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Summary of Results

Health Topic:   Mental health and behavioural conditions
Guidance:   Schizophrenia (update)
Description:   The summary of the published clinical guideline on Schizophrenia (update). It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

All Party Parliamentary Group on Mental Health (2010) Implementation of NICE guideline on Schizophrenia

Description: The APPG sent questionnaires to every Mental Health Trust in England. Just over half of the 73 Trusts responded to the survey. The results identified serious challenges to the delivery of psychological services, particularly CBT, to all service users with a diagnosis of schizophrenia. CBT is one of the recommendations set out in the NICE guideline.

Practice appears not to be in line with guidance National

All Party Parliamentary Group on Mental Health (2011) Treatment of schizophrenia across NHS trusts: progress and barriers in implementation of best practice

Description: A survey was sent to every NHS Mental Health Trust in England. 68% of trusts responded and 86% of these reported specific changes as a result of NICE guidelines. However, over half of trusts had encountered difficulties funding implementation of the guideline. The majority of problems related to provision of psychological therapies, which appeared to be the greatest barrier to implementation of the NICE guideline.

Doubts about or mixed impact in practice National

Willis C et al (2010) Antipsychotic polypharmacy in a community psychiatric clinic European Neuropsychopharmacology PP s483-s484

Description: The EPEX electronic caseload system was used to obtain information on all patients with a diagnosis of schizophrenia/schizoaffective disorder at the community clinic. From a caseload of 480 patients, 101 relevant individuals were identified. Of these, 31 (31%) patients were prescribed more than one antipsychotic. The most common combination was a typical depot antipsychotic with an atypical oral antipsychotic (39%)

Doubts about or mixed impact in practice Local

Prytys M et al (2011) Implementing the NICE Guideline for Schizophrenia Recommendations for Psychological Therapies: A Qualitative Analysis of the attitudes of CMHT staff Clinical Psychology and Psychotherapy 18, 48-59

Description: Small study - The authors audited four CMHT's and five care coordinators from each team were interviewed. Results found that of the 20 care coordinators who participated in the study, 12 knew that both Cognitive Behaviour Therapy (CBT) and family intervention (FI) are psychological interventions recommended by the NICE guideline.

Doubts about or mixed impact in practice Local

The NHS Information Centre for Health and Social Care (2011) Use of NICE-appraised medicines in the NHS in England-2009, Experimental Statistics

Description: This is the second report commissioned by the Metrics Working Group to look at the variation in use of postively appraised medicines in relation to the expected use as predicted by NICE. In all, 47 medicines in 18 groups, relating to 29 technology appraisals were considered. Out of the 12 groups where a comparison could be made (these are presented in Section 1 of the technology section results), observed use by the NHS in England was higher than the predicted use for eight and lower for three.

Not graded National

Thalitaya M D et al (2011) POMHS 9B - Antipsychotic prescribing in people with a learning disability Psychiatria Danubia Vol. 23, Suppl. 1, pp 50-56. Conference paper

Description: This study presents results of a quality improvement programme on the use of antipsychotic medication in people with a learning disability. A case note baseline audit was conducted between 3rd January and 7th February 2011 using a standard data collection tool provided by POMH-UK; 7 clinical teams in Essex and Bedfordshire & Luton participated in the re-audit. Baseline results found between 70-98% of patients had documented evidence of a general assessment of side effects.

Practice appears to be in line with guidance Local

Payne, J. (2011) Do assertive outreach patients with schizophrenia receive adequate cardiovascular risk monitoring as per NICE guidance? Clinical Pharmacist. Conference Publication: (var.pagings). 3 (3) (pp S1), 2011. Date of Publication: March 2011.

Description: This audit aimed to determine whether annual cardiovascular risk assessments are conducted in people with schizophrenia by Nottinghamshire NHS Trust?s Assertive Outreach (AO) Team, in line with NICE guidance and whether results are documented in the patients' secondary care notes. Patients? notes were checked between Oct-Dec 2009, and findings show cardiovascular risk monitoring varied between 35% - 70% and that less than 30% of patients had information recorded in their secondary care notes.

Doubts about or mixed impact in practice Local

The Schizophrenia Commission (2012) The abandoned illness: a report from the Schizophrenia Commission.

Description: The Schizophrenia Commission was set up in November 2011 to review how outcomes for people with schizophrenia and psychosis can be improved. This report presents findings from formal evidence gathering sessions involving over 80 experts, results from an online survey responded to by 2500 people, findings from visits to services across England and relevant published research literature. Findings included that only 1 in 10 of those who could benefit receives Cognitive Behavioural Therapy.

Practice appears not to be in line with guidance National

Royal College of Psychiatrists (2013) Report of the National Audit of Schizophrenia (NAS) 2012

Description: This report measured implementation of the 2009 NICE guideline on schizophrenia in England and Wales, reporting on the use of psychological therapies and prescribing of antipsychotic medications. 60/64 eligible NHS Mental Health Trusts in England and Wales submitted data on a sample of 100 adults under their care. Findings include 43% of eligible patients had not been offered clozapine, with no documented reason; and 16% of service users were receiving more than one antipsychotic drug at a time.

Doubts about or mixed impact in practice National

Jesudason, P. et al (2013) Physical health monitoring of patients taking antipsychotic medication in primary and secondary care: A complete audit European Psychiatry. Volume 28, Supplement 1, 2013 - Abstracts of the 21st European Congress of Psychiatry

Description: This audit sought to establish whether patients taking antipsychotics received appropriate annual health screens. Initial audit of 82 case notes found that monitoring of physical health comorbidity in patients with serious mental illness was poor. Re-audit one year later, following interventions, found recommendation of physical health monitoring to primary care increased from 40.2% to 76.8%, as did monitoring frequency, including weight (7.3% to 54.3%) and blood pressure (7.3% to 49.4%).

Practice appears not to be in line with guidance Local

This page was last updated: 10 January 2013

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.