Management of patients with severe mental disorders
1、 Service object
Patients with serious mental illness who are diagnosed clearly and live at home within the jurisdiction. Serious mental diseases refer to a group of mental diseases with clinical manifestations of hallucinations, delusions, serious thinking disorders, behavioral disorders and other psychiatric symptoms, and patients' social life ability is seriously damaged. It mainly includes schizophrenia, schizophrenic affective disorder, paranoid psychosis, bipolar disorder, mental disorders caused by epilepsy, mental retardation accompanied by mental disorders.
2、 Service content
（1） Patient information management
When the patients with serious mental diseases are included in the management, the family members need to provide or directly transfer the disease diagnosis and treatment related information from the professional medical and health institutions that originally undertook the treatment task, at the same time, conduct an evaluation for the patients, establish the general residents' health records for them, and fill in the supplementary form of personal information of the patients with serious mental diseases according to the requirements.
（2） Follow-up evaluation
The patients with serious mental diseases under corresponding management shall be followed up at least 4 times a year, and the risk assessment shall be carried out for each follow-up; Check the mental state of the patient, including feeling, perception, thinking, emotion, will and behavior, insight, etc; Ask the patient about physical disease, social function, medication and laboratory test results. Among them, The risk assessment is divided into 6 levels (Level 0: no behavior in line with the following 1-5 levels; Level 1: verbal threats, shouting, but no smashing behavior; Level 2: smashing behavior, limited to the home, targeted at property. Can be persuaded to stop; Level 3: obvious smashing behavior, regardless of the situation, targeted at property; can not accept persuasion to stop; Level 4: continuous smashing behavior, regardless of the situation, targeted at property or people, can not accept persuasion to stop. Including self-injury, suicide; Level 5 : Any violence against people with controlled dangerous weapons, or arson, explosion and other acts, whether at home or in public).
（3） Classified intervention
According to the risk grade of the patient, whether the mental symptoms disappear, whether the insight is completely restored, whether the work and social functions are restored, and whether the patient has adverse drug reactions or physical diseases, the patients are classified for intervention.
1. Patients with unstable condition. If the risk is grade 3 to 5, or the symptoms of mental illness are obvious, lack of insight, acute adverse drug reactions or serious physical diseases, the patient should be referred to the superior hospital immediately after treatment. If necessary, report to the local public security department and assist in sending to hospital for treatment. For patients who are not hospitalized, they will be followed up within 2 weeks with the joint assistance of psychiatrists, residents' committees and police.
2. The patient's condition is basically stable. If the risk is level 1 to 2, or the mental symptoms, insight, and social function are at least in one aspect poor, first of all, we should judge whether the condition fluctuates or the drug efficacy is poor, or accompanied by adverse drug reactions or deterioration of physical symptoms. Respectively take measures to adjust the dosage of the current drug within the prescribed dose range and find out the cause for symptomatic treatment. If necessary, contact the original doctor in charge of the patient, or treat under the guidance of a psychiatrist. After preliminary treatment, observe for 2 weeks. If the situation is stable, maintain the current treatment plan, and follow up at 3 months; If the preliminary treatment is invalid, it is recommended to refer to the superior hospital and follow up the referral within 2 weeks.
3. Patients with stable condition. If the risk is level 0, the mental symptoms basically disappear, the self-knowledge basically recovers, the social function is in general or good condition, there is no serious adverse drug reaction, the physical disease is stable, and there is no other abnormality, continue to implement the treatment plan formulated by the superior hospital, and follow up at 3 months.
4. According to the control of the patient's condition, each follow-up will provide targeted health education and life skill training for the patient and his family members, and provide psychological support and help to their families.
（4） Physical examination
If the patient's condition permits, after obtaining the consent of the guardian and the patient himself, the health examination shall be carried out once a year, which can be combined with follow-up. The contents include general physical examination, blood pressure, body weight, blood routine (including white blood cell classification), transaminase, blood glucose, and electrocardiogram.
