Complex Clinical Conundrums in Psychiatry by Kuppuswami Shivakumar & Shabbir Amanullah

Author:Kuppuswami Shivakumar & Shabbir Amanullah
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

10.4 Summary of Approach

One common theme to successfully mitigating the challenges raised above is the use of tools that allow us to quantify severity, monitor response, and measure side effect burden in psychosis. Measurement-based care (MBC) is a practice framework that enables clinical decisions to be based on routinely collected client data during treatment. MBC approaches have empirical support in many fields of medical practice. With the introduction of specific tools in DSM-5, a specific emphasis has been provided to the use of MBC in routine practice. Using MBC framework greatly enhances the overall outcomes in depressed subjects, compared to providing the same treatments but without periodic measurements. Analogous to pragmatic RCTs that purport to make trials close to real-world practice, MBC enables our clinical practice to move closer to the trials, thus enabling patients to achieve the incremental benefits seen when they participate in trials.

The use of MBC in EIP can help clinicians and patients to make informed decisions about antipsychotic choice, dose changes, treatment switching, and compliance. In addition, it can also provide objective tools for patient and family education and provide a basis for evaluation of the clinical program. Most MBC initiatives, including the scales promoted by DSM working groups, focus on short instruments that can be used both at baseline and to assess change over the course, mostly based on self-report to reduce measurement burden [18]. We provide a minimal set toolkit (Table 10.3) that can be used for MBC in EIP practice, which can help us navigate a number of conundrums if used in conjunction with evidence-based recommendations discussed above.Table 10.3A toolkit measurement-based care in first-episode psychosis

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