Materiały źródłowe

• #1 Psychosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568796/

  Psychosis is an amalgamation of psychological symptoms resulting in a loss of contact with reality. […] Psychosis can result in high levels of distress for patients and loved ones, which is why it has become a primary target of treatment for medical professionals. […] Nursing Management includes assessing vital signs, assessing neuro vitals, assessing the thought process, administering antipsychotic agent, keeping the patient in a calm isolated room, speaking in a slow and calm manner, avoiding all stimuli, interacting gently with patients, being comforting, ensuring patient safety, educating the family about the illness, constantly checking up on the patient, ensuring the patient is not violent towards others, and ensuring the patient has no suicidal ideations. […] A safe and therapeutic environment, with calm, empathetic patient interactions, are essential for treating psychotic symptoms. […] Early intervention is essential for long term outcomes.

• #1 11.4 Applying the Nursing Process to Schizophrenia – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/11-4-applying-the-nursing-process/

  Assessment includes interviewing the client, observing verbal and nonverbal behaviors, and completing a mental status examination and a psychosocial assessment. […] It is also important to assess for suicide risk for clients with psychosis. […] When assessing hallucinations, do not imply the perceptions are real. […] Assess the clients ability to perform activities of daily living. […] Determine if the client is taking their medications as prescribed, their effectiveness, and if they are experiencing side effects. […] Nurses also assess for adverse effects of medications, such as involuntary movements associated with the use of antipsychotic medications. […] Hospitalization is indicated during the acute phase of schizophrenia if the client is considered a danger to self or to others.

• #1 Chapter 11 Psychosis and Schizophrenia – Nursing: Mental Health and Community Concepts – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK590027/

  The overall goal in the acute phase of schizophrenia is patient safety and stabilization. […] Nursing interventions focus on providing safety, promoting hygiene and nutrition, improving socialization, encouraging hope and self-esteem, preventing falls, using specific therapeutic techniques, addressing physiological needs, and implementing collaborative interventions. […] Clients with command hallucinations require close monitoring for suicide, homicide, and other violence risk. Implement interventions to reduce risk of suicide as described in the Application of the Nursing Process in Mental Health Care chapter. […] Regularly engage with the client. Initially interact briefly about low-anxiety topics like the weather and gradually increase the duration and frequency of interactions as they become more comfortable. […] Convey unconditional acceptance, empathy, and support.

• #1 Schizophrenia Nursing Care and Management

  https://nurseslabs.com/schizophrenia/

  Risk for Imbalanced Nutrition: less than body requirements related to self-neglect and refusal for self-care. […] […] […] Nursing Care Planning and Goals […] Reduce severity of psychotic symptoms […] Prevent recurrence of acute episodes […] Meet patients physical and psychosocial needs […] Help patient gain optimum level of functioning […] Increase clients compliance to treatment and nursing plan […] […] […] Nursing Interventions […] Establish trust and rapport. Dont touch client without telling him first what you are going to do. Use an accepting, consistent approach; short, repeated contacts are best until trust has been established. Language should be clear and unambiguous. Maintain a sense of hope for possible improvement, and convey this to the patient. […] Maximize level of functioning. Avoid promoting dependence by doing only what the patient cant do for himself. Reward positive behavior and work with him to increase his personal sense of responsibility in improving functioning.

• #1 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with schizophrenia may include: Clients with schizophrenia are prone to injury due to auditory and visual hallucinations caused by abnormalities in the brains processing of sensory information. These hallucinations can be distressing and interfere with the clients ability to function in daily life. […] Be alert for signs of increasing fear, anxiety, or agitation. This might herald hallucinatory activity, which can be very frightening to the client, and the client might act upon command hallucinations (harm self or others). […] Explore how the hallucinations are experienced by the client. Exploring the hallucinations and sharing the experience can help give the person a sense of power that he or she might be able to manage the commanding, hallucinatory voices.

• #1 Schizophrenia Nursing Care and Management

  https://nurseslabs.com/schizophrenia/

  Promote social skills. Provide support in assisting him to learn social skills. […] Ensure safety. Maintain a safe environment with minimal stimulation. […] Ensure adequate nutrition. Monitor patients nutritional status and if the patient thinks his food is poisoned, let him fix his own food if possible or offer him foods in closed containers that he can open. Institute suicide and/or homicide precautions as appropriate. […] Keep it real. Engage patient in reality-oriented activities that involve human contact (e.g., workshops, inpatient social skills training). Clarify private language, autistic inventions, or neologisms. […] Deal with hallucinations by presenting reality. Explore the content of hallucinations. Avoid arguing about the hallucinations. Tell them you do not see, hear, smell, or feel it but explain that you know that these hallucinations are real to him.

• #1 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Decrease environmental stimuli when possible (low noise, minimal activity). This decreases the potential for anxiety that might trigger hallucinations and helps calm the client. […] Engage the client in reality-based activities such as card playing, writing, drawing, doing simple arts and crafts, or listening to music. Redirecting the clients energies to acceptable activities can decrease the possibility of acting on hallucinations and help distract from voices. […] Administer clozapine, as indicated. […] Coping strategies for patients with schizophrenia involve developing adaptive ways to manage symptoms and daily challenges. These may include engaging in stress-reducing activities such as exercise, practicing relaxation techniques, participating in supportive therapy or support groups, maintaining a structured routine, and utilizing problem-solving skills to address specific difficulties.

• #1 11.4 Applying the Nursing Process to Schizophrenia – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/11-4-applying-the-nursing-process/

  During the stabilization and maintenance phases, planning focuses on education, support, and skills training for the client and family. […] Clients with command hallucinations require close monitoring for suicide, homicide, and other violence risk. […] Promote hygiene in clients experiencing psychosis by concisely and explicitly stating expected hygiene tasks. […] Regularly engage with the client. […] Convey unconditional acceptance, empathy, and support. […] Fall risk may be increased due to orthostatic hypotension, impaired balance, bradykinesia, or other movement disorders. […] The client may also be experiencing physiological problems related to nutritional status, sleep, and elimination due to their symptoms of psychosis. […] Interventions for clients experiencing psychosis previously discussed in this chapter can also be categorized by the standard of Implementation by the American Psychiatric Nursing Association.

• #1 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Treatment for psychosis involves a combination of antipsychotic medicines, talking therapies and social support. […] Your treatment is likely to involve a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team. […] An early intervention team is a team of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis. […] Treatment for psychosis will vary, depending on the underlying cause. You’ll receive specific treatment if you’ve been diagnosed with an underlying mental health condition as well. […] Antipsychotic medicines are usually recommended as the first treatment for psychosis. […] Antipsychotics can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts.

• #1 Schizophrenia Nursing Care and Management

  https://nurseslabs.com/schizophrenia/

  Promote compliance and monitor drug therapy. Administer prescribed drugs and encourage the patient to comply. Ensure that patient is really taking the drug. Observe for manifestations that warrant hypersensitivity reactions and toxicity. […] Encourage family involvement. Involve family in patient treatment and teach members to recognize impending relapse (e.g. nervousness, insomnia, decreased ability to concentrate). Suggest ways how families can manage symptoms.

• #1 Recognition and Differential Diagnosis of Psychosis in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html

  Do not prescribe antipsychotics to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring. […] Psychotic symptoms are debilitating and can be terrifying to patients and their families. Prompt recognition of the etiology may improve treatment, consultation, and prognosis. […] Any patient with a primary diagnosis of a psychotic disorder will benefit from close collaboration between behavioral health specialists and the primary care physician. […] The early use of antipsychotics, particularly clozapine (Clozaril), can decrease the risk of suicide in patients with schizophrenia, which may be as high as 15%, particularly in the initial phase of the illness. […] Despite optimal treatment, patients with schizophrenia and other psychotic disorders often have deficits in social functioning, are unable to maintain employment, and lack appropriate housing. […] New and developing models are providing promising approaches toward integrated, patient-centered care for individuals with primary psychotic disorders.

