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Nityanand Rehabilitation Centre (NRC)

Treatment Protocol

PHYSICHIATRIST ROLE TIME
DURATION

PSYCHOLOGIST & MEDICAL &
PSYCHIATRIC SOCIAL WORKER

ACUTE PHASE   ACUTE PHASE
Step 1 1 to 6 Weeks Step 1
Diagnostic work up (based on rating scales and objective data) from client, parent and guardian. Psychosocial Evaluation from family.
Step 2 Step 2
Case Formulation and Management Plan (Psychopharmacological and Medical Management) Psychosocial assesment with client (based on individual sessions & observation from inhouse staff & nursing staff.) A good rapport is established at this stage.
Step 3 Step 3
Assessment of drug efficacy and side effect profile. Problem areas identification & goal setting.
STABILIZATION PHASE   STABILIZATION PHASE
Step 4 7 to 12 Weeks Step 4
Serial Mental status examination using rating scales ( 3 wkly) Contracting with the patient, family members & conducting  family sessions to give an overview of the case & future treatment plan.
Step 5 Step 5
Drug augmentation / add on / switch to new appropriate molecule. Individual counseling & on going assesment of identified problem areas using rating scales.
Step 6 Step 6
Assessment of symptom control & side effect profile monitoring. Developing therapeutic alliance & following psychosocial management plan.
STABLE PHASE   STABLE PHASE
Step 7 13 to 20 Weeks Step 7
Ensures that symptom remission or control is sustained.  Observation of maladaptive behaviour & formulation of client oriented behaviour management plan.
Step 8 Step 8
Maintain or improve the patients level of functioning and quality of life. Group dynamics & social skills training (Interpersonal relationship / effective communication / problem solving / assessment of aptitude potentials & liabilities.)
Step 9 Step 9
Continue to monitor adverse effects / therapeutic drug level / blood dyscrasias Training the client --                           
* Time Management                           
* Self Management                                 
* Stress Management                        
* Finance Management                      
* Vocational Training & Independent Lliving skills.                                         
* Need based psychological testing (Personality / IQ / EQ / Aptitude / Interest / Career guidance ).
PHASE OF PSYCHOEDUCTION   PHASE OF PSYCHOEDUCTION
Step 10 21 to 28 Weeks Step 10
Explaining and educating regarding biological model of illness to patient and family. Family work - Effective family communication (Interpersonal difficulties) and problem solving.
Step 11 Step 11
The role of stressful life events, expressed emotions, support systems and drug compliance in relapse prevention. Training the family members about patient handling & crisis intervention.
Step 12 Step 12
Making the patient and the family member aware about the realistic functional limitations and prognosis. Assesment of family support system & vocational guidelines.
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