Read more about opus in the British Medical Journal (2005;331:602-5, 17 Sep):
-----------------------------------------------------------------------------------------------------------------------------------
Opus:
Methods
Inclusion
criteria
Patients
are included from inpatient and outpatient mental health services in
Copenhagen, patients fulfilling the following inclusion criteria can be offered
treatment:
(1) age 18 to 35 years and legal residence in the
catchment areas
(2) F2 diagnosis: schizophrenia, schizotypal
disorder, persistent delusional disorder, acute and transient psychotic
disorder, schizoaffective disorder, induced delusional disorder, or unspecified
non-organic psychosis according to ICD-10 research criteria,(10) based on
Schedules for Clinical Assessment in Neuropsychiatry, SCAN version 2.0 (since
1999 version 2.1) (11)
(3) no exposure to antipsychotic medications
exceeding 26 weeks of continuous medication
(4) absence of mental retardation, organic mental
disorder, and psychotic condition only due to acute intoxication or a
withdrawal state
OPUS
team provides the following treatment modalities:
Assertive
community treatment
The
integrated treatment is provided by the multidisciplinary teams and can be
defined as a rich assertive community treatment model,(12) including protocols
for medication, family involvement, and social skill training. Two
multidisciplinary teams in Copenhagen are established and trained to provide
the integrated treatment modelled on assertive community treatment. Each team
includes the following disciplines: psychiatrist, psychologist, psychiatric
nurse, occupational therapist, and social worker. Caseload is approximately 10
and never exceeded 15 for any professional team member. Each patient is offered
integrated treatment for a period of two years. A primary team member is
designated for each patient and is then responsible for maintaining contact and
co-coordinating the treatment within the team and across different treatment
and support facilities. The patients are visited in their homes or other places
in their community, or they are seen at the office according to the patients'
preference. When hospitalised, the patient is visited weekly at the hospital. During
inpatient treatment, the treatment responsibility is transferred to the
hospital. The office hours are Monday to Friday from 8 a.m. to 5 p.m. All team
workers has a cell telephone with an answering function. Outside office hours
patients can leave a message and be sure that the team will respond the next
morning. A crisis plan is developed for each patient. The patients are
encouraged to take responsibility for their own affairs as soon as possible
during the process of recovery. If the patient is reluctant about treatment,
the team tries to motivate the patient to continue treatment and stay in
contact with the patient.
The
fidelity of the programme, which was measured with IFACT (Index of Fidelity of
Assertive Community Treatment) (13) was 70 percent in Copenhagen. The factors
responsible for the reduced fidelity were time-limited treatment, 24-hour
coverage in other settings, and for each patient, approximately two contacts
weekly with the patient, patient's family and collaborating partners.
Antipsychotic
medication
Patients
are offered antipsychotic medication according to guidelines from the Danish
Psychiatric Society, which recommends a low-dose strategy for first-episode
psychotic patients and use of second-generation antipsychotic drugs as first
choice.(14) Psycho-education is carried out along with antipsychotic
medication, and team members pays close attention to adverse events.
Psycho-educational
family treatment
Psycho-educational
family treatment is offered to patients in contact with at least one significant
other. The family treatment follows McFarlane's manual for Psycho-educational
Multiple Family Group Treatment(15) and includes 18 months' treatment, 11/2
hours biweekly in a multiple-family group with two therapists and 4-6 families,
including the patients. The multiple-family group focus on problem solving and
development of skills to cope with the illness.
Social
skill training
Patients' social skills is assessed using the WHO Psychiatric Disability Assessment.(16) The patients who are unable to work in a group were offered individual training. Patients with an intermediate level of impaired social skills are offered social skills training focusing on medication, coping with symptoms, conversation, problem solving, and conflict-solving skills in a group of maximum six patients and two therapists.(17) Patients who does not need social skills training receives individual psycho-education.
22.01.06