/> Psychosocial Interventions Gerarde Dawe
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Psychosocial Assessment - Deliberate Self Harm, this should identify motives for the act,
and those associated problems which are potentially amenable to intervention such as
psychological or social problems, mental disorder, alcohol or substance misuse.
REFERENCE:-  Document 122448 NHS CRD  

Psychosocial interventions following suicide attempt
Prevention / Treatment - specific interventions
                                   Psychiatric management of poor compliance with after-care
                                   Guaranteed in-patient shelter
                                   Psychosocial crisis intervention
                                   Cognitive - behavioural treatment
Conclusions - only cognitive - behavioural therapy appeared to significantly reduce incidence
of repeated suicide attempts.
REFERENCE:- Document 122817 NHS CRD
Research Resources 

Mental Health: A  Report of the Surgeon General.             Mental Health Nursing Resources
Elements in the Report                                                                        
- Management of Severe Mental Illness in Hospital
  and in the Community.
- Research Training and Practice; & Research relating        Nursing Education Online Resources
  to issues in the care of the severely mentally ill.                
- Psychological Management Techniques.
- Ethics of Cognitive Behavioural Psychotherapy.
- Family Interventions
- Case Management                                                        Nursing Resources Northern Ireland
Psychosocial Interventions Specialist Practice World Wide Network
Mental Health Resources
Nursing Resources Northern Ireland   Psychosocial-Interventions Development
NAMI   Publications


Schizophrenia may effect the most basic functions that give people a feeling
of individuality, uniqueness and self-direction.
Our reality boundary may be effected.
We may hallucinate.
We may develop feelings of bewilderment.
We may become fearful.
We may believe that our deepest thoughts, feelings and acts may be known to,
or controlled by others.

Signs to watch out for:-   Severe Sleeplessness
                                    Extreme Withdrawal
                                    Thoughts of Life not worth living.
                                    Irrational Talk
                                    Disruption of Normal Routine

Treatment for Person:- Physical; Biological; Psychological; Social; Vocational;
Spiritual; Cultural; Medical; Occupational; Relaxation; Educational; Family;   
Care of Person by:-  Self; Family; Friends; Society; Social Work; Medical;
Nurses Midwives Health Visitors;
How is recovery to be protected?              How are relapse factors to be noted?   
How may families help?
(Life Style)                                              (Community Services)       (CAUSE)
During an episode of Schizophrenia, your experience and interpretation
of the world may be disrupted.
You may lose touch with reality:- 
                                   see things that are not there
                                   hear things that are not there
                                   taste things that are not there
                                   smell things that are not there
                                   feel things that are not there
                                   act in an unusual way in response to hallucinations
                                   act in an unusual way in response to delusions
People experiencing Psychosis and Schizophrenia episodes
respond to treatment and care.
Symptoms of Schizophrenia:- 
Positive Symptoms
           - 3 main positive symptoms
           - Feelings of being controlled by outside forces, your thoughts & actions are taken over.
           - Hearing, Seeing, Smelling, Feeling, Tasting things that are not there. ( Hallucinations)
           - False Beliefs fixed and out of keeping with others in your culture.        ( Delusions)

Negative Symptoms         ( These may be complicated by side-effects of medication )
                              -  Tiredness all the time
                              -  You Cannot Concentrate
                              -  You may loose energy
                              -  You may loose motivation
                              -  Simple things may become impossible for you
                              -  Talking to your friends may become a chore
                              -  Your eating may get neglected
                              -  You may neglect to keep warm

Maintaining relationships may become difficult for you
Maintaining interest may become difficult for you
Maintaining affection in friends and loved ones may become difficult for you

The effect of this experience of Psychosis or Schizophrenia is that recovery from
the social damage caused by the Negative Symptoms is a barrier to your rehabilitation.

Elements of Caring for the Person include:-
Medication Management; Stress Vulnerability; Family Work; Information Processing;
Coping with symptoms.
Mathias, P, & Thompson, T. (2000) Lyttle's Mental Health and Disorder 3rd edition
London, Balliere Tindall.
nelh nhs uk Health informatio resources                 Schizophrenia Society of Nova Scotia

Evidence   NHS Journals & Data Bases                 Schizophrenia Society of British Columbia

Evidence Schizophrenia NHS                               Schizophrenia Society of Manitoba

UK NHS Portal for Schizophrenia                         Schizophrenia Society of Ontario

Schizophrenia   © 2010 RCPsy                            Schizophrenia Society of Saskatchewan    

