치료적 공동사회의 치료전귀에 관한연구 ᅳ ( I I )치료적 공동사회와 일 의학적 정신과 병등에서의 비교연구 ᅳ

Studies on Treatment Outcome of Therapeutic Community — ( E) A Comparison Study between a Therapeutic Community and a Medically Oriented Ward —

The authors organized and has deen operating a MIXED therapeutic milieu in an university hospital since 1981, which is structurally modified one and is including heterogenous patient subgroups of various diagnositc entities. Based on this experience, the authors has been performing a series of treatment outcome study of this modified therapeutic community. This paper is the second one of the series; a comparison study of outcome between 131 patients who were treated in our therapeutic community ward (TCW) and 124 patients who were treated in a medically oriented ward (MOW). In this study, only the patients of five major diagnostic entities were included; acute functional psychoses (AFP), schizophrenia (SPR), manic disorders (MD), neurotic disorders (ND) and borderline patients (BP), and their outcomes were evaluated by measuring discharge rate of signing out against medical advice (AMA%), drop-out rate of follow-up treatm ent and the Psychiatric Inpatient Assessment Scale (PIAS) which was developed by the authors. The results were as follows: 1. The treatm ent outcomes of both neurotic disorders and borderline patient subgroups were significantly superior in TCW to those of MOW in terms of lower AMA per cent, lower drop-out rate and higher PIAS scores. 2. As for both of acute functional psychoses and manic disorders, the treatm ent outcomes seemed to be inferior in TCW to those of MOW w ith higher AMA per cent, higher drop-out rate but no significant difference of PIAS scores between two wards However the only exception is higher D-score for manic disorder in TCW. 3. Of the schizophrenic subgroup, the outcome can be evaluated to be superior in TCW than in MOW w ith higher D-score and lower AMA.% and drop-out rate significantly, but the author failed to find any significant difference on other PIAS scores, this will need further controlled study and discussion. 4. These findings generally seemed to be complimentary and not incongruent with the results of our previous study of the series.