Goed gestart is half behandeld

Implementatie en borging van vroegdetectie en interventie in de psychosezorg
06/05/2022
Birgit Seelen-de Lang, Karin Janssen, Nienke Duijnhouwer, Paul de Bont
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Volume 57, Issue 5

Samenvatting

Well begun is half done:

Implementation and maintenance of early detection and intervention in mental health care for psychosis.

N. Duijnhouwer, B. Seelen-de Lang, K. Janssen & P. de Bont

The past decade mental health organizations worldwide implemented Early Detection and Intervention (EDI) teams for help-seeking non-psychotic patients with a high risk profile for psychosis. A growing body of evidence shows that EDI helps diminish the burden of the symptoms and problems associated with the risk profile,  substantially decreases the transition rate to first psychotic episodes and is cost effective. Nevertheless, to many professionals and organizations in mental health EDI is still unknown and implementation is not prioritized. In order to further help bridge the gap between scientifically proven guidelines and clinical practice this article evaluates the implementation of EDI in a mental health organization. To foster dissemination and implementation of EDI in clinical practice the authors present useful pitfalls and success factors.

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  • Samenvatting
    • Implementatieproblemen
  • Implementatie EDI in GGZ Oost Brabant
  • Resultaten
  • Discussie
  • Literatuurlijst
  • Over de auteur
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Afgelopen decennia zijn Early Detection and Intervention (edi) teams gestart voor niet-psychotische cliënten met een ultrahoog psychose-risicoprofiel. Studies tonen aan dat een edi-team problemen rond psychose effectief behandelt, het aantal nieuwe psychosen drastisch vermindert en kosteneffectief is. Toch worstelen ggz-organisaties met opzet en behoud van edi-teams. Om de kloof tussen klinische praktijk en evidence-based richtlijnen te verkleinen, wordt de implementatie en borging van een edi-team geëvalueerd.

Steeds meer GGZ-instellingen in Nederland en wereldwijd bieden een zorgaanbod van vroege opsporing en interventie aan voor hulpzoekende, niet-psychotische cliënten met een ultrahoog risicoprofiel (UHR) voor psychose. Deze aanpak, in Nederland vooral bekend als Early Detection and Intervention (EDI), is al jarenlang in Europese  en Nederlandse richtlijnen opgenomen (iepaw, 2005; nice, 2013; WerkgroepPsychose, 2017).

Recente reviews en meta-analyses onderstrepen met steeds robuustere evidentie het belang om EDI te implementeren in de GGZ (Bosnjak Kuharic et al., 2019; P. Fusar-Poli et al., 2020; Hutton & Taylor, 2014; Mei et al., 2021; Nelson et al., 2019; Stafford et al., 2013; van der Gaag et al., 2012; Zhang et al., 2020). Want EDI voor UHR reduceert klachten, verbetert de kwaliteit van leven, verkleint de kans op een transitie naar een eerste psychose en kost op termijn minder geld (Ising et al., 2017; Jin et al., 2020).

