ICD-11 was released by WHO in 2018 and approved by the World Health Assembly (WHA) in 2019. The revision for all chapters was guided by the principles of global applicability, scientific validity and ...clinical utility. The new chapter for mental health is termed 06 Mental, Behavioural or Neurodevelopmental Disorders (MBND). The ICD-11 with its chapter on Mental, Behavioural or Neurodevelopmental Disorders, its Mortality and Morbidity Statistics (MMS), Coding Tool and Reference Guide, Clinical Descriptions and Diagnostic Guidelines (CDDG), and other tools for translation and implementation offers an innovative approach for individualised diagnosis, treatment and care of people with mental disorders. For supporting the international process of implementation, WHO has installed an International Advisory Group for Training and Implementation of ICD-11 MBND. Development, Concept and Structure of ICD-11 will be presented. Selected changes from ICD-10 to ICD-11 like new diagnostic categories, revision of diagnostic criteria, introduction of dimensional symptom qualifiers or course descriptors, and options for complex coding with regard to their innovative strength, controversial potential and impact on diagnostics, treatment and care will be briefly discussed. National challenges for implementation - partly informed by international field trials, administrative, organisational, educational and training requirements - will be outlined. The new ICD-11 chapter on Schizophrenia or other primary psychotic disorders will serve as an example to discuss potential impact on treatment selection and outcome.
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The EPA Guidance on the Quality of eMental health interventions in the treatment of psychotic disorders (1), based on systematic literature review, found strong evidence that web- and mobile based ...interventions for people with schizophrenia and/or other psychotic disorders are feasible and acceptable both for patients and caregivers. There was moderate evidence that eMental health interventions may improve specific elements of mental healthcare processes, such as shared-decision-making, symptom monitoring, disease management, information provision, empowerment, and there was preliminary evidence that they may also improve outcomes by fostering symptom reduction and treatment adherence. E-mental health interventions hold promise to shape the future of mental healthcare delivery through increasing service accessibility, reducing stigma and self-stigma, and providing timely and flexible support to individuals with psychotic disorders and their caregivers. Nevertheless, it is important to also consider other aspects such as the lack of ethical guidelines and quality assurance mechanisms, and the need to analyse the legal frameworks about eMental health in different nations when developing and implementing eMental health interventions. We did not identify ethical guidelines or quality assurance systems specifically developed for eMental health interventions targeting people with psychotic disorders. E-mental health interventions are efficacious to increase mental health literacy. We also found preliminary evidence that eMental health interventions are efficacious to treat psychotic disorders. Recent overviews (2) are coming to similar conclusions. Future research needs to provide better controlled, sufficiently powered studies to provide definite answers to open questions. Gaebel et al., 2016, DOI 10.1007/s00406-016-0677-6 Donahue, Rodriguez, Shore, 2021, doi.org/10.1007/s11920-021-01242-y
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Abstract Body
In times of global crisis like the present Covid-19 pandemic, digital technology is rapidly conquering the health and mental health & care sector, speeding up e-Mental Health (eMH) ...implementation on a regional, national and global scale. Making this an organized move, guidance and regulation, legislation and training, but basically also awareness and acceptance building need to ensure the use of efficient, safe and high-quality eMH products and services. Special attention needs to focus on broadening public and professional eMH literacy, providing needs-tailored approaches for target groups, and training mental health workforce and services. Guidance, evaluation and involvement of relevant stakeholders should help to identify how citizens will best benefit from eMH&Care in its various forms. The Transnational Policy for e-Mental Health, a guidance document for European policymakers and stakeholders has been developed by the Interreg-funded eMEN project (www.nweurope.eu/emen) in six EU countries to promote implementation of high-quality eMH & care across NW-Europe. Project partners from Belgium, France, Germany, Ireland, the Netherlands and the UK contributed to product and policy-guidance development, promoting communication and research. eMEN is currently continuing its work in the Interreg-funded Capitalisation phase to scaling up the implementation of eMH&Care. The Transnational Policy within the scope of national information and training sessions on eMH will be promoted for action planning and implementation by policymakers and stakeholders at the national level. Further meetings will also take place at the European level to promote and support implementation of eMH&Care in NW-Europe and beyond.
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No significant relationships.
