Article

Indicators of conformance with guidelines of schizophrenia treatment in mental health services.

Services for Medical Research, Les Chales 1983, Evolene, Switzerland.
Psychiatric Services (impact factor: 2.38). 08/2008; 59(7):782-91. DOI:10.1176/appi.ps.59.7.782 pp.782-91
Source: PubMed

ABSTRACT The aim of this study was to develop indicators of conformance in clinical practice with guidelines for care in schizophrenia. Recommended guidelines rarely apply to all patients and need to allow for social ability, family context, and phase of the disorder. These indicators were therefore devised for tailoring to patient characteristics and allowing for factors that may justify the lack of adherence to clinical guidelines.
A team of senior clinicians and methodologists reviewed three clinical guidelines (from the Schizophrenia Patient Outcomes Research Team, McEvoy and colleagues, and the National Institute for Health and Clinical Excellence) and defined criteria for their operationalization into clinical indicators. For each indicator, the team defined criteria for eligibility (requirements to be met to qualify for evaluation), conformance (criteria to be satisfied to comply with each recommendation), and moderators (factors that could justify the lack of application of a given recommendation). These indicators were tested with a random sample of 807 patients with schizophrenia or schizoaffective disorders in outpatient facilities, long-term residential facilities, and hospital units for acute care in the Piedmont region of Italy.
A set of 15 indicators was derived, nine concerning pharmacological treatment and six for general care and psychosocial rehabilitation. Moderators such as patient or family refusal of antipsychotic treatment and the patient's level of disability helped to justify a considerable proportion of nonconformant care.
The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.

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    Dataset: morris et al schizophr bull advance access
    Richard Morris, Oren Griffiths, Michael E Le Pelley, Thomas W Weickert
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    Article: Attention to Irrelevant Cues Is Related to Positive Symptoms in Schizophrenia.
    Richard Morris, Oren Griffiths, Michael E Le Pelley, Thomas W Weickert
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    ABSTRACT: Many modern learning theories assume that the amount of attention to a cue depends on how well that cue predicted important events in the past. Schizophrenia is associated with deficits in attention and recent theories of psychosis have argued that positive symptoms such as delusions and hallucinations are related to a failure of selective attention. However, evidence demonstrating that attention to irrelevant cues is related to positive symptoms in schizophrenia is lacking. We used a novel method of measuring attention to nonpredictive (and thus irrelevant) cues in a causal learning test (Le Pelley ME, McLaren IP. Learned associability and associative change in human causal learning. Q J Exp Psychol B. 2003;56:68-79) to assess whether healthy adults and people with schizophrenia discriminate previously predictive and nonpredictive cues. In a series of experiments with independent samples, we demonstrated: (1) when people with schizophrenia who had severe positive symptoms successfully distinguished between predictive and nonpredictive cues during training, they failed to discriminate between predictive and nonpredictive cues relative to healthy adults during subsequent testing and (2) learning about nonpredictive cues was correlated with more severe positive symptoms scores in schizophrenia. These results suggest that positive symptoms of schizophrenia are related to increased attention to nonpredictive cues during causal learning. This deficit in selective attention results in learning irrelevant causal associations and may be the basis of positive symptoms in schizophrenia.
    Schizophrenia Bulletin 01/2012; · 8.80 Impact Factor
  • Source
    Article: Attention to Irrelevant Cues Is Related to Positive Symptoms in Schizophrenia
    Richard Morris, Oren Griffiths, Michael E Le Pelley, Thomas W Weickert
    [show abstract] [hide abstract]
    ABSTRACT: Many modern learning theories assume that the amount of attention to a cue depends on how well that cue predicted important events in the past. Schizophrenia is associated with deficits in attention and recent theories of psychosis have argued that positive symptoms such as delusions and hallucinations are related to a failure of selective attention. However, evidence demonstrating that attention to irrelevant cues is related to positive symptoms in schizophrenia is lacking. We used a novel method of measuring attention to nonpredictive (and thus irrelevant) cues in a causal learning test (Le Pelley ME, McLaren IP. Learned associability and associative change in human causal learning. Q J Exp Psychol B. 2003;56:68–79) to assess whether healthy adults and people with schizophrenia discriminate previously predictive and nonpredictive cues. In a series of experiments with independent samples, we demonstrated: (1) when people with schizophrenia who had severe positive symptoms successfully distinguished between predictive and nonpredictive cues during training, they failed to discriminate between predictive and nonpredictive cues relative to healthy adults during subsequent testing and (2) learning about nonpredictive cues was correlated with more severe positive symptoms scores in schizophrenia. These results suggest that positive symptoms of schizophrenia are related to increased attention to nonpredictive cues during causal learning. This deficit in selective attention results in learning irrelevant causal associations and may be the basis of positive symptoms in schizophrenia.
    Schizophrenia Bulletin 01/2012; 39(3):575-582. · 8.80 Impact Factor

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Keywords

15 indicators
 
acute care
 
areas needing improvement
 
Clinical Excellence
 
clinical guidelines
 
clinical indicators
 
considerable proportion
 
family context
 
general care
 
hospital units
 
long-term residential facilities
 
National Institute
 
nonconformant care
 
outpatient facilities
 
patient's level
 
patients
 
Piedmont region
 
psychosocial rehabilitation
 
Schizophrenia Patient Outcomes Research Team
 
senior clinicians