3
Treatment
Setting and Housing
Î Hospitalize patients:
• Who pose a threat to self or others
• Who are unable to care for themselves
• Who need constant supervision
• For whom outpatient treatment is unsafe or ineffective
Î Day or partial hospitalization, home care, family crisis therapy, crisis
residential care, and assertive community treatment
• For patients who do not need formal hospitalization
• Patients may be moved from one level of care to another as needed
Treatment Plan
Î Formulate and implement a treatment plan
• Identify treatment targets and use objective outcome measures to determine
effectiveness of treatment
• Set realistic expectations for what constitutes successful treatment
• Use objective quantitative rating scales to monitor clinical status (eg, Positive
and Negative Symptoms Scale (PANSS); Brief Psychiatric Rating Scale (BPRS);
Negative Symptoms Assessment (NSA))
Î Develop a treatment alliance and promote treatment adherence
• Relate patient's individual goals to treatment outcomes
• Assess and address factors that affect adherence
▶ Side effects
▶ Lack of insight
▶ Patient perception of medication risks and benefits
▶ Cognitive/memory impairments
▶ Therapeutic alliance
▶ Financial, transportation, and other practical barriers
▶ Cultural beliefs
▶ Social support
• Consider assertive outreach
Î Provide patient and family education
• Nature of the illness
• Signs of relapse
• Coping strategies
Î Treat comorbid conditions including nicotine dependence and other
substance use disorders
• Substance abuse rehabilitation programs
• Pharmacological interventions for alcohol abuse
• Nicotine replacement therapies
• Bupropion (use with caution; may activate psychosis or be diverted for abuse)
• Psychosocial interventions
Î Ensure that services are coordinated
Î Integrate treatments from multiple clinicians
Î Document treatment over the course of illness