• #1 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  The nurses care plan should be individualized to meet the patients individual needs and should provide comprehensive care. It is important for nurses to work with the patients healthcare team to provide quality care and support to those with acute psychosis. […] A nurses role in treating acute psychosis is to assess the current situation, make an individualized care plan, provide education and support, and coordinate care with other healthcare providers. […] The most important part of a care plan for acute psychosis is to provide comprehensive care that is individualized to the patients needs. […] Nursing interventions that can be used to treat acute psychosis includes educating the patient and family, medication management, and psychotherapy. […] The goal of treating acute psychosis is to reduce symptoms, improve functioning, and reduce psychosocial distress. […] Follow-up assessments are important to monitor progress and make any necessary adjustments to the care plan.

• #1 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  Psychotherapy can help the patient process their experiences, identify triggers and develop coping skills to manage symptoms. […] Teaching the patient and their family about psychosis helps to reduce stigma, increase understanding, and build trust between the patient and the care team. […] Appropriate medication management is essential to managing acute psychotic symptoms. Medication can help to reduce symptoms and improve functioning. […] Psychotherapy can help the patient process difficult experiences related to psychosis and learn ways to manage symptoms and cope with triggers. […] Nurses should offer regular follow-up assessments to the patient in order to monitor progress and make necessary changes to the care plan. […] The nurse should review the patients medication regularly to assess the effectiveness and possible side effects.

• #1 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  This diagnosis is based on the patients history of symptoms and their current mental health status. […] This diagnosis is based on the patient experiences of distress due to the symptoms of psychosis that cause problems in the person’s day-to-day life. […] The goal is to help the patient improve their self-care, such as taking medications appropriately and engaging in activities to manage stress. […] The goal is to help the patient reduce psychosocial distress such as anxiety and depression due to psychosis. […] Nurses must provide education to the patient and their family about psychosis, possible triggers, strategies for managing, and any warning signs of relapse. […] Nurses must assess the patients medication needs, provide med reminders, monitor safety, and provide education about side effects.

• #1 The nurse’s role in managing psychosis | Nursing Times

  https://www.nursingtimes.net/mental-health/the-nurses-role-in-managing-psychosis-24-09-2002/

  The phenomenon known as psychosis is part of several serious mental illnesses, including schizophrenia and bipolar affective disorder. Characteristic symptoms such as hallucinations, delusions and paranoia present great difficulties for patients and their families and friends. […] Cognitive and behavioural therapies aim to modify the individuals beliefs, thoughts and behaviour in psychosis. The therapist works collaboratively with the patient to unravel the fabric of his or her psychosis. […] Nurses do not prescribe such medication but administer it, presenting a potential threat to the therapeutic alliance if people are not willing to take drugs. Basic trust between patients and nurses aids the taking of medication. […] Psychosis is usually treated with antipsychotic medication if it persists for more than a few days.

• #1 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Talking therapies can help reduce the intensity and anxiety caused by psychosis. […] Family intervention is known to be an effective form of therapy for people with psychosis. […] If your treatment for psychosis is not working, you might be offered rehabilitation. […] Your rehabilitation team will include people from different parts of the health and care system, such as a rehabilitation psychiatrist, mental health nurse, occupational therapist and social worker. […] If you’re experiencing a particularly severe psychotic episode and your care team think you would be best cared for in a hospital or clinic, they will explain this to you and encourage you to admit yourself for care. […] Acts of violence and aggression are fairly uncommon in people with psychosis. […] It’s important to stress that these methods are only used in extreme circumstances and are not routinely used to treat psychosis.

• #1 Psychosis | healthdirect

  https://www.healthdirect.gov.au/psychosis

  A person with psychosis may be prescribed antipsychotic medicines. These medicines work by altering chemicals in the brain, including dopamine. […] Mental health services can also provide practical support for people with psychosis. Essential components of recovery include: stable accommodation, financial security, social support, having a meaningful role in society. […] People suffering from long-term psychosis may benefit from rehabilitation and assistance to find suitable work. […] Many mental illnesses are best treated by a team of different health professionals working together, including: psychiatrists, psychologists, mental health nurses, occupational therapists. […] Treatment for illnesses that cause psychosis may last for several years. […] If you have experienced psychosis in the past, you can reduce the chance of recurrence by: avoiding drugs and alcohol, following your doctor’s advice, including taking any medicines as prescribed, reducing stress, getting enough sleep, learning ways to cope with stress.

• #1 Psychosis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.psychosis-care-instructions.ut2455

  A person with psychosis cannot tell the difference between what is real and what is not real. It can cause strange thoughts and behaviors. Psychosis can be treated with medicines and counseling. It is important to take your medicines exactly as prescribed, even when you feel well. You will need ongoing follow-up care and may need lifelong treatment. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. […] If you are caring for someone with psychosis, it is important that you take care of yourself as well. Learn about psychosis. Know the first signs that symptoms are getting worse. […] Call your doctor now or seek immediate medical care if: A person with psychosis mentions suicide. If a suicide threat seems real, with a specific plan and a way to carry it out, you should stay with the person, or ask someone you trust to stay with the person, until you get help.

• #1 Early Psychosis Treatment | UC San Diego Health

  https://health.ucsd.edu/care/behavioral-mental-health/first-episode-psychosis-program/

  UC San Diego Health’s early psychosis program is dedicated to getting young people and their families the help they need, as early as possible. […] With early intervention and treatment at our clinic, you may recover completely from a first psychotic episode or learn coping strategies for dealing with continuing or future psychotic symptoms. […] We offer assessments and treatment for adolescents and young adults with warning signs of psychosis, signs of early or first-episode psychosis and acute psychosis. […] Our treatment approach is evidence-based, adaptable and tailored to your needs and preferences. […] First-episode psychosis refers to a person who is experiencing their first psychotic episode. […] This is why UC San Diego Health’s early psychosis care program focuses on diagnosing and treating adolescents and young adults.

• #1 Early Psychosis Treatment | UC San Diego Health

  https://health.ucsd.edu/care/behavioral-mental-health/first-episode-psychosis-program/

  Early diagnosis and intervention offer the best chance of recovery. […] After you have been evaluated, your care team will develop a treatment plan that may include a combination of medication management to reduce symptoms and get the best treatment relief at the lowest possible dose, individual psychotherapy sessions to learn about yourself, your condition and how to manage it and resume normal activities, group psychotherapy for adolescent, adult and multi-family support, cognitive behavioral therapy, wellness education, and employment and college support, personalized intensive outpatient care to address psychiatric and functional needs of people who require a higher level of care than regular clinic visits, peer-support services to learn from and help others with psychosis, referrals to UC San Diego Health inpatient care for patients who need the highest level of care, consultations and second opinion evaluations to confirm a diagnosis or treatment approach with our specialists, recovery and follow-up care for continued support, monitoring and assistance with lifestyle changes for long-term wellness.

• #1 New Journeys and first episode psychosis | Washington State Health Care Authority

  https://www.hca.wa.gov/billers-providers-partners/program-information-providers/new-journeys-and-first-episode-psychosis

  Early intervention with evidence-based treatment decreases the duration of untreated psychosis (DUP), improving outcomes over a lifetime, resulting in reduced health care costs, and improved quality of life for individuals and their families. […] New Journeys coordinated specialty care is a treatment curated to meet the needs of those experiencing a first episode of psychosis with treatment services of a higher intensity than those offered in regular outpatient settings. Treatment provides evidence-based health and recovery support interventions for youth and young adults when first diagnosed with psychosis. […] New Journeys services are delivered by multi-disciplinary mental health professionals who work as a team and provide the treatment, rehabilitation, and support services for individuals to achieve their own goals.

• #1 Early Psychosis Intervention Center offers specialized care for patients with or at risk for psychosis | Ohio State Medical Center

  https://wexnermedical.osu.edu/departments/innovations/psychnews/early-psychosis-intervention-center

  EPICENTER provides patients with a personalized menu of treatments combined with family education and support. […] Family education plays a large role in patient recovery. […] The care team, person with psychosis and family meet to discuss whats occurring, what treatments are available and then build a care plan. […] We use shared decision making, Dr. Breitborde says. […] At EPICENTER, a persons care plan is flexible and often changes over time as they accomplish a goal and move forward to achieve additional goals. […] Many people receiving care at EPICENTER also struggle with other health and mental health conditions. […] The team provides comprehensive care to address all conditions and issues in a persons treatment plan. […] The EPICENTER team partners with five community mental health agencies to help us provide coordinated specialty care for first-episode psychosis across Ohio.

