فصلنامه آرشیو توانبخشی
سال سوم شماره 3 (پیاپی 7، پاییز 1381)

People with schizophrenia continuous type (previously labeled as chronic), constitute the majority of inpatients in rehabilitation wards. These patients, apart from the characteristic signs and symptoms of schizophrenia, suffer from anxiety. This anxiety, not influenced by antipsychotic medications, can be a part of the schizophrenia per se, but it may be due to the unfavorable frame and quality of life in mental hospital wards. Every attempt in decreasing the anxiety of these patients, can be regarded as a step toward a more perfect treatment and rehabilitation plan, and elevating the quality of their lives. In this research the application of drawing and painting as a method to decrease the anxiety of these patients was evaluated. 100 schizophrenic patients (according to DSM-IV criteria) who were hospitalized in long stay rehabilitation wards of Razi psychiatric center for at least 2 years, entered the research procedure. Their anxiety level was measured by the Cattel anxiety questionnaire. 50 patients, who were selected as experimental group, had 15 one hour sessions of drawing and painting. For the remainder 50 patients who were the control group, various neutral activities (as placebo) were performed, during those hours. Medications were unchanged during the research. After the 15th session the anxiety levels of patients were evaluated for the second time. The scores obtained in the first and second evaluations in each group and between two groups were analyzed by appropriate statistical methods. In comparing the mean scores obtained from the first and second measurements in experimental group by applying the t-test (in correlated groups), the difference was statistically significant (t=67.5, P<0.0l). Sessions of drawing and painting with appropriate duration and frequency can significantly diminish the anxiety in long stay schizophrenic patients in rehabilitation wards.

The main objective at study was to assess the communication and interaction of psychotic patient above age of 18 in 2000. The study sample consist of 80 psychotic patients (38 female and 42 male) from Razi and Imam Hossein Hospital and Raad and Sina outpatient clinic, selected based on occupational therapist using the Assessment of Communication and Interaction Skills Questionnaire (ACIS). Statistical analyses of information have done by spearman coefficient correlation, Mann Whitney and Wilcoxon tests. Spearman of correlation, mann-and wilcoxon Findings indicate: 1-The average grade of ACIS test in the group of schizophrenic patients were significantly lower than the group schizoaffective patients (P<0.00l). 2-The average of ACIS test in the group of inpatient was lower than the group of outpatient (p<0.00l). 3-No significant difference was found for the average grade of ACIS test in the group of male & female. The obtained results show the weakness of communication and interaction skills in schizophrenic patient and also inpatients. The obtained results of this investigation give useful information about the communication and interaction skill of patient to the occupational therapists but application of this instrument needs more studies.

Schizophrenia has different clinical manifestations, although, it is one disorder patients divided to two groups type 1 and type 2. type 1 who have positive and type 2 who have negative signs. They have chronic schizophrenia and treated at least with one antipsychotic drug. With checklist the signs were controlled. In these chronic patients, hallucinations (positive sign) are seen with almost all of negative signs. In the other hand, (1) Flat affect (2) A logia & volition (3) Social inattentiveness (4) Inability to feel intimacy are seen more than another signs. For these above patients new antipsychotic must be examined.

Because of the recent increasing in the number of counseling centers in Iran, evaluating them seems an unquestionable necessity and one of its most important components is assessing the client's satisfaction. So, the service satisfaction Scale-30 (Greenfield et al, 1989), Which is the product of UCSF's satisfaction research program, after being translated to Persian, was tested in an Iranian population for its psychometric properties. First, in regard of its understandability, the scale was administered on 33 clients of nine centers. After a revision in the wording and sentencing of the translated scale based on the results of the first stage, it was administered again on another 121 clients (71% women, 29% men, and in a range of 18 to 65 years old) to determine its reliability, and eventually, on another 50 clients (78% women, 22% men, and in the ages between 18 to 75 years old) to determine its validity. The mean correlation of the answers (0.35) and the scale's Chronbach a coefficient (0.94) indicate a high internal consistency. Criterion validity was ascertained by calculating the correlation coefficient between the client's scores on the scale and their performance on three open-ended questions about their counseling experiences (0.53). So, the score 95 was determined as the scale's cut-off point.

One of the most important of mental health problems is care and management of psychiatric patients. In order to assess, effective factors on duration of stay on hospitalized patients a study has done in Razi psychiatric center. This study has done in retrospective - descriptive way. The results of this study showed, there is no relationship between factors such as age, sex, place of birth and residence, occupational situation, source of reference and kind of treatment with length of stay in hospital. Moreover, this study suggested patients with schizophrenic disorders, had longer stay than patients with Mood