치료적 공동사회의 치료전귀에 관한 연구ᅳ( I )혼합치료환경 내에서의 환자 아군들 간의 비교 연구

Studies on Treatment Outcome of Therapeutic Community (I) A Comparison Study between Patients，Subgroups in the Mixed Therapeutic Milieu

The authors organized and has been operating a MIXED therapeutic milieu in an university hospital since 1981，which is a 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 primarily focused on a comparison study of outcome between five major patient subgroups in the mixed milieu; Acute Functional Psychosis (A F P ), Schizophrenia (SP R ), Manic Disorder (M D ), Neurotic Disorder (ND) and Borderline Patient (B P ), by measuring discharge rate of against medical advice (AMA) and drop-out rate of follow-up treatment, and the Psychiatric Inpatient Assessment Scale (PIAS), which was developed by the authors. The authors also discussed about the interactional dynamics of each subgroups occurring on the process of milieu therapy. The results are as follows: 1. Of the whole patients included in this paper, discharge AMA rate was 23.1% and drop-out rate was 18. Z%. M D subgroup showed the highest discharge AMA rate and drop-out rate, while ND subgroup showed the lowest ones (P < 0 . 01). The other subgroups failed to show any significant difference. 2. The whole patients can be devided into two gross groups; N D and BP on the one hand, and A F P , S P R and M D on the other hand, by the level of PIAS scores at each time of admission and discharge. D-Score which means the difference between admission score and discharge score showed good improvement of 2. 93&#12316;3. 50 (average 3. 20) in all five subgroups, however, there was no significant difference between five subgroups.