• #1 EPC Missouri – Early Psychosis Care Missouri

  https://epcmissouri.org/

  First Episode Psychosis (FEP) can affect individuals of any age, gender, race, or cultural background. A first episode usually presents as a crisis for the individual experiencing the event as well as their family. Some risk factors include a family history of psychosis, a history of trauma or abuse, substance use, and social isolation. […] Individuals usually show clear changes in their behavior before psychosis begins. Quickly helping them to access the right care can help with recovery in many ways. Fast access to care can reduce how often hospitals are used and the severity of symptoms. It can also help maintain social support and families involvement. […] Many who experience first episode psychosis recover with early identification and intervention. Many describe recovery as a journey to renewed well-being after psychosis. Recovery may involve finding strengths, building resilience, and moving toward a brighter future. Psychosis is a collection of symptoms which affect a persons thoughts, feelings, and behavior. Symptoms can appear suddenly or gradually. Examples of these symptoms include: […] Psychosis is more common than many people realize. About 3% of people experience an episode of psychosis at some point in their lives. While schizophrenia is the most common cause of a first episode of psychosis (FEP), many who experience psychosis never develop schizophrenia.

• #1 First Episode Psychosis | Department of Human Services | Commonwealth of Pennsylvania

  https://www.pa.gov/agencies/dhs/resources/mental-health-substance-use-disorder/first-episode-psychosis.html

  Research has shown significant success using a treatment approach known as Coordinated Specialty Care (CSC). CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible. […] National and international studies have demonstrated that early intervention and coordination of services for FEP can prevent the long-term effects of psychosis and avoid the disruption of developmental progress in youth and young adults experiencing early psychosis.

• #1 HeadsUp | Focused on ending the stigma around psychosis

  https://headsup-pa.org/

  Take the first step and learn more about early psychosis. […] At a PA FEP (First Episode Psychosis) center, treatment is designed with each individual in mind and involves many types of trained, caring professionals who will work with each person on a plan of recovery. The Coordinated Specialty Care (CSC) model is a comprehensive and team-based model, emphasizing hope, empowerment, and collaborative management of care. […] If you or someone you know is experiencing psychosis, here’s how to reach out. HeadsUp does not offer clinical services or emergency care. […] You’re never alone. Get clinical help from a center near you.

• #1 New Journeys and first episode psychosis | Washington State Health Care Authority

  https://www.hca.wa.gov/billers-providers-partners/program-information-providers/new-journeys-and-first-episode-psychosis

  Service components include: Individual and/or group psychotherapy, Supported employment and education, Family psychoeducation and support, Psychiatry, Peer support. […] New Journeys is currently available in the following areas: Behavioral health resources (Grays Harbor and Olympia), Cascade Community Healthcare Mental Health Services (Lewis and Cowlitz County), Catholic Charities (Chelan, Douglas, and Wenatchee), Comprehensive Healthcare (Yakima), First episode psychosis (FEP) Comprehensive (Franklin County), First episode psychosis (FEP) SeaMar (Clark County), First episode psychosis (FEP) SeaMar (Snohomish County), Frontier Behavioral Health (Spokane), Harborview Step Team (King County), Kitsap Mental Health services (Kitsap County), Peninsula Behavioral health (Port Angeles), Valley Cities Behavioral Health Care (Renton).

• #1 Systematic review of pathways to care in the U.S. for Black individuals with early psychosis | Schizophrenia

  https://www.nature.com/articles/s41537-021-00185-w

  These discrepancies highlight Black individuals likely face unique challenges prior to the receipt of CSC or other mental health services. […] In recent years there has been increased acknowledgment that Black individuals along with their family members experience less desirable pathways to care for FEP. […] The current study aims to systematically assess qualitative, quantitative, and mixed-methods studies that have examined Black individuals and/or their family members experiences prior to the initiation of outpatient services for FEP in the US. […] The results of this review of pathways to care were divided into three main categories: experiences during the premorbid and prodrome phases, help seeking experiences and treatment delays, and the DUP. […] The qualitative synthesis of these studies suggests that the misattribution of symptoms (e.g., depression, substance use, developmental changes) during the prodromal phase and personal and societal stigma associated with seeking mental health services contributing to delays in treatment.

• #1 Systematic review of pathways to care in the U.S. for Black individuals with early psychosis | Schizophrenia

  https://www.nature.com/articles/s41537-021-00185-w

  This combination of factors (stigma, structural barriers, misattribution of symptoms) contributes to more delays in treatment initiation—delays that may connect to why Black individuals have been more likely to present with more severe psychotic symptoms. […] This challenging path contributes to delays in the initiation of treatment for Black families, thus lengthening the DUP. […] While findings from two studies found no significant difference in the DUP between Black and White individuals, both studies found the duration was longer in Black individuals by as much as eight months. […] Treatment delays are common among individuals with early psychosis regardless of race, however, the pathway to get there has been identified as more traumatic and less straightforward for Black individuals. […] This review fills an important gap in the literature by focusing on Black populations specifically and by including studies that gather data from Black family members using a mixture of methods.

• #1 Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services | The British Journal of Psychiatry | Cambridge Core

  https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/reducing-duration-of-untreated-psychosis-care-pathways-to-early-intervention-in-psychosis-services/7B8BD46F5561AA1B2FDB3F182F0899B2

  Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed. […] To document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway. […] A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP. […] Community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP.

• #1 Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services | The British Journal of Psychiatry | Cambridge Core

  https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/reducing-duration-of-untreated-psychosis-care-pathways-to-early-intervention-in-psychosis-services/7B8BD46F5561AA1B2FDB3F182F0899B2

  The delay in reaching criteria treatment within mental health services was strongly correlated with delay in accessing EIS (T2), following referral to mental health services when psychotic. […] Overall, delay in accessing EIS would appear, therefore, to directly contribute to DUP. […] We attempted to understand the relative impact on DUP of reducing each of its significant components. This analysis is particularly relevant to the development of interventions to understand the scale of change required to bring individuals with long DUP to below what may be a critical threshold. […] Our findings suggest that care pathways to EIS involving CMHTs may prolong DUP as a result of under-recognition, poor disclosure or disengagement; services associated with reduced delay were crisis and the EIS teams, which have in common assertive and flexible home-based approaches to engagement that young people strongly endorse. […] Our findings suggest that an experimental intervention designed to reduce the numbers of individuals with DUP of over 6 months to less than 6 months would predict an impact on positive symptoms with an effect size of approximately 0.3.

• #1

  https://www.who.int/news-room/fact-sheets/detail/schizophrenia

  A range of effective care options for people with schizophrenia exist, and these include medication, psychoeducation, family interventions, cognitive-behavioural therapy and psychosocial rehabilitation (e.g., life skills training). […] Facilitated assisted living, supported housing and supported employment are essential care options that should be available for people with schizophrenia. […] A recovery-oriented approach giving people agency in treatment decisions is essential for people with schizophrenia and for their families and/or caregivers as well.

• #1 Acute psychosis: community care after hospital discharge | Medicine Today

  https://medicinetoday.com.au/mt/2020/august/feature-article/acute-psychosis-community-care-after-hospital-discharge

  The physical health of people with psychosis is easily overlooked but is a key responsibility of the GP. […] Recovery is a broad concept that encompasses not just the absence of acute symptoms of psychosis but also one of gaining hope, an understanding of ones capacity and limitations, autonomy and purpose. […] The GP has an important role in ensuring the patient has access to psychosocial supports and promoting medication concordance, which are key to reducing the risk of relapse. The GPs role then extends to ensuring the patients physical health needs are also addressed. Ensuring this care gives the patient the best chance of remaining well.

