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The Opus Project: ....continued Return to Forum Criteria for Admission 1) The patient is aged 18 – 45 (In Århus 16 – 45) with national register address in Copenhagen or Frederiksberg municipality or Århus Amt. 2) The patient must meet the research criteria in ICD-10 for the diagnosis F2X: Schizophrenia, paranoia (acute and passing), and schizoaffective psychosis or unspecified non-organic psychosis. 3) If any former psychotic incidents have occurred, then they cannot have been treated with adequate medical treatment. The borderline adequate medical treatment is here defined as with neuroleptica (doses of Perfenazin/Zuclopenthixol over 16mg daily or adequate doses of other neuroleptica for more than 12 weeks). 4) The patient cannot be mentally retarded. 5) The patient cannot have known neurological or endocrine disruptions that can de due to the present psychotic symptoms. 6) The patient understands and speaks Danish enough to be examined and treated without the need of an interpreter. 7) The patient signs a paper agreeing to take part in the project. The use of psychoactive drugs does not result in exclusion. The psychotic state must not be due to toxication or withdrawal syndrome. Method The teaching covers: 1) The aim of the project If the early signs of illness or positive signs of psychosis are there, the patient is recommended to the project, by the GP or by the Community Mental Health Centre. Treatment a) Continued contact with the psychosis team. a) At the core of the intensive psychosis team’s (also called the outreach psychosis team) treatment is the patients contact to the team and this involves an individual contact person, who through a continued and persistent effort, seeks to keep contact with the patient. Furthermore, to secure continuity between the various treatments arrangements and sectors as well as to give concrete support following the changing demands of the patient. If the patient is not hospitalised the multidisciplinary psychosis team takes care of every aspect of treatment phases. Each practitioner is responsible for a maximum of 10 patients and a minimum contact is a weekly meeting, lasting 30 minutes. The meeting is held in the patient’s own home to support the patient’s resources and train their societal skills in a neutral environment. In the critical stages one or several daily visits in the home might be discussed (Stein and Test, 1980). Supervision of the psychosis team, family treatment and individual talk courses will be secured. At one or more days of hospitalisation the responsibility for treatment is with the hospital ward, while the patient’s case manager will take part in the treatment conferences, discharge discourse and other interviews in which the patient’s future treatment is discussed and planned. If the patient is treated in the day centre at the Community Mental Health Centre then the patient will obtain the status of daytime patient and the responsibility for the treatment will be with the centre. b) The medical treatment has the aim of an effective anti-psychotic result with as few side effects as possible. The treatment is designed individually. The guidelines are given by Dansk Psykiatrisk Selskab´s promotion of the use of the more recent atypical neuroleptika for the first time psychosis and the knowledge that patients, in the early stages of the illness, do not need high doses. When the psychotic stage has been stable for at least 12 weeks reducing the doses should be contemplated, keeping close coordination with the clinical state. There is an aim to measure the serum level of neuroleptika with respect to the judging of compliance. c) The family treatment begins as soon as the patient is admitted and has given consent to the contract of the family. Furthermore, the family has to show a willingness to co-operate in the project. The family treatment consists of 3 parts: 1) A family session consists of a minimum of three meetings between the practitioner and the relatives without the patient participating. The scope of these meetings is to create an alliance within the family and to map former indications of the illness. If there is a crisis in the family, crises help is offered. 2) A teaching seminar for 4-6 families, who afterwards create a Multiple-Family group. The patients do not participate. The families are provided with lessons in psychosis, reasons, treatment and prognosis. 3) The Multiple-Family group is a closed group, with 4-6 families with participation of the patients and two practitioners. The group have their meetings lasting approximately 90 minutes, every second week, for 1½ year. The Multiple-Family model provides the possibilities for the developing of the families social network and help break the isolation, guilt and stigmatisation that are often connected to a psychotic disease. The work form is based on structured problem solving, improving communication, hands on support for the outside influences and the increase of awareness of early signs of psychotic relapse. This is important for in the first years the most important issue is the prevention of the psychotic relapse. Later the focus is on the increase of the patient’s level of function within society and to prepare for the termination of the treatment. The families are encouraged to keep contact with each other, independently of the group (Hogarty, 1986; Mari and Striener, 1994; Dixon and Lehman, 1995; McFarlane, 1995; Penn and Mueser, 1996 Schooler, 1997). d) If the patient needs to develop societal skills appropriate for their age, they are offered specified training, either individually, in the home environment or by group, following the principals of cognitive behavioural therapy. Emphasis is put on the training of communicative skills, handling of the early signs of psychotic relapse and the medical treatment. The social part of the treatment plan has the aim to strengthen the patient’s ability to function and take part in society, and engage themselves, consistent with their abilities, in education, employment and/or activities. Contact with psychosis team joint treatment lasts 1½ year after inclusion. During that time the patient and family are recommended to be aware of all the treatments major components: contact with the team, anti-psychotic medicine, family treatment and societal skill training and/or rehabilitation. After 18 months the patient is transferred to the relevant Community Psychiatric/ Community Mental Health Centre. Patients that are not admitted to the project can proceed with their treatment at the psychiatric ward or at the Community Mental Health/ Community Psychiatric Centre where they are registered and assigned. If during the course of treatment the patient wishes to stop participating and break contract with the team they can transfer instead to standard treatment. In this case the patient is then assigned to the relevant place of treatment. Registration Evaluation and Research Organisation and Responsibility The people responsible for the joint project (styregruppe, control group) are: Ralf Hemmingsen and Merete Nordentoft from HS and representatives from the Margistraten´s 3rd department in Copenhagen Municipal Council. Also, from Århus Amt there are Niels Reisby, Leif Gjørtz Christiansen and Per Jørgensen. Furthermore, the research committee connected to the project consists of PhD students Mai-Britt Abel, Pia Jeppesen and Per Kassow. Ethical Aspects Funding Page 3: Organisational Issues for Establishing the OPUS |
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