non biological treatment For Schizophrenia (ACT) Flashcards
name one non biological treatment
Assertive Community Treatment (ACT)
What is ACT?
who is it used to help?
what does it involve?
how long is the service?
What is the frequency?
-used to help patients with schizophrenia who have frequent relapses and bouts of hospitalisation with difficulties living independently, meeting personal goals and getting on with others.
-involves caring for the person in their own home, community locations, homeless shelters, or wherever is most appropriate and convenient for the patient.
-prevents institutionalisation.
-it is a lifelong service, no automatic termination of contact with clients if an appointment is missed, a multidisciplinary team approach to intensive case management.
-high frequency pf patient contact (typically once a week no less than 60 minutes.
Characteristics of ACT
hourly coverage
attention
focus
help with what to avoid what?
treatment
visits
commitment
help if condition gets worse?
what’s good about working alongside other professionals ?
-24 hour coverage, including emergencies.
-offered long-term but not unlimited; goal is to eventually transition you to other services or for you to maintain what you have learned on your own.
-close attention to illness management
-A focus on those who need the most help from the community health service.
-helping with independence, rehabilitation, and recovery, and to avoid homelessness and rehospitalisation.
-treatment of the patient in real-life setting, high frequency of contact with clients and assistance with practical problems in living.
-visiting them and helping, rather than offering therapies, with enough staff to offer this support and related treatment, rather than at the clinic.
-A commitment to spend as much time with the person as necessary to rehabilitate them and support them offering treatment for all needs.
-if a patients condition worsens, they can be treated in a hospital setting or may be moved into sheltered accommodation if they cannot live by themselves.
-working with other professionals such as psychiatrists, nurses, social workers and people with whom the treatment has worked, so that a whole team can focus on the individual in question.
strengths
supporting studies
What did Van Vugt et al 2011 look at?
what did they find?
What does this therefore prove?
Reson symptoms
What did Nishio et al 2012 look at?
What did the measures show?
What does this therefore mean ACT successfully allows people to do?
application
-what else is ACT used for (not just Sz)?
-What makes ACT more effective?
What do surveys tend to suggest?
Who does it work with?
studies (supporting)
-ACT provides a multidisciplinary team approach to intensive case management.
Van Vugt et al 2011 carried out a study looking at the outcomes for individuals using ACT programmes in the Netherlands. The studies 530 patients from 20 different outpatient treatment teams. they found that team structure was the most important for better outcomes and that it was better to stick to the original model for ACT which depends strongly on the structure of the team.
Therefore proving that is is important to have a team of professionals such as psychiatrists, nurses, social workers and people with whom the treatment has worked, so that a whole team can focus on the individual in question.
-reason symptoms
Nishio et al 2012 looked to see whether ACT was helpful when transferring patients from the institution to the community. looked at 41 patients hospitalised for severe mental illness, meeting conditions for ACT. The measures showed a significant decrease in number of days and frequency of hospitalisations as well as emergancy visits over a one-year period from before to after hospital discharge. Their anti-psychotic drug also decreased significantly.
Therefore, ACT successfully allows people to live longer in the community without symptoms becoming and worse. However, this study focuses on mental health illness and not schizophrenia specifically.
-Application
Act is used in several mental health cases, not only Sz. The more carefully implemented an ACT programme is, the more effective it is. Surveys tend to suggest clients appreciate ACT. Act seems to work with all age groups, both genders and across different cultures.
who looks at the outcomes for individuals using ACT programmes in the Netherlands. The studies 530 patients from 20 different outpatient treatment teams.?
Van Vugt 2011
who looked to see whether ACT was helpful when transferring patients from the institution to the community. looked at 41 patients hospitalised for severe mental illness, meeting conditions for ACT.
Nishio et al 2012
weaknesses
-ethics and control
what did Gomory 2001 suggest?
what question does this raise?
what % of patients feel forced?
what do case managers set more of for who?
-expense
where does ACT work best?
why is this?
what does this link back to?
why is this a weakness?
-ethics and control
However, Gomory 2001 suggests that ACT is paternalistic and coercive in that clients do not have a choice whether to take part in treatment. This raises the question of social control and the client not having control.
it is suggested that around 11% of patients feel forced into the treatment. It seems that case managers set more limits for clients who have worse symptoms, more arrests, hospitalisations and recent drug abuse.
-expense
ACT works best in heavily populated areas where there is a high incidence of people with schizophrenia needing care in the community. This is because of the effort and intensive focus that is required as part of treatment. Adequate staffing is required to undertake this hands-on therapy.
This links back to social deprivation for Sz. If urban heavily populated areas seem to have more people with Sz than rural areas, perhaps ACT works best in urban areas because there can be that focus - teams can be brought in because there are enough cases to warrant it.
The weakness here is that it may not be provided where there are not many cases because of cost complications.
who suggests that ACT is paternalistic and coercive in that clients do not have a choice whether to take part in treatment.
Gomory 2001