• #1 Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08008-z

  Barriers include a culture that remains biomedically- or task-oriented, diverse understandings of PCC, and practical aspects like time constraints or patient characteristics such as impaired ability to communicate. […] Participants expected increased person centeredness as they worked towards that end, and with it, better quality of care. […] Practicing person-centered care emerged as a conscious and active choice of actions with the overall goal of including the patient in the care process. […] Staff-patient conversations emerged as a major point of person-centered actions. […] The care plan emerged as one core feature of patient participation. […] Participants described changes resulting from their improved person-centered approach and routines, and these clustered around contacts with the patients, personal or professional development, and the care environment.

• #1 Acute psychosis: community care after hospital discharge | Medicine Today

  https://medicinetoday.com.au/mt/2020/august/feature-article/acute-psychosis-community-care-after-hospital-discharge

  Successful transition of a patient back to community care after an episode of acute psychosis requires good communication between the hospital and GP, and clear planning. GPs have a crucial role in ensuring medication concordance and psychosocial support, and monitoring the patients physical health needs. […] Community care of patients with a psychotic illness requires good communication between specialists, GPs and mental health services; this remains a challenge. […] Antipsychotic medication is an essential foundation for recovery after an episode of acute psychosis; however, more than medication is needed. […] Patients often discontinue antipsychotic medications; careful discussion and monitoring can help improve medication concordance. […] GPs can use their knowledge of local services to refer patients for appropriate psychosocial support and rehabilitation.

• #1 Early Psychosis Treatment | UC San Diego Health

  https://health.ucsd.edu/care/behavioral-mental-health/first-episode-psychosis-program/

  Throughout treatment, patients are empowered and educated about how to manage their condition and are involved in treatment planning and choices. […] Family members may participate in family therapy sessions and group therapy sessions with other families to learn about psychosis, coping and communication skills, and how to better support their loved ones. […] As a patient at UC San Diego Health, your care draws on the expertise of psychiatrists, psychologists, social workers and therapists. All have training and expertise in early psychosis. Together, they work to comprehensively diagnose, treat and manage your mental health condition.

• #1 Schizophrenia: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/schizophrenia-nursing-diagnosis-care-plan/

  Schizophrenia is a mental illness that affects the way a person thinks, perceives information, responds emotionally, and behaves. […] Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. […] Psychosis from schizophrenia may result in a disconnection from reality with symptoms of delusions and hallucinations. […] Patients with schizophrenia may display a lack of social skills and struggle with navigating social constructs, roles, and cues. […] Patients with schizophrenia are at risk for non-suicidal self-injury (NSSI) and deliberate self-harm, which can lead to suicide. […] Schizophrenia can cause feelings of suspiciousness and a perception of threats where none exist. […] Schizophrenia carries a suicide rate of 10%, much higher than the general population.

• #1 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with schizophrenia based on the nurses clinical judgment and understanding of the patients unique health condition. […] Goals and expected outcomes may include: The client will express thoughts and feelings in a coherent, logical, goal-directed manner. The client will demonstrate reality-based thought processes in verbal communication. The client will spend time with one or two other people on structured activity-neutral topics. The client will spend two to three five-minute sessions with the nurse sharing observations in the environment within three days. The client will be able to communicate in a manner that can be understood by others with the help of medication and attentive listening by the time of discharge.

• #1

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2455

  A person with psychosis mentions suicide. If a suicide threat seems real, with a specific plan and a way to carry it out, you should stay with the person, or ask someone you trust to stay with the person, until you get help. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: […] Your symptoms repeatedly upset your daily activities.

• #1 Postpartum Psychosis: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24152-postpartum-psychosis

  Postpartum psychosis (PPP) is a mental health emergency. This condition affects a persons sense of reality, causing hallucinations, delusions, paranoia or other behavior changes. In severe cases, people with PPP may attempt to harm themselves or their newborn. This condition is treatable, and early treatment increases the odds of a good outcome. […] Because of this, PPP is a mental health emergency. If you have the symptoms of PPP or are near someone who shows signs of it, its important to seek immediate help. […] People with postpartum psychosis have a much higher risk of harming themselves, dying by suicide or harming their children. […] Because PPP disrupts a persons sense of reality, many people who have it are completely unaware that they have a mental health or medical issue. […] For those reasons, inpatient mental healthcare for PPP is almost always involuntary.

• #1

  https://www.geron.org/News-Events/GSA-News/CEO-Blog/dementia-related-psychosis-gsa-experts-identify-ways-to-improve-care

  A new white paper from The Gerontological Society of America (GSA) highlights the variety of challenges that persons with dementia-related psychosis and their caregivers have encountered during moves through different health care settings and proposes strategies to address these challenges. […] It is estimated that over 2 million Americans with dementia experience delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). This group of symptoms, known as dementia-related psychosis, frequently goes undetected in people who may be struggling with other complex behavioral and psychological symptoms of dementia. […] When left untreated, the hallucinations and delusions that frequently occur in patients with dementia can cause significant patient and caregiver distress and often lead to institutionalization, said Gary W. Small, MD, FGSA, who chaired the workgroup. There is a pressing need for greater awareness of the condition and more effective diagnostic and treatment strategies.

• #1

  https://www.geron.org/News-Events/GSA-News/CEO-Blog/dementia-related-psychosis-gsa-experts-identify-ways-to-improve-care

  According to the white paper, psychosis in dementia is associated with an increased risk of recurrent hospitalization and the need for more restrictive levels of care. Better care of individuals with dementia-related psychosis requires new initiatives and advocacy at several levels. […] Primary care needs full support to be able to better identify and care for these patients, both in terms of education about dementia-related psychosis and its management, and also by providing enhanced access to expert and specialty care, particularly for providers in rural communities, said Alexis Eastman, MD, who also served on the workgroup. […] The white paper indicates that because patients with dementia-related psychosis who transition across settings of care may be at risk for worsening symptoms, such transitions should occur only when mandatory and be carefully managed by health care professionals who have experience specific to the care of persons with dementia. In long-term care settings, team-based approaches to care and additional education for staff, as well as surveyors, could help enhance resident quality of life and support guideline-based care.

• #1 ICU Psychosis: Treatment, Causes, Symptoms, Definition & Medication

  https://www.medicinenet.com/icu_psychosis/article.htm

  ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. […] The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid and is upsetting and frightening to the patient and family members. […] The treatment of ICU psychosis depends on the cause(s). Many times the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms. […] Fortunately, ICU psychosis usually resolves completely when the patient leaves the ICU. […] To help prevent ICU psychosis, many critical care units are now using more liberal visiting policies, providing periods for sleep, protecting the patient from unnecessary excitement, minimizing shift changes in the nursing staff caring for a patient, orienting the patient to the date and time, reviewing all medical procedures with an explanation about what to expect, asking the patient if there are any questions or concerns, talking with the family to obtain information regarding religious and cultural beliefs, and even coordinating the lighting with the normal day-night cycle, etc.

• #1

  https://www.nursingcenter.com/cearticle?an=00152193-202310000-00006&Journal_ID=54016&Issue_ID=6785686

  Although most people with psychosis do not behave in a violent manner, a patient experiencing disturbed sensory perception may hear command voices instructing them to harm themself or others. Likewise, those with disturbed thought processes may exhibit paranoia, distrust others, and believe others want to cause them harm. In either case, nurses should consider safety measures to protect staff, patients, and others. One effective measure is maintaining a safe distance from the patient until an assessment is performed and the risk of violence is minimal. […] Understanding the etiology and differential process for diagnosing psychosis better prepares nurses to render appropriate care leading to faster and improved patient outcomes. Similarly, using proper nursing interventions increases the safety and quality of interactions.

• #2 Chapter 11 Psychosis and Schizophrenia – Nursing: Mental Health and Community Concepts – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK590027/

  Approximately 3 percent of the people in the United States experience psychosis at some point in their lives. About 100,000 adolescents and young adults in the US experience their first episode of psychosis each year. […] The term psychosis describes conditions where there is a loss of contact with reality. When a person experiences psychosis, their thoughts and perceptions are disturbed, and the individual has difficulty understanding what is real and what is not real. Symptoms of psychosis include delusions and hallucinations, where the client is seeing, hearing, or experiencing other sensations and experiences that aren’t real. […] Psychosis can be a symptom of various mental illnesses, such as schizophrenia, bipolar disorder, severe depression, or severe anxiety, but there are also other potential causes.

