More information on treatment:
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others is encouraged. Individual progress is
assessment via daily observations and
neuropsychological and psychiatric
assessments. This data informs the care plan
and is used to determine readiness to enter
the treatment stage.
The aims of treatment are to develop
personal autonomy and promote functional
recovery. The focus is on supporting clients to
improve their orientation and memory,
managing their alcohol consumption and
developing good relationships. The
programme also focuses on working with
managing impulses and behaviours, apathy
and motivation.
The programme is structured around a
timetable which is designed to help clients to
familiarise themselves with the routines and
activities of daily living. The physical
environment is set up to facilitate
understanding (through signs, colour coding
and whiteboards) and an appropriate level of
stimulation (eg noise management). Assistive
technology, such as memory apps on an iPad,
is used where this will be helpful.
Interventions are primarily based upon
the behavioural model and include diary
keeping, activity scheduling, graded tasking,
problem solving and memory cueing. The
‘errorless learning’ approach is also used, so
that clients do not make errors while learning
new information.
It can take two to three years for clients to
reach their full potential, and therefore
resettlement and recovery in the community
need to be carefully planned and
psychologically informed. The individual’s
support needs will need to be thoroughly
assessed, and a longer-term plan will need to
be made to support relapse prevention and
develop an appropriate level of independence
and structured activities.
*****
Back to
independence
Brynawel’s ARBD programme
transformed Kate’s prospects
Fifty-year-old ‘Kate’ was referred to Brynawel
Rehab in August 2016, following a diagnosis
of ARBD from her consultant psychiatrist. She
had been admitted to hospital in November
2015 with a range of symptoms caused by
heavy alcohol use and malnutrition resulting
in seizures, ataxia and problems with
articulation and swallowing reflex. Kate had
trained as a nurse and worked in the NHS
before and after having her family, and had
been very highly regarded by her colleagues.
The results of her first neuropsychological
assessment on admission to Brynawel
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suggested that she had difficulty planning
tasks. This was evident from Kate’s inability
to maintain her room to a manageable
standard or to plan basic self-care tasks such
as showering and personal care. Initial
findings from the assessment highlighted a
variety of problems with her immediate
memory, her visuospatial ability and her
delayed memory, which was extremely low.
Her results were supportive of a diagnosis
of Korsakoff’s with additional complications.
She underwent follow-up psychological and
psychiatric assessments in November and
then again for the final time in January 2017,
using different versions of a battery of tests.
Kate had been very emotional on arrival,
with periods of intense crying. Her sleeping
and eating were quick to settle, but by week
‘Kate’s results were
supportive of a
diagnosis of
Korsakoff's with
additional
complications.’
two she was noticed to have incontinence,
diagnosed by a GP as anxiety-related. By the
end of the first month she had begun to
engage more in activities but was still noted
to be unable to spontaneously initiate tasks
such as keeping her room clean, although she
had been able to use memory aids.
Staff were able to report an improvement
in her engagement and socialisation, it was
apparent by the second month that she still
had problems initiating communication or
tasks and decision-making. Although she had
managed memory tasks in sessions, her recall
of these tasks later on was poor. Her
symptoms of depression had lessened over
the 26 weeks and her levels of anxiety were
lower than when first admitted.
Kate’s daughter acknowledged a marked
improvement in her mother’s functioning,
following her admission to Brynawel. Within
weeks Kate had been able to recall the daytime
activities she had been engaging in and,
following small prompts, she could continue an
accurate conversation about what had been
ha ppening. This had been ‘the first time we
had noticed such a change in our mother’…
‘We felt like we had our mother back!’
They were aware that Kate could not
initiate memories, but she was now able to
recollect things quite well with a prompt. She
seemed happier and had been able to make
friends with other residents. Staff from
Admission criteria for
ARBD programme
PATIENTS WILL:
• have a diagnosis of ARBD
made by a suitably
qualified clinician using
modified Oslin criteria.
For more information see
https://bit.ly/2Hm4TwV
• have a standard assessment
document as part of
the referral, including
attached baseline scores
• have undergone physical
stabilisation, ie detoxed and currently abstinent from
alcohol. Be on oral thiamine supplements
• be in phase two or early phase three of Royal College of
Psychiatry/ Wilson et al five-phase recovery model
– for more information see https://bit.ly/2xT5vuq
• be thought to be able to engage in the components
of the treatment package (eg diary keeping)
Exclusion criteria
PATIENTS WILL:
• still be in the acute confusional stage of the natural
history of ARBD (and therefore still requiring medical
management)
• be in late phase three, phase four or phase five
(signpost to appropriate services)
• have significant physical health comorbidity where
medical stabilisation is required
Brynawel continued to support Kate in the
community for six weeks, providing support
with her cognitive rehabilitation, offering
assistance with memory aids and adaptations
in her own home and continuing to support
her reintegration into the community using a
graded approach to her discharge.
A year on, Kate has maintained abstinence
and lives independently. The alternative
option, which was suggested before her
admission onto Brynawel Rehab’s ARBD
Programme, was placement in a care home for
the frail elderly, at 50 years of age.
Dr Alyson Smith is consultant clinical
psychologist at Brynawel Rehab
June 2018 | drinkanddrugsnews | 21