PSICOSI E ABUSO DI SOSTANZE: LE EVIDENZE SUGLI INTERVENTI NON FARMACOLOGICI - More Comunicazione
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XXI CONGRESSO NAZIONALE SINPF Milano, 29-31.01.2020 “Elementi Innovativi in Neuropsicofarmacologia e nuove frontiere terapeutiche” PSICOSI E ABUSO DI SOSTANZE: LE EVIDENZE SUGLI INTERVENTI NON FARMACOLOGICI Massimo Clerici Dipartimento di Medicina e Chirurgia Università degli studi di Milano Bicocca massimo.clerici@unimib.it
segnalibro APPROCCIO MULTIDISCIPLINARE ALLA PERSONA AFFETTA limiti attuali del concetto di DA SCHIZOFRENIA co-diagnosi CON COMORBIDITÀ l’offerta EB nel trattamento MEDICHE psicosociale delle psicosi in “doppia diagnosi” dalle opzioni terapeutiche alla inevitabile riorganizzazione dei Servizi Take Home Messages
Addiction
Psychiatry
EPA
Special
Section
Addiction Psychiatry, WPA Special Section
APPROCCIO MULTIDISCIPLINARE ALLA PERSONA AFFETTA DA SCHIZOFRENIA CON COMORBIDITÀ MEDICHE
APPROCCIO MULTIDISCIPLINARE ALLA PERSONA AFFETTA DA SCHIZOFRENIA CON COMORBIDITÀ MEDICHE
APPROCCIO MULTIDISCIPLINARE ALLA PERSONA AFFETTA DA SCHIZOFRENIA CON COMORBIDITÀ MEDICHE
APPROCCIO
MULTIDISCIPLINARE
ALLA PERSONA AFFETTA
DA SCHIZOFRENIA
CON COMORBIDITÀ
MODELLO DI MEDICHE
PRESA IN
CARICO
* psichiatra
75%
* psichiatra e
psicologo
25%ANCHE IL SISTEMA DI CURA DELLA “DOPPIA DIAGNOSI” E’
OGGI SEMPRE PIU’ SPESSO DISORGANIZZATO
La maggior parte dei professionisti ammette che la propria
formazione in questo ambito non è stata sufficiente
Dai pochi studi emergono costi elevati e, spesso, livelli d’impiego
dei Servizi socio-sanitari inappropriati
Ci sono evidenze di un eccessivo Molti modelli di trattamento
focus sull’urgenza (suicidio, risultano non aggiornati…
autolesività, violenza e costanti psicoterapie, riabilitazione
necessità di ospedalizzazione) psicosociale,polifarmacoterapia
Ancora troppo poca attenzione Eccessiva
agli interventi psicosociali EB e esclusione/stigmatizzazione a
al case management intensivo carico dei familiari (privacy!)
del paziente
(“medicina d’iniziativa”) Incremento delle richieste di
controllo socialeThe PADDI (Psychiatric and
Addictive Dual Diagnosis in Italy) Study
Participants (Mental Health Trusts):
24 in the North
42 5 in the Centre
13 in the South
Comorbid “psychotic” and alcohol/drugs misusing patients 681/9238 7.6%
People with SMI cared in Mental Health Trusts
Sex M/F ratio = 5.75:1
Mean age M 39 ± 12 years
F 44 ± 12 years
(t-test = 3.73, p = 0.0002)The PADDI (Psychiatric and
Addictive Dual Diagnosis in Italy) Study
Results: Dependence† and treatment for substance use by
SMI diagnoses2007 peer-oriented group interventions directed by a professional leader, despite heterogeneity of clinical models, are consistently effective in helping clients to reduce substance use and to improve other outcomes contingency management also appears to be effective in reducing substance use and improving other outcomes, but has been less thoroughly studied and rarely used in routine programs long-term residential interventions, again despite heterogeneity of models, are effective in reducing substance use and improving other outcomes for clients who have failed to respond to outpatient interventions and for those who are homeless intensive case management, including assertive community treatment, consistently improves residential stability and community tenure, but does not consistently impact substance use
2007 Several promising interventions, including family psychoeducation, intensive outpatient programs, self-help programs, and jail diversion and release programs, have received minimal research attention but warrant further study
o There is inconsistent evidence to support any individual psychotherapy intervention o Treatment of co-occurring severe mental illness and substance use disorder has heterogeneous evidence (studies are limited by heterogeneity of interventions, participants, methods, outcomes, and measures) o Future research will need to address methodological standardization, longitudinal perspectives, interventions for subgroups and stages, sequenced interventions, and the changing realities of treatment systems
There is a lack of evidence of effectiveness of the included interventions. Motivational interviewing and some family interventions may have some benefit. Cost-effectiveness has not yet been addressed in any studies, and further research is needed to determine whether any of these interventions can be recommended.
Interventi precoci
nella schizofrenia
Improved clinical outcomes at
2 years of intervention…
These included:
• Positive and negative
symptoms scores
• Reduced hospital bed days
• Significantly less
comorbid substance use
• Better adherence to
treatment, and more
satisfaction with
treatment
Outcomes were not
sustained over 5 years;
however
• OPUS cohort were living
more independently
• Less hospital bed days than
standard care2012 Services should be integrated and well coordinated: o team approach o be multidisciplinary o have specialist-trained personnel (including 24-hour access) o include a range of program types o provide for long-term follow-up Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses Further quality trials in this area will contribute to the growing body of data of effective interventions
Integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction
“
”
Central intake Unit
(Multimodality Approach
Workgroup)
Treatment Units for Intensive Care Units for Intensive Treatment
(Emergency Unit) (Addiction Community Center/TC)
Crisis Detoxification Facilities Out- (and inpatients) detoxification
Complex Detoxification Consultation General practitioners
Day hospital and Clinic Day hospital and Clinic/TherCom
Outreach: ACT & Harm-reduction Outpatient psychosocial treatmentsCome prendersi cura della persona
affetta da SMI e uso di alcol/droghe dal punto
di vista psicosociale?
Sono state proposte diverse tipologie
di intervento integrato per l’abuso
di sostanze, probabilmente efficaci
in soggetti con “doppia diagnosi”:
1. Counseling di gruppo
2. Terapia cognitivo-comportamentale
3. Contingency management
4. Trattamento residenziale a lungo termineYou can also read
