보호병동 치료 후 낮병원으로 전원된 정신분열병 환자의 임상특성

The Clinical Characteristics of the Schizophrenic Patients Transferred to Day Hospital after Treatment in Closed Ward

The authors investigated the personal backgrounds, past medical histories and clinical characteristics of 235 schizophrenic patients admitted to the closed ward of Seoul National University Hospital for 6 years since 1983. 78 patients of them were directly transferred to day hospitaKDH group) and the other 157 patients were referred to out-patient clinic(OPD group) after discharge. Following results were obtained : 1) In the DH group, the mean age was significantly lower and the proportion of the unmarried patients was considerably higher than those of the OPD group. As for the occupation, the proportion of high school students and repeaters of college entrance exam 一 so called unprofitable jobs - was comparatively higher in the DH group than that in the OPD group. One of the reasons for this difference might be that the day hospital in S.N.U.H. was already composed of young patients. Another reason for the difference might be that the office workers and housewives were expected to come back to their previous roles upon discharge. Moreover, the program for rehabilitation such as occupational therapy was not fully provided in the day hospital as yet. 2) Though there were no significant difference in the duration of illness between both groups, the frequency of previous admissions in the DH group was more than that in the OPD group and similarly the total duration of previous admissions was longer in the DH group. These findings do not suggest that the more chronic patients were transferred to day hospital but that the day hospital might be utilized to avoid the potentially deleterious effects of prolonged hospitalization such as regression, damaged self-image, and isolation from the family and the community. 3) The DH group patients were discharged most frequently on 5th or 6th week after admission and the OPD group on 9th or 10th week. And the average daily dosage of antipsychotics at discharge was significantly higher in the DH group. Such findings suggest that the day hospital, so far, tended to be used as a transitional modality from inpatient to outpatient aftercare in schizophrenic patients. 4) As to the evaluation of clinical outcome and prognosis, the DH group was more negatively rated than the OPD group. In association with this finding, there were more residual symptoms such as social withdrawal, aggressive behavior, emotional blunting and lack of volition in the DH group. These findings may be seen as indication that the treatment goals such as the improvement of the social skills, the motivation of the isolated patients, and the activation of group activities were looked on as important in the day hospital program