• #2 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  A nurses care plan focuses on providing comprehensive nursing care for those with acute psychosis. This care plan will describe the assessment, diagnosis, outcomes, interventions, rationales and evaluation that must be provided to those with acute psychosis. It is important for nurses to remember that the care plan should be individualized depending on the patients needs. […] Nurses must assess environmental triggers such as stressors or life events that may be contributing to the acute psychotic symptoms. […] Nurses must assess the living situation and environment of the patient including potential triggers, resources, and general safety. […] Nurses must ask the patient questions regarding their mental health and any relevant medical history in order to determine the best course of treatment.

• #2 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Schizophrenia is a complex mental disorder that requires comprehensive assessment and care planning. This article explores the essential assessment, nursing diagnosis, goals, interventions for schizophrenia and offers practical guidance on how to manage this condition effectively. […] Nursing care plans and management for schizophrenia involve recognizing schizophrenia, assessing positive and negative symptoms, establishing trust and rapport, reducing symptoms, enhancing communication, maximizing the level of functioning, improving social functioning, developing coping strategies, promoting medication compliance, and evaluating the support system. […] The following are the nursing priorities for patients with schizophrenia: Establish therapeutic rapport and trust, Monitor and manage symptoms, Administer antipsychotic medications, Provide education and support, Assist with daily living skills, Collaborate with interdisciplinary team, Ensure a safe environment.

• #2 The nurse’s role in managing psychosis | Nursing Times

  https://www.nursingtimes.net/mental-health/the-nurses-role-in-managing-psychosis-24-09-2002/

  Nurses have a key role to play in helping them to do so. […] The nurses role at this time is to help people appreciate where medication and biochemistry fit into their explanation of the psychosis. […] The integration of psychosis into ones persona is more challenging and perhaps more healthy. […] Sensitivity, support and the provision of emotional space for reflection are crucial when nursing people who are recovering. […] A baseline of trust and respect is necessary. An approach that empowers and respects the individual is paramount to recovery.

• #2 Schizophrenia Nursing Care and Management

  https://nurseslabs.com/schizophrenia/

  Risk for Imbalanced Nutrition: less than body requirements related to self-neglect and refusal for self-care. […] […] […] Nursing Care Planning and Goals […] Reduce severity of psychotic symptoms […] Prevent recurrence of acute episodes […] Meet patients physical and psychosocial needs […] Help patient gain optimum level of functioning […] Increase clients compliance to treatment and nursing plan […] […] […] Nursing Interventions […] Establish trust and rapport. Dont touch client without telling him first what you are going to do. Use an accepting, consistent approach; short, repeated contacts are best until trust has been established. Language should be clear and unambiguous. Maintain a sense of hope for possible improvement, and convey this to the patient. […] Maximize level of functioning. Avoid promoting dependence by doing only what the patient cant do for himself. Reward positive behavior and work with him to increase his personal sense of responsibility in improving functioning.

• #2 11.4 Applying the Nursing Process to Schizophrenia – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/11-4-applying-the-nursing-process/

  During the stabilization and maintenance phases, planning focuses on education, support, and skills training for the client and family. […] Clients with command hallucinations require close monitoring for suicide, homicide, and other violence risk. […] Promote hygiene in clients experiencing psychosis by concisely and explicitly stating expected hygiene tasks. […] Regularly engage with the client. […] Convey unconditional acceptance, empathy, and support. […] Fall risk may be increased due to orthostatic hypotension, impaired balance, bradykinesia, or other movement disorders. […] The client may also be experiencing physiological problems related to nutritional status, sleep, and elimination due to their symptoms of psychosis. […] Interventions for clients experiencing psychosis previously discussed in this chapter can also be categorized by the standard of Implementation by the American Psychiatric Nursing Association.

• #2 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Help the client to identify the needs that might underlie the hallucination. What other ways can these needs be met? Hallucinations might reflect needs for anger, power, self-esteem, and sexuality. […] Accept the fact that the voices are real to the client, but explain that you do not hear the voices. Validating that your reality does not include voices can help the client cast doubt on the validity of his or her voice. […] Help the client identify times when the hallucinations are most prevalent and frightening. This helps both nurse and client identify situations and times that might be most anxiety-producing and threatening to the client. […] In many cases, swift, decisive intervention can prevent a person from committing suicide or harming others. […] Stay with clients when they are starting to hallucinate and direct them to tell the voices they hear to go away. Repeat often in a matter-of-fact manner.

• #2 Psychosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568796/

  Psychosis is an amalgamation of psychological symptoms resulting in a loss of contact with reality. […] Psychosis can result in high levels of distress for patients and loved ones, which is why it has become a primary target of treatment for medical professionals. […] Nursing Management includes assessing vital signs, assessing neuro vitals, assessing the thought process, administering antipsychotic agent, keeping the patient in a calm isolated room, speaking in a slow and calm manner, avoiding all stimuli, interacting gently with patients, being comforting, ensuring patient safety, educating the family about the illness, constantly checking up on the patient, ensuring the patient is not violent towards others, and ensuring the patient has no suicidal ideations. […] A safe and therapeutic environment, with calm, empathetic patient interactions, are essential for treating psychotic symptoms. […] Early intervention is essential for long term outcomes.

• #2 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Decrease environmental stimuli when possible (low noise, minimal activity). This decreases the potential for anxiety that might trigger hallucinations and helps calm the client. […] Engage the client in reality-based activities such as card playing, writing, drawing, doing simple arts and crafts, or listening to music. Redirecting the clients energies to acceptable activities can decrease the possibility of acting on hallucinations and help distract from voices. […] Administer clozapine, as indicated. […] Coping strategies for patients with schizophrenia involve developing adaptive ways to manage symptoms and daily challenges. These may include engaging in stress-reducing activities such as exercise, practicing relaxation techniques, participating in supportive therapy or support groups, maintaining a structured routine, and utilizing problem-solving skills to address specific difficulties.

• #2 Schizophrenia Nursing Care and Management

  https://nurseslabs.com/schizophrenia/

  Promote social skills. Provide support in assisting him to learn social skills. […] Ensure safety. Maintain a safe environment with minimal stimulation. […] Ensure adequate nutrition. Monitor patients nutritional status and if the patient thinks his food is poisoned, let him fix his own food if possible or offer him foods in closed containers that he can open. Institute suicide and/or homicide precautions as appropriate. […] Keep it real. Engage patient in reality-oriented activities that involve human contact (e.g., workshops, inpatient social skills training). Clarify private language, autistic inventions, or neologisms. […] Deal with hallucinations by presenting reality. Explore the content of hallucinations. Avoid arguing about the hallucinations. Tell them you do not see, hear, smell, or feel it but explain that you know that these hallucinations are real to him.

• #2 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  This diagnosis is based on the patients history of symptoms and their current mental health status. […] This diagnosis is based on the patient experiences of distress due to the symptoms of psychosis that cause problems in the person’s day-to-day life. […] The goal is to help the patient improve their self-care, such as taking medications appropriately and engaging in activities to manage stress. […] The goal is to help the patient reduce psychosocial distress such as anxiety and depression due to psychosis. […] Nurses must provide education to the patient and their family about psychosis, possible triggers, strategies for managing, and any warning signs of relapse. […] Nurses must assess the patients medication needs, provide med reminders, monitor safety, and provide education about side effects.

• #2 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Treatment for psychosis involves a combination of antipsychotic medicines, talking therapies and social support. […] Your treatment is likely to involve a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team. […] An early intervention team is a team of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis. […] Treatment for psychosis will vary, depending on the underlying cause. You’ll receive specific treatment if you’ve been diagnosed with an underlying mental health condition as well. […] Antipsychotic medicines are usually recommended as the first treatment for psychosis. […] Antipsychotics can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts.

