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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]).

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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.)

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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.

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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.

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

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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.

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7. Integrate treatments from multiple clinicians.

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

References

NOTE:
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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