treatments for psychosis; how the nhs has pioneered new ...€¦ · promoting recovery in psychosis...
TRANSCRIPT
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Treatments for psychosis; how the
NHS has pioneered new research and service models to improve outcomes.
Paul French
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Promoting recovery in psychosis
• For many years a diagnosis associated with psychosis was assumed to be catastrophic.
• Don’t talk to people about their hallucinations. • Stories of clinicians saying you would be better off with cancer. • We have known about 20 year loss of life compared to peers for a long
time.
• “all these recovery messages not helpful for those people that don’t recover”
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Perceptions of mental health and mental illness have changed
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Policy Implementation Guidelines
• Introduction of EIP services in 1998 as part of the National Service Framework
• Promoted the importance of working with people in their First Episode of Psychosis
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What does an early psychosis team do
1. Highlighted the possibility to prevent psychosis in the ultra high risk individuals
2. Reduce DUP (Duration of Untreated Psychosis):
3. Optimise initial experience of acute care & treatment:
4. Maximise recovery & prevent relapse during critical period:
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Age of onset for schizophrenia
0
5
10
15
20
25
30
35
age
12-14
age
15-19
age
20-24
age
25-29
age 30
34
age
35-39
age
40-44
age
45-49
age 50
54
age
55-59
Pe
rce
nta
ge
Females %
Males %
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“The jewel in the crown of the NHS mental health reform because:
• Service users like it
• People get better
• It saves money”
Professor Louis Appleby;
Track conference
Birmingham April 29th 2009
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Lost generation report published by RETHINK 2014
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Ministerial announcement
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Access and Waiting Times Standard for Psychosis
• More than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral (Rising to 60% by 2020)
2 parts
Part 1 - get people access quickly 2 weeks
Part 2 – get people the right interventions
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How are we doing
0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0%
ENGLAND
NORTH OF ENGLAND
MIDLANDS AND EAST OF ENGLAND
LONDON
SOUTH WEST OF ENGLAND
SOUTH EAST OF ENGLAND
Start of Treatment
People started Treatment within 12 weeks % People started Treatment within 6 weeks % People started Treatment within 2 weeks %
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Interventions to maximise outcomes associated with a First Episode of Psychosis
• Referral to EIP and start treatment within 2 weeks
• Offer CBT for Psychosis
• Offer Family Interventions
• Offer Clozapine (if not responded to other meds)
• Provide Supported Employment Programmes
• Assessment of Physical Health
• Promoting Healthy Lifestyles (exercise, smoking cessation, diet)
• Offer carer focused education and support
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kg
Months 12 24 0 48 36
Established Psychosis RCTs
10
5
20
15
12 kg
4 kg
3 kg
Alvarez-Jimenez et al; CNS Drugs, 2008 22: 547-562
Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal
First episode of psychosis RCTs
Established psychosis RCTs
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Jo Hodgekins, Paul French, Max Birchwood, Miranda Mugford, Rose Christopher, Max Marshall, Linda Everard Helen Lester, Peter Jones, Tim Amos, Swaran Singh, Vimal Sharma, Anthony P. Morrison, David Fowler Schizophrenia Research 2015
0
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General Population At Risk of Psychosis First Episode Psychosis Delayed Recovery
Weekly Hours Time Use Across Different Groups
Meddian Hours Mean Hours
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In conclusion
• EIP services are well and truly embedded within clinical practice right across the NHS in England
• Theses services have achieved a huge amount over the past couple of years to see people within a 2 week time frame – internationally recognised
• We are now evaluating what interventions are offered to individuals and their families to promote recovery and measuring whether this is achieved
• We are the only country in the world that measure delays to services for people with psychosis in days and weeks not months and years.
• Cancer UK – more than 25,000 patients joined clinical trials last year - we need to encourage research across our services and ensure people get access to early trials and we make the most of research opportunities.