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RUNNING HEAD: Psychosis NOS Treatment Plan1

Psychosis NOS Treatment Plan

Ginsey Temple

Western Carolina University

RTH 352: Process and Techniques

Jennifer Hinton

Psychosis NOS Treatment Plan2

Name: Sam Taylor (Name Changed For Confidentiality)Age: 15yoSex: Male Race: African-American Occupation: StudentMarital Status: SingleDate of Admission: 7/15/2011

Abstract: 15 year old African American male who is currently diagnosed with psychotic disorder (NOS) and a Global Assessment Functioning of 20.

Key Words:Psychotic Disorder (NOS), Visual Hallucinations, Global Assessment Functioning (GAF), Bipolar Disorder, Schizoaffective Disorder.

Diagnosis and Literature Review: According to Merck Manual Medical LibraryPsychotic Disorder NOS- Brief psychotic disorder consists of delusions, hallucinations, or other psychotic symptoms for at least 1 day but < 1 mo, with eventual return to normal premorbid functioning. Preexisting personality disorders (eg, paranoid, histrionic, narcissistic, schizotypal, borderline) predispose to its development.

Global Assessment Functioning- This is a number scale 1-100 used in mental health to rate a patient’s social, occupational, and psychological functioning. A score of 20-11 = Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.

Terminology at this Behavioral Health Facility:

2East (Children’s and Adolescent Unit)

Team 2 (Adolescents 12-18 if still in High School)

EP (Elopement Precautions) High Risk of escaping or evading treatment

PL2 (Precaution Level) How frequently a patient will be monitored PL2- Every 15minutes

Reason for Admission: Patient not stabilized he is requiring inpatient psychiatric treatment to stabilize his psychotic symptoms.

Chief Complaint: “I was hiding from the shadows; because the voices told me to”

Informants: Patient stepfather supplied valuable information regarding the patient since his admission to a regional children’s hospital 7/12/2011. Stepfather was with the patient during his previous stay at that facility.


History of Present Illness: The patient is a 15yo, African American, male, student. Patient presented to the hospital after being picked up by the local police he was delivered to the hospital by emergency medical services. He was found in the airport 7/12/2011 in the men’s restroom in a very disorganized, psychotic state. He had been flying from another southeastern state to NC for a brief layover and then to return home to another state. The information is a little unclear as if the patient was completely compliant with his medication during his attendance at a church camp which he attended from last week Wednesday-Saturday and then visited with aunts and uncles in the state of origin Saturday and Sunday of the last week. What is clear is that when he was found in the airport he was frightened, paranoid, suspicious, speaking of auditory and visual hallucinations, disorganized and grandiose. Step father was able to report that had a conversation with the patient Sunday evening and the patient stated “I’m just frustrated with myself.” Stepfather did not think much of this, but has known the patient for the past 9 years. Stepfather is aware of the patient’s previous diagnosis of bipolar disorder with psychotic features and his history of decompensations with aggressive, psychotic and irritable symptoms. Stepfather also reported that the patient did not sleep well yesterday in the hospital. The pediatric team was requesting input from psychiatry as to how to treat the patient at this time and what would be the best plan for his disposition.

Past Psychiatric History: The patient does have a history of previously being hospitalized at the age of 14 at a state facility for what appears to be related to a psychotic decompensation at that time. He was hospitalized 05/2009 for hallucinations and strange behaviors and he was diagnosed with bipolar disorder. He has been treated with Abilify since that time and has maintained his outpatient status. His present dosing of Abilify is 10mg at nighttime. A few months ago the medications were changed from Abilify to Risperdal this was done for cost savings approach. The patient developed elevated prolactin levels and also glactorrea thus causing the discontinuation of Risperdal. The patient seems to do fairly well when he is compliant with the Abilify 10mg at bed time.

Family History: According to the stepfather on the maternal side of the family there was a great grandmother with schizophrenia and also a cousin who has been diagnosed with schizophrenia. To his knowledge he reports that there was no mental illness on the biological father’s side of the family.

