Psychotic disorders

Introduction top

Treatmenttop

Treatment - Treatment protocols for Schizophreniatop

• British (NICE) guideline for the treatment of schizophrenia
  

  British national guideline regarding the most important interventions in primary and specialized care for people with schizophrenia.  Thorough, 264 page long, including an almost textbook discussion of the history, epidemiology, pathophysiology, and the social, diagnostic, and treatment consequences of the disorder.  Completed in 2003 and published in November 2005 under the aegis of the National Institute for Clinical Excellence (NICE).  Available as a PDF file.

• Practice guideline from the American Psychiatric Association
  

  Guideline  of the American Psychiatric Association (APA) for the diagnosis and treatment of people with schizophrenia (APA Practice Guideline 2004), an expert consensus guideline of 120 pages.  Available  as a PDF file.  An abridged version with decision trees is also available  file via this link.

• Treatment of Schizophrenia, consensus document
  

  American Expert Consensus Guideline from 1999.  More than 80 pages long, the document is available online as an Acrobat reader file and may be printed once for for personal use.  Includes a Guide for Patients.

Treatment -- treatment options, othertop

• Case management
  

  A review from the Cochrane group which takes a critical view of the value of case management as propagated in the scientific literature. Concludes that there is no evidence that case management has a positive effect on the social functioning of patients.

• Day hospital, admission, or ambulatory care? (1)
  

  Three recent reviews from the Cochrane Library are impressed by the value of day hospitalisation in comparison to other forms of care. Day care appears to have clear advantages over hospital admission.
  Here a link to the (abstract of the) first review: Marshall, M., Crowther, R., Almaraz-Serrano, A., Creed, F., Sledge, W., Kluiter, H., Roberts, C., Hill, E. & Wiersma, D. (2002) Day hospital versus admission for acute psychiatric disorders. The Cochrane Library, Issue 2, 2003.

• Day hospital, admission, or ambulatory care? (2)
  

  Three recent reviews from the Cochrane Library are impressed by the value of day hospitalisation in comparison to other forms of care. Day care appears to have clear advantages over hospital admission.
  Here a link to the (abstract of the) second review: Marshall, M., Crowther, R., Almaraz-Serrano, A.M. & Tyrer, P. (2001) Day hospital versus out-patient care for acute psychiatric disorders. The Cochrane Library, Issue 2, 2003.

• Day hospital, admission, or ambulatory care? (3)
  

  Three recent reviews from the Cochrane Library are impressed by the value of day hospitalisation in comparison to other forms of care. Day care appears to have clear advantages over hospital admission.
  Here is a link to the (abstract of the) third review: Catty, J., Burns, T. & Comas, A. (2001) Day centres for severe mental illness. The Cochrane Library, Issue 2, 2003.

• Family intervention for schizophrenia
  

  Balanced review from the  Cochrane Library of the scientific background and results from research regarding the effectiveness of family interventions for people with schizophrenia.
  Pharoah, F.M., Mari, J.J. & Streiner, D. (1999) Family intervention for schizophrenia. The Cochrane Library, Issue 2, 2003, amendment 2006.

• Individual psychodynamic psychotherapy and psychoanalysis
  

  Cochrane review from 2001 which concludes that there is no scientific evidence for the use of psychodynamically oriented psychotherapy techniques with hospitalised people with schizophrenia.

• Fatty acids and schizophrenia?
  

  A number of studies suggests that in some cases a disturbed fatty acid metabolism contributes to the development of psychoses.  Correction of these disturbances with diet might then lead to improvement in symptoms.  This recent review from the Cochrane Library concludes that more research is necessary.
  Joy, C.B., Mumby-Croft, R. & Joy, L.A. (2003) Polyunsaturated fatty acid supplementation for schizophrenia. The Cochrane Library, Issue 2, 2003.

Treatment - Cognitive therapytop

• Cognitive behaviour therapy for schizophrenia
  

  This Cochrane review discusses the significance of cognitive behaviour therapy (CBT) for schizophrenia.

Treatment - Pharmaceutical treatmenttop

• Medications such as antipsychotics, anticholinergics, betablockers, vitamine E, and fatty acids
  

  The Cochrane Schizophrenia Group discusses the scientific evidence for the effectiveness of various new and older antipsychotics, including depot antipsychotics and many other pharmaceutical interventions.   The reviews consist of abstracts wherein the research literature is discussed from a very critical scientific perspective.  The evidence of effectiveness, side effects and alleged benefits are discussed.

• Lithium 1 (English)
  

  In an updated Cochrane review published in 2007, it is concluded that there is no randomised trial-based evidence that lithium on its own is an effective treatment for people with schizophrenia. The evidence available on augmentation of antipsychotics with lithium is inconclusive, but does justify further, large, simple, and well-designed trials. These should concentrate on two target groups: 1) people with no affective symptoms, so that trialists can determine whether lithium has an effect on the core symptoms of schizophrenia, 2) people with schizoaffective disorders for whom lithium is widely used in clinical practice, although there is no evidence to support this use.

Treatment - Non-pharmaceutical treatments, othertop

• ISPS
  

  Website of the International Society for the Psychological Treatments of the Schizophrenias and other Psychoses (ISPS), a network of people who wish to support and propagate the psychological approach.

Treatment - Psychoeducationtop

• Psychoeducation
  

  Cochrane review of the effectiveness of family and patient education (psychoeducation). Concludes that psychoeducation in combination with antipsychotic medication is an inexpensive and effective form of treatment.

Treatment - Rehabilitationtop

• Assertive Community Treatment (ACT)
  

  This Cochrane review describes ACT as an effective approach for organising healthcare for people with severe psychiatric disorders. ACT lowers hospital costs and improves quality of life.

