慢性精神病患再復健的探討

THE RESEARCH WORK OF REHABILITATION IN CHRONIC PSYCHIATRIC PATIENTS

本研究採用簡短精神症狀量表評估慢性精神病患，共約一百三十三名，分成兩組，一組為控制組有六十五人；另一組為實驗組共六十八人。兩組的年齡、發病年數、教育程度、治療情況、定向感均相當。而用來增強工作的是少許金錢、零食、香煙、旅遊及其他康樂活動。至於控制組為不工作的患者，實驗組為自動自發從事工作的患者，以半年為一梯次，為期一年半，再由醫師、心理技師、社工員、護理長組戓三人為一組的評估小組，經過一年半的研究結果顯示，實驗組不論在精神狀況、人際關係、生活態度上均有明顯的改善。而兩組之差異水準第一梯次t-value ＝－0.8033,　P＞0.05，第二梯次t-value＝－2.2676, P＜0.025，第三梯次t-value＝－3.2981 P＜0.005。而實際上最可喜的還是一些嚴重的精神症狀消失或減輕，如心理焦慮、情感退縮、思考欠組織、不尋常動作、行為遲滯、不合作、不尋常思考、情感遲滯、定向感等，因此生活變得更主動且有目標。然而本所在缺乏訓練有素的復健師之情況下，僅以護理工作人員兼職的方式，培訓讓患者在單純的環境下自動自發選擇工作。所以實驗組的種種改善，不但給本所帶來莫大的鼓舞，也使患者本身再度跨出自力更生的脚步。

In this study, Brief Psychiatric Rating Scale was used to examine 133 chronic psychiatric patients, they were divided into two groups, one was control and non work group, 65 patients, the other was experimental and work group, 68 patients. 133 patients were under controlled in age, education, illness period, medical therapy and conditions of disorientation, the disorientation must be below 2 grade by Brief Psychiatric Rating Scale. The study proceeded for a year and six months, and six months was a section and 3 sections in all. A few reinforcers were used in the study, such as: food, money, cigarette, trip and recreation etc. Team members participated in this study were psychiatrist, clinical psychologist, social worker and chief nurse. Each team had three members and we had two teams and examined patients alternatively. The social worker and chief nurse provided information of patients outward and inward. According to the results of our study, the experimental group showed much more progress than the control group in respect to attitude towards life, interpersonal relationship and mental conditions which revealed in significant level between two groups. In section I, t-value = -0.8033 P>0.05, section II, t-value = -2.2676, P<0.025, section III, t-value =-3.2981, P<0.005. Some mental symptoms were reduced or disappeared after joinning in work such as: anxiety, emotional withdrawal, conceptual disorganization, motor retardation , uncooperativeness, unusual thought content, blunted affect, disorientation. Our hospital had no occupational therapist and the patients learned to work under supervision of nurses only, and they also selected and joined their work automatically. We are deeply encouraged by the results of our study, our model of social rehabilitation enables to take care themselves after long time struggling against their illness.