Understanding NICE guidance – Glossary [63]

Advance directives

Written instructions agreed between a service user and health professional before treatment begins, in which the service user specifies his or her preferred treatments and identifies the treatments he or she does not wish to receive. They guide health professionals in the event that the service user becomes unable to make decisions for him or herself. Advance directives allow people, for instance, to set out treatment that they would not want to receive (for example, electroconvulsive therapy, or a medicine they know gives them bad side effects), or treatment preferences (for example, the service user may wish to be given lorazepam rather than haloperidol in the event of needing rapid tranquillisation). Doctors sometimes will not follow advance directives for medical reasons. If they don’t, they will write this in a person’s notes, explaining why they couldn’t follow the directive.

Antipsychotic medication

There are two main types of antipsychotic medication, commonly referred to as conventional and atypical antipsychotics. Conventional antipsychotics have been around for many years while the atypical ones have only become available more recently.

Conventional antipsychotics cause more extrapyramidal side effects (see below) than atypical antipsychotics, whereas, on average, atypicals may cause more weight gain than conventionals. Atypical antipsychotics include amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole (in special circumstances) and zotepine. Clozapine is only used for the treatment of treatment-resistant schizophrenia (see below). Conventional antipsychotics include chlorpromazine, haloperidol, trifluoperazine, flupenthixol and others. Your doctor or pharmacist will be able to tell you whether a medicine is a conventional or an atypical antipsychotic.

Assertive outreach team (also known as assertive community treatment) This service delivers intensive, and often comprehensive, treatment and care in community settings for people with serious mental health problems, especially people needing a lot of help.

Cognitive behavioural therapy

A psychological treatment that helps 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. It’s useful for reducing symptoms, reducing breakdowns and helping to understand the illness and may help people take their medicines regularly.

Community mental health team

The standard community-based team that offers assessment, treatment, and care to adults with mental health problems in the community.

Crisis resolution and home treatment teams

Services that provide intensive home-based, crisis-orientated treatment of an acute episode by staff who deal with such situations during and beyond office hours. Teams can help manage acute episodes in the community rather than in inpatient care.

Depot antipsychotic

A special preparation of an antipsychotic in an oily solution, which is injected into the muscle.

Following injection, the medicine is slowly released. This results in the medicine staying in the blood over fairly long periods, so that injections can be given every few weeks.

Early intervention teams/services

Services that provide early identification and initial treatment, during the first 3 years of illness, to people aged between 14 and 35 years who have the first symptoms of schizophrenia.

Extrapyramidal side effects

Problems with movement, such as parkinsonism (stiffness, shaking and slowness), akathisia (marked restlessness), and dystonia (altered muscle tension), which are common side effects of antipsychotics (especially conventional antipsychotics).

Family work (or family interventions)

Family sessions providing support and treatment that are based on psychological principles. Family work can improve symptoms and reduce the chance of breaking down. It's especially helpful for people who have recently had a breakdown, are at risk of having a breakdown, or have symptoms remaining after being ill.

Rapid tranquillisation

The use of medicine to quickly control extreme agitation, aggression and potentially violent behaviour that put the individual or those around them at risk of physical harm. The aim is to sedate the person to minimise the risk without the person losing consciousness.

‘Sectioning’

When a doctor believes that a person is so ill that he or she is unable to make a decision about treatment, or if a person who is ill refuses to receive treatment, the doctor can ‘section’ him or her under the Mental Health Act. If this happens, you will receive your care in an inpatient unit. This allows the doctors and nurses to assess and sometimes to treat you against your will. They can only treat your mental illness without your agreement; they can’t make you have treatments for anything else (such as operations).

Service user

In this booklet, a person with schizophrenia who is receiving care from the NHS.

Standard doses

The recommended dose range listed in the British National Formulary (or BNF), a reference book for doctors.

Supported employment

An approach to helping service users find and stay in work, without going through lots of training first.

Tardive dyskinesia

Abnormal movements of the lips, jaw, tongue and facial muscles, and sometimes the arms, legs and body, that the person can’t help making. This can be a long-term side effect of antipsychotics, which can be irreversible.

Treatment-resistant schizophrenia (TRS)

Schizophrenia that doesn’t appear to improve despite the person having tried a number of different antipsychotic medicines.