Social History: The patient is scheduled to be a 10th grader this coming school year in a large city in another state. He is reported to be a good student receiving A’s and B’s. The patient did attend church camp in yet a different state last Wednesday-Saturday. He is involved in an adolescent church group. Stepfather reported that he is not aware that the patient has had any contact with illicit substances of any type. He has no legal history to date.

Review of Symptoms: Patient reports today that he is fatigued and he would like to sleep, but has difficulty dealing with his racing thoughts. He denied any difficulties


with cardiovascular, respiratory, gastrointestinal, genitourinary or musculoskeletal systems.

Mental Status Examination: When the patient was seen today his vital signs were stable and he was in no acute medical distress. At the present time his height is 5 feet, 6 inches tall, temperature of 98.7 degrees Fahrenheit, pulse rate of 90 beats per minute, respirations 16 breaths per minute, slightly elevated blood pressure 156/84 but an oxygen saturation level of 100%. When this writer met with the patient in his room he was sitting bedside and appeared to be mentally distressed. At times he would grab his head in a painful sense. He acknowledged the writer was very polite. He demonstrated variable eye contact, blunted and flat affect with disorganized and tangential thinking. At times he was grandiose and hyper religious and stating “the holy spirit monitored my medications with me when I was on a recent trip.” He was able to recall his feelings of hearing voices at the airport directing him to hide in the men’s room. He went on to talk about “they were talking about worldly things.” With further discussion he did admit to having auditory command hallucinations of “bad spirits.” During the remainder of the interview he did lie down and essentially stared at the ceiling and listened to the conversation. He did appear to be responding to internal stimuli and was quite distressed. His affect was blunted and flat, but there was no evidence of potential harm to self or others. He did appear to be tires, wishing to sleep at this time. Insight is limited and judgment is poor.

Allergies:No known drug allergies

Diagnoses:

Axis 11. Psychotic Disorder, NOS2. Rule out Bipolar disorder, mixed with psychotic symptoms3. Rule out schizoaffective disorder

Axis 21. Deferred

Axis 31. No acute medical issues

Axis 41. Possible non compliance with psychotropic medications, ongoing mental

health concerns and recent acute decompensation.Axis 5

1. GAF at the time 20

Recreation Therapy Initial Assessment:Leisure Interest

Arts and Crafts Exercise


Family Activities Gardening Listening to music Movies Play a musical instrument Reading Social Activities Sports Table Games Traveling Video Games Walking Writing

Personal Challenges Concentration Self esteem/self confidence Time Management

Is there any reason you are unable to participate in Recreation Groups: No

List some things that you do well: Act, play video games, and Bebop (making sounds with my mouth).

If you could change something about yourself what would it be: The way I act.

What do you do for recreation or fun: Play video games with hands and make animal sounds.

Why are you in the hospital: Relax

What are your goals for hospitalization: “Patient refuses”


Phase One

Definition

Psychotic Disorder NOS means that a patient is diagnosed with a Psychotic

disorder that is not otherwise specified. This diagnosis is often used to describe

individuals in stages of psychosis that are not advanced enough for a specific

diagnoses or the best diagnoses has not yet been determined for that individual; both are

considered based on a person’s symptoms. Psychosis NOS is considered a mental illness

that does not fall under a specific mental illness, psychosis itself is often a symptom of

another underlying cause or condition (American Psychiatric Association 2013).

According to the Juneau Alliance for Mental Health, Inc., Psychosis NOS is used to

describe patient's that are in early stages of diagnosis, and it is not clear what the

best diagnosis is according to a persons symptoms. In accordance with this, the two

main symptoms that coincide with Psychotic disorders are delusions and hallucinations

(U.S. National Library of Medicine, 2016). The U.S. National Library of medicine

describes delusions as “false beliefs” and hallucinations as “false perceptions, such as

hearing, seeing, or feeling things that are there” (U.S. National Library of Medicine,

2016, para. 1). A diagnosis of psychosis NOS is not a lifelong diagnoses, it changes as a

patient’s situation is better understood with time, patient history and testing for

different diagnoses (Juneau Alliance for Mental Health, Inc., 2016).

