Glossary of Terms

Acute Day Hospital:

A unit that provides assessment and treatment services during daytime hours for acutely ill individuals who would otherwise be treated in traditional psychiatric inpatient units.

Adherence:

The behaviour of taking medicine according to treatment dosage and schedule as intended by the prescriber. In this guideline, the term 'adherence' is used in preference to 'compliance', but is not synonymous with 'concordance', which has a number of meanings.

Advance directives:

Written instructions agreed between a service user and health professional in advance of treatment. Service users specify their preferred treatments and identify treatments they do not wish to receive; these preferences are used to guide clinicians in the event of the service user becoming incapable of making such decisions. For example, a service user might ask not to receive electroconvulsive therapy, or a drug found to have bad side effects (such as haloperidol), and might specify the use of lorazepam rather than haloperidol in the event of needing rapid tranquillisation. The service user should understand the nature of the condition for which treatment might be required (e.g. an acute episode of schizophrenia), the need for treatment (antipsychotics during an acute episode, lorazepam to induce calm), the expected benefits of the proposed treatment, and the possible adverse consequences. Advance directives cannot be used to refuse treatment altogether when subject to the Mental Health Act (e.g. if a person does not want to take any antipsychotic drug during an acute episode of schizophrenia).

Akathisia:

A motor condition characterised by a feeling of restlessness, an urge to move about constantly and an inability to sit still; a common extrapyramidal side effect of antipsychotic drugs.

Assertive community treatment (assertive outreach):

Intensive treatment and care in a community setting for people with serious mental health problems. Care is provided by a multidisciplinary team, and usually involves dedicated sessions with a psychiatrist; care is exclusively devoted to a defined group of people (those with serious mental illness). Team members share responsibility for clients, so that several members may work with the same client and members do not have individual case-loads; the team attempts to provide all psychiatric and social care, rather than referring to other agencies; care is provided at home or workplace as far as possible; treatment and care are offered assertively to uncooperative or reluctant service users; and team adherence to treatment regimens is emphasised.

Atypical antipsychotic:

One of a class of newer antipsychotic drugs, including amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine, which may be better tolerated than other antipsychotic agents, with a lower risk of extrapyramidal side effects and hyperprolactinaemia. Clozapine is also listed in the British National Formulary as an atypical antipsychotic, but its use is restricted to individuals with schizophrenia who are unresponsive or intolerant to conventional antipsychotic therapy.

Cognitive behavioural therapy (CBT):

A psychological intervention designed to enable people to establish links between their thoughts, feelings or actions and their current or past symptoms, and to re-evaluate their perceptions, beliefs or reasoning about the target symptoms. The intervention should involve at least one of the following: (1) monitoring thoughts, feelings or behaviour with respect to the symptom; (2) being helped to use alternative ways of coping with the target symptom; (3) reducing stress.

Community Mental Health Team:

A multidisciplinary, community-based team that offers assessment, treatment and care to adults with mental health problems. Many such teams operate using a case management model in which team members have their own individual case-loads.

Concordance:

An agreement between a service user and a health professional about when and how medicines are taken. The agreement is reached after negotiation that respects the beliefs and wishes of the user. Although the alliance is reciprocal, the health professional recognises the primacy of the service user's decisions about taking the recommended medicine. The term is also used to describe agreement regarding the presence and nature of illness (lack of concordance between a service user and a health professional is also sometimes described as a lack of insight by the service user).

Conventional antipsychotic:

One of the class of older antipsychotic drugs whose efficacy correlates with their D2 dopamine receptor blocking activity (e.g. chlorpromazine and haloperidol). Most of these drugs were developed before clozapine; in this guideline, the term 'conventional antipsychotic' refers to a 'typical antipsychotic' in contrast to an 'atypical antipsychotic' drug. It should be noted, however, that some drugs (e.g. sulpiride) now regarded as 'typical' or 'conventional' have pharmacological properties similar to the atypicals

Costs (direct):

The costs of all the goods, services and other resources that are consumed in the provision of a health intervention. They can be medical or non-medical.

