Psychosocial Interventions in the Management of Schizophrenia
Section 5: Recommendations for audit and research

5.1 Key points for audit

Firm outcome measures related to psychosocial intervention techniques are difficult to identify in ordinary clinical practice where standardised assessments are not often used. Some outcome measures are already recorded, such as:

  1. Number of admissions/length of admission
  2. Number of contacts with psychiatric services.

Other assessments are carried out as part of routine clinical care, but not in a formal way which would permit audit:

  1. Assessment of mental health, including minor exacerbations of symptoms
    This assessment could be formalised using a scale such as the Royal College of Psychiatrists Health of the Nation Outcome Scales (HoNOS).39

There are a number of other assessment scales which tend only to be used in research and clinical trials.

  1. Assessment of compliance with medication (possibly including plasma drug levels)
  2. Recording of episodes of depression and suicide attempts
  1. Social assessment
    Several of the studies on Family Intervention have used the Social Functioning Scale developed by Birchwood.40

HoNOS includes some measures of social functioning.

  1. Assessment of patient's and carers' satisfaction with services provided
  1. Assessment of patient's and carers' knowledge of schizophrenia
    This might be assessed using the Knowledge About Schizophrenia Inventory (KASI).25

A separate area is the provision of services and an audit of the implementation of the guideline would require recording of items such as:

  1. Number of interventions undertaken
  2. Number of Health Professionals trained and available to provide interventions
  3. Size of 'At Risk' population.

5.2 Recommendations for research

Several clinical trials are underway which should clarify the efficacy and applicability of Cognitive Behaviour Therapy in the management of schizophrenia. The value of Cognitive Behaviour Therapy in the acute phase of illness requires further investigation.

The effectiveness of Family Intervention has been established, but further clarification of the contribution of individual components of the approach is needed. Further research is also required on outcomes (including patient and carer satisfaction measures) and on the continuation of the approach following an initial treatment programme.

Some studies have found these techniques less widely accepted and effective in ordinary clinical practice than expected from research studies.38, 42, 43Further evaluation in this area is desirable.

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