- Investigations are ordered at the time of assessment as per protocol: CT scan, EEG, ECG, CBC, liver functions, prolactin, electrolytes, urea, TSH and urine drug screen. Weight is also recorded.
- In addition, cognitive testing is arranged as soon as possible.
- Use of prescription and other order sheets is initiated.
- Any psychotic disorder (DSM-IV): presence of delusions, hallucinations and/or thought disorder for greater than one week.1
- Symptoms not clearly explained by an organic brain syndrome or other medical disorders.
- Not having received antipsychotic treatment for longer than one month.
1 Psychotic disorder irrespective of etiology. In cases where there is clear evidence of previous affective disorder and the presenting symptoms are clearly a recurrence of an affective disorder with psychotic symptoms, such cases may be brought for discussion and not directly accepted into PEPP.
All dispositions are conveyed to the referral source. All patients and their families are informed of an initial two year involvement, if admitted to the program.
Tier I:
- Referred but not screened (basic demographic information to be collected)
Tier II:
- Screening only
- Patient screened for disposition. See attached chart
Tier III:
- Screening and Assessment only
- Psychiatric consultation
- Investigation
- Treatment recommendations
- Patient may be offered periodic consultation if primary aspects of care are to be provided elsewhere
Tier IV:
- Assessment and medical treatment without involvement of case manager or other disciplines:
All of Tier III above, plus medical treatment as per attached protocol. This may vary from a single consultation/assessment to multiple periodic assessments with or without medical management provided by the program psychiatrist
Tier III and IV apply mostly to individuals outside the epidemiological catchment area.
Tier V:
Full program participation with involvement of case managers and other disciplines (psychology, occupational therapy) for two years is available only to individuals living within the catchment area (London and Middlesex, pop. 390,000). Patients complete the assessment and treatment protocol. Patients are seen by the case manager at least weekly and by the treating psychiatrist biweekly until clinical stability is achieved. Patients are reviewed regularly with the attending psychiatrist for medical management and with clinical/education leader for psychosocial management. Patients not responding to treatment within three months are reviewed in a formal team discussion.
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