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Literatuurlijst

  1. Akwa GGZ (2021). Rapport Uitkomsten Online panel Akwa GGZ Screening op problematisch alcoholgebruik en op hoog risico op psychose.
  2. Bond, G. R., Drake, R.E., McHugo, G.J., Peterson, A.E., Jones, A.M. & Williams, J. (2014). Long-term sustainability of evidence-based practices in community mental health agencies. Adm Policy Ment Health, 41 (2), 228-236. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23266661. doi:10.1007/s10488-012-0461-5
  3. Bosnjak Kuharic, D., Kekin, I., Hew, J., Rojnic Kuzman, M. & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews, 2019 (11). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31689359. doi:10.1002/14651858.CD012236.pub2
  4. de Jong, Y., Mulder, C.L., Boon, A.E., Deen, M., van ‘t Hof, M. & van der Gaag, M. (2018). Screening for psychosis risk among adolescents in Child and Adolescent Mental Health Services: a description of the first step with the 16-item version of the Prodromal Questionnaire (PQ-16). Early Interv Psychiatry, 12 (4), 669-676. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27860294. doi:10.1111/eip.12362
  5. Fusar-Poli, P., Rutigliano, G., Stahl, D., Davies, C., De Micheli, A., Ramella-Cravaro, V., . . . McGuire, P. (2017). Long-term validity of the At Risk Mental State (ARMS) for predicting psychotic and non-psychotic mental disorders. European Psychiatry, 42, 49-54.
  6. Fusar-Poli, P., Salazar de Pablo, G., Correll, C.U., Meyer-Lindenberg, A., Millan, M.J., Borgwardt, S., . . . Arango, C. (2020). Prevention of Psychosis: advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/32159746. doi:10.1001/jamapsychiatry.2019.4779
  7. Gibbons, C.R., Stirman, S.W., DeRubeis, R.J., Newman, C.F. & Beck, A.T. (2013). Research setting versus clinic setting: which produces better outcomes in cognitive therapy for depression? Cognitive Therapy and Research, 37 (3), 605-612. doi:10.1007/s10608-012-9499-7
  8. GGZ Standaarden (2021). Zorgstandaard Psychose. .
  9. Hansen, N.B., Lambert, M.J. & Forman, E.M. (2002). The Psychotherapy Dose-Response Effect and Its Implications for Treatment Delivery Services. Clinical Psychology: science and Practice, 9 (3), 329-343. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1093/clipsy.9.3.329. doi:10.1093/clipsy.9.3.329
  10. Hasmi, L., Pries, L.K., Ten Have, M., de Graaf, R., van Dorsselaer, S., Bak, M., . . . van Os, J. (2021). What makes the psychosis ‘clinical high risk’ state risky: psychosis itself or the co-presence of a non-psychotic disorder? Epidemiol Psychiatr Sci, 30, e53. Retrieved from . doi:10.1017/S204579602100041X
  11. Hutton, P. & Taylor, P.J. (2014). Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis. Psychol Med, 44(3), 449-468. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23521867. doi:10.1017/S0033291713000354
  12. IEPAW (2005). International clinical practice guidelines for early psychosis. International early psychosis association group. British Journal of Psychiatry, 187, 120-124.
  13. Ising, H.K., Lokkerbol, J., Rietdijk, J., Dragt, S., Klaassen, R.M., Kraan, T., . . . van der Gaag, M. (2017). Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: the Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial. Schizophr Bull, 43 (2), 365-374. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27306315. doi:10.1093/schbul/sbw084
  14. Ising, H.K., Veling, W., Loewy, R L., Rietveld, M.W., Rietdijk, J., Dragt, S., . . . van der Gaag, M. (2012). The Validity of the 16-Item Version of the Prodromal Questionnaire (PQ-16) to Screen for Ultra High Risk of Developing Psychosis in the General Help-Seeking Population. Schizophrenia Bulletin, 38 (6), 1288-1296. Retrieved from http://schizophreniabulletin.oxfordjournals.org/content/38/6/1288.abstract. doi:10.1093/schbul/sbs068
  15. Jin, H., Tappenden, P., MacCabe, J.H., Robinson, S., McCrone, P. & Byford, S. (2020). Cost and health impacts of adherence to the National Institute for Health and Care Excellence schizophrenia guideline recommendations. Br J Psychiatry, 1-6. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/33308329. doi:10.1192/bjp.2020.241
  16. McNemar, Q. (1947). Note on the sampling error of the difference between correlated proportions or percentages. Psychometrika 12, 153–157. https://doi.org/10.1007/BF02295996
  17. Mei, C., van der Gaag, M., Nelson, B., Smit, F., Yuen, H.P., Berger, M., . . . McGorry, P.D. (2021). Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis. Clinical Psychology Review. doi:10.1016/j.cpr.2021.102005
  18. Nelson, B., Amminger, G.P., Bechdolf, A., French, P., Malla, A., Morrison, A.P., . . . McGorry, P.D. (2019). Evidence for preventive treatments in young patients at clinical high risk of psychosis: the need for context. The Lancet Psychiatry. Retrieved from http://www.sciencedirect.com/science/article/pii/S2215036619305139. doi:https://doi.org/10.1016/S2215-0366(19)30513-9
  19. Maher, L., Gustafson, D. & Evans, A. (2010). Sustainability Model and Guide. NHS Institute for Innovation and Improvement. https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/NHS-Sustainability-Model-2010.pdf
  20. NICE. (2013). Psychosis and schizophrenia in children and young people. The NICE guideline on recognition and management. London: the British Psychological Society and The Royal College of Psychiatrists.
  21. Proctor, E.K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C. & Mittman, B. (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health, 36 (1), 24-34. doi:10.1007/s10488-008-0197-4
  22. Schirmbeck, F., van der Burg, N. C., Blankers, M., Vermeulen, J.M., McGuire, P., Valmaggia, L.R., . . . de Haan, L. (2021). Impact of Comorbid Affective Disorders on Longitudinal Clinical Outcomes in Individuals at Ultra-high Risk for Psychosis. Schizophr Bull. Retrieved from . doi:10.1093/schbul/sbab088
  23. Stafford, M.R., Jackson, H., Mayo-Wilson, E., Morrison, A.P. & Kendall, T. (2013). Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ, 346, f185. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23335473. doi:10.1136/bmj.f185
  24. van der Gaag, M., Nieman, D.H., Rietdijk, J., Dragt, S., Ising, H.K. Klaassen, R.M., . . . Linszen, D.H. (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophr Bull, 38 (6), 1180-1188. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22941746. doi:10.1093/schbul/sbs105
  25. van der Gaag, M., Nieman, D.H. & van den Berg, D. (2013). CBT for Those at Risk of a First Episode Psychosis. Evidence-based psychotherapy for people with an ‘At Risk Mental State’. East Sussex: routledge.
  26. Waller, G. & Turner, H. (2016). Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get backon track. Behaviour Research and Therapy, 77, 129-137. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=psyc13&AN=2016-07436-017.
  27. WerkgroepPsychose. (2017). Zorgstandaard Psychose. Retrieved from https://www.ggzstandaarden.nl/zorgstandaarden/psychose/preview
  28. Yung, A.R., Yuen, H.P., McGorry, P.D., Phillips, L.J., Kelly, D., Dell’Olio, M., . . . Stanford, C. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry, 39 (11-12), 964-971.
  29. Zhang, T., Xu, L., Tang, X., Wei, Y., Hu, Q., Hu, Y., . . . Wang, J. (2020). Real-world effectiveness of antipsychotic treatment in psychosis prevention in a 3-year cohort of 517 individuals at clinical high risk from the SHARP (ShangHai At Risk for Psychosis). Aust N Z J Psychiatry, 54 (7), 696-706. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/32436725. doi:10.1177/0004867420917449