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Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance.
Ostuzzi, Giovanni; Barbui, Corrado; Hanlon, Charlotte; Chatterjee, Sudipto; Eaton, Julian; Jones, Lynne; Silove, Derrick; Ventevogel, Peter.
Afiliação
  • Ostuzzi G; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. giovanni.ostuzzi@gmail.com.
  • Barbui C; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
  • Hanlon C; Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia.
  • Chatterjee S; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK.
  • Eaton J; Sangath Centre, Porvorim, Goa, India.
  • Jones L; School of Population Health, Melbourne, Australia.
  • Silove D; London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
  • Ventevogel P; CBM International, Bensheim, Germany.
BMC Med ; 15(1): 197, 2017 Dec 11.
Article em En | MEDLINE | ID: mdl-29224570
ABSTRACT

BACKGROUND:

Populations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings.

METHODS:

Following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations.

RESULTS:

When first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions.

CONCLUSIONS:

Adapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transtornos Psicóticos / Socorro em Desastres / Antipsicóticos Tipo de estudo: Diagnostic_studies / Guideline Limite: Humans Idioma: En Revista: BMC Med Assunto da revista: MEDICINA Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Itália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transtornos Psicóticos / Socorro em Desastres / Antipsicóticos Tipo de estudo: Diagnostic_studies / Guideline Limite: Humans Idioma: En Revista: BMC Med Assunto da revista: MEDICINA Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Itália