Mental Health Nursing and First Episode Psychosis

Issues in Mental Health Nursing, 32:2–19, 2011 Copyright © Informa Healthcare USA, Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.3109/01612840.2010.523136

Mental Health Nursing and First Episode Psychosis Loes van Dusseldorp, MSc, RN Regional Emergency Healthcare Network, Radboud University Nijmegen Medical Centre, Netherlands

Peter Goossens

Issues Ment Health Nurs Downloaded from informahealthcare.com by 80.100.26.71 on 01/06/11 For personal use only.

Saxion University of Applied Sciences, Deventer, Netherlands; Dimence Mental Health Care Centre, Deventer, Netherlands; Scientific Institute for Quality of Healthcare, and Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

Theo van Achterberg Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

the individuals and their families, the effects of a FEP can be immense. The patient often becomes confused, scared, depressed, socially isolated, embarrassed, and worried about disclosure. The patient is often devastated by the sudden disruption of his or her life and goals; compared to the normal population, such patients are also at a greater risk for suicide (Bertelsen et al., 2007; Kelly, O’Meara Howard, Smith, 2007; Reed, 2008). The families of such patients often feel hopeless and overwhelmed; emotions such as fear, sadness, guilt, and anger prevail (Askey, Gamble, & Gray, 2007). During the past few years, considerable research has been undertaken to enhance the early identification and treatment of FEP. This research has addressed: early detection; diagnosis and treatment; the effectiveness of psychological interventions such as cognitive behavior therapy (CBT); the offering of family therapy and education; social interventions aimed at education, work, and social relations; cannabis-focused interventions; and psycho-education (Askey et al., 2007; Bertelsen et al., 2007; Edwards et al., 2006; Kelly et al., 2007; Killackey, Jackson, & McGorry, 2008; Leavey et al., 2004; McEvoy et al., 2006; Menezes, Arenovich, & Zipursky, 2006; Penn et al., 2005; Petersen et al., 2005; Rosenbaum et al., 2005). In addition to research on intervention and treatment, several studies have focused on the perspective of the service users (Etheridge,Yarrow, & Peet, 2004; McKenzie, 2006; O’Toole et al., 2004). That is, the experience of patients of early intervention treatment. Mental health care guidelines have also already been developed in the Netherlands, the UK, and the US for the treatment of diverse psychiatric disorders. The most relevant guidelines for the treatment of conditions that may involve a FEP are those for the treatment of schizophrenia (American Psychiatric Association [APA], 2004; National Institute for Health and Clinical Excellence (NICE), 2009; Trimbos Instituut, 2005b), bipolar disorder (APA, 2002), and depression (Trimbos Instituut, 2005a).

The purpose of this literature review is to identify mental health nursing’s contribution to the care and treatment of patients with a first episode of psychosis; A systematic literature review was undertaken, with 27 articles selected for study. Five domains were identified: development of therapeutic relation, relapse prevention, enhancement of social functioning, stimulation of medication adherence, and support of family members. The level of evidence of mental health nursing’s contribution to the care and treatment of those undergoing their first episode of psychosis was low. Our review suggests that mental health nurses should reflect upon their own daily practices within the five domains.

First episode psychosis (FEP), or so-called early psychosis, refers to the first time that a person experiences a psychotic episode or psychotic symptoms such as delusions, hallucinations, erratic behavior, social disclosure, apathy, self-neglect, or disordered thought (Early Psychosis Prevention and Intervention Centre [EPPIC], 2006; Oosthuizen et al., 2005; Reed, 2008). The incidence of FEP in the Netherlands and Northern England, respectively, is reported to be 2.2 and 3.09 per 10,000 persons annually (Boonstra et al., 2008; Reay et al., 2009). In Australia, the incidence is reported to be 16.7 per 10,000 personyears for males and 8.1 per 10,000 per person-years for females (Amminger et al., 2006). When people present with symptoms of a FEP, they may display some or all of the symptoms, appear agitated or depressed, be unaware of what is happening, or completely aware of what is happening. A FEP usually occurs in adolescence, which is already a time of major change and upheaval (Reed, 2008). For Address correspondence to Loes van Dusseldorp, Regional Emergency Healthcare Network, Radboud University Nijmegen Medical Centre, St. Annastraat 297-299, 6525 GT Nijmegen, Netherlands. Email: [email protected]

