Management Of Patients With Severe Mental Disorders
I. service objects
Patients with severe mental illness who have been diagnosed clearly and live at home. Heavy sex mental disease is to point to clinical expression to have psychosis sex symptom such as hallucination, delusional, serious thinking obstacle, behavior disorder, and a group of mental disease that patient social life ability is damaged badly. It mainly includes schizophrenia, schizoaffective disorder, paranoid psychosis, bipolar disorder, epilepsy caused by mental disorders, mental retardation accompanied by mental disorders.
II. Service content
(1) patient information management
In patients with severe mental illness should be brought into the management, should be provided by family members, or directly from the original professional medical institutions responsible for treating the disease diagnosis and treatment of relevant information, at the same time for patients to make a comprehensive evaluation, established for the general residents' health records, and fill in the patients with severe mental illness as requested personal information table.
(2) follow-up evaluation
Patients with major mental illness should be followed up at least 4 times per year, and risk assessment should be conducted for each follow-up. Examine the patient's mental state, including sensation, perception, thinking, emotion, volitional behavior, self-awareness, etc. The patients were asked about their physical diseases, social functions, medication and laboratory test results. The risk assessment is divided into 6 levels (0: failure to engage in any of the following 1 to 5 levels; Level 1: verbal threats, Shouting, but no smashing; Level 2: smashing behavior, limited at home, for property. Can be persuaded to stop; Level 3: obvious smashing behavior, regardless of occasion, for property; Unable to be persuaded to stop; Level 4: continuous smashing behavior, regardless of occasion, for property or people, can not be persuaded to stop. Including self-injury and suicide; Level 5: any act of violence against a person with a controlled dangerous weapon, or arson, explosion, etc., whether at home or in public).
(3) classified intervention
Patients were classified according to their risk rating, whether their mental symptoms disappeared, whether their self-knowledge recovered completely, whether their work and social functions recovered, and whether they had adverse drug reactions or physical diseases.
1. Patients with unstable condition. If the risk is grade 3-5 or the symptoms of psychosis are obvious, lack of self-awareness, acute adverse drug reactions or serious physical diseases, the patient shall be immediately referred to the superior hospital after symptomatic treatment. If necessary, report to local public security department and assist in hospital treatment. Patients who were not hospitalized were followed up within 2 weeks with the help of psychiatrists, residents' committee members and police.
2. Patients with stable condition. If dangerous sex is 1 ~ 2 grade, or mental symptom, self-knowledge, social function condition has on the one hand at least poorer, answer to judge above all is illness wave motion or medicaments curative effect not beautiful, still have accompanying medicaments adverse reaction or somatic symptom aggravation. Adjust the current drug dose within the prescribed dose range and find the cause of symptomatic treatment measures, if necessary, get in touch with the original patient in charge of the doctor, or under the guidance of psychiatrists treatment, after preliminary treatment observation for 2 weeks, if the situation tends to be stable, can maintain the current treatment plan, 3 months follow-up; If the initial treatment is ineffective, it is recommended to transfer to the superior hospital and follow up the referral situation within 2 weeks.
3. Patients with stable condition. If the risk is grade 0, and the mental symptoms basically disappear, the self-knowledge basically recovers, the social function is normal or good, no serious adverse drug reactions, stable physical diseases, no other abnormalities, continue to implement the treatment plan formulated by the superior hospital, and follow up at 3 months.
4. According to the control situation of the patient's condition, the patients and their families were given targeted health education, life skills training and other rehabilitation guidance, and psychological support and help were provided for the family members during each follow-up.
(4) physical examination
If the patient's condition permits, after obtaining the consent of the guardian and the patient himself, health examination shall be conducted once a year, which can be combined with follow-up. The content includes general physical examination, blood pressure, weight, blood routine (including leukocyte classification), transaminase, blood glucose, electrocardiogram.