Schizophrenia IMH                                                Schizophrenia Search

                                                                          Schizophrenia NIMh          

Schizophrenia choosing well SANE/Rethimk          APA  © 2011  Learn / Research  
Mental health information for all

Priory Health Care                      

Pharmacy Magazine Modules                  

Health Professionals 
Psychosocial Interventions for Schizophrenia - Effective Health Care Bulletin  - PDF File Download

Middlesex University EMILIA    EMILIA 2    EMILIA 3   

Mental Health Research - York       

Trip Clinical Search Engine ~ data base        

Handbook for Leading Inpatient and Residential Psychoeducational Group  PSYCHOEDUCATIONAL GROUP THERAPY FOR THE DUALLY DIAGNOSED A Handbook for Leading Inpatient and Residential Psychoeducational Groups for Mentally  Ill Chemical Abusers

Bipolar Disorder Center: http://www.healthline.com/health/bipolar-disorder

Defining Severe / Serious Mental Illness -
The House of Commons Committee Report (1994)

Diagnosis:        schizophrenia
                       schizo-affective disorder
                       paranoid psychosis
                       major depression

Duration:           at least one year since the onset of the disorder

Disability:          sufficiently severe disability to seriously impair functioning or role
                       performance in at least one of the following areas.
                       - occupation
                       - family responsibilities
                       - accommodation

House of Commons Select Committee (1994)
Better off in the Community? Care of people who are seriously mentally ill.
Vol 1 HMSO London.
Care for the Person with Schizophrenia - Effective Health Care. August 2000.
Volume 6. Number 3. ISSN: 0965-0288

Supportive Educational Interventions
(Individual Psycho educational Programme)

Family - Social - Biological - Pharmacological: Support, Information, Management.
Pekkala, E., Merinder, L. (2000) Psycho educational intervention for schizophrenia
and other severe mental illness. The Cochrane Review. Issue 3. Oxford. Update Software.

(Family Work)
Provision of support - Education - Interaction - Lower burden of care.
Decrease stress within the family. Education about schizophrenia. Training in problem solving.
Collaboration with relatives who care for the person with schizophrenia.
Reduce emotional stress. Reduce burden on relatives.
Enhance family ability to anticipate problems. Reduce feelings of anger.
Reduce experience of guilt.
Goal setting for person suffering with schizophrenia. 
Agreement on limit setting. Agreement on appropriate solitude balanced within family interaction.
Opportunity for adaptation in family interaction.
Exploration of family expectations for care and support.
Forum for healing hostility. Sharing disagreeable ideas.
Department of Health (1999) The National Service Framework for Mental Health. -
Modern standards and service models. :London. DoH.

Skills Training

(Life Skills)
Promote independent daily living. Money management. Home management. Domestic skills.
Personal care. 
Nicol, M., Robertson, I., Connaughton, J. (2000) Life skills for chronic mental illness
Cochrane Review. Issue 3. Oxford. Update Software.

(Social Skills)
Enhance social performance. Reduce distress. Assessment of  interpersonal skills.
Communication. Perception. Social cue processing. Give and receive social reinforcement.
Build and develop individual elements of social skill into competent social performance.
Pilling, S., Orbach, G., Connaughton, J. (2000) Social skills programmes for schizophrenia.
The Cochrane Review. Issue 3. Oxford. Update Software.

(Vocational Skills)
Pre vocational training. Sheltered work. Supported employment.
Crowther, R., Bond, G., Huxley, P., Marshall, M. (2000) Vocational rehabilitation
for people with severe mental disorders. (Protocol) 
The Cochrane Review. Issue 3. Oxford. Update Software.

Symptom focused interventions.

(Cognitive behavioural therapy)
Distress reduction. Examination of distressing belief.
Challenge thinking patterns that cause distress.
Promotion of reasoning. Look for alternative choices. Improve mental state.
Spend time with patient.
Jones, C., Cormac, I., Mota. J., Campbell, C. (2000) Cognitive behaviour therapy
for schizophrenia. The Cochrane Review. Issue 3. Oxford. Update Software.

(Cognitive rehabilitation)
Retraining - memory, attention, speed of mental processing and mental abstraction,
to improve overall mental functioning
Spring, B., Ravdin, I., (1992) Cognitive remediation in schizophrenia:
Should we attempt it? Schizophrenia Bulletin.  18: 15 - 20.
Hayes, R., McGrath, J. (2000) Cognitive Rehabilitation for people with schizophrenia
and related conditions. The Cochrane Review Oxford. Update Software.

