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CONSENT FOR INVESTIGATIONS AND TREATMENT

As a final step in the first assessment interview, the case manager obtains consent from the patient and if necessary, the family to begin the comprehensive tests and laboratory investigations. The consent includes a letter of information to the client and family about the various medical and psychosocial interventions, as well as the expectation for participation in their assessment and treatment and in the evaluation of the treatment program. The consent to treatment informs the patient and family that PEPP is constantly evaluating the effectiveness of treatment through frequent rating scales and other means to monitor symptoms, side effects, personal and family goals, etc.
The case manager will secure appointments for investigations such as CT scan, EEG, ECG, blood tests (thyroid functions, CBC, LFT, drug screening, etc.) through the Program secretary. When all the investigations are completed, the case manager will arrange and attend appointment(s) with the treating psychiatrist to provide the patient and family with the results.

STEPS (SUMMARY)

  • Patient has already received a screening assessment unless the patient is an inpatient and is regarded by the treating psychiatrist to meet
    criteria for a psychotic disorder.
  • Consent for participation in assessment, treatment and program evaluation is signed by patient and family. This is arranged by the case manager at the time of the initial assessment. If another clinician is the initial contact for assessment, he/she ensures consent is signed.
  • Procedure: patient and family are instructed to come for a 2-3 hour period if outpatient. Similar procedure is followed with inpatient but perhaps over a longer period. Case manager sees patient and family together and then family alone. Psychiatrist sees patient alone for a full assessment; psychiatrist and case manager discuss their respective findings briefly before meeting patient and family for feedback.
  • All protocols related to patient’s symptoms are completed by the psychiatrist. The rest of the protocol is initiated by the case manager including the family assessment. This involves completion of the three versions of the Wisconsin Quality of Life Index. For families of inpatients, completion of the Wisconsin Quality of Life Index will be the responsibility of the social worker. For details of what is contained in the protocol, refer to the protocol itself (see below).
  • A referral request is confirmed with the family doctor before patient is seen by a Program psychiatrist irrespective of the initial source of the referral. A consultation note is sent to the patient’s family physician prepared by the psychiatrist and case manager jointly or includes reports from both. Form 14 (Consent to Release/Share Information with Family Physician) is signed by the patient.
  • The patient is presented in detail at the following Monday morning program meeting before he/she can be admitted to the PEPP for treatment.

The presentation includes findings from instruments (symptom scales) completed as part of baseline assessment. This allows confirmation of diagnosis of a psychotic disorder.

  • Research staff are informed as soon as the assessment time is booked.
  • All future appointments with the psychiatrist are booked by the case manager.

DIAGNOSIS

Only diagnosis of a psychotic disorder (DSM-IV)1 is given at this point.

  • Issues regarding differential diagnosis are addressed and efforts at engaging the patient in treatment are initiated.
  • Diagnosis is reviewed at the end of one year unless the treating psychiatrist has reason to review it earlier or the patient/family seek more specific explanations regarding diagnosis.
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