치료적 공동사회의 치료전귀에 관한 연구 ᅳ ( III) 혼합치료 환경내에서의 부적응증에 관한 일 연구 —

Studies on Treatment Outcome of Therapeutic Community ᅳ ( III ) Possible Contraindications of the Mix ed Therapeutic Milieu

The authors organized and has been operating a mixed therapeutic mileu in an university hospital since 1981, which is structurally modified one and is including heterogenous patient subgroups of various diagnostic entities. Based on this experience, the authors has been performing a series of treatment outcome study of this modified therapeutic community. This paper is a trial to identify the possible presence of contraindication of our MIXed therapeutic milieu. From out clinical experience, we suspected 3 patient subgroups as the possible contraindication; Organic Brain Syndromes (OBS), Posttraumatic neurosis (PTN) and Antisocial Personality Disorders(APD) • 42 consecutive patients of these 3 subgroups admitted to out mixed milieu during 2 year period (Sept. 1, 1981 to Aug. 31, 1983) were evaluated for their outcome by measuring discharge rate of signing out against medical advice (AMA % \ drop-out rate of follow-up treatment (Drop-out %)y and the Psychiatric Inpatient Assessment Scale (PIAS) which was developed by the authors, and they were compared with the outcome of 131 patients of control group which was presented in our previous reports. We also examined their antitherapeutic effects to other patients or to the mixed therapeutic milieu per se. The results showed that： 1. Organic brain syndrome patients could be considered as one of the identified contraindication to our mixed therapeutic milieu in terms of significantly low outcome of their own. 2. Though the outcomes of post-traumatic neuroses and antisocial personality disorders were not significantly lower than that of the control group, they could be also considered as one of the contraindications to our therapeutic milieu in terms of thier antitherapeutic nature to other patients and therapeutic community perse. 3. It was suggested by the authors that antisocial personlality disorder patients may be much more benificially indicated to HOMOGENOUS therapeutic community rather than mixed therapeutic milieu.