Demographic

According to the National Institute Mental Health (NIMH) “the word psychosis

is used to describe conditions that affect the mind, where there has been some loss

of contact with reality” (National Institute of Mental Health. 2015). All psychosis


disorders have any combination of four key features; delusions (false beliefs)

hallucinations (seeing or hearing things that are not truly there), disorganized thinking

incoherent speech, disorganized abnormal or inappropriate behaviors, and negative

symptoms (American Psychiatric Association 2013; NIMH, 2015).

One factor suspected to contribute to an individual’s diagnosis of Psychosis are

genetic factors. According to the National Alliance of Mental Illness (NAMI) there are

many genes associated with developing psychosis; it also notes that just because a person

has any of those genes that they are going to develop psychosis (NAMI, 2016a).

“Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as

Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis” (NAMI, 2016a,

para. 10). A third contributing factor that can lead to psychosis is trauma, with an event

or events- sexual assault and death of a loved one are two examples given by NAMI. The

NAMI also says “marijuana, LSD, amphetamines and other substances can increase the

risk of psychosis in people who are already vulnerable” (NAMI, 2016a, para. 9).

It is estimated that approximately three in every 100 people will experience a

psychotic episode in their lifetime. Looking at age as a contributing factor it is concluded

“Young adults are placed at an increased risk to experience an episode of psychosis

because of hormonal changes in the brain that occur during puberty” (NAMI, 2016a,

para. 1)

Strengths of Patient

When reviewing the write-up on my patient one of the things that he has going for

him is the understanding and support that he seems to have from his stepfather. It is noted

that the last time the patient was in a hospital his stepfather was the one who stayed with


him. A second factor that is to the patient’s benefit is that he does well in school. He is

currently set to go to the 10th grade in the upcoming school year, in the state where he is

from. It is reported that he does well in school, receiving grades averaging between A’s

and B’s.

From the report it also appears that the patient has a strong support group that

exists outside of his family. He is involved in an adolescent church group and was on his

way back home from a weeklong camp he attended with the group. Upon admittance it

appeared that the patient is in good physical health with only slightly raised blood

pressure. The last noted strength, in regards to my patient, is that he has a large variety of

interests. He claims to like arts and crafts, exercise (walking and watching movies),

family activities, gardening, music, movies, reading, social activities, sports, gaming,

traveling, and writing. Many of these could later be included into recreational therapy

sessions with the patient.

Needs of Patient

The patient lacks insight to his illness. He knows that there is something different

about himself, and at his age and with his symptoms it is hard to know exactly

what is ailing him. My patient might be considered to have Anosognosia, “from

the Greek meaning ‘to not know a disease’” (NAMI,2016b, para 1). According to

NAMI there are two main reasons that an individual may have Anosognosia,

“unaware of their own mental health condition or that they can’t perceive their

condition accurately” (NAMI, 2016b, para. 2). The later of these two reasons

applies to my patient; he knows that he has a mental illness but is unable to fully

understand what it is and how it is affecting him.


Patient complains of racing thoughts, which are disturbing his sleep and his

ability to relax. Racing thoughts are often symptoms of a mood disorders, where

an individual has continuing and protruding thoughts that disrupt things in their

lives, such as sleep and ones ability to relax. “Racing thoughts literally mean

that thoughts race, or go very fast” (Droogendijk, 2009). Along with

insomnia, the patient’s racing thoughts have the potential to affect other

areas of his life if they are not helped. Helping to control racing thoughts could

help a patient to feel they are more in control of themselves and then their lives.

Patient says a personal challenge for him is of self-confidence and self-esteem,

not much more is given. Self-confidence is defined by the Psychology Dictionary

as ones self-assurance in their, judgments, their ability to meet the demands of a

task, overall abilities, and being confident that something they have done is okay.