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FIRST EPISODE PSYCHOSIS

These guidelines provide information on the diagnosis and treatments for psychosis (e.g., pharmacotherapy, psycho-education, life and social skills training, psychotherapeutic interventions, peer support groups). However, none of these guidelines specifically addresses the treatment of FEP in any depth; the focus is on the treatment of schizophrenia or psychosis in general. Given that mental health nurses constitute the majority of the work force in most mental health care facilities, they can make an important contribution to the treatment of mental health patients. However, the aforementioned research programs and treatment guidelines provide little information on the role of the mental health nurse in cases of FEP. The aim of the present review is therefore to gain greater insight into mental health nursing for patients with FEP. The following two research questions were formulated for this purpose. •

What is known about the contribution of mental health nursing to the care and treatment of patients with a first episode psychosis? • What level of evidence supports this knowledge? METHOD Search Strategy A systematic search of the following databases was conducted for the period January 1989 to May 2009: Medline, PsycINFO, EMBASE, CINAHL, NAZ (Database with Dutch nursing research articles), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. The following search terms were used: “early psychosis” or “first episode psychosis” or “first psychosis” or “psychotic disorder” and “nursing” or “nursing objectives” or “nursing problems” or “nursing diagnosis” or “nursing actions” or “nursing interventions” or “nursing outcomes” or “mental health nursing” or “psychiatric nursing.” In addition, we searched the databases using the Mesh terms “psychotic disorder” and “psychiatric nursing.” Furthermore, cross-references judged to be relevant were added to the database and all references were checked for other relevant publications as well. Inclusion and Exclusion Criteria Articles in Dutch, English, French, and German were considered and articles in which the content of the nursing process is described were included with no special requirements regarding research design of the publication type. Given that the 1.85% life-time prevalence of psychotic disorders involves mostly schizophrenia, bipolar disorder, and major depressive disorder with psychotic features (Per¨al¨a et al., 2007), it was decided to only include articles that concerned these disorders in the present review. The exclusion criteria were thus:

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•

articles about first psychosis related to an organic or substance-induced psychotic disorder and • articles published before 1989. Selection Procedure In Figure 1 a detailed outline of the selection procedure is presented. Of the initial 323 references, 27 were selected for inclusion. The selection process was conducted by the first and second authors separately. To start with, the titles and abstracts from all of the references were examined by the first and second authors separately; consensus was reached on the preliminary inclusion of 38 articles. Of these, five articles were duplicates and four were secondary sources. The remaining 29 articles were then ordered for closer examination; 2 articles could not be obtained, which left 27 articles for inclusion in the review: 3 qualitative studies, 6 quantitative studies, 5 narrative reviews, 9 practice reports, and 4 opinion reports (see Tables 1 through 5). Content Analysis The content of the 27 articles was analyzed in three steps. First, the focus of each article was determined. Second, the categories were identified. And third, the central themes (i.e., domains of nursing) were identified. The content analysis was peer reviewed by the second and third authors. RESULTS Five domains for the potential contribution of mental health nurses to the care for patients with FEP could be distinguished. The domains were, in sequence of the total level of evidence per domain (i.e., level I through VII) (Polit & Beck, 2008): development of therapeutic relationship, relapse prevention, enhancement of social functioning, stimulation of medication adherence, and support of family members. Only a minority of the 27 articles devoted attention to the contributions of mental health nurses to the care for patients with, specifically, a FEP. The majority of the 27 articles described the contribution of mental health nurses to the care for patients with schizophrenia or psychosis in general. Given that the population described in these articles also included patients with a FEP, however, it was decided to include these articles as well. Development of Therapeutic Relationship The review of the literature showed 11 articles that addressed the therapeutic relationship between mental health nurses and patients with a FEP or a psychosis in general. Two of the articles reported quantitative research; three reported qualitative research; two were narrative reviews; two were practice reports; and two were reports of opinion (see Table 1). According to various authors, establishment of a trusting, reciprocal, and supportive relationship is essential for helping

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Level of Evidence∗

Level VI

Publication Type (Methods)

Forchuck et al., 2003

Level IV

McCann, 2002 Level IV

Nursing Contribution

Complementary approaches may be used to treat and resolve a psychotic episode, notably medication, cognitive behavioral therapies, and education. Processes of mental health Qualitative study (grounded Hope is of great importance for nurses to enable young theory methodology; n = 9 patients with schizophrenia. adults with schizophrenia to patients n = 8 family Nurses can enable the process of have hope for the future n = 24 nurses) recovering hope. Changing roles and Qualitative study (naturalistic Role changing during phases of relationships for clinical design, ethnographic recovery: staff with clients recovering method of data analysis, 1. Psychosis: parental surrogate and from psychosis n = 10 teams) technical expert; 2. Improvement: teacher, resource person, and counselor. 3. Recovery: counselor, co-coordinator, resource person and partner for patient and family

Move with the client and shift roles

Enhance motivation Develop pathways to wellness.

