les interventions psychosociales pour troubles mentaux ...‰rris/beauchamp_joanny_ppt.pdf ·...

Les interventions psychosociales

pour troubles mentaux graves:

Guides de pratique issus de la

littérature

Projet d’intégration présenté à la Faculté des études

supérieures et postdoctorales en vue de l’obtention du grade

de Maîtrise en sciences (ergothérapie)

Joanny

Beauchamp

Contexte du projet

• Contexte des soins en santé mentale au Québec

• 2 à 3% de la population présente un trouble de santé

mentale grave (MSSS, 2005)

• Services fragmentés qui ne répondent pas aux

standards de pratiques recommandées (Latimer, 2005)

Contexte du projet

Trouble de santé mentale grave

Perte du réseau social

Isolement social

Difficulté à réaliser ses

activités quotidiennes

Perte des rôles sociaux

(Association des psychiatres du Canada, 2005) (OMS, 2001) (Funk et al.,

2010)

Contexte du projet

Développement et implantation des services en santé mentale

Pratique basée sur les

données probantes

Concept de rétablissement

(Tenhula et al., 2009) (Mueser, 2003) (MSSS, 2005) (Farkas, 2007) (Sheherd et al., 2008) (Corrigan, 2006)

Objectifs du projet

• Identification des recommandations

internationales en matière de meilleures pratiques

à mettre en place auprès de personnes

présentant un trouble de santé mentale grave

• Conception d’une grille de vérification

Méthodologie

Recension des articles dans

PubMed

Recension des avis des comités

internationaux

Résultats: Grille de vérification

Résultats: Interventions

psychosociales recommandées

1. Interventions de psychoéducation

• Psychoéducation sur la maladie

• Gestion de la maladie et du rétablissement

2. Interventions de suivi intensif dans le milieu

3. Interventions axées sur l’adaptation à la maladie et

l’apprentissage d’habiletés

• Entraînement aux habiletés sociales

• Thérapie cognitivo-comportementale

• Remédiation cognitive

• Etc.

Liste de références 1





4. Interventions orientées vers la restauration des

rôles sociaux et de la place citoyenne

• Réadaptation vocationnelle

• Implication dans le choix du traitement et des

objectifs

5. Interventions auprès de la famille

6. Interventions qui intègrent la comorbidité

• Intégration d’un traitement pour comorbidité aux

traitements conventionnels

• Interventions motivationnelles

• Interventions de résolution de problèmes






7. Interventions pour premier épisode psychotique

• Services spécialisés et accès rapide

• Établissements résidentiels

• Interventions en continu pendant 5 ans

• Interventions de prévention du suicide

8. Interventions de soutien par les pairs

9. Interventions sur la prise de conscience de la

condition physique et l’adoption d’un mode de vie

sain




Discussion: Retour sur les

résultats obtenus

• Paradigme médical traditionnelVS

• Nouveau paradigme

Les interventions recensées peuvent s’inscrire dans deux paradigmes de soins

• Approche centrée sur le client et prise de décision partagée

L’intégration du client dans le processus de

réadaptation

(Corrigan et McCraken,

2005)

(Tenhula et al., 2009) (Shepherd et al.,

2008)

Rétablissement

Discussion: Les enjeux

d’implantation

Enjeux d’implantation des

services

Enjeux politiques

Manque de ressources

Complexité de l’implantation

d’une nouvelle pratique

(Association des psychiatres du Canada, 2005) (Kopelowicz et al., 2009) (SAMSHA,

2009)

Conclusion

• Rôle de l’ergothérapeute

• Phases subséquentes du projet de recherche plus

large

Période de questions

Liste de références

(Section Résultats)• Association des psychiatres du Canada (2005). "Guide de pratique clinique - Traitement de la schizophrénie." La

Revue canadienne de psychiatrie 50(1): 1FS - 61FS. 1, 3, 4, 5, 6, 7, 8

• Bertolote J, M. P., et al. (2005). "Early intervention and recover, 3y for young people with early psychosis: consensus statement." The British Journal of Psychiatry 48: 116-119. 1, 4, 5, 6, 7, 8

• Bond, G., M. Salyers, et al. (2004). "How evidence-based practices contribute to community integration." Community Mental Health Journal 40(6): 569-588. 1, 2, 4, 5, 6

• British Association for Psychopharmacology (2008). "Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines." Journal of Psychopharmacology: 1-54. 3

• Canadian Network for Mood and Anxiety Treatments (2009). "Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009." Bipolar Disorders 11: 225-255. 3

• Canadian Network for Mood and Anxiety Treatments (2009). "Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication." Journal of Affective Disorders 117: S5-S14. 1, 3, 5