For my patient improving his self-confidence could also help boost his self-

esteem. Self-esteem is “ the degree to which the qualities contained in our self-

concept are seen to be positive” (Psychological Dictionary. 2012, para.1 b.).

Being able to help my patient with this self-confidence and esteem could only

prove to be to his benefit; improving these areas will, in theory help him to have a

better view of him-self and his capabilities.

Environmental Barriers

One of the most pervasive environmental barriers for individuals with Psychotic

disorders are the attitudes of others toward them and stigma. Dingfelder (2009)

talks about the fear others still have regarding individuals with mental illnesses.

The article states that, “Some attitudes have gotten worse over time: For instance,


people are twice as likely today than they were in 1950 to believe that mentally ill

people tend to be violent” when in reality this is not true (Dingfelder, 2009, para.

8). It is also believed that this new, and deeper fear by individuals comes from the

fact that we are learning more information about mental illnesses and psychosis

(Dingfelder, 2009)

Looking at the patient’s future, finding places of employment may also be a

problem. In general individuals within the age 15 to 24 have difficulties

finding work, for individuals with psychosis at this age the difficulty is only

greater (Bassett, Lloyd, & Bassett. 2001). Some individuals “felt that once

people knew that they had been diagnosed with a mental illness, they would

not want to know them because of the stigma attached to mental illness

(Bassett, Lloyd, & Bassett. 2001, para.1 pg. 69). Individuals in the study

“Work Issues for Young People with Psychosis: Barriers to Employment” felt

that there were issues of changing treatment, specifically side effects of

medication changes that are of concern in relation to their work ethic and

capabilities. All of these are challenges that my client will face, he is 15 and

has Psychosis NOS, when he seeks employment in the future he is almost

guaranteed to have a difficult time.

Cultural Information

Religious- According to NAMI, individuals that are from a more religious

background are more likely to have “…visual or auditory hallucinations with a

religious content, such as hearing God’s voice…” (NAMI, 2016a, para. 25). To


go along with this they suggest that it can be beneficial to work with a

professional that is more sensitive and open to different cultural aspects (NAMI,

2016a).

Patient is 15 years old - According to Garey, “the illness most often associated

with psychosis, schizophrenia, usually doesn't show up until very late adolescence

or early adulthood” (Garey, 2015, para. 2). The patient does have other family

with schizophrenia and with the patient’s age he may be showing early symptoms.

Patient is an African American male

He is a student going into the 10th grade in the upcoming school year.


Phase 2

Efficacy Research

Goddard, A.T. & Gilmer, M.J. (2015). The role and impact of animals with pediatric

patients. Continuing Nursing Education, 41(2), 65-71. doi: 103796873

1. Summary

The main focus of this article, The Role and Impact of Animals with Pediatric

Patients, is to look at Animal-facilitated therapy articles and studies; specifically

articles that are focused in Pediatric setting. Findings of this article conclude

positive data and beneficial outcomes. The most evident of the positive finding were

in decreasing pain and anxiety of patients in pediatric settings. This article is a

meta-analysis, instead of reviewing a single study it looks at several related studies,

how they were conducted, and their conclusions; an overall conclusion is then made

based on the information taken for the reviewed articles. There were two main

types of articles looked are; Animal- Assisted Activity (AAA) and Animal-Assisted

Therapy (AAT), specifically using dogs. The article goes into more detail of each

method and lists finding that are in other articles that are associated with each

therapy type. Following this is a section on AAT dogs, then found benefits of canine

therapy in general, canine therapy with children, and then some additional benefits

to patients. The article ends with some exceptions to their finding and that

additional research should be done on the topic.

2. Subjects and Methods

The study was “conducted in October and November 2012 to accessible library


databases, including PubMed, Psych- INFO, Medline, and CINAHL” (pg. 66, para.4). In

searching for articles, the study focused on studies that revolved around animals in

therapy sessions in youth, children, adolescents, and pediatrics looking at least 19

different studies. The study itself did not look at individuals or a group of people; it

instead looked at and reviewed other studies. Reviewed studies varied in

participants, study lengths, and locations. Most of the reviewed studies were all

conducted with children, though a few were reviewed that were conducted with

adults.