Trusting relationship

Advocate for the most effective treatment Forge an effective alliance with families and patients Attempt to understand Be friendly Tune in Reveal oneself Be there for patient Maintain confidentiality

Clinical case management model is Therapeutic relationship the most useful for community health care.

Reported Outcome

The chart can be used successfully with patients, families, and staff to optimize antipsychotic medication treatment. Development of interpersonal Qualitative study (grounded Nurses develop interpersonal relationships by community theory methodology; n = 9 relationships via mutual relating, mental health nurses’ patients n = 8 family which can be influenced by context: relationships with young n = 24 nurses) – personal and professional adults with FEP attributes; – time limitations, dominant medical course, and urgency of situation.

The role of community mental Narrative review health nurses in the prevention of psychotic relapse for patients with schizophrenia Levels of recovery from Practice report psychotic disorder chart (development of the chart)

Topics

Freeman, 2002 Level VII Nurses’ role in management of Opinion report psychosis

McCann & Level IV Baker, 2001

Sousa, 1998

Meulenbroeks Level VI et al., 1998

Author/Year

TABLE 1 Development of Therapeutic Relation


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Level VI

Reed, 2008

Impact of FEP on patient, their families, and caregivers.

Relapse prevention plans (RPP) among patients with schizophrenia

Polit, D. F., & Beck, C. T. (2008)

Level II

van Meijel et al., 2006

∗

Level IV

Sousa & Frazier, 2004 Therapeutic dialogue

Therapeutic relationship Discharge planning

Clarify what is happening Access appropriate inpatient and long-term care Assertive approach to engaging client and family Boosters of treatment and support Give information Prepare an action plan

Smith’s model provides a scientific Build a personal action plan tool to achieve more structured for the client early signs monitoring and relapse prevention work

Preliminary factor analysis on the LORS suggested two subfactors: institutional support and self-advocacy (r = .661). No significant correlation with the BASIS-32.

Providing early help is particularly important in schizophrenia. The earlier a psychotic illness is effectively treated, the less likely negative symptoms and negative social consequences are to develop. Quantitative study (RCT; n = Clinical but no statistically 48 nurses n = 95 patients significant differences in relapse Instruments: PANSS, rates (p = .12). Significant effect Insight Scale, WAI, CGI, for the subscale “attribution of CASH). symptoms” (p = .04) from the Insight Scale; also for Working Alliance Inventory total score (p = .03), goal dimension (p = .05), and bond dimension (p = .02). Narrative review Early intervention and treatment are critical for the achievement of better clinical outcomes and the alleviation of psychological impact on patients and their families.

Comparison of LORS Quantitative study (n = 45 (Level of Recovery from patients) Psychotic Disorder Scale) and BASIS-32 (Behaviour and Symptom Identification Scale) (Pilot comparing two instruments) Stevens & Sin, Level VI A self-management model Practice report 2005 of relapse prevention for psychosis (Pilot implementing Smith’s Self-Management Training manual) Rogers, 2006 Level VII Principles of early Opinion report intervention in the treatment of psychosis


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L. VAN DUSSELDORP ET AL.

Initial search: 325 hits Medline: n = 239 PsycInfo: n = 4 Embase: n = 0 CDSR: n = 0 CCRCT: n = 0 NAZ: n = 73 CINAHL: n = 9

References excluded (n = 287)