Counselling and supportive psychotherapy:

For the purpose of this guideline, 'counselling and supportive psychotherapy' is defined as a discrete psychological intervention (regular planned meetings, usually 50 min or 1 h in length, which are facilitative, non-directive and/or relationship focused, with the content of sessions largely determined by the service user), which does not fulfil the criteria for any other psychological intervention.

Crisis resolution and home treatment:

A service that provides intensive home-based, crisis-oriented treatment of an acute psychiatric episode by staff with a special remit to deal with such situations during and beyond office hours. The objective is to manage acute episodes in the community rather than in hospital.

Depot antipsychotic:

A preparation of an ester of an antipsychotic compound in an oily solution, which is injected intramuscularly. Following injection, the drug is slowly released from the injection site. This results in relatively stable plasma drug levels over long periods, allowing the injections to be given every few weeks.

Dystonia: A state of disordered tonicity of muscles; an extrapyramidal side effect of antipsychotic drugs.

Early Intervention Service:

Service that provides early identification and initial treatment to people aged 14–35 years with a first presentation of psychotic symptoms, during the first 3 years of their illness; a requirement set out by the National Health Service Plan.

Effectiveness:

The extent to which a specific intervention, when used under ordinary circumstances, does what it is intended to do. Clinical trials that assess effectiveness are sometimes called management trials

Efficacy:

The extent to which an intervention produces a beneficial result under ideal conditions. Clinical trials that assess efficacy are sometimes called explanatory trials and are restricted to participants who fully cooperate. The randomised controlled trial is the accepted 'gold standard' for evaluating the efficacy of an intervention.

Extrapyramidal side effect:

Movement disorder such as parkinsonism, akathisia and dystonia, commonly caused by antipsychotic pharmacotherapy, due to dopamine receptor blockade in the non-pyramidal tract neuronal pathways that influence or control movements.

Family interventions:

Family sessions with a specific supportive or treatment function based on systemic, cognitive behavioural or psychoanalytic principles, which must contain at least one of the following: (1) psycho-educational intervention; (2) problem-solving and crisis management work; (3) interventions with the identified service user.

Loading dose:

A very high initial dose of a drug, administered in an attempt to increase the rate of response.

NICE 2002:

In this guideline, 'NICE 2002' is used to indicate recommendations from the NICE Technology Appraisal 43 on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia (see 'References' section).

Parkinsonism:

A group of neurological disorders characterised by decreased muscular activity, tremor and muscular rigidity.

Randomised controlled trial:

Also termed 'randomised clinical trial'. An experiment in which investigators randomly allocate eligible people into groups to receive or not to receive one or more interventions that are being compared. The results are assessed by comparing outcomes in the different groups. Through randomisation, the groups should be similar in all aspects apart from the treatment they receive during the study.

Relative risk:

Also known as risk ratio; the ratio of risk in the intervention group to the risk in the control group. The risk (proportion, probability or rate) is the ratio of people with an event in a group to the total in the group. A relative risk (RR) of 1 indicates no difference between comparison groups. For undesirable outcomes, an RR of less than 1 indicates that the intervention was effective in reducing the risk of that outcome.

Standard dosage:

The recommended dosage range listed in the British National Formulary; this normally reflects the information contained in the manufacturers' Summary of Product Characteristics as well as advice from an external panel of experts.

Supported employment:

An approach to vocational rehabilitation that attempts to place clients immediately in competitive employment

Tardive dyskinesia:

Abnormal involuntary movements of the lips, jaw, tongue and facial muscles, and sometimes the limbs and trunk; a side effect of antipsychotic drug treatment.

Treatment-resistant schizophrenia:

A variably defined condition. A reasonable and fairly practical definition, one used for the NICE Technology Appraisal of atypical antipsychotics, is "a lack of a satisfactory clinical improvement despite the sequential use of the recommended doses for 6–8 weeks of at least two antipsychotics, at least one of which should be an atypical".