The Social Work Dictionary by Robert L. Barker defines Evidence-based Practice as:
The use of the best available scientific knowledge derived from
randomized controlled outcome studies, and metaanalyses of
existing outcome studies, as one basis for guiding professional interventions and effective therapies, combined with professional ethical standards, clinical judgement, and practice wisdom (pp. 149).
Based on professional research and literature the following practices have been determined by the PORT study to be efficatious treatments for people who have schizophrenia: Case Management (ACT Team), Family supports and interventions, supported employment and housing, social skills training and reality oriented therapy (individual and group) (Sands 248, 2001).
The following is a list of the PORT recommendations (Lehman et al (1998b):
1. Antipsychotic medications, other than clozapine, should be used as the first treatment to reduce psychotic symptoms.
2. The dosage of antipsychotic medication for an acute symptom epidsode shoud be in the range of 300-1000 chlorpromazine per day for a minimum of 6 weeks.
3. People experiencing their first acute symptom episode should be treated with a low dosage antipsychotic medication between 300-500 mg a day.
4. "Rapid neuroeptization", or massive loading doses of antipychotic medications, should NOT be used.
5. No one medication has been found to be superior over the others therefore, choice of antipsychotic medication should be based on the individuals needs, history of medication usage and their tolerance to the medication.
6. Monitoring of the antipsychotic medications in the blood level should be limited to the following: 1 When person is not responding to current dosage of medicine. 2 When it is unclear whether the person is having side effects from the drugs or having symptoms from the disorder. 3 When multiple drugs are being taken that could interact with each other. 4 When noncompliance is suspected.
7. The use of anti-parkinson agents to reduce extrapyramidal side effects should be based on a case-to-case basis.
8. People who experience symptom relief from an anti-psychotic medication should continue to take the medicine for at least one year in order to reduce the risk of relapse or to worsen the symptoms.
9. The maintenance dosage should be in the range of 300-600 CPZ a day.
10.Reassessment of the dosage level should be ongoing. People who have only had one episode of positive symptoms before receing the medicine and who have experienced no symptoms in a year from starting the medicine should be put on a trial period off the medication.
11. Intermittent dosages should not be used continously because they can cause higher relapse rates and .
12. Depot antipsychotic therapy is strongly recommended for people who do not comply with oral medication.
13. Clozapine should be offered to people whose positive symptoms don not respond adequately to two different classes of antipsychotic medications.
14. Clozapine should be offered to people who display violent behavior and persisntent psychotic symptoms , who have not responded to two different types of medications.
15. Clozapine should be offered to patients who require antipsychotic medication but who have bad side effects from other antipsychotic medications
16. People who have a reduction in positive symptoms on conventional antipsychotic medications, but who hve significant EPS who do not respond to anti-parkinson agents, should be offered a trial of risperidone.
17. People who experience symptoms of other significant disorders, including depression or anxiety, can recieve a trial dosage an additional medication.
18. People who experience significant positive symptoms despite the use of antipsychotic therapy should receive a trial of adjunctive pharmacotherapy.
19. People who do not respond to antipsychotic therapy should be considered for a trial of Electro Shock Therapy, either alone or in conjunction with antipsychotic medications if a) the persn hs been ill for less than 1 year or if over 1 year and they are in the early phase of an acute episode. b) if catatonic or affective symptoms are persistent.
20. The number of treatments of ECT given to a Schizophrenic patient should be equivalent to the number given to a patient with an affective disorder, 12 treatments.
21. Regressive forms of ECT should not be used for people with Schizophrenia.
22. Individual and group therapy that incorporates the psychodynamic model shoud not be used for individuals with Schizophrenia.
23. People with the disorder should be offered individual and group therapy that incorporates support, education, and cognitive and behavioral skill training to improve the individuals functioning.
24. People who have continuous contact with their family should be offered family pyschosocial therapy that lasts at least 9 months.
25. Family therapy should be offered to families of all individuals with Schizophrenia. It should not be restricted to those family who have high levels of expressed emotion.
26. Family therapy shoud not be based on the belief that family dysfunction caused the individual to have Schizophrenia.
27. Vocational services should be offered to people with the following characteristics: a) they have the desire to be employed, b) has a history of employment, c) has a minimal history of psychiatric hospitalizations, d) have been identified as possessing good work skills.
28. The following services should be available to all people who qualified in
recommendation 27. The services include: a) prevocational training, b) transitional employment, c) supported employment, d) vocational counseling and educational services.
29. Services such as ACT and ICM sould be available to those people who utilize services from providers frequently.
30. ACT should be targeted at individuals who are at risk of being rehospitalized and who have trouble following treatment guidelines.