- No relevance for title and abstract

Potential relevant abstracts screened n = 38

Articles excluded (n = 11) 5 Duplicates 4 Secondary resources 2 Unavailable

Articles included n = 27

FIGURE 1 Flow Diagram of the Selection Procedure CDSR = Cochrane Database of Systematic Reviews; CCRT = Cochrane Central Register of Controlled Trials; NAZ = Dutch Database of Care (Nederlands Artikelendatabank voor de zarg)

patients with a psychosis, in general, and a FEP, in particular (Forchuk, Jewell, Tweedell, & Steinnagel, 2003; Freeman, 2002; McCann, 2002; McCann & Baker, 2001; van Meijel et al., 2006; Meulenbroeks, van Meijel, & Winter, 1998; Reed, 2008; Rogers, 2006; Sousa, 1998; Sousa & Frazier, 2004; Stevens & Sin, 2005). Several strategies can help nurses establish a reciprocal relationship: attempt to understand, friendliness, tuning in, revealing oneself, being there for the patient, and maintaining confidentiality. Authors report how the therapeutic relationship can affect various aspects of a patient’s recovery from a FEP. One aspect is the uncovering of hope (McCann, 2002). Having had a psychotic episode often undermines a patient’s motivation, his or her sense of purpose in life, and any hope for the future. An ability to foster hope on the part of a patient is thus considered an important aspect of the role of the professional nurse. The therapeutic relationship can also help alleviate not only anxiety but also confusion and thereby enable the patient to feel more in control (Reed, 2008).

A supportive therapeutic relationship can help prevent relapse (van Meijel et al., 2006; Meulenbroeks et al., 1998; Sousa, 1998; Sousa & Frazier, 2004; Stevens & Sin 2005). In the development of a relapse prevention plan, patient and nurse will have one or more therapeutic dialogues (Souza & Frazier, 2004). These dialogues can influence the patient’s perspective on his or her illness, their decisions regarding adherence to treatment, and consideration of alternative forms of treatment in order to realize his or her goals. Conversely, the preparation of a relapse prevention plan can enhance the alliance among nurse, patient, and patient’s family (van Meijel et al., 2006; Sousa, 1998). This finding is confirmed by Stevens and Sin (2005) who found Smith’s 10-step model of relapse prevention to be an ideal tool for working collaboratively. The relationship between nurse and patient often includes discussions of the side effects of medication and intramuscular injections. A basic level of trust between patient and nurse, a demonstration of understanding, and professional support can all promote the taking of medication (Freeman, 2002; Rogers 2006).

FIRST EPISODE PSYCHOSIS


Finally, Forchuk et al. (2003) investigated the role changes that clinical staff experience while working with patients recovering from a psychosis. During the recovery process, in which patients undergo profound changes, the counseling role and importance of the therapeutic relationship become evident. In fact, nurses report perceiving the therapeutic relationship to be the cornerstone of their work with such patients. In short, the therapeutic relationship is the basis of care in mental health nursing and must be built on good rapport, trust, genuineness, and patient-centered goals if it is to be effective (Reed, 2008). Nonetheless, the literature revealed only 11 articles on the contribution of mental health nurses in this regard and the level of evidence was low in general (see Table 1).

Relapse Prevention The literature revealed 13 articles on the contribution of nurses to relapse prevention: four of the articles reported quantitative research; three were narrative reviews; two were practice reports; and four were reports of opinion. All of the articles showed the prevention of psychotic relapse to receive considerable attention within treatment programs although with differing levels of evidence (see Table 2) (Freeman, 2002; Gillam, 2002; van Meijel, 1996; van Meijel et al., 2003a, 2003b, 2004; van Meijel et al., 2006; Meulenbroeks et al., 1998; Renwick et al., 2009; Rogers, 2006; Sin, Taylor, & Kendall, 2009b; Sousa & Frazier, 2004; Stevens & Sin, 2005). Limited or lack of insight into symptoms, no recognition of the early signs of psychosis, poor adherence to medication, and life events were all reported to magnify the risk of psychotic relapse. Several interventions focused on minimizing the risks of psychotic relapse, with the formulation of a relapse prevention plan appearing to be most important. Three of the articles concerned the development or use of a relapse prevention plan with more or less the same content. The most recent article using more or less the same relapse prevention plan was that of van Meijel et al. (2006). Four phases characterized the preparation of the prevention plan in this study: preparation, listing of early warning signs, monitoring, and action plan. The results of the randomized controlled trial using this procedure to prepare a relapse prevention plan showed significant clinical, but not statistically significant, differences in the rates of relapse. However, statistically significant effects on patient insight and the working alliance between patient and nurse were found. Furthermore, the nurses evaluated the intervention as meaningful and stated that it provided a fruitful means for psycho-education of the individual patient and his or her family. Stevens and Sin (2005) report on the use of Smith’s 10-step model of relapse prevention in a pilot clinical study to structure the monitoring of early signs of relapse and prevention activities to a greater extent. Although the reliability and validity of this model are not reported, Stevens and Sin perceive the Smith model to be an ideal tool for relapse prevention and to have

