The clinical characterization of the patient with primary psychosis aimed at personalization of management
| Autor: | Michael F. Green, Ruud van Winkel, Jouko Miettunen, Philip D. Harvey, Graham Thornicroft, Keith H. Nuechterlein, Marc De Hert, Dolores Malaspina, Silvana Galderisi, Jim van Os, Mario Maj, Victor Peralta, Patrick D. McGorry, Joseph Ventura, Peter B. Jones, Wolfgang Gaebel, Sinan Guloksuz, Robin M. Murray |
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| Přispěvatelé: | Maj, M., van Os, J., De Hert, M., Gaebel, W., Galderisi, S., Green, M. F., Guloksuz, S., Harvey, P. D., Jones, P. B., Malaspina, D., Mcgorry, P., Miettunen, J., Murray, R. M., Nuechterlein, K. H., Peralta, V., Thornicroft, G., van Winkel, R., Ventura, J., RS: MHeNs - R2 - Mental Health, MUMC+: MA Psychiatrie (3), MUMC+: Hersen en Zenuw Centrum (3), Psychiatrie & Neuropsychologie |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
cognitive-behavioral therapy
protective factor medicine.medical_treatment IMPROVE PHYSICAL HEALTH psychiatric antecedent neurocognition Psychological intervention environmental exposure NEGATIVE SYMPTOMS 0302 clinical medicine physical comorbidities term-follow-up QUALITY-OF-LIFE practical need Primary psychosis severe mental-illness psychiatric comorbiditie RATING-SCALE media_common Supported employment MAJOR DEPRESSIVE DISORDER family history practical needs schizophrenia spectrum disorders STRESSFUL LIFE EVENTS obstetric complications Cognitive behavioral therapy Psychiatry and Mental health positive dimension internalized stigma Special Articles Psychological resilience Pshychiatric Mental Health environmental exposures Psychosocial medicine.medical_specialty physical comorbiditie negative dimension psychosocial interventions media_common.quotation_subject social cognition psychosocial intervention 03 medical and health sciences psychiatric antecedents recovery Quality of life (healthcare) Social cognition psychiatric comorbidities medicine protective factors Psychiatry obstetric complication resilience business.industry Mental health Primary psychosi 030227 psychiatry schizophrenia social functioning Human medicine business 030217 neurology & neurosurgery personalization of treatment |
| Zdroj: | World Psychiatry World Psychiatry, 20(1), 4-33. Wiley |
| ISSN: | 1723-8617 |
| DOI: | 10.1002/wps.20809 |
| Popis: | The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medication is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery-oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience. |
| Databáze: | OpenAIRE |
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