The articles that reviewed younger individuals including studies done with

childhood cancer patients, those in pain units, others with selective mutism, patients

with mood disorders, physical or cognitive disabilities. They also made it so it was

limited to include the terms pet therapy and animal assisted therapy.

The study also reviews the specifics of two types of Animal Facilitated

Therapies: (AFT) Animal Assisted Activity Therapy (AAA), and Animal Assisted

Therapy (AAT).. AAA is defined as “activities that involve pets visiting people” and

are “often “meet and greet” in nature” (Table 1, pg. 67). AAA is in a less structured

format that gives individuals more freedom in their interactions with the therapy

animals. AAT is defined as an “integrated part of treatment plan” and is “often for

people who have physical, social, emotional, or cognitive needs” (Table 1, pg. 67).

AAT is more structured, with specific, scheduled interactions with a goal in mind for

sessions.

3. Findings and Implications

“In experimental studies within the pediatric population, physiological,


psychological, and emotional benefits have been supported” (pg. 68, para. 5). In some

cases there were findings of reduction of pain, in others, improvement of mood. In some

of the older studies reviewed, there were reports of non-verbal patients speaking during

the time they spent with a dog. In a study of an AAT at a psychiatric unit with adults with

schizophrenia, individuals were reported to show improvement in their self-determination

and esteem after eight weeks. The overall conclusion in the study was “In experimental

studies within the pediatric population, physiological, psychological, and emotional

benefits have been supported” (pg. 65 para 5). Despite the positive finding in the study,

there were that more research is needed and as well. Things that qualify as exceptions for

these studies would be if an individual is scared of dogs, allergic to dogs or they may just

not like dogs; however another animal could potentially be considered instead in such a

situation.

The meta-analysis of the article found “systematic benefits of animal-facilitated

therapies to reduce pain, decrease psychological distress, and decrease anxiety,”

(pg.70 para. 1) also “the use of an animal to facilitate conversation, lead discussion,

or break communication barriers has been demonstrated through both research

and anecdotal reports” (pg.70 para. 1). The overall conclusion of the article is that

AAA and AAT are beneficial. The study notes that “there has been a recent surge in

literature related to Animal Facilitated Therapy and benefits to pet companionship over

the last 10 years, further study of AAT, especially in teens and youth, is indicated” (pg.

70 para 5). It also suggests that studies could further benefit by being used in different

areas and populations within the included age groups. Cancer patients were included in a

study, but other studies in areas such as psychological units, burn units, mental disability


centers, and others. If such studies were conducted then there would be an overall larger

pool of data to pull findings from and more data in general on the affects of AAA and

AAT.

The study also notes that there is “a lack of scientific data defining a specific protocol

for these animal-facilitated intervention procedures” (pg. 70 para. 6). In each study there

was no standardized way in which the studies were performed, each study was conducted

differently; not all studies had given conclusions.

Over all it seemed that the researchers found what they were looking for given the

information that they found. They found positive correlations in using dogs in AAA or

AAT sessions with younger populations. Despite this they feel that there should be more

studies conducted to help create further findings, with the hope that they will also be

positive. With further studies there is a hope that more benefits can be found in the use of

Animal Assisted Activity and Animal Assisted Therapy.

4. Applications of this Case

When reviewing this article only one specific reviewed article went along with

my case study. This article was a study conducted using AAA in an adult psychiatric

ward. The study found the AAA helped with improvement for individuals with

schizophrenia; more specifically in areas of self-esteem and determination, in

reducing positive psychiatric symptoms with overall positive affects to patients’

health. My patient is currently in a psychiatric facility due to recent episode of

psychosis, and appears to have continuing hallucinations. One of the noted benefits

of the study at the adult psychiatric ward was a reduction in positive psychiatric


symptoms. This means that with AAA individuals had reductions in their

hallucinations, though it does not specifically say of it was in frequency, length, or

intensity. Still a reduction in positive symptoms is a reduction and beneficial.

