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Background: Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed.Aims: To document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway.Method: Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed.Results: A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP.Conclusions: Community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP. [ABSTRACT FROM AUTHOR]

Background : Despite randomized controlled trials (RCTs) being regarded as the gold standard for intervention research in mental health, there is a lack of guidance on the practicalities of setting up and conducting such trials in the NHS. Aims : To provide information for new clinical trials collated from the experiences of carrying out the NCCHTA-funded CUtLASS trial (reported in an HTA Monograph entitled “Randomised controlled trials of conventional versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment”). Conclusions : The main practical considerations in clinical trials can be grouped into issues of Staffing, Trial Management and Data Management. Matters that impact on recruitment include the research question, the interest of clinicians in that question, the extent of clinical equipoise, and the provision of adequate reimbursement of service support costs associated with participation in the trial. [ABSTRACT FROM AUTHOR]

Background: Early intervention teams attempt to improve outcome in schizophrenia through earlier detection and the provision of phase-specific treatments. Whilst the number of early intervention teams is growing, there is a lack of clarity over their essential structural and functional elements. Methods: A 'Delphi' exercise was carried out to identify how far there was consensus on the essential elements of early intervention teams in a group of 21 UK expert clinicians. Using published guidelines, an initial list was constructed containing 151 elements from ten categories of team structure and function. Results: Overall there was expert consensus on the importance of 136 (90%) of these elements. Of the items on which there was consensus, 106 (70.2%) were rated essential, meaning that in their absence the functioning of the team would be severely impaired. Conclusion: This degree of consensus over essential elements suggests that it is reasonable to define a model for UK early intervention teams, from which a measure of fidelity could be derived. [ABSTRACT FROM AUTHOR]

The article focuses on the move of National Institute for Clinical Excellence to issue guidance on the use of antipsychotic drugs in the treatment of schizophrenia in Great Britain. It was pointed out that the guidance had a national implementation time of three months, and carries the expectation that health professionals take it fully into account when exercising their clinical judgement. It has also cited the benefits of the new drugs in comparison with conventional antipsychotic agents.

The authors focus on the new research and development funding system in the British National Health Service (NHS) and summarizes its current situation. In March 31, 1996, NHS Executive required all NHS trusts to declare their net costs of carrying out and supporting non-commercial research and development, known as the Culyer Return or Culyer Declaration. Under the new method of funding, the initial research and development Levy will approximately be £400,000,000. This is the sum of the costs declared by trusts plus the amount the NHS Executive retains for national and regional programs. The funding system will distribute money in two schemes, portfolio funding and task linked funding.

Abstract: Major problems with existing RCTs evaluating psychosocial interventions for psychosis and substance misuse have been identified, in particular small sample sizes, high attrition rates, and short follow up periods. With a sample size of 327 and a follow up of 2 years, the MIDAS trial in the UK is to date the largest RCT for people with psychosis and substance use and is evaluating an integrated MI and CBT (“MiCBT”) client therapy. Whilst the outcomes of the study are not yet available, data on recruitment and retention indicate that attrition rates in MIDAS are low and the majority of those allocated to treatment received a substantial number of therapy sessions. Sample characteristics are in line with those reported in epidemiological studies and are indicative of the challenges facing mental health services attempting to manage the client group: substance use is often longstanding, with frequent use at moderate or severe level and low motivation for change, and seen in the context of low levels of functioning and significant psychopathology. We conclude that this is a methodologically robust study that will have results generalisable to mental health services. [Copyright &y& Elsevier]

Objective: To assess whether clozapine is likely to be more cost-effective than other second-generation antipsychotics (SGAs) in people with schizophrenia. Methods: An integrated clinical and economic multicenter, rater-blind, randomized controlled trial (RCT) compared clozapine to the class of other SGAs, using the perspectives of the National Health Service, social support services, and patients. The practice setting was secondary and primary care in the United Kingdom; patients were followed for 1 year. Incremental cost-effectiveness ratios (ICERs), net benefit statistics, and cost acceptability curves were estimated. Results: The ICER for clozapine was £33,240 per quality-adjusted life-year (QALY) (range £23,000–70,000 for the sensitivity analyses). The proportion of simulations when clozapine was more cost-effective than other SGAs reached 50% if decision-makers are prepared to pay £30,000 to £35,000 per QALY. This is at the top of the range of acceptable willingness-to-pay values per QALY implied by decisions taken by the National Institute for Health and Clinical Excellence (NICE). Conclusions: This study adds to a limited body of evidence comparing clozapine to other SGAs and is the first economic and clinical RCT to compare clozapine to the class of other SGAs using the lower cost of generic clozapine and a pragmatic trial design. Policy decisions by the NICE suggest that additional reasons would be needed to accept clozapine as effective and efficient if it had a high probability of having ICERs more than £35,000 per QALY. The results and limitations of the analysis suggest that there is still a need for further economic evaluation of clozapine. [ABSTRACT FROM AUTHOR]

These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.