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Talking therapies backed by NICE for psychosis prevention

The National Institute for Health and Care Excellence has recommended that the NHS offer cognitive behavioural therapy (CBT) as opposed to antipsychotic drugs to people considered at increased risk of developing psychosis.

The new recommendation appears in NICE’s updated clinical guideline on the care of adults with psychosis and schizophrenia. NICE notes that in most cases a first episode of psychosis is preceded by a prodromal period, where a person may exhibit a range of behavioural and psychological symptoms.

NICE also recommends that for a first episode of psychosis patients are offered oral antipsychotics in conjunction with psychological interventions, such as family intervention and individual CBT; this recommendation has also been applied to people with an acute exacerbation or recurrence of psychosis or schizophrenia.

NICE says: “Antipsychotic drugs are often used to prevent the development of psychosis and to treat the disorder, though these can have certain side effects. Cognitive behavioural therapy is another measure often used, where therapists work collaboratively with a patient to talk through psychotic experiences and modify unhelpful thought patterns and behaviours.”

Naomi Phillips, head of policy and campaigns at the mental health charity Mind, said: “We are pleased that NICE has acknowledged CBT can help not just those with a diagnosis, but that it could also play a preventive role and its use should be extended to those who may be prone to developing schizophrenia. We know that talking therapies can be effective and don’t have the unpleasant side effects that many drugs bring.”

NICE also advises that, before starting antipsychotics, healthcare professionals should assess, at a baseline level, the nutritional status, diet and level of physical activity of patients. It also recommends that people with psychosis or schizophrenia who smoke should be offered help to stop.

The choice of antipsychotic medication should be made by the service user and healthcare professional together, and doctors should provide information and discuss each drug’s likely benefits and possible side effects, it recommends.

Ms Phillips said that even though schizophrenia is fairly common, there is still a huge stigma surrounding it which can prevent people seeking help. “That’s why it’s so vital that healthcare professionals monitor individuals and look out for symptoms early, particularly those identified as being more susceptible. With the right support, it is possible to recover.”

The guideline also calls for more support for carers, recommending that they should be offered an assessment of their own needs provided by mental health services.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11134408

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