On the other hand the rest of the article, as a whole, seems to focus on and lean

toward AAT as being the better of the two therapies in most cases, it provides more

information on it, as it seems to have been used and reviewed in more studies in the

article. These findings were not just in children but also in adults and even staff at

facilities.

All of the studies reviewed were completed with dogs, which is the animal I

would choose for my patient who is at in-patient care psychiatric ward. I think AAT

would be a better fit for my patient because it requires charting, has scheduled

visits, a predetermined length of time, and most importantly a specific treatment

activity and goal for a single individual for each session.

Top Three Strengths/Needs

Strengths:

Cl. Is smart, and does well in school averaging grades with A’s and B’s

Cl. has a strong support system within his family and adolescence church

group.

Cl. has many interests

Needs:

Increase ability to relax

Increase self-esteem/confidence

Insight to his illness


Calm racing thoughts

Goals

Increase overall relaxation ability

Work on building up self-esteem and confidence

Increase awareness’s insight to diagnoses

Facility

North Carolina Children’s and Adolescent Unit at a Behavioral Health Facility,

inpatient.

Intervention

For my cl. I am going to use Animal-Assisted Therapy (AAT) with a dog as my

intervention. This type of animal therapy has been found to have emotional,

physiological, and psychological benefits (Goddard & Gilmer, 2015). In the article

AAT is reported to reduce anxiety, the time with the dog is relaxing and provides a

positive distraction. (Goddard & Gilmer, 2015). Using dogs in AAT sessions has also

been show to bring pleasure and happiness, entertainment, enjoyment by snuggling,

providing company and to be calming. (Goddard & Gilmer, 2015). The article also

suggest that getting a patient to perform tasks with the animals is relaxing and can

help them focus on something aside form what is bothering. The scope of this plan is

to have my cl. learn five commands for the dog to demonstrate. The commands I

intend to use sit, lay down, stay, give a high five and shake; all of these trick are ones

the dog already knows. The intervention will be done in the cl.’s room, which he is

currently confined to. The plan is for sessions to continue through out the duration


of the cl.’s stay, more tricks and task can be added overtime as the cl.’s ability to get

the dog to demonstrate tasks for him, on its own, increases.

Objectives

1. Skill Practice: The TR will bring in the dog for 15 min. 2x dat, once in the

morning and in the late afternoon,; ea. session the cl. will work on learning

commands for tricks, that the dog already knows, for the dog to demonstrate

while the cl. stays relaxed and focused on what he is doing.

2. Functional Use of Skill: After the first wk. the cl. will demonstrate,

successfully, two of the five tricks though to him while staying focused on the

dog and without getting worked up.

Progress Notes

S (Subjective Data)- On the first day, in the fist session patient said “ I love dogs!”

When it was time for the first session he said “I don’t want it go”. After this in ea.

session he said “Hi, how are you today?” to the dog when it entered the room, and

said “By, see you soon,” every time it left. When learning the cues for the tricks for

the first three days, six sessions, the cl. would say, “I just want to pet it.” The

sessions after that he would say “good dog” after a trick was completed. When

demonstrating two tricks the cl. said, ā starting, “we can do this.” When he

successfully showed sit and lay down with the dog he asked “can I show you

another?” When we were leaving after the independent demonstration the client

said, “I hope I can keep doing this, I feel much better after”.


O (Objective Data)- Cl. was very excited on the first day in the first session, getting

off the bed and giving the dog a hug. Leaving after the first session the cl. seemed

very upset and laid down staring at the ceiling as we left. In the session following

the cl. seemed happy when we arrived and to slowly be less upset when we left.

During sessions the cl. seemed to be focused on what he was doing and seemed to

be in a better mood when we left, after the first six sessions. Cl. also was calm and

did not appear tense when we were in the room. On the eighth day, the first of the

second wk, cl. was able to successfully complete two tricks and an additional trick;

he seemed overall happier and really liked working with the dog, the RT sessions

seemed to be helping.

