A Nursing Tool for Insight and Adherence in Psychosis

1. ANursing Tool for Insight and Adherence in Psychosis Promoting Insight and Enhancing Recovery Sharon Sousa, Ed.D.,R.N.,C.S. College of Nursing University of Massachusetts Dartmouth

2. A Nursing Tool for Insight and Adherence in Psychosis • Poor insight makes successful collaborations in treatment more difficult and is an exceptionally troubling impediment to improvement

3. A Nursing Tool for Insight and Adherence in Psychosis • Increasing adherence and insight may enhance the potential for recovery • At present, there are few cost-effective strategies to improve insight in psychosis

4. A Nursing Tool for Insight and Adherence in Psychosis • We developed the Levels of Recovery from Psychotic Illnesses Scale (LORS) as a teaching tool for patients with psychotic illnesses to enhance insight & adherence • The LORS was also developed for educating families and clinicians

5. LORS

6. A Nursing Tool for Insight and Adherence in Psychosis The State of Massachusetts Department of Mental Health Treatment Guidelines for Schizophrenia (1999) cites the LORS as an example of an educational tool for this population.

7. A Nursing Tool for Insight and Adherence in Psychosis • Designed to identify strengths and weaknesses in insight in order to provide the basis for an intervention to enhance and promote change and recovery • This intervention (LORS Enabled Dialogue) appears to increase insight into mental illness

8. LORS Pilot Study • 45 patients with psychotic illnesses • The LORS was administered by clinicians • The BASIS 32 (Behavior and Symptom Identification Scale was self-administered • Instruments were completed at baselines, 6 months and 12 months

9. LORS Pilot Study Results • 2 factors with a factor loading of a least .58 • Tentatively named Institutional Support and Self-advocacy • Factor significantly correlated (.661) with each other but not with any of the BASIS 32 scores

10. LORS Pilot Study Limitations– no formal training procedure • Factor analysis lf LORS = multiple measures from same person • BASIS 32 correlations used individual items rather than factors • LORS clinician administered, BASIS 32 self-administered

11. LORS Pilot Study Conclusions – 2 distinct factors with the LORS • Future research directed to identifying whether changes in LORS can contribute to improvement in adherence and recovery

12. LED Intervention • Meet with clinicians most involved with the patient (group home director, case manager, therapists, psychiatrist, etc.) • Get information about functioning in areas on the LORS • Conduct clinical interview with the patient

13. LED Intervention • Ask patient about their overall goals • Where would they like to be, what would they like to be doing, what do they want to change? • Common goals: Move into independent living, find a job, meet a girlfriend/boyfriend, get the staff to stop hassling me

14. LED Intervention for Clinicians • A clinician encircles the LORS categories for each column & row • Patients can have a “map” that has items from each column • A preliminary scoring system ranks each item through “anchor” points

15. LED Intervention for Patients • Go over brief directions with patient • Ask that they encircle each item that currently indicates where they are on the LORS • Patients most often greatly underestimate the extent of their disabilities

16. Clinician

17. Patient

18. LED Dialogue • Compare the 2 LORS – use Motivational Interviewing style • Draw attention to the differences • Remind patient of their goals • Indicate what treatments are necessary in order for patient to attain goals • Frame the recovery possibilities with treatment

19. ConclusionProposed Future LORS Research • Further factor analytic work with a large sample to test for reliability and validity of the LORS • Manualization of the LORS and LED • Clinical trials of the LED