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several benefits for not only clients but also families, clinicians, and the health care service. Finally, in yet another pilot study Sousa and Frazier (2004) reported their Levels of Recovery from Psychotic Disorder Scale (LORS) to be useful for the discussion of insight into mental illness, treatment, and medication adherence with mental health patients. Moreover, such discussion with patients, health care providers, and the families of patients was found to clearly reduce the risk of relapse. In other articles, a secondary outcome of the development of a relapse prevention plan has been reported, namely: empowerment of the patient (van Meijel et al., 2006; Sousa & Frazier, 2004; Stevens & Sin, 2005). In all of the relapse prevention plans just reviewed, mental health nurses played a central role. The focus, in this role, was generally upon the following aspects of relapse prevention: education regarding positive and negative symptoms, education regarding the consequences of substance use, increased awareness of early warning signs and stress triggers, development of coping strategies, and development of an action plan. The most essential aspect appeared to be the enhancement of motivation on the part of the patient and illness acceptance. In conclusion, we found 13 articles to address the contributions of mental health nurses to relapse prevention. The level of evidence of the studies was low with the exception of one study, which had Level II evidence.

Enhanced Social Functioning The literature review showed nine articles that addressed the contribution of mental health nurses in connection with the social functioning of patients with a psychosis or, specifically, a FEP. Two of the articles reported quantitative research; three were practice reports; one was a narrative review; and three were reports of opinion (see Table 3). Seven of the articles showed mental health nurses to play an important role in psychosocial interventions aimed to support the social functioning of the patient (Gillam, 2002; Linszen et al., 1998; Meulenbroeks et al., 1998; Renwick et al., 2009; Roks, Sebregts, Roza, & Jansen, 2008; Sousa, 1998; Waldheter et al., 2008). The psychosocial interventions involved: life and social skills training, psycho-education, and/or coping abilities training. The provision of CBT by the mental health nurse was also reported to play an important role in the facilitation of recovery from a FEP. Waldheter and colleagues (2008) report significantly positive results of CBT conducted on an individual basis on symptom improvement, particularly for positive symptoms (i.e., delusions or hallucinations), adaption to illness, and increased quality of life. Given the documented potential of CBT, researchers have called for integration of CBT into the treatment services provided for early psychosis (see Waldheter et al., 2008). According to Sin et al. (2009b) and Rogers (2006), mental health services and mental health nurses should work to help people with mental health problems gain access to local

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Level of Evidence∗

Level VI

Level VI

Level VII

Level VII

Level VI

Level VI

Level IV

Author/Year

van Meijel, 1996

Meulenbroeks et al., 1998

Freeman, 2002

Gillam, 2002

van Meijel et al., 2003a

van Meijel et al., 2003b

Sousa & Frazier, 2004

Publication Type (Methods)

Evaluation of intervention protocol to prevent psychotic relapse among patients with schizophrenia Comparison of Level of Recovery from Psychotic Disorder Scale (LORS) and Behaviour and Symptom Identification Scale (BASIS-32) (Pilot use of the two instruments)

Preliminary factor analyses on the LORS suggested two subfactors: institutional support and self-advocacy (r = .661). No significant correlation with the BASIS-32.

Quantitative study The intervention contributed (Questionnaire survey of 26 significantly to treatment and care. nurses) Quantitative study (n = 45 patients)


preparation listing of early warning signs monitoring action plan See van Meijel et al. (2003a) Provision of individualized psycho-education for patient and family Insight regarding symptoms Psycho-education

1) 2) 3) 4)

Psychosocial interventions: CBT, monitoring for early warning signs, and case management Intervention protocol has four phases for nurses to follow:

Identification of warning signs of relapse Support during life-events

Early warning is important for Relapse prevention protocol prevention of psychotic relapse. Psycho-education More nursing research is necessary to develop new methods. Clinical case management model is the Psychosocial interventions most useful for community care health care.

