to cause deficits in social skills. This includes medi-
cation and symptom management, recreation, basic
conversation, and self-care. The cognitive remedia-
tion model focuses on improving underlying cogni-
tive impairments by emphasizing such things as
paying attention and planning. Improvements in
these basic cognitive functions enhance learning
in the other two models as well. Information about
modules for teaching social problem-solving skills is
available on the web site of Psychiatric Rehabilita-
tion Consultants at http://www.psychrehab.com.
Family education and therapy are known to di-
minish the negative effects of schizophrenia and re-
duce the relapse rate (Dyck et al., 2000). While inclu-
sion of the family is a factor that improves outcomes
for the client, family involvement often is neglected
by health care professionals (Aquila & Korn, 2001).
Families often have a difficult time coping with the
complexities and ramifications of the client’s illness.
This creates stress among family members that is
not beneficial for the client or family members. Fam-
ily education helps to make family members part of
the treatment team. See Chapter 4 for a discussion
of the National Alliance for the Mentally Ill (NAMI)
Family-to-Family Education Program.
In addition, family members can benefit from a
supportive environment that helps them cope with
the many difficulties presented when a loved one has306 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
Box 14-1
➤ ABNORMALINVOLUNTARYMOVEMENTSCALE(AIMS) EXAMINATIONPROCEDURE
Client identification: Date:
Rated by:
Either before or after completing the examination procedure, observe the client unobtrusively at rest (e.g., in
waiting room).
The chair to be used in this examination should be a hard, firm one without arms.
After observing the client, he or she may be rated on a scale of 0 (none), 1 (minimal), 2 (mild), 3 (moderate), and
4 (severe) according to the severity of symptoms.
Ask the client if there is anything in his/her mouth (i.e., gum, candy, etc.) and if there is to remove it.
Ask client about the current condition of his/her teeth. Ask client if he/she wears dentures. Do teeth or dentures
bother client now?
Ask client whether he/she notices any movement in mouth, face, hands, or feet. If yes, ask to describe and to what
extent the movements currently bother patient or interfere with his/her activities.
Have client sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at entire
body for movements while in this position.)
Ask client to sit with hands hanging unsupported. If male, hands between legs; if female and wearing
a dress, hands hanging over knees. (Observe hands and other body areas.)
Ask client to open mouth. (Observe tongue at rest within mouth.) Do this twice.Ask client to protrude tongue. (Observe abnormalities of tongue movement.) Do this twice.Ask client to tap thumb with each finger as rapidly as possible for 10–15 seconds; separately with right
hand, then with left hand. (Observe facial and leg movements.)
Flex and extend client’s left and right arms. (One at a time.)Ask client to stand up. (Observe in profile. Observe all body areas again, hips included.)*Ask client to extend both arms outstretched in front with palms down. (Observe trunk, legs, and
mouth.)
*Have client walk a few paces, turn and walk back to chair. (Observe hands and gait.) Do this twice.*Activated movements.012340123401234012340123401234012340123401234