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Ward atmosphere and outcome of treatment of acute schizophrenia

1967; Elsevier BV; Volume: 5; Issue: 2 Linguagem: Inglês

10.1016/0022-3956(67)90028-3

1879-1379

Sheppard G. Kellam, Solomon C. Goldberg, Nina R. Schooler, Audrey Berman, June L. Shmelzer,

Mental Health and Psychiatry

The purpose of this study was to examine the relationship among various dimensions of ward atmosphere in twelve wards of four hospitals (N = 202), and the short-term outcome of schizophrenic patients treated with either phenothiazines or placebo. The detailed rationale and description of the quantified measures of ward atmosphere is the subject of an earlier paper.15 The wards were divided into 'high' and 'low' groups along each ward atmosphere dimension for analysis of the association of dimensions of ward atmosphere with treatment outcome. Hypotheses were formulated and tested that patients will improve more if assigned to wards: (1) whose other patients are less disturbed; (2) whose patients are less aggressive; (3) where the other patients are less alone; (4) where the patients not alone form larger rather than smaller social clusters; (5) where there is more staff-patient contact; (6) where patients are given more adults status; (7) where the ward census is smaller; (8) where the number of patients/staff member is smaller. Although the study hospitals did not have an explicit policy regarding transfer of patients from ward to ward on the basis of improvement, they tended to assign new patients to different wards according to initial severity of illness. The effect of ward atmosphere on short-term symptom reduction depended on the kind of symptom in question. The greatest number of effects were found on 'paranoid' symptoms, while the least number of effects were found on symptoms of 'withdrawal'. Symptoms which could not be classified as 'paranoid' or 'withdrawal' held an intermediate position. The results generally conformed to the hypotheses concerning the association of good treatment outcome with wards with low disturbed behavior, low aggressive behavior, low aloneness, high cluster-size and high staff-patient contact (called patient behavior variables). However, the results were diametrically opposed to the hypotheses, at a statistically significant level, for the ward atmosphere dimensions adult status, ward census, and number of patients/staff member. The latter have been termed hospital policy dimensions. The interpretation is offered that the patient behavior dimensions of ward atmosphere are a part of far more powerful social forces affecting clinical course than are the hospital policy dimensions.