• #2 Recognition and Differential Diagnosis of Psychosis in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html

  Do not prescribe antipsychotics to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring. […] Psychotic symptoms are debilitating and can be terrifying to patients and their families. Prompt recognition of the etiology may improve treatment, consultation, and prognosis. […] Any patient with a primary diagnosis of a psychotic disorder will benefit from close collaboration between behavioral health specialists and the primary care physician. […] The early use of antipsychotics, particularly clozapine (Clozaril), can decrease the risk of suicide in patients with schizophrenia, which may be as high as 15%, particularly in the initial phase of the illness. […] Despite optimal treatment, patients with schizophrenia and other psychotic disorders often have deficits in social functioning, are unable to maintain employment, and lack appropriate housing. […] New and developing models are providing promising approaches toward integrated, patient-centered care for individuals with primary psychotic disorders.

• #2 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  Psychotherapy can help the patient process their experiences, identify triggers and develop coping skills to manage symptoms. […] Teaching the patient and their family about psychosis helps to reduce stigma, increase understanding, and build trust between the patient and the care team. […] Appropriate medication management is essential to managing acute psychotic symptoms. Medication can help to reduce symptoms and improve functioning. […] Psychotherapy can help the patient process difficult experiences related to psychosis and learn ways to manage symptoms and cope with triggers. […] Nurses should offer regular follow-up assessments to the patient in order to monitor progress and make necessary changes to the care plan. […] The nurse should review the patients medication regularly to assess the effectiveness and possible side effects.

• #2 Psychosis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.psychosis-care-instructions.ut2455

  A person with psychosis cannot tell the difference between what is real and what is not real. It can cause strange thoughts and behaviors. Psychosis can be treated with medicines and counseling. It is important to take your medicines exactly as prescribed, even when you feel well. You will need ongoing follow-up care and may need lifelong treatment. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. […] If you are caring for someone with psychosis, it is important that you take care of yourself as well. Learn about psychosis. Know the first signs that symptoms are getting worse. […] Call your doctor now or seek immediate medical care if: A person with psychosis mentions suicide. If a suicide threat seems real, with a specific plan and a way to carry it out, you should stay with the person, or ask someone you trust to stay with the person, until you get help.

• #2 Early Psychosis Treatment | UC San Diego Health

  https://health.ucsd.edu/care/behavioral-mental-health/first-episode-psychosis-program/

  Early diagnosis and intervention offer the best chance of recovery. […] After you have been evaluated, your care team will develop a treatment plan that may include a combination of medication management to reduce symptoms and get the best treatment relief at the lowest possible dose, individual psychotherapy sessions to learn about yourself, your condition and how to manage it and resume normal activities, group psychotherapy for adolescent, adult and multi-family support, cognitive behavioral therapy, wellness education, and employment and college support, personalized intensive outpatient care to address psychiatric and functional needs of people who require a higher level of care than regular clinic visits, peer-support services to learn from and help others with psychosis, referrals to UC San Diego Health inpatient care for patients who need the highest level of care, consultations and second opinion evaluations to confirm a diagnosis or treatment approach with our specialists, recovery and follow-up care for continued support, monitoring and assistance with lifestyle changes for long-term wellness.

• #2 Systematic review of pathways to care in the U.S. for Black individuals with early psychosis | Schizophrenia

  https://www.nature.com/articles/s41537-021-00185-w

  Findings also noted the initiation of treatment generally occurred after a catalytic event, to which Black individuals with FEP and their family members described as the manifestation of severe positive symptoms (e.g., suicidal or homicidal ideation), interactions with law enforcement, or an accident (e.g., vehicular). […] The underutilization of behavioral health services among Black individuals prior to FEP may be a plausible explanation for the decreased likelihood that Black individuals will have a comorbid diagnosis prior to onset of psychosis. […] This may be connected to findings from two qualitative family studies which found societal stigma about seeking mental health services or structural barriers such as financial strains and limited access were reported by a number of Black individuals and families.

• #2 Systematic review of pathways to care in the U.S. for Black individuals with early psychosis | Schizophrenia

  https://www.nature.com/articles/s41537-021-00185-w

  These discrepancies highlight Black individuals likely face unique challenges prior to the receipt of CSC or other mental health services. […] In recent years there has been increased acknowledgment that Black individuals along with their family members experience less desirable pathways to care for FEP. […] The current study aims to systematically assess qualitative, quantitative, and mixed-methods studies that have examined Black individuals and/or their family members experiences prior to the initiation of outpatient services for FEP in the US. […] The results of this review of pathways to care were divided into three main categories: experiences during the premorbid and prodrome phases, help seeking experiences and treatment delays, and the DUP. […] The qualitative synthesis of these studies suggests that the misattribution of symptoms (e.g., depression, substance use, developmental changes) during the prodromal phase and personal and societal stigma associated with seeking mental health services contributing to delays in treatment.

• #2 Systematic review of pathways to care in the U.S. for Black individuals with early psychosis | Schizophrenia

  https://www.nature.com/articles/s41537-021-00185-w

  This combination of factors (stigma, structural barriers, misattribution of symptoms) contributes to more delays in treatment initiation—delays that may connect to why Black individuals have been more likely to present with more severe psychotic symptoms. […] This challenging path contributes to delays in the initiation of treatment for Black families, thus lengthening the DUP. […] While findings from two studies found no significant difference in the DUP between Black and White individuals, both studies found the duration was longer in Black individuals by as much as eight months. […] Treatment delays are common among individuals with early psychosis regardless of race, however, the pathway to get there has been identified as more traumatic and less straightforward for Black individuals. […] This review fills an important gap in the literature by focusing on Black populations specifically and by including studies that gather data from Black family members using a mixture of methods.

• #2 Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services | The British Journal of Psychiatry | Cambridge Core

  https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/reducing-duration-of-untreated-psychosis-care-pathways-to-early-intervention-in-psychosis-services/7B8BD46F5561AA1B2FDB3F182F0899B2

  The delay in reaching criteria treatment within mental health services was strongly correlated with delay in accessing EIS (T2), following referral to mental health services when psychotic. […] Overall, delay in accessing EIS would appear, therefore, to directly contribute to DUP. […] We attempted to understand the relative impact on DUP of reducing each of its significant components. This analysis is particularly relevant to the development of interventions to understand the scale of change required to bring individuals with long DUP to below what may be a critical threshold. […] Our findings suggest that care pathways to EIS involving CMHTs may prolong DUP as a result of under-recognition, poor disclosure or disengagement; services associated with reduced delay were crisis and the EIS teams, which have in common assertive and flexible home-based approaches to engagement that young people strongly endorse. […] Our findings suggest that an experimental intervention designed to reduce the numbers of individuals with DUP of over 6 months to less than 6 months would predict an impact on positive symptoms with an effect size of approximately 0.3.

• #2 Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08008-z

  Barriers include a culture that remains biomedically- or task-oriented, diverse understandings of PCC, and practical aspects like time constraints or patient characteristics such as impaired ability to communicate. […] Participants expected increased person centeredness as they worked towards that end, and with it, better quality of care. […] Practicing person-centered care emerged as a conscious and active choice of actions with the overall goal of including the patient in the care process. […] Staff-patient conversations emerged as a major point of person-centered actions. […] The care plan emerged as one core feature of patient participation. […] Participants described changes resulting from their improved person-centered approach and routines, and these clustered around contacts with the patients, personal or professional development, and the care environment.

• #2 Acute psychosis: community care after hospital discharge | Medicine Today

  https://medicinetoday.com.au/mt/2020/august/feature-article/acute-psychosis-community-care-after-hospital-discharge

  Successful transition of a patient back to community care after an episode of acute psychosis requires good communication between the hospital and GP, and clear planning. GPs have a crucial role in ensuring medication concordance and psychosocial support, and monitoring the patients physical health needs. […] Community care of patients with a psychotic illness requires good communication between specialists, GPs and mental health services; this remains a challenge. […] Antipsychotic medication is an essential foundation for recovery after an episode of acute psychosis; however, more than medication is needed. […] Patients often discontinue antipsychotic medications; careful discussion and monitoring can help improve medication concordance. […] GPs can use their knowledge of local services to refer patients for appropriate psychosocial support and rehabilitation.

