Evaluation of a Collaborative Care Program for Patients With Treatment-Resistant Schizophrenia: Protocol for a Multiple Case Study

Abstract

Background Approximately one-third of all patients with schizophrenia are treatment resistant. Worldwide, undertreatment with clozapine and other effective treatment options exist for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular health care models do not optimally fit this patient group. The Collaborative Care (CC) model has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental health care facilities. The key principles of the CC model are that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is multidisciplinary in nature and uses evidence-based interventions. We developed a tailored CC program for patients with TRS. Objective In this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of the CC program for patients with TRS. Moreover, we aim to gain insight into the experiences of professionals, patients, and informal caregivers with the program. Methods This study will be underpinned by a multiple case study design (N=20) that uses a mixed methods approach. These case studies will focus on an Early Psychosis Intervention Team and 2 Flexible Assertive Community treatment teams in the Netherlands. Data will be collected from patient records as well as through questionnaires, individual interviews, and focus groups. Patient recruitment commenced from October 2020. Results Recruitment of participants commenced from October 2020, with the aim of enrolling 20 patients over 2 years. Data collection will be completed by the end of 2023, and the results will be published once all data are available for reporting. Conclusions The research design, framed within the process of developing and testing innovative interventions, is discussed in line with the aims of the study. The limitations in clinical practice and specific consequences of this study are explained. International Registered Report Identifier (IRRID) DERR1-10.2196/35336

Application Research of Humanistic Care and Situational Integration in Nursing of Schizophrenia in Recovery Period

“…The impact of psychological interventions on improving patients has been confirmed by a large number of studies with very precise effects [ 30 ]. Some studies on psychological interventions for patients with somatic disorders have shown improved quality of life in patients who received psychological interventions [ 31 ]. For patients with psychiatric disorders, psychological interventions can also improve their quality of life.…”

Kegawat Daruratan dan Treatment Pasien Schizophrenia Dengan Perilaku Kekerasan Berulang : Study Case

“…Clozapine mungkin merupakan satu-satunya antipsikotik yang efektif untuk menekan perilaku agresif. Penting untuk mengidentifikasi populasi schizophrenia yang rentan dan memberikan pengobatan serta perawatan yang efisien (10) Perawatan kesehatan mental yang harusnya disarankan untuk memberikan intervensi awal manajemen penyakit anti-stigma (14),( 15),( 17), (18) dan psikoedukasi keluarga kepada orang yang didiagnosis schizophrenia dan pengasuh keluarga mereka, membantu mereka mengembangkan pemahaman optimis tentang konsep schizophrenia dan mengurangi konsekuensi negatif stigma publik dan internal (16), (18) . Sangat penting juga bagi pengelola kesehatan jiwa di fasilitas kesehatan tingkat pertama untuk lebih berperan dalam melakukan kontrol dalam hal perawatan dan terapi kolaboratif.…”

Including families in schizophrenia treatment: a systematic review

“…Re-admission of schizophrenic patients to mental health services for less than one day has become a popular issue for intervention from both service providers, families as part of the closest unit of sufferers and needs attention from the community. There are various factors that cause the return of schizophrenic patient to be re-admitted in mental health services, such as unmarried status, previous history of forced entry, longer forced entry days, and shorter total days of admission, which were associated with an increased risk for one year re-enrollment [9]- [11]. The impacts of re-admission include; increased cost of care, longer treatment, increased burden on family and clients, decreased quality of life and cognitive, and disease severity.…”