• Corrigan, P. (2006). "Recovery from schizophrenia and the role of evidence-based psychosocial interventions." Expert Review of Neurotherapeutics 2006(6): 7. 1, 2, 3, 4, 5, 6, 8

• Dixon LB, Dickerson F, et al. (2010). "The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements." Schizophrenia Bulletin 36(1): 48-70. 2, 3, 4, 5, 6, 9


(Section Résultats)• Falloon, I. R. H., I. Montero, et al. (2004). "Implementation of evidence-based treatment for schizophrenic disorders:

two-year outcome of an international field trial of optimal treatment." World psychiatry 3(2): 104-109. 1, 2, 3, 5

• International Early Psychosis Association Writing Group (2005). "International clinical practice guidelines for early

psychosis." The British Journal of Psychiatry 48(s): 120-124. 1, 5, 6, 7

• Jung, X. and R. Newton (2009). "Cochrane Reviews of non-medication-based psychotherapeutic and other

interventions for schizophrenia, psychosis, and bipolar disorder: A systematic literature review." International Journal

of Mental Health Nursing 18(4): 239-249. 1, 2, 5

• Kane, J. (2009). "Creating a health care team to manage chronic medical illnesses in patients with severe mental

illness: the public policy perspective." Journal of Clinical Psychiatry 71(Suppl 3): 37-42. 9

• Kopelowicz, A. and R. Liberman (2003). "Integrating treatment with rehabilitation for persons with major mental

illnesses." Psychiatric Services 54(11): 1491-1498. 1, 2, 3, 4, 5, 6

• Kreyenbuhl J, Buchanan RW, et al. (2010). "The Schizophrenia Patient Outcomes Research Team (PORT): updated

treatment recommendations 2009." Schizophrenia Bulletin 36(1): 94-103. 2, 3, 4, 5, 6, 9

• Latimer, E. (2005). "Community-based care for people with severe mental illness in Canada." International Journal of

Law and Psychiatry 28(5): 561-573. 2, 4, 6

• Lehman AF, Kreyenbuhl J, et al. (2004). "The Schizophrenia Patient Outcomes Research Team (PORT): updated

treatment recommendations 2003." Schizophrenia Bulletin 30(2): 193-217. 2, 3, 4, 5, 6, 9


(Section Résultats)• Lehman AF and Steinwachs DM (2003). "Evidence-based psychosocial treatment practices in schizophrenia:

lessons from the patient outcomes research team (PORT) project." The Journal of the American Academy of

Psychoanalysis and Dynamic Psychiatry 31(1): 141-154. 2, 3, 4, 5, 6, 9

• McGurk, S., E. Twamley, et al. (2007). "A Meta-Analysis of Cognitive Remediation in Schizophrenia." American

Journal of Psychiatry 164(12): 1791-1802. 3

• Medalia, A. and R. Lim (2004). "Treatment of Cognitive Dysfunction in Psychiatric Disorders." Journal of Psychiatric

Practice 10(1): 17-25. 3

• Mueser, K., W. Torrey, et al. (2003). "Implementing evidence-based practices for people with severe mental illness."

Behavior Modification 27(3): 387-411. 1, 2, 3, 5, 6

• National Collaborating Centre for Mental Health (2010). Schizophrenia. The NICE Guideline on core interventions in

the treatment and management of schizophrenia in adults in primary and secondary care. London, The Royal

College of Psychiatrists. 2, 3, 5

• National Institute for Health and Clinical Excellence (2006). "Bipolar disorder : The management of bipolar disorder in

adults, children and adolescents, in primary and secondary care." Retrieved 3 décembre 2010, from

www.nice.org.uk/CG038. 1, 2, 3, 5, 9

• National Institute for Health and Clinical Excellence (2009). "Schizophrenia : Core interventions in the treatment and

management of schizophrenia in adults in primary and secondary care." Retrieved 3 décembre 2010, from

www.nice.org.uk/CG82. 1, 2, 3, 5

http://www.nice.org.uk/CG038.



