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NICE: Updated schizophrenia and psychosis guidelines

Carers of people with schizophrenia need more support, the National Institute for Health and Care Excellence (NICE) has claimed. 

Updated guidance on treating and managing psychosis and schizophrenia in adults claims carers' needs should also be assessed so that they get the right level of support. 

Service users should be offered support from people who have recovered from psychosis or schizophrenia, the recommendations claim. 

And clinicians should also provide information and advice about effective use of medication, identifying and managing symptoms, accessing support services, coping with stress, and what to do in a crisis. 

Professor Mark Baker, centre for clinical practice director at NICE, said: “There is considerable fear and stigma linked to psychosis and schizophrenia. The first few years after onset can be very upsetting and chaotic. 

"This guideline sets out how best to treat and manage people with schizophrenia, from the first episode through to management of further acute episodes and longer term care.”

Clive Travis, representing service users on the guideline development group, said:"There seemed little science in my care until the latter part of that decade [2000] beyond random attempts to get a drug that suited me and other aspects of the care seemed more traditional than scientifically well founded. My carers were left with a bitter taste due to lack of support. 

“I was not alone among users to lose my employment, almost as though to do so was part and parcel of the condition. The new schizophrenia guideline makes the possibility of employment part of the recovery and also better recognises the role of the carer.

“The newly updated guideline is a major stride in the long walk which is the history and science of recovery from schizophrenia and psychosis and will enable much of what happened to me to happen less often, less damagingly, in a less costly way or not at all. People with schizophrenia and psychosis can and do get better, get their life back and enjoy it again and this guideline will give them their best chance yet of doing that.”

Key recommendations

Referral from primary care: 

If a person is distressed, has a decline in social functioning and has:

 - Transient or attenuated psychotic symptoms or  

 - Other experiences or behaviour suggestive of possible psychosis or 

 - A first-degree relative with psychosis or schizophrenia

They should be referred for assessment without delay to a specialist mental health service or an early intervention in psychosis service because they may be at increased risk of developing psychosis. 

Treatment options to prevent psychosis: 

If a person is considered to be at increased risk of developing psychosis (as described above): 

 - Offer individual cognitive behavioural therapy (CBT) with or without family intervention and interventions recommended in NICE guidance for people with any of the anxiety disorders, depression, emerging personality disorder or substance misuse.

First episode psychosis: 

Assess for post-traumatic stress disorder and other reactions to trauma because people with psychosis or schizophrenia are likely to have experienced previous adverse events or trauma associated with the development of the psychosis or as a result of the psychosis itself. 

Support for carers: 

Carers of people with psychosis or schizophrenia should be offered an assessment (provided by mental health services) of their own needs and discuss with them their strengths and views. A care plan should be developed to address any identified needs and a copy given to the carer and their GP and ensure it is reviewed annually.

Promoting recovery and possible future care: 

People with psychosis or schizophrenia who wish to find or return to work should be offered supported employment programmes. For people who are unable to work or unsuccessful in finding employment other occupational or educational activities, including pre-vocational training should be considered.

The newly updated guidance is available to view on the NICE website