A (Analysis)- The sessions appear to be well liked by the cl., he has shown relaxation

in his body language as the sessions are conducted and overall happier after the

sessions. The cl. seems to feel very comfortable around the dog and willing to work

with both the dog and myself. The patient has been able to state that he notices a

positive change in his mood. It seems that he will be willing to continue with the

sessions and I intend to do so. I plan to continue the sessions and add an additional

five min. to the session during which time the client can practice on his own, just pet

the dog, play with it, or whatever he likes. The client can use this as a free time, in

hopes to see even more improvement in his relaxation

P (Plan)- I will continue with this tx. for the remainder of the time that Sam is here. I

believe my cl. should (after leaving this facility) continue to partake in AAT therapy,

specifically with dogs, because of his love for them. Before his discharge from this


facility I plan to get in contact with organizations that provide AAT back in and

around my cl.’s hometown.

Discharge Plan

Sam Taylor is a 15 y.o. AFM admitted to the Children’s and Adolescent Unit at a

Behavioral Health Facility in North Carolina with the main Dx of Psychosis NOS, his

discharge date has yet to be determined. His current intervention is Animal Assisted

Therapy (AAT) on his own with a Recreational Therapist while he is housed here.

The goal and objective during his tx. c. me is to aid him in relaxation while he is

here; I hope that he can then continue this therapy once he leaves my care. He still

faces challenges with staying relaxed in-between sessions but seems to be showing

improvement. I believe my cl. should (after leaving this facility) continue to partake

in AAT therapy, specifically with dogs, because of this love for them. After getting

written permission from his stepfather I am going to sign him up in an AAT program

that best fits his needs, so he can resume treatment once he returns home.

V. Temple, RT Student

April 29. 2016

References


American Psychiatric Association (2013). Diagnostic Statistic Manual 5th Edition.

Schizophrenia spectrum and other psychotic disorders. Retrieved

March 17, 2016 from

http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425

596.dsm02

Bassett, J. & Lloyd, C. & Bassett, H. (2001). Work issues for young people with

psychosis: barriers to employment. British Journal of Occupational Therapy

64(2), 66-72.

Colman A.M. (2012 a.) Psychology Dictionary. What is self-confidence? Retrieved

March 15, 2016 form http://psychologydictionary.org/self-confidence/

Psychology Dictionary. What is self-esteem?. (2012 b.) Retrieved March 15,

2016 from http://psychologydictionary.org/self-esteem/

Dingfelder S. F. (2009). Stigma: Alive and well. American Psychiatric Association, 40

(issue), pages. Retrieved January 29, 2016 from

http://www.apa.org/monitor/2009/06/stigma.aspx

Droogendijk, D. (2009, January 30). Bipolar mania symptoms Retrieved March 14,

2016 from http://www.bipolardisordersymptoms.info/bipolar-

symptoms/racing-thoughts.htm

Garey, J. (2015). Watching for signs of psychosis in teens. Retrieved

January 28, 2016 from http://www.childmind.org/en/posts/articles/2015-7-20-

warning-signs-psychosis-schizophrenia-teens

Goddard, A.T. & Gilmer, M.J. (2015). The role and impact of animals with pediatric

patients. Continuing Nursing Education, 41(2), 65-71. doi:103796873


National Alliance of Mental Illness. (2016a). Psychosis. Retrieved January 25, 2016 from

http://www.nami.org/Learn-More/Mental-Health-Conditions/Related-

Conditions/Psychosis

National Alliance of Mental Illness. (2016b). Anosognosia. Retrieved February 13,

2016 from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-

Conditions/Anosognosia

National Library of Medicine. (2016). Psychotic Disorders. Retrieved January 25, 2016

from https://www.nlm.nih.gov/medlineplus/psychoticdisorders.html

National Institute of Mental Health (2015). What is psychosis? Retrieved March 16,

2016 from

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psychosis.shtml

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http://www.jamhi.org/poc/view_doc.php?type=doc&id=8825&cn=7

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