慢性精神病患出院後社會適應的評估

ASSESSMENT OF SOCIAL ADJUSTMENT OF DISCHARGED CHRONIC PSYCHOTIC PATIENTS

本研究為在一個取向於多元性，整體性治療的精神專科醫院，接受復健治療後出院的72名慢性精神病患，在社區中社會功能的評估與分析。每一個病人均按著者所設計的社會復歸能力評量表以及社會適應狀況評量表給予評估，並求兩表之間的相關性。評量結果發現大多數病人有中等程度以上的社會功能，分析病人的個人基本資料則發現，接受政府醫療費用資助的貧民病人以及教育程度較低的病人，社會功能較佳，而年輕者則傾向於有較差的社會功能，病人的性别，婚姻狀況，及診斷別等則與其社會功能的程度無關。兩表之評量總分之間有正向的相關關係，其中病人在復健病房中日常生活的表現及在復健工作場中工作態度與能力之表現，和病人在社區中社會功能的程度，更有顯著的正向相關關係。病人出院後病狀之是否再發則難由其在住院中的表現預測之，著者發現愈規則性的接受長期門診追踪治療的病人，愈能維持長期的穩定病情。本研究指出一個慢性精神病患之社會復歸結果如何，可在復健之初預估之，著者將根據研究結果，修定社會復歸能力評量表，並準備進一步進行前瞻性大規模的研究。

The level of social adjustment of 72 chronic psychotic patients discharged from the rehabilitation ward of a comprehensive and continuous care oriented mental hospital (Taipei City Psychiatric Center) was assessed by mean of a specifically designed rating scale. The result showed only of the patients were at the low level, while 61% and 29% of the patients were at the middle and upper level of social adjustment respectively. The authors endeavored to design a rehabilitation potential rating scale to assess various conditions of the patients during the first month after admission to the rehabilitation ward. The level of social adjustment of the patients in the community was significantly correlated with their ability of self-care, social skill, and drug compliance in the ward as rated by the nurses and their attitudes to and ability in the sheltered workshop as rated by the occupational therapist. On the contrast, the level of social adjustmen was not correlated with the family attitude to rehabilitation, availability of family resorces for occupation in the community and the manifested symptoms of the patients in the ward. Those patients who got government medical financial aid, at lower educational level and at middle age had better social adjustment in the community. This findings suggest the possibility of establishment of a rating scale to predict the patient's level of social adjustment in the community at the very early phase of the patient's admission to rehabilitation ward. Regular attendance to the after-care clinic with regular medication is the key factor for these patients to maintain stable mental condition and long-term tenure in the community.