Models of Inpatient Care

EPPIC has a 16-bed inpatient unit devoted to the treatment of young people with early psychosis. Such a unit is unusual, being one of a handful of such specialized facilities around the world. As with other components of the EPPIC model, the principles adopted within the unit are not unique and can be applied in other less specialized inpatient settings, including the treatment of patients with early psychosis as part of a general psychiatric service. This is generally facilitated by physically demarcating a section of the unit as the ''early psychosis wing''. This sends a potent message, which is otherwise lost, to patients and staff that their management and prognosis is substantially different from patients with more established illnesses. Other models of care emphasize residential alternatives to inpatient care [75], but these models still require back-up from traditional inpatient services where the special needs of early psychosis patients are not responded to.

Inpatient care in early psychosis focuses on symptom reduction and containment [1]. It emphasizes brief admissions in order to prepare patients for community treatment in the home or through an outpatient case management service. There needs to be close integration between different elements of the service, with staff members working across the different components of the programme and a case manager being assigned immediately on entry to the early psychosis service. The median length of stay in the EPPIC inpatient unit is 9 days (mean 13 days), and 6 days for subsequent (re)admissions.

Low doses of antipsychotics are standard practice during the acute phase. Disturbed behaviour is managed by targeted nursing interventions, liberal use of benzodiazepines as "antipsychotic-sparing" agents, and minimizing the use of potentially traumatic interventions such as seclusion and restraint.

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BiPolar Explained

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