During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are ...primary and persistent.
In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice.
Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings.This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones.The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment.Several recommendations are provided for the identification of secondary negative symptoms in clinical settings.
The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is ...a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms.However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.
Introduction The stigma of mental illness is still a major challenge for psychiatry. For patients, stigma experiences and self-stigma are associated with reduced quality of life and increased ...vulnerability to a more chronicle illness course. Nevertheless, there is a scarcity of validated therapeutic approaches addressing strategies for coping with stigma. Objectives and aims A manualized psycho-educational group therapy for stigma coping and empowerment (STEM) should be tested for efficacy in patients with depression and schizophrenia. The study was funded by a research grant of the Federal Ministry of Education and Research. Methods A cluster-randomized RCT with two arms including 30 mental health care services (psychiatric inpatient services, day-units, and outpatient services, as well as inpatient psychiatric rehabilitation services) was conducted. The intervention consisted of 8 sessions regular psycho-education group therapy and 3 sessions addressing stigma coping and empowerment. Controls received 11 sessions regular psycho-education. Primary outcome variable was quality of life (WHO-QOL). Assessments were conducted directly before and after the intervention, and at 3, 6 and 12 months follow-ups. Results A total of 469 patients participated and more than 300 participants (approx. 65%) completed the 12-month follow-up. First results of the analysis will be presented at the conference. Conclusions Since the statistical analysis is currently in progress, no conclusions concerning the efficacy of the tested therapeutic approach can be done by now. Nevertheless there is a strong need for supporting patients in developing positive stigma coping strategies. STEM is the first therapeutic approach to our knowledge tested for efficacy in a RCT.
Introduction The goal of value-based healthcare is to improve the quality of care while also lowering healthcare costs. Values may also include societal or research benefits. Objectives To outline ...the emergence and quality-related concepts of value-based healthcare. Aims To give a comprehensive overview and critical discussion of quality aspects of value-based mental healthcare including aspects of personal, societal and scientific values. Methods Review of quality aspects of value-based mental healthcare. Results The quality aspect of value-based healthcare includes the implementation of patient-centered care and may include the assessment of societal values or values for research purposes. Current concepts focus on the reduction of disability-adjusted life years to measure the achievement of values, but may need to be broadened to include benefits to society as a whole or the progress of knowledge about mental disorders in research. Conceptually, addressing such broader value issues may lead to increased benefits and a better appraisal of the value of mental healthcare. Conclusions The trend towards value-based mental healthcare aims at creating an efficient care delivery model, that strongly focuses on achieving favorable patient outcomes and may in the future also include creating societal values. It includes the development and implementation of suitable mental health policies and comprehensive quality assessment, plus a broad conceptualization of the value-term and its assessment in value-based mental healthcare.
The EPA Guidance Project Introduction In European countries, guidelines are important tools in quality assurance in mental healthcare. However, not all topics relevant to the quality of mental ...healthcare provision are covered by guidelines, e.g. due to limited availability of data and data protection constraints. Therefore, in 2008, the European Psychiatric Association (EPA) established the EPA Guidance project with a view to produce practical guidance papers on topics relevant to quality assurance in mental healthcare. Objectives To improve the quality of mental healthcare in Europe by disseminating written information based on best evidence and psychiatric practice, especially in areas where guidelines are lacking. Aims To describe the current status of the EPA Guidance project. Methods Review of the EPA Guidance project and its Guidance documents. Results EPA Guidance documents provide evidence- and consensus-based recommendations on topics relating to the quality assurance of mental health services, such as quality of mental health service structures and processes, and building trust in mental health services. Conclusions European harmonization of the quality assurance of mental healthcare may be advanced on a supranational level with the help of the European Guidance. Its recommendations may be adapted to national or regional conditions to suit the needs, priorities and legislation of European constituents. Reference Gaebel W, Becker T, Janssen B, Munk-Jorgensen P, Musalek M, Rössler W, Sommerlad K, Tansella M, Thornicroft G, Zielasek J. EPA guidance on the quality of mental health services. Eur Psychiatry 2012 27:87–113 Gaebel W Möller H-J. European Guidance – a project of the European Psychiatric Association. European Psychiatry 2012 27:65-67
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