SPECIAL TREATMENT OPTIONS FOR HIGH PROFILE PATIENTS

I have been thinking of making a collection of treatment plans for the more difficult or high profile patients on the inpatient unit. The advantages might be [1] the plans would be available for subsequent admissions providing continuity and a head start at re-admission, [2] improved coherence and reliability of interventions, and [3] since each plan is for a particular kind of client, some aspects of the plan might be transferable to similar clients

Consistent application of intervention provides security for patient and staff; ability to evaluate and modify planning; and, consequently, improved therapeutic outcome

Many of the more difficult clients have more than one ‘problem’ and, often, the difficulty stems from interaction of the problems. As an example, the prognosis of a patient with Bipolar Disorder who is treatment compliant may be excellent but, while compliance is usually an issue, co-occurrence of narcissistic traits often makes the patient severely resistant to treatment. Some kinds of difficult client profiles are [1] paranoia with dementia or brain injury, [2] Bipolar Disorder I, manic, with narcissistic traits, [3] Bipolar Disorder I, manic, with antisocial traits, and [4] Borderline Personality Disorder [ICD 10 suggests that the etiology of the borderline is PTSD in an individual with biologically rooted affective instability,] [5] Schizophrenia with Dependent, Avoidant – or otherwise fragile – Personality

It will be useful to continue to identify such profiles. Suggestions as to profiles and treatment are invited. I request that you do not make entries or insertions in this binder but communicate with me directly. If the collection turns out to be useful, I will set up a means of communication

The contents of this binder are available for use. At the present time, I have not deleted references that might identify particular clients. Therefore, copies should not be taken out of the facility. If administration approves, the contents will be available on the local intranet

When automation, it will be possible to easily incorporate the special treatment options in the regular inpatient treatment plans. Such automation will have additional advantages: [1] availability for re-admission and continuity – at re-admission, it would be necessary only to modify old plans, [2] master treatment plans would require entry only of changes, [3] numerous major and minor advantages of automation such as suggestions for medical necessity and goals, and [4] continuity with outpatient care

Anil Mitra