Objective Evaluation of an Activity Treatment Program for Seriously Regressed Schizophrenic Patients

Abstract

During the past two decades, there has been an increasing interest in various activity programs for the care and treatment of chronic schizophrenic patients. Though these programs have differed in content and method, the basic principles and objectives have remained the same. The philosophy underlying their organization, as stated by Myerson(13), is that the deterioration observed in long-term schizophrenic patients is due, in part, to the lack of social and physical stimulation on typical chronic wards. In this unstimulating environment, social and personal habit patterns slip into disuse and the incentive to control the direct expression of pathology in behavior is reduced. It is hypothesized, that, by introducing the patient to a socially stimulating atmosphere, the deterioration due to these "hospitalization" effects can be reversed. The objective is not to "cure" the disease, but to improve hospital adjustment to a point where the patient is more selfmaintaining and accessible to other forms of treatment. The results of several studies of activity programs (l,2,4,6,7,IO,18,19,20,21) have tended to support the ·assump-tions underlying this treatment technique.The purpose of the present study was to place a severe test on the hypothesis, that chronic schizophrenic patients improve during an activity program, by selecting only the most regressed long-term patients for treatment, and by objectively measuring what changes, if any, could be produced in this group.The problem of devising a satisfactory method of evaluating the response of patients to treatment is a persistent one. Psychiatric judgments of change have not been adequate mainly because of their subjective nature and lack of explicit criteria. Malamud(12) pointed out the need for a standardized means of describing a research population in terms of classifying the kinds and severity of symptoms. This would provide a more adequate description of the changes produced and make possible the comparison of the results of different studies. This approach has led to the development of a number of standardized psychiatric rating scales, the main advantage being one of providing explicit criteria for the judgments.The need for objective, quantifiable measures of psychopathology, which are sensitive to gradual changes in behavior, has led also to the use of standard psychological tests. There have been two main objections to their use: (A) that no scores are obtained on patients who are unwilling to co-operate or too severely impaired to respond appropriately(9), and (B) that test scores may not be interpreted in terms of the dimensions of behavior they were designed to measure. For example, an intelligence test score may reflect characteristics of the patient such as confusion, withdrawal or distractibility rather than intrinsic intellectual processes(16).The ideal criteria for a measure of psychopathology would be those which, (A) objectively measured dimensions of behavior related to mental health, (B) covered the range of mental health from normalacy to sev...

Re-Evaluation of an Activity Treatment Programme with Regressed Schizophrenic Patients

“…At that time, the patients were transferred to a much larger ward which had a total patient population of 80. The activity program was continued, very similar in nature to the original program which has been described (5). However, while on the original ward there was one staff member (physio-therapist, attendants, occupational therapists, and music therapists) per 3.6 patients, on the new ward the ratio was 1:8.…”

“…Lately, similar treatment programs have been referred to as "total push" therapy (3). Although medical treatment was continued, as indicated, the patients did not receive psychotherapy by trained personnel, This study is a further evaluation and follow-up of the original group of patients, one year after the previous report (5) or two years after the beginning of treatment. The main reason for reevaluation was the fact that the original program was terminated after the patients had been on the treatment for one year and four months.…”