Psychosis With Coexisting Substance Misuse: The NICE Guideline on Assessment and Management in Adults and Young People (National Clinical Guideline No. 120)

produced by The National Collaborating Centre for Mental Health, commissioned by The National Institute for Health and Clinical Excellence. The British Psychological Society and the Royal College of Psychiatrists, London, England, 2011, 326 pages, $90.00 (paper with CD-ROM).

This book consists of a set of guidelines developed for the purpose of advising on the assessment and management of adults and young people, 14 years and older, who suffer from and/or manifest symptoms related to psychosis and coexisting substance misuse.

The guidelines and recommendations were produced and elaborated upon by a multidisciplinary team of health care professionals, as well as a service user organization and a career guideline methodologist, after careful consideration of the best available evidence. Hopefully, the guidelines will be useful for clinicians and service commissioners in planning and providing high-quality care models of intervention for people with psychosis and coexisting substance misuse, as well as for relatives and significant others of these individuals.

In the context of this book, clinical practice guidelines are systematically developed statements designed to assist clinicians and service users (patients, caregivers, and the public) in making decisions about appropriate treatment strategies for specific conditions. The intervention methods are derived from the best available research evidence, using predetermined and systematic methods to identify and evaluate evidence related to the specific condition being assessed. Guidelines, of course, are not a substitute for professional knowledge and clinical judgment.

The aim of the guidelines in this volume is to improve standards of care and decrease unacceptable variations in the provision and quality of the care provided across the United Kingdom’s National Health Service. The conceptualization of this type of guideline was initiated in England and Wales in 1999 via the National Institute for Health and Clinical Excellence (NICE). It is the goal of national organizations such as NICE to help develop written clinical protocols directed to local health care groups. The intent of this type of guideline is to improve and assist with care provided by professionals in primary, community, secondary, and tertiary settings, as well as other health care professionals who have direct contact with, and make decisions concerning the care of, adults and young people with psychosis and coexisting substance misuse.

The book provides a clear understanding of psychosis with coexisting substance misuse, which includes incidence and prevalence, course and prognosis, etiology, diagnosis, and treatment options and management following the guidelines of the National Health Service system and the issue of the cost of care in this context. Also addressed are the methods used to develop these guidelines, which included systematic clinical literature review, health economics methods, stakeholder contributions, and validation of the guideline.

Sections pertaining to the experience of care, such as personal accounts, review of qualitative research efforts, qualitative analysis, and a set of appropriate recommendations, are included. Assessment and care pathways are also addressed, including primary and secondary care issues, inpatient and residential care components, and the evidence on which the clinical recommendations are based. The most relevant and important service delivery models are discussed. To provide a different point of view, the roles of psychological interventions are discussed, and evidence-based recommendations are suggested. Likewise, a review of pharmacologic and physical interventions is provided that is, again, based on demonstrated evidence.

A significant portion of the book is dedicated to the diagnosis and care of young people with psychosis and coexisting substance misuse, as this topic is, of course, the foundation of the book. The final section is dedicated to a summary of recommendations based on the principle of care; that is, the recognition of the psychosis and its relationship to coexisting substance misuse, its role within primary and secondary care in the context of mental health services and substance misuse services, and the specific issues related to the young population affected by psychosis and substance misuse.

In summary, this is a comprehensive text, with well-referenced and clear areas of discussion related to young people who suffer from psychosis and substance misuse. In my opinion, professionals who are exposed to and/or treat young persons suffering from psychosis and misuse of substances must be acquainted with this book and not only read it, but have it available in times of need. This is exactly what I intend to do.

Pedro Ruiz, MD

pruiz2@med.miami.edu

Author affiliation: University of Miami Miller School of Medicine, Miami, Florida.

Potential conflicts of interest: None reported.