Reported Outcome

Complementary approaches may be used to treat and resolve a psychotic episode, most notably medication, CBT, and education. Medical and psychosocial Opinion report Inform mental health nurses about interventions to treat people developments in the treatment of with schizophrenia schizophrenia. Development and pilot testing of Practice report (Model for the Working with protocols is generally a nursing intervention protocol development of unpopular among care providers. to help prevent psychotic evidence-based nursing Emphasis on individualization of relapse in patients with interventions; van Meijel et method was highly appreciated by schizophrenia al., 2002) the nurses

Early warning signs for Narrative review prevention of psychotic relapse for patients with schizophrenia The role of community mental Narrative review health nurses in the prevention of psychotic relapse for patients with schizophrenia The nurse’s role in the Opinion report management of psychosis

Topics

TABLE 2 Relapse Prevention


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A self-management model of relapse prevention for psychosis (Pilot implementation of Smith’s Self-Management Training manual) Principles of early intervention in the treatment of psychosis

Stevens & Sin, 2005

Treatment of acute episodes and promotion of recovery for adults with schizophrenia

Sin et al., 2009b

∗

Relationship between individual appraisal of stress and symptoms in FEP

Renwick Level IV et al., 2009

Polit, D. F., & Beck, C. T. (2008)

Level VII

Relapse prevention plans (RPP) among patients with schizophrenia

van Meijel Level II et al., 2006

Rogers, 2006 Level VII

Level VI

Recognition of early warning signs in patients with schizophrenia

van Meijel Level VI et al., 2004 Promising preliminary results regarding contribution of nurses to prevent psychotic relapse via early recognition and intervention. Effectiveness of protocol studied in a RCT. Smith’s model provides a scientific tool to achieve more structured early signs monitoring and relapse prevention work

Monitor early relapse warning signs Build a personal action plan for the client Stress triggers Coping strategies

Systematic and continuous early recognition and early intervention.

Providing early help is particularly Psycho-education for patient and important in schizophrenia. The family, including drug education earlier a psychotic illness is Identify and treat depression and effectively treated, the less likely suicide risk negative symptoms and social Agree on a relapse prevention plan consequences are to develop. Quantitative study (RCT; n = 48 Clinical but no statistically significant Give information nurses n = 95 patients; differences in relapse rates (p = .12). Systematic assessment of Instruments: PANSS, Insight Significant effect for “attribution of promoting or hindering factors Scale, WAI, CGI, CASH) symptoms” subscale (p = .04) of the using RPP plan Insight Scale; also for Working Systematically inventory early Alliance Inventory total score (p = signs .03), goal dimension (p = .05), and Instruct and assist with the bond dimension (p = .02). recognition and scoring of early signs Prepare action plan Quantitative study (crossSignificant relation (p = .001) between Acknowledge the interaction higher levels of depression and higher between symptoms and appraisal sectional design with linear levels of subjective stress. Significant of stress multiple regression; n = 78 relation (p = .004) between lower Increase coping abilities patients; Instruments: levels of psychotic symptoms and DSM-IV, GAF, SAPS, SANS, higher levels of perceived stress. CDSS, Beiser Scale, WHOQOL, and PSS) Opinion report Despite the strong evidence base for the Develop a person-centered plan interventions recommended in the Psychological treatment guideline, there is still a long way to Conduct physical health checks go to incorporate the guidance into routine care.

Opinion report

Practice report

Narrative review


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Level of Evidence∗ Publication Type (Methods)

Level VII Medical and psychosocial interventions to treat people with schizophrenia

Level VII Principles of early intervention in the treatment of psychosis

Level VI

Gillam, 2002

Rogers, 2006

Roks et al., 2008

Assertive Community Therapy for patients with FEP (Evaluation of the program)

Level VI

Practice report

Opinion report

Opinion report

Training pack: Early Practice report Psychosis (translation into Dutch) The role of community Narrative review mental health nurses in the preventions of psychotic relapse in patients with schizophrenia The Levels of Recovery from Practice report Psychotic Disorder Chart (Development of chart)

Topics

Sousa, 1998

Meulenbroeks Level VI et al., 1998

Linszen et al., Level VI 1998

Author/Year

Reported Outcome

The contribution of nurses concerns the module social interventions Psychosocial interventions


The chart can be used successfully Psychosocial rehabilitation with patients, families, and staff to optimize antipsychotic medication treatment. Inform mental health nurses about Psychosocial interventions: developments in the treatment of CBT, life/social skills schizophrenia. training, assessment, and case management. Providing early help is particularly Clarify what is happening important in schizophrenia. The Avoid stigmatization earlier a psychotic illness is Support with transition back effectively treated, the less likely to ordinary life negative symptoms and social Assertive approach for consequences are to develop. engagement of client and family Boosters of treatment and support Most of the Early Intervention Provide family and social Service outcomes are available: support decrease of drop-out (