• #2 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  The nurses care plan should be individualized to meet the patients individual needs and should provide comprehensive care. It is important for nurses to work with the patients healthcare team to provide quality care and support to those with acute psychosis. […] A nurses role in treating acute psychosis is to assess the current situation, make an individualized care plan, provide education and support, and coordinate care with other healthcare providers. […] The most important part of a care plan for acute psychosis is to provide comprehensive care that is individualized to the patients needs. […] Nursing interventions that can be used to treat acute psychosis includes educating the patient and family, medication management, and psychotherapy. […] The goal of treating acute psychosis is to reduce symptoms, improve functioning, and reduce psychosocial distress. […] Follow-up assessments are important to monitor progress and make any necessary adjustments to the care plan.

• #2 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with schizophrenia based on the nurses clinical judgment and understanding of the patients unique health condition. […] Goals and expected outcomes may include: The client will express thoughts and feelings in a coherent, logical, goal-directed manner. The client will demonstrate reality-based thought processes in verbal communication. The client will spend time with one or two other people on structured activity-neutral topics. The client will spend two to three five-minute sessions with the nurse sharing observations in the environment within three days. The client will be able to communicate in a manner that can be understood by others with the help of medication and attentive listening by the time of discharge.

• #2

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2455

  A person with psychosis mentions suicide. If a suicide threat seems real, with a specific plan and a way to carry it out, you should stay with the person, or ask someone you trust to stay with the person, until you get help. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: […] Your symptoms repeatedly upset your daily activities.

• #2 Postpartum Psychosis: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24152-postpartum-psychosis

  Postpartum psychosis (PPP) is a mental health emergency. This condition affects a persons sense of reality, causing hallucinations, delusions, paranoia or other behavior changes. In severe cases, people with PPP may attempt to harm themselves or their newborn. This condition is treatable, and early treatment increases the odds of a good outcome. […] Because of this, PPP is a mental health emergency. If you have the symptoms of PPP or are near someone who shows signs of it, its important to seek immediate help. […] People with postpartum psychosis have a much higher risk of harming themselves, dying by suicide or harming their children. […] Because PPP disrupts a persons sense of reality, many people who have it are completely unaware that they have a mental health or medical issue. […] For those reasons, inpatient mental healthcare for PPP is almost always involuntary.

• #2

  https://www.geron.org/News-Events/GSA-News/CEO-Blog/dementia-related-psychosis-gsa-experts-identify-ways-to-improve-care

  A new white paper from The Gerontological Society of America (GSA) highlights the variety of challenges that persons with dementia-related psychosis and their caregivers have encountered during moves through different health care settings and proposes strategies to address these challenges. […] It is estimated that over 2 million Americans with dementia experience delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). This group of symptoms, known as dementia-related psychosis, frequently goes undetected in people who may be struggling with other complex behavioral and psychological symptoms of dementia. […] When left untreated, the hallucinations and delusions that frequently occur in patients with dementia can cause significant patient and caregiver distress and often lead to institutionalization, said Gary W. Small, MD, FGSA, who chaired the workgroup. There is a pressing need for greater awareness of the condition and more effective diagnostic and treatment strategies.

• #2 ICU Psychosis: Treatment, Causes, Symptoms, Definition & Medication

  https://www.medicinenet.com/icu_psychosis/article.htm

  ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. […] The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid and is upsetting and frightening to the patient and family members. […] The treatment of ICU psychosis depends on the cause(s). Many times the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms. […] Fortunately, ICU psychosis usually resolves completely when the patient leaves the ICU. […] To help prevent ICU psychosis, many critical care units are now using more liberal visiting policies, providing periods for sleep, protecting the patient from unnecessary excitement, minimizing shift changes in the nursing staff caring for a patient, orienting the patient to the date and time, reviewing all medical procedures with an explanation about what to expect, asking the patient if there are any questions or concerns, talking with the family to obtain information regarding religious and cultural beliefs, and even coordinating the lighting with the normal day-night cycle, etc.

• #3 Early Psychosis | Mass.gov

  https://www.mass.gov/info-details/early-psychosis

  Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. […] Psychosis is a symptom, not an illness, and it is more common than you may think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as three in 100 people will have an episode at some point in their lives. […] First-episode psychosis (FEP) refers to when a person first shows signs of beginning to lose contact with reality. Acting quickly to connect a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person’s future.

• #3 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Help the client to identify the needs that might underlie the hallucination. What other ways can these needs be met? Hallucinations might reflect needs for anger, power, self-esteem, and sexuality. […] Accept the fact that the voices are real to the client, but explain that you do not hear the voices. Validating that your reality does not include voices can help the client cast doubt on the validity of his or her voice. […] Help the client identify times when the hallucinations are most prevalent and frightening. This helps both nurse and client identify situations and times that might be most anxiety-producing and threatening to the client. […] In many cases, swift, decisive intervention can prevent a person from committing suicide or harming others. […] Stay with clients when they are starting to hallucinate and direct them to tell the voices they hear to go away. Repeat often in a matter-of-fact manner.

• #3 11.4 Applying the Nursing Process to Schizophrenia – Nursing: Mental Health and Community Concepts

  https://wtcs.pressbooks.pub/nursingmhcc/chapter/11-4-applying-the-nursing-process/

  During the stabilization and maintenance phases, planning focuses on education, support, and skills training for the client and family. […] Clients with command hallucinations require close monitoring for suicide, homicide, and other violence risk. […] Promote hygiene in clients experiencing psychosis by concisely and explicitly stating expected hygiene tasks. […] Regularly engage with the client. […] Convey unconditional acceptance, empathy, and support. […] Fall risk may be increased due to orthostatic hypotension, impaired balance, bradykinesia, or other movement disorders. […] The client may also be experiencing physiological problems related to nutritional status, sleep, and elimination due to their symptoms of psychosis. […] Interventions for clients experiencing psychosis previously discussed in this chapter can also be categorized by the standard of Implementation by the American Psychiatric Nursing Association.

• #3 Recognition and Differential Diagnosis of Psychosis in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html

  Do not prescribe antipsychotics to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring. […] Psychotic symptoms are debilitating and can be terrifying to patients and their families. Prompt recognition of the etiology may improve treatment, consultation, and prognosis. […] Any patient with a primary diagnosis of a psychotic disorder will benefit from close collaboration between behavioral health specialists and the primary care physician. […] The early use of antipsychotics, particularly clozapine (Clozaril), can decrease the risk of suicide in patients with schizophrenia, which may be as high as 15%, particularly in the initial phase of the illness. […] Despite optimal treatment, patients with schizophrenia and other psychotic disorders often have deficits in social functioning, are unable to maintain employment, and lack appropriate housing. […] New and developing models are providing promising approaches toward integrated, patient-centered care for individuals with primary psychotic disorders.

• #3 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  Psychotherapy can help the patient process their experiences, identify triggers and develop coping skills to manage symptoms. […] Teaching the patient and their family about psychosis helps to reduce stigma, increase understanding, and build trust between the patient and the care team. […] Appropriate medication management is essential to managing acute psychotic symptoms. Medication can help to reduce symptoms and improve functioning. […] Psychotherapy can help the patient process difficult experiences related to psychosis and learn ways to manage symptoms and cope with triggers. […] Nurses should offer regular follow-up assessments to the patient in order to monitor progress and make necessary changes to the care plan. […] The nurse should review the patients medication regularly to assess the effectiveness and possible side effects.

• #3 Systematic review of pathways to care in the U.S. for Black individuals with early psychosis | Schizophrenia

  https://www.nature.com/articles/s41537-021-00185-w

  Findings also noted the initiation of treatment generally occurred after a catalytic event, to which Black individuals with FEP and their family members described as the manifestation of severe positive symptoms (e.g., suicidal or homicidal ideation), interactions with law enforcement, or an accident (e.g., vehicular). […] The underutilization of behavioral health services among Black individuals prior to FEP may be a plausible explanation for the decreased likelihood that Black individuals will have a comorbid diagnosis prior to onset of psychosis. […] This may be connected to findings from two qualitative family studies which found societal stigma about seeking mental health services or structural barriers such as financial strains and limited access were reported by a number of Black individuals and families.

