evidence-based rehabilitation interventions for adolescents with schizophrenia spectrum disorders...
TRANSCRIPT
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EVIDENCE-BASED REHABILITATION INTERVENTIONS FORADOLESCENTS WITH
SCHIZOPHRENIA SPECTRUMDISORDERS –
FROM LITERATURE REVIEW TO PRACTICE
Kiki Metsäranta, RN, Nurse Manager
Anna Laine, RN, BHSc
Breaking barriers, The Nordic Conference of Mental Health Nursing
11 – 13 September 2013
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BACKGROUND
• Adolescent Psychiatry Rehabilitation Unit is under development – from in-patient to out-patient– out patient rehabilitation services have been centralized– for adolescents with psychotic disorders and/or neuropsychiatric problems– impaired functionality
• Need for – evidence-based care methods to improve adolescent psychiatric
rehabilitation– safe and effective treatments
10.04.23 [email protected]
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MAIN FOCUS ON DEVELOPING WORK
• We decided to focus on Schizophrenia – one of the most severe mental disorder appearing typically in the late
adolescence or early adulthood. – a chronic disorder – impairing patients social and cognitive functioning– expensive diseases economically and humanely
10.04.23 [email protected]
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THE AIMS
1. To do literature review for evidence-based interventions for adolescents with schizophrenia spectrum disorders
2. To find out how this knowledge can be tailored for daily practice in adolescent psychiatric rehabilitation unit
10.04.23 [email protected]
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LITERATURE REVIEW
• An electronic search February 2013– CINAHL, Pubmed and PsycINFO
• inclusion criteria– English language– adolescent population – intervention included– diagnosis of schizophrenia spectrum
disorders– empirical research– studies published after the January 1st
2000.10.04.23 [email protected]
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RESULTS
• 1032 initially identified abstracts• 166 articles were retrieved • 12 articles were included based to
inclusion criteria.
10.04.23 [email protected]
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TARGET GROUP OF INTERVENTION
• 5 individual • 3 integrative – family, patient• 2 in-patient (individual)• 1 family• 1 group intervention
10.04.23 [email protected]
INTERVENTION
• Cognitive rehabilitation therapy (CRT)• Computer- assisted, CARC (based on
CRT)• Cognitive behavioral therapy (CBT)• EPP (Early Psychosis Program)• Intensive community management• Family focused intervention• Telepsychiatry• In- patient treatment – restrain,
holding, seclusion, time-out
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INTERVENTION - COGNITIVE
10.04.23 [email protected]
• CRT– training programme– cognitive differentation, attention, memory and social perception– may have a positive effect on cognition and cognitive flexibility
• CBT– focused on the present– time- limited– problem- solving oriented– patients learn specific skills
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INTERVENTION - COGNITIVE
• EPP (Calgary Early Psychosis Program)– case management, psychiatric management and medication,
strategies, cognitive-behavior therapy, group therapy and family interventions
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INTERVENTION – CASE STUDIES
10.04.23 [email protected]
• Intensive community management – the family's determination to avoid
hospitalization– work of the families concerned– intensive community resources – ready availability of inpatient beds
• Telepsychiatry– interactive sessions by teleconferencing
• Family-focused intervention – community based– family-centered– self-management– group sessions
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INTERVENTION- IN-PATIENT
10.04.23 [email protected]
• In - patient treatment – restrain, holding, seclusion, time-out
– high risk group of restrain during inpatient treatment
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CHOOSING AND IMPLEMENTING NEW INTERVENTIONS
• Cognitive remediation treatment – CRT
• Cognitive behavioral therapy – CBT– Social Cognition and Interaction Training (SCIT)– Acceptance and commintment therapy (ACT)
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• Importance of medical treatment – monitoring and motivating• Preventing and minimize risks of relapses and substance abuse
AND THAT WAS NOT ALL /BONUS MATERIAL /
WHAT ELSE?
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ENABLERS OF THE DEVELOPMENT PROJECT
• Need for evidence based rehabilitation
• Manager involvement and support
• Importance to improve rehabilitation
• Easy to use
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CHALLENGES• Clear implementation plan is needed
– Training– Follow-up– Feedback– Administration´s support
• Resource – Time, support
• Barriers must be verify– Weak collaboration between different professional level– Resistance
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WHAT WE HAVE LEARNED
Support from administration is important
Nurses´ professional indentity have increased
We can make improvement if we want it