42 THE SEVERE AND PERSI STENT MENTAL ILLNESS PRO GRESS NOTES PLANNER 7. Review Psychoactive Chemicals (7) A. The client's use of psychoactive chemicals (e. g., nicotine, caffeine, alcohol, street drugs) was reviewed. B. The client's pattern of psychoactive chemic al use was connected to his/her symptoms. C. The client was supported as he/she acknowledged that his/her psychoactive chemical use is affecting his/her anxiety symptoms. D. The client was reinforced for decreasing his/her psychoactive chemical use, lead ing to a decrease in anxiety symptoms. E. The client denies any connection between his/her psychoactive chemical use and his/her anxiety symptoms and has continued to use psychoactive chemicals, despite encouragement to discontinue this. 8. Recommend Sub stance Abuse Evaluation and/or Termination (8) A. It was recommended to the client that he/she terminate the consumption of mood-altering substances that could contribute to anxiety. B. The client was referred for a substance abuse evaluation to more com pletely assess his/her substance abuse concerns and how they may trigger anxiety. C. The client was referred for substance abuse treatment to assist him/her in discontinuing his/her consumption of mood-altering substances. D. As the client has decreased his/her use of mood-altering substances, he/she has experienced a decrease in anxiety, and this was reviewed. E. The client has declined any evaluation or treatment related to his/her substance use and was encouraged to seek this out at a later time. 9. Differentiate Anxiety Symptoms (9) A. The client was assisted in differentiating anxiety symptoms that are a direct effect of his/her severe and persistent mental illness, as opposed to a separate diagnosis of an anxiety disorder. B. The client was provi ded with feedback regarding his/her differentiation of symptoms that are related to his/her severe and persistent mental illness, as opposed to a separate diagnosis. C. The client's specific anxiety disorder, which is freestanding from his/her severe and persistent mental illness, was reviewed. D. The client has been unsuccessful in identifying ways in which his/her anxiety symptoms are related to his/her mental illness or a separate anxiety disorder. 10. Differentiate Reality versus Hallucinations/Delus ions (1 0) A. The client was assisted in differentiating between actual life situations and those that appear real but are due to hallucinations or delusions. B. Positive feedback was provided to the client as he/she identified several situations that hav e appeared real but are actually due to hallucinations or delusions. C. Redirection was provided to the client as he/she continues to struggle with reality testing and is uncertain about the reality of his/her hallucinations or delusions. 11. Acknowledge Anxiety Related to Delusional Experiences (1 1) A. It was acknowledged that both real and delusional experiences could cause anxiety. B. The client was provided with support as he/she acknowledged his/her anxieties and worries, which are related to both the real experiences and delusional experiences. 