(Section Résultats)• National Institute for Health and Clinical Excellence (2009). "Depression: The treatment and management of

depression in adults." Retrieved 3 décembre 2010, from http://guidance.nice.org.uk/CG90. 1, 2, 5, 8

• National Institute for Health and Clinical Excellence (2009). "Borderline personality disorder: treatment and

management." Retrieved 3 décembre 2010, from www.nice.org.uk/CG78. 5, 8

• Royal Autralian and New Zealand College of Psychiatrists (2004). "Australian and New Zealand clinical practice

guidelines for the treatment of bipolar disorder." Australian and New Zealand Journal of Psychiatry 38: 280-305. 1, 3, 5

• Royal Autralian and New Zealand College of Psychiatrists (2005). "Royal Australian and New Zealand College of

Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders." Australia and New

Zeland Journal of Psychiatry 39(1-2): 1-30. 1, 2, 3, 4, 5, 7

• Royal Australian & New Zealand College of Psychiatrists (2009). "Schizophrenia - Australian Treatment Guide for

Consumers and Carers." Retrieved 3 décembre 2010, from http://www.ranzcp.org/resources/clinical-practice-

guidelines.html. 1, 3, 4, 5

• Shean, G. (2009). "Evidence-based psychosocial practices and recovery from schizophrenia." Psychiatry 72(4): 307-

320. 2, 3, 4, 5

• Sin, J., N. Moone, et al. (2007). "Developing services for the carers of young adults with early-onset psychosis -

implementing evidence-based practice on psycho-educational family intervention." Journal of Psychiatric and Mental

Health Nursing 14(3): 282-290. 5

http://guidance.nice.org.uk/CG90.


http://www.ranzcp.org/resources/clinical-practice-guidelines.html.






(Section Résultats)

• Substance Abuse and Mental Health Services (2011). "SAMHSA's National Registry of Evidence-

based Programs and Practices." U.S. Department of Health and Human Services. Retrieved 11 avril

2011, from http://www.nrepp.samhsa.gov/. 2, 4, 5, 6, 7

• Van Os, J. (2009). "Schizophrenia treatment: content versus delivery." Acta Psychiatrica

Scandinavica(438): 29-32. 2

• Velligan, D., R. Kern, et al. (2006). "Cognitive rehabilitation for schizophrenia and the putative role of

motivation and expectancies." Schizophrenia Bulletin 32(3): 474-485. 3

• Ziedonis, D., D. Smelson, et al. (2005). "Improving the care of individuals with schizophrenia and

substance use disorders: consensus recommendations." Journal of Psychiatric Practice 11(5): 315-

339. 2, 6

http://www.nrepp.samhsa.gov/.


• Association des psychiatres du Canada (2005). "Guide de pratique clinique - Traitement de la schizophrénie." La Revue canadienne de psychiatrie 50(1): 1FS - 61FS.

• Corrigan, P. (2006). "Recovery from schizophrenia and the role of evidence-based psychosocial interventions." Expert Review of Neurotherapeutics 2006(6): 7.

• Corrigan, P. W. and S. G. McCracken (2005). "Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation." Social Work 50(1): 31-39.

• Farkas, M. (2007). "The vision of recovery today: what it is and what it means for services." World psychiatry 6: 68-74.

• Funk, M., S. Saxena, et al. (2010). "People with mental disabilities cannot be forgotten. WHO urges development programmes to include people with mental and psychosocial disabilities." Retrieved 18 septembre 2010, from http://www.who.int/mediacentre/news/releases/2010/mental_disabilities_20100916/en/index.html.

• Kopelowicz, A. and R. Liberman (2003). "Integrating treatment with rehabilitation for persons with major mental illnesses." Psychiatric Services 54(11): 1491-1498.

http://www.who.int/mediacentre/news/releases/2010/mental_disabilities_20100916/en/index.html.

http://www.who.int/mediacentre/news/releases/2010/mental_disabilities_20100916/en/index.html.


• Latimer, E. (2005). "Community-based care for people with severe mental illness in Canada." International Journal of Law and Psychiatry 28(5): 561-573.

• Ministère de la Santé et des Services Sociaux (MSSS) (2005). Plan d'action en santé mentale. Québec, Ministère de la Santé et des Services Sociaux.

• Mueser, K., W. Torrey, et al. (2003). "Implementing evidence-based practices for people with severe mental illness." Behavior Modification 27(3): 387-411.

• Substance Abuse and Mental Health Services (2011). "SAMHSA's National Registry of Evidence-based Programs and Practices." U.S. Department of Health and Human Services. Retrieved 11 avril 2011, from http://www.nrepp.samhsa.gov/.

• Shepherd, G., J. Boardman, et al. (2008). Making Recovery a Reality. Sainsbury Centre for Mental Health. Londres.

• Tenhula, W. N., A. S. Bellack et R. E. Drake. (2009). «Chapter 12.13 -Schizophrenia: Psychosocial Approaches». Dans B. J. Sadock, V. A. Sadock et P. Ruiz (édit.), Kaplan and Sadock's Comprehensive Textbook of Psychiatry (9nd ed.) Vol. 1 (1556-1572). Philadelphia, Lippincott Williams & Wilkins (LWW).

http://www.nrepp.samhsa.gov/.

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