(Token economy)
Improvement in negative symptoms of schizophrenia.
McMonagle, T., Sultana, A. (2000) Token economy for schizophrenia.
The Cochrane Review. Issue 3. Oxford. Update Software.

Service Provision

(Assertive community treatment)
Community based multidisciplinary team. - psychiatrist - sister/charge nurse -
staff nurse - social worker - occupational therapist - nursing assistant -
community psychiatric nurse - senior house officer - senior registrar -
liaison psychiatric nurse - specialist nurse practitioner - general medical practitioner -
research nurse - administrator - administrative assistant - transport officer.

Small case load. 24 hour cover. Frequent home contact.
Multidisciplinary team-work in the community. Low client:staff ratio. Assertive outreach.
Medication adherence. Emergency cover. Intensive case management.
Bouras, N., Turnell, G., Brough, D., Watson, J. (1986) Model for integration of
community psychiatric and primary care.
Journal of the Royal College of General Practitioners 36: 62-6.
McGraw, J., Bond, G. (1995) Critical ingredients of Assertive Community Treatment:
judgements of the experts. Journal of Mental Health Administration 22: 113-25.
Marshall, M. Lockwood, A. (2000) Assertive community treatment for
people with severe mental disorders. The Cochrane Review. Issue 3. Oxford. Update Software.

(Community mental health teams)
Nurse - Occupational Therapist - Psychiatrist - Psychologist
Bennett, D., Freeman, H. (1991) Principles and Prospects. Pages 1-39.
in Community Psychiatry Edinburgh: Churchill Livingstone.
Merson, S. Tyrer, P. Onyett, S. (1992) Early intervention in psychiatric emergencies:
a controlled clinical trial. The Lancet 339: 1311-4.
Tyrer, P., Coid, J. Simmons, S. (2000) Community mental health teams for
people with severe mental illness and disordered personality.
The Cochrane Review Issue 3. Oxford. Update Software.

(Home based care & Initial crisis intervention)
24 hour Mental Health 1st Aid.
Querido, A.,  (1968) The shaping of community mental health care.
British Journal of Psychiatry  114: 293-302.
Weisman, G. (1989) Crisis Intervention. in Bellack, A, (ed).
A clinical guide for the treatment of schizophrenia. New York. Plenum Press.

(Acute Day Hospital)
Creed, F., Black, D., Anthony, P. (1990) Randomised controlled trial of day patient
versus inpatient psychiatric treatment. British Medical Journal 300: 1033-1037.
Sledge, W., Tebes, J., Rakfeldt, J. (1996) Day Hospital crisis respite care versus
inpatient care. part 1. clinical outcomes. American Journal of Psychiatry 153: 1065-1073.
Creed, F., Mbaya, P. Lancashire, S, (1997) Cost effectiveness of day and
inpatient psychiatric treatment: results of a randomised controlled trial.
British Medical Journal 314: 1381-1385.
Almaraz-Serrano, A., Marshall, M. Creed, F. (2000) Day hospitals for
people with psychiatric disorders (protocol) The Cochrane Review Issue 3.
Oxford. Update Software.

(Day Care)
Crisis House.
Catty, J., Burns, T., Comas, A. (2000) Day centres for severe mental illness. (protocol)
The Cochrane Review Issue 3. Oxford. Update Software.

(Case Management)
Co-ordinating services. Case Manager. Assess needs. Develop care plan. Provide care.
Audit quality. Maintain contact. Improve social functioning. Improve quality of life.
Holloway, F. (1991) Case management for the mentally ill: looking at the evidence.
International Journal of Social Psychiatry 37: 2-13.
Thornicroft, G. (1991) The concept of case management for long term mental illness.
International Review of Psychiatry 3: 125-32.
Rossler, W., Loffler, B. Fatkenheuer, A., Riecher-Rossler, A. (2000) Case management
for schizophrenic patients at risk of rehospitalisation - a case control study.
European Archives of Psychiatry & Clinical Neuroscience
Kanter, J. (1991) Integrating case management and psychiatric hospitalisation.
Health & Social Work 16: 34-42.
Rossler, W., Loffler, W. Fatkenheuer, B. Reicher-Rossler, A. (1992) Does case
management reduce the rehospitalisation rate? Acta Psychiatricia Scandinavia. 86:445-9.
Marshall, M. Grey, A., Lockwood, A., Green, R., (2000) Case management for
people with severe mental disorders. The Cochrane Review Issue 3. Oxford. Update Software.

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