• #3 Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08008-z

  Barriers include a culture that remains biomedically- or task-oriented, diverse understandings of PCC, and practical aspects like time constraints or patient characteristics such as impaired ability to communicate. […] Participants expected increased person centeredness as they worked towards that end, and with it, better quality of care. […] Practicing person-centered care emerged as a conscious and active choice of actions with the overall goal of including the patient in the care process. […] Staff-patient conversations emerged as a major point of person-centered actions. […] The care plan emerged as one core feature of patient participation. […] Participants described changes resulting from their improved person-centered approach and routines, and these clustered around contacts with the patients, personal or professional development, and the care environment.

• #3 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  The nurses care plan should be individualized to meet the patients individual needs and should provide comprehensive care. It is important for nurses to work with the patients healthcare team to provide quality care and support to those with acute psychosis. […] A nurses role in treating acute psychosis is to assess the current situation, make an individualized care plan, provide education and support, and coordinate care with other healthcare providers. […] The most important part of a care plan for acute psychosis is to provide comprehensive care that is individualized to the patients needs. […] Nursing interventions that can be used to treat acute psychosis includes educating the patient and family, medication management, and psychotherapy. […] The goal of treating acute psychosis is to reduce symptoms, improve functioning, and reduce psychosocial distress. […] Follow-up assessments are important to monitor progress and make any necessary adjustments to the care plan.

• #3 Postpartum Psychosis: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24152-postpartum-psychosis

  Postpartum psychosis (PPP) is a mental health emergency. This condition affects a persons sense of reality, causing hallucinations, delusions, paranoia or other behavior changes. In severe cases, people with PPP may attempt to harm themselves or their newborn. This condition is treatable, and early treatment increases the odds of a good outcome. […] Because of this, PPP is a mental health emergency. If you have the symptoms of PPP or are near someone who shows signs of it, its important to seek immediate help. […] People with postpartum psychosis have a much higher risk of harming themselves, dying by suicide or harming their children. […] Because PPP disrupts a persons sense of reality, many people who have it are completely unaware that they have a mental health or medical issue. […] For those reasons, inpatient mental healthcare for PPP is almost always involuntary.

• #3 ICU Psychosis: Treatment, Causes, Symptoms, Definition & Medication

  https://www.medicinenet.com/icu_psychosis/article.htm

  ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. […] The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid and is upsetting and frightening to the patient and family members. […] The treatment of ICU psychosis depends on the cause(s). Many times the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms. […] Fortunately, ICU psychosis usually resolves completely when the patient leaves the ICU. […] To help prevent ICU psychosis, many critical care units are now using more liberal visiting policies, providing periods for sleep, protecting the patient from unnecessary excitement, minimizing shift changes in the nursing staff caring for a patient, orienting the patient to the date and time, reviewing all medical procedures with an explanation about what to expect, asking the patient if there are any questions or concerns, talking with the family to obtain information regarding religious and cultural beliefs, and even coordinating the lighting with the normal day-night cycle, etc.

• #4 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Help the client to identify the needs that might underlie the hallucination. What other ways can these needs be met? Hallucinations might reflect needs for anger, power, self-esteem, and sexuality. […] Accept the fact that the voices are real to the client, but explain that you do not hear the voices. Validating that your reality does not include voices can help the client cast doubt on the validity of his or her voice. […] Help the client identify times when the hallucinations are most prevalent and frightening. This helps both nurse and client identify situations and times that might be most anxiety-producing and threatening to the client. […] In many cases, swift, decisive intervention can prevent a person from committing suicide or harming others. […] Stay with clients when they are starting to hallucinate and direct them to tell the voices they hear to go away. Repeat often in a matter-of-fact manner.

• #4 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  Psychotherapy can help the patient process their experiences, identify triggers and develop coping skills to manage symptoms. […] Teaching the patient and their family about psychosis helps to reduce stigma, increase understanding, and build trust between the patient and the care team. […] Appropriate medication management is essential to managing acute psychotic symptoms. Medication can help to reduce symptoms and improve functioning. […] Psychotherapy can help the patient process difficult experiences related to psychosis and learn ways to manage symptoms and cope with triggers. […] Nurses should offer regular follow-up assessments to the patient in order to monitor progress and make necessary changes to the care plan. […] The nurse should review the patients medication regularly to assess the effectiveness and possible side effects.

• #4 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  The nurses care plan should be individualized to meet the patients individual needs and should provide comprehensive care. It is important for nurses to work with the patients healthcare team to provide quality care and support to those with acute psychosis. […] A nurses role in treating acute psychosis is to assess the current situation, make an individualized care plan, provide education and support, and coordinate care with other healthcare providers. […] The most important part of a care plan for acute psychosis is to provide comprehensive care that is individualized to the patients needs. […] Nursing interventions that can be used to treat acute psychosis includes educating the patient and family, medication management, and psychotherapy. […] The goal of treating acute psychosis is to reduce symptoms, improve functioning, and reduce psychosocial distress. […] Follow-up assessments are important to monitor progress and make any necessary adjustments to the care plan.

• #4 ICU Psychosis: Treatment, Causes, Symptoms, Definition & Medication

  https://www.medicinenet.com/icu_psychosis/article.htm

  ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. […] The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid and is upsetting and frightening to the patient and family members. […] The treatment of ICU psychosis depends on the cause(s). Many times the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms. […] Fortunately, ICU psychosis usually resolves completely when the patient leaves the ICU. […] To help prevent ICU psychosis, many critical care units are now using more liberal visiting policies, providing periods for sleep, protecting the patient from unnecessary excitement, minimizing shift changes in the nursing staff caring for a patient, orienting the patient to the date and time, reviewing all medical procedures with an explanation about what to expect, asking the patient if there are any questions or concerns, talking with the family to obtain information regarding religious and cultural beliefs, and even coordinating the lighting with the normal day-night cycle, etc.

• #5 Nursing Diagnosis for Schizophrenia: 6 Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/schizophrenia-nursing-care-plans/

  Help the client to identify the needs that might underlie the hallucination. What other ways can these needs be met? Hallucinations might reflect needs for anger, power, self-esteem, and sexuality. […] Accept the fact that the voices are real to the client, but explain that you do not hear the voices. Validating that your reality does not include voices can help the client cast doubt on the validity of his or her voice. […] Help the client identify times when the hallucinations are most prevalent and frightening. This helps both nurse and client identify situations and times that might be most anxiety-producing and threatening to the client. […] In many cases, swift, decisive intervention can prevent a person from committing suicide or harming others. […] Stay with clients when they are starting to hallucinate and direct them to tell the voices they hear to go away. Repeat often in a matter-of-fact manner.

• #5 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  The nurses care plan should be individualized to meet the patients individual needs and should provide comprehensive care. It is important for nurses to work with the patients healthcare team to provide quality care and support to those with acute psychosis. […] A nurses role in treating acute psychosis is to assess the current situation, make an individualized care plan, provide education and support, and coordinate care with other healthcare providers. […] The most important part of a care plan for acute psychosis is to provide comprehensive care that is individualized to the patients needs. […] Nursing interventions that can be used to treat acute psychosis includes educating the patient and family, medication management, and psychotherapy. […] The goal of treating acute psychosis is to reduce symptoms, improve functioning, and reduce psychosocial distress. […] Follow-up assessments are important to monitor progress and make any necessary adjustments to the care plan.

• #5 Nursing care plan for acute psychosis

  https://nursipedia.com/nursing-care-plan-acute-psychosis/

  Psychotherapy can help the patient process their experiences, identify triggers and develop coping skills to manage symptoms. […] Teaching the patient and their family about psychosis helps to reduce stigma, increase understanding, and build trust between the patient and the care team. […] Appropriate medication management is essential to managing acute psychotic symptoms. Medication can help to reduce symptoms and improve functioning. […] Psychotherapy can help the patient process difficult experiences related to psychosis and learn ways to manage symptoms and cope with triggers. […] Nurses should offer regular follow-up assessments to the patient in order to monitor progress and make necessary changes to the care plan. […] The nurse should review the patients medication regularly to assess the effectiveness and possible side effects.

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