psychiatry, Department of Psychiatry and
Psychotherapy of the Heinrich-Heine-University, Düsseldorf and Past
President German Psychiatric Association (DGPPN)
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“There are still many
inequalities that exist in mental health, some of which are
particularly pertinent for people with schizophrenia. These
inequalities are even more difficult to overcome for people from
ethnic minorities, who often gain access to help at a very late
stage. This guideline is the first to tackle these problematic
issues by undertaking a full evidence review of the problems faced
by people from African Caribbean groups in accessing UK services. I
can thoroughly recommend this world class guideline to anyone with
an interest in the evidence about what works for people with
schizophrenia".
- Professor Dinesh Bhugra, President, Royal College of Psychiatrists
(2008-2011)
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Correction
Unfortunately one appendix that was supposed to be
included on the free data CD-ROM that accompanies Schizophrenia
(Updated edn), was missed out. It can however be downloaded
for free below:
Appendix 15d: Service-level
interventions study characteristics tables
NICE Mental Health Guidelines
These guidelines from NICE set out clear
recommendations, based on the best available evidence, for health
care professionals on how to work with and implement physical,
psychological and service-level interventions for people with
various mental health conditions.
The book contains the full guidelines that cannot be obtained
in print anywhere else. It brings together all of the evidence that
led to the recommendations made, detailed explanations of the
methodology behind their preparation, plus an overview of the
condition covering detection, diagnosis and assessment, and the
full range of treatment and care approaches.
The accompanying free CD-ROM contains all the data used as
evidence, including:
- Included and excluded studies.
- Profile tables that summarise both the quality of the evidence
and the results of the evidence synthesis.
- All meta-analytical data, presented as forest plots.
- Detailed information about how to use and interpret forest
plots.
Full Contents
1. PREFACE
1.1
National guideline
1.2 The
national schizophrenia guideline
2. SCHIZOPHRENIA
2.1 The
disorder
2.2
Incidence and prevalence
2.3
Possible causes of schizophrenia
2.4
Assessment
2.5 Engagement,
consent and therapeutic alliance
2.6 Language
and stigma
2.7 Issues for
families and carers
2.8 Treatment
and management of schizophrenia in the NHS
2.9 The
economic cost of schizophrenia
3. METHODS USED TO UPDATE THIS
GUIDELINE
3.1
Overview
3.2 The
scope
3.3 The
guideline development group
3.4 Clinical
questions
3.5 Systematic
clinical literature review
3.6 Health
economics methods
3.7 Stakeholder
contributions
3.8 Validation
of the guideline
4. EXPERIENCE OF CARE
4.1
Introduction
4.2
Methodology
4.3 Personal
accounts from people with schizophrenia
4.4 Personal
accounts from carers
4.5 Summary of
themes from service users’ and carers’ experiences
4.6
Recommendations
5. ACCESS AND ENGAGEMENT
5.1
Introduction
5.2 Early
intervention
5.3 Access and
engagement to service-level interventions
6. PHARMACOLOGICAL INTERVENTIONS IN
THE TREATMENT AND MANAGEMENT OF SCHIZOPHRENIA
6.1
Introduction
6.2 Initial
treatment with antipsychotic medication
6.3 Oral
antipsychotics in the treatment of the acute episode
6.4 Promoting
recovery in people with schizophrenia that is in remission –
pharmacological relapse prevention
6.5 Promoting
recovery in people with schizophrenia whose illness has not
responded adequately to treatment
6.6 Treatment
with depot/long-acting injectable antipsychotic medication
6.7 Side
effects of antipsychotic medication
6.8
Effectiveness of antipsychotic medication
6.9 Health
economics
6.10 From evidence to
recommendations
6.11 Recommendations
7. ECONOMIC MODEL – COST EFFECTIVENESS
OF PHARMACOLOGICAL INTERVENTIONS FOR PEOPLE WITH
SCHIZOPHRENIA
7.1
Introduction
7.2 Economic
modelling methods
7.3 Results
7.4 Discussion
of findings – limitations of the analysis
7.5
Conclusions
8. PSYCHOLOGICAL THERAPY AND
PSYCHOSOCIAL INTERVENTIONS IN THE TREATMENT AND MANAGEMENT OF
SCHIZOPHRENIA
8.1
Introduction
8.2 Adherence
therapy
8.3 Arts
therapies
8.4 Cognitive
behavioural therapy
8.5 Cognitive
remediation
8.6 Counselling
and supportive therapy
8.7 Family
intervention
8.8
Psychodynamic and psychoanalytic therapies
8.9
Psychoeducation
8.10 Social skills
training
8.11 Recommendations
(Across all treatments)
9. SERVICE-LEVEL INTERVENTIONS IN THE
TREATMENT AND MANAGEMENT OF SCHIZOPHRENIA
9.1
Introduction
9.2 Interface
between primary and secondary care
9.3 Community
mental health teams
9.4 Assertive
outreach (Assertive community treatment)
9.5 Acute day
hospital care
9.6 Vocational
rehabilitation
9.7 Non-acute
day hospital care
9.8 Crisis
resolution and home treatment teams
9.9 Intensive
case management
10. SUMMARY OF
RECOMMENDATIONS
10.1 Care across all
phases
10.2 Initiation of
treatment (First episode)
10.3 Treatment of the acute
episode
10.4 Promoting recovery
10.5 Research
recommendations
11. APPENDICES
12. REFERENCES
13. ABBREVIATIONS