1. Assess symptoms and establish a diagnosis.

  • Establish an accurate diagnosis, considering other psychotic disorders in the differential diagnosis because of the major implications for short- and long-term treatment planning. If a definitive diagnosis cannot be made but the patient appears prodromally symptomatic and at risk for psychosis, reevaluate the patient frequently.

  • Reevaluate the patient's diagnosis and update the treatment plan as new information about the patient and his or her symptoms becomes available.

  • Identify the targets of each treatment, use outcome measures that gauge the effect of treatment, and have realistic expectations about the degrees of improvement that constitute successful treatment.

  • Consider the use of objective, quantitative rating scales to monitor clinical status (e.g., Abnormal Involuntary Movement Scale [AIMS], Structured Clinical Interview for DSM-IV Axis I Disorders [SCID], Brief Psychiatric Rating Scale [BPRS], Positive and Negative Syndrome Scale [PANSS]).


2. Formulate and implement a treatment plan.

  • Select specific type(s) of treatment and the treatment setting. (This process is iterative and should evolve over the course of the patient's association with the clinician.)


3. Develop a therapeutic alliance and promote treatment adherence.

  • Identify the patient's goals and aspirations and relate these to treatment outcomes to increase treatment adherence.

  • Assess factors contributing to incomplete treatment adherence and implement clinical interventions (e.g., motivational interviewing) to address them. Factors contributing to incomplete treatment adherence include

    • patient's lack of insight about presence of illness or need to take medication,

    • patient's perceptions about lack of treatment benefits (e.g., inadequate symptom relief) and risks (e.g., unpleasant side effects, discrimination associated with being in treatment),

    • cognitive impairment,

    • breakdown of the therapeutic alliance,

    • practical barriers such as financial concerns or lack of transportation,

    • cultural beliefs, and

    • lack of family or other social support.

  • Consider assertive outreach (including telephone calls and home visits) for patients who consistently do not appear for appointments or are nonadherent in other ways.


4. Provide patient and family education and therapies.

  • Work with patients to recognize early symptoms of relapse in order to prevent full-blown illness exacerbations.

  • Educate the family about the nature of the illness and coping strategies to diminish relapses and improve quality of life for patients.


5. Treat comorbid conditions, especially major depression, substance use disorders, and posttraumatic stress disorder.


6. Attend to the patient's social circumstances and functioning.

  • Work with team members, the patient, and the family to ensure that services are coordinated and that referrals for additional services are made when appropriate.


7. Integrate treatments from multiple clinicians.


8. Carefully document the treatment, since patients may have different practitioners over their course of illness.


Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
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