• Cognitive rehabilitation for people with schizophrenia and related disorders
  

  Cochrane review of the significance of cognitive rehabilitation for people with schizophrenia and related disorders. Concludes that this treatment method may help develop a greater sense of self-worth.

• Destigmatising and education (WPA)
  

  In 1996 the World Psychiatric Association (WPA) established an international programme to combat the stigmatisation of people with schizophrenia.  Its associated website is multilingual (but not in Dutch) and hopes to contribute to the destigmatisation with information for professionals, patients, and family.

• Life Skills Training
  

  Life Skills Training is often given as a component of a rehabilitation programme.  In this Cochrane review, the authors wonder if, given its lack of a convincing effectiveness, it is still responsible to provide this form of care outside of clinical trials.

• What kinds of the vocational guidance and affective?
  

  Is job therapy or (day) clinic pre-vocational training effective, or is it better to provide guidance in the search for paid work with direct placement and on-the-job training (supported employment)?  A recent Cochrane review considers this dilemma and comes out in favour of supported employment.

  Crowther R, Marshall M, Bond G, Huxley P. Vocational rehabilitation for people with severe mental illness. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003080. DOI: 10.1002/14651858.CD003080

Bipolar disorderstop

• NICE guideline polar disorder
  

  The British NICE guideline for bipolar disorders gives detailed information about many aspects of diagnosis, treatment and clinical guidance of people with a bipolar (manic-depressive) illness. The guideline is downloadable as a PDF file.

• Lithium Plus Werkgroep (English/Dutch)
  

  This Dutch- and English-language website by a workgroup of practitioners and other care givers offers a wealth of information about bipolar disorders (manic depression) and the treatment thereof. Many useful links in English and Dutch are listed.

Patient and family organisations & informationtop

• Schizophrenia: A Handbook For Families
  

  Really is a complete handbook put together by Health Canada in collaboration with the Schizophrenia Society of Canada. It consists of a wide variety of information about schizophrenia, in particular about all kinds of everyday problems that arise from the symptoms of the disorder.

• SimplePsych
  

  A site directed at  mental health care consumers.  Includes a lot of concise information about psychoses, schizophrenia, and their treatment.

Psychosestop

• Early intervention in schizophrenia
  

  This link brings you to an early intervention review in English written by Spanish authors. The review can be downloaded as a PDF file. It contains a detailed review on the possibilities and challenges in this field of schizophrenia research.

• Netwerk Vroege Psychose
  

  Dutch and English-language website which  provides information about psychoses, symptoms, and treatment as well as a lot of other useful information. It is primarily aimed at care givers but is also appropriate for patients and their family. The information is   provided by members of the "Netwerk Vroege Psychose" (Early Psychosis Network),  a group of psychiatrists concerned with patients and family members who confronted with a psychosis for the first time.

• Prodromes: symptom recognition
  

  Many psychoses begin with aspecific premonitory symptoms called prodromes.  Recognition of these prodromes can improve early treatment and in the case of relapse, lead to faster effective treatment. This site, which seems to originate from the EPPIC in Australia (see also EPPIC under the Research heading), provides extensive information about the nature and epidemiology of prodromes. This link also leads to information in many languages about psychosis for patients and relatives.

Researchtop

• EPPIC: Epidemiology, pathogenesis, and treatment options for schizophrenia
  

  The EPPIC programme is an Australian research and treatment centre in Australia especially for people with early psychotic symptoms or people who have an increased risk of developing psychosis later.  Provides extensive information about treatment, psychoeducation, and research.

• National Alliance for Research on Schizophrenia and Depression (NARSAD)
  

  It takes a bit of looking but this American organisation provides a wealth of information. Particularly interesting for researchers and clinicians who are interested in new developments.  The site offers not just orientation information about schizophrenia and depression, but especially information about recent subsidised research and congresses, and thus a good overview of the state of scientific research concerning schizophrenia

• National Institute of Mental Health (NIMH)
  

  The website pf this American institute provides, among other things, information about current and proposed research and subsidy possibilities.

• PRIME: Prevention through Risk Identification Management & Education
  

  PRIME is the Yale University research project aimed at young people who may run the risk of developing psychotic problems.  The objectives of the research project are comparable to those of EPPIC (see above) and TIPS (see below).

• TIPS: early intervention in psychosis
  

  TIPS is a Norwegian-Danish project whose objective is to treat people with severe psychiatric illnesses as early as possible in the hope of improving long-term patient prospects.  The essence of the research is to increase the understanding of severe psychiatric disorders and to reduce stigmatisation by providing information to the community.  It is hoped, among other things, to reduce the time between the first symptoms and treatment of psychoses (Duration of Untreated Psychosis).  The site is in Norwegian and English and provides information about current TIPS research, the design of the research, and its publications.  There is also English-language information about psychoses.

Schizophreniatop

• Information about schizophrenia and other psychoses
  

  A wealth of information about psychoses and schizophrenia aimed at professionals.  The site is supported by the National Alliance for the Mentally Ill (NAMI). In addition to general and current research information, it offers continuing education certification courses by the American Society for Schizophrenia (APA) and slide shows which provide accessible information.

• Schizophrenia
  

  This  National Institute of Mental Health (NIMH) site provides accessible information about schizophrenia, its causes, incidence, treatment, and prognosis for a broad audience. Thanks to a logical classification system, more specific information is quickly found. The easiest way is to enter "schizophrenia" in the search field on the right upper part of the NIMH welcome page.

• London Institute of Psychiatry (Maudsley)
  

  Extensive information about various aspects of schizophrenia for professionals, researchers, students, and patients can be found on the site of the London Institute of Psychiatry, the acclaimed Maudsley Hospital in London.

Legislationtop