Nidotherapy in the treatment of substance misuse, psychosis and personality disorder: secondary analysis of a controlled trial

Abstract

Aims and methodTo examine the clinical outcome and bed usage in patients with comorbid substance misuse and psychosis. The patients were randomised to ordinary assertive outreach team care or to enhanced assertive outreach with nidotherapy. Ratings of clinical symptoms, social function, engagement with services, bed usage (primary outcome after 1 year) and economic costs were assessed at baseline and at 6 and 12 months after randomisation.ResultsPatients referred to nidotherapy had similar reduction in symptoms and engagement, with marginal superiority in social function (P= 0.045). There was a 110% reduction in hospital bed use after 1 year compared with control assertive care (P= 0.03). The mean cost savings for each patient allocated to nidotherapy was £14705 per year, mainly as a consequence of reduced psychiatric bed use.Clinical implicationsNidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage.

On the clinical utility and empirical verification of nontraditional interventions: Nidotherapy as exemplar

“…Finally, it is important to note that although controlled clinical trials generally support the effectiveness of nidotherapy, these trials have examined a relatively narrow range of patients (primarily those with severe mental illness and substance use disorders), with modest sample sizes. As a result, although some studies have documented significant improvement in patients undergoing nidotherapy (e.g …”

“…The clinical utility of nidotherapy is reasonably well established; controlled clinical trials (e.g. 13 ) and case reports (e.g. 14 ) converge to confirm that patients undergoing nidotherapy generally show improved functioning post-treatment.…”

“…As a result, although some studies have documented significant improvement in patients undergoing nidotherapy (e.g. 13 ), others have reported nonsignificant or marginally significant results, due in part to the modest number of patients assessed (e.g. 8,27 ).…”

Nidotherapy in the successful management of comorbid depressive and personality disorder

“…As such, it can be regarded as an intervention that is more of a quasi‐treatment, as the whole focus of management is to change the environment, not the person. It can be used at any point in the management of a psychiatric patient but is often particularly useful when all other interventions have failed and has supportive evidence of efficacy from controlled investigations . It comprises four phases, personal understanding (an in‐depth assessment of the patient's reasoning and functioning), environmental analysis (of physical, social and personal environments), the development of a timetable of environmental change (the nidopathway), and monitoring and adjustment of the nidopathway.…”

“…It can be used at any point in the management of a psychiatric patient but is often particularly useful when all other interventions have failed 2 and has supportive evidence of efficacy from controlled investigations. 3,4 It comprises four phases, personal understanding (an in-depth assessment of the patient's reasoning and functioning), environmental analysis (of physical, social and personal environments), the development of a timetable of environmental change (the nidopathway), and monitoring and adjustment of the nidopathway. We describe here the value of planned and systematic environmental change as the likely cause of dramatic and long-lasting improvement in someone with what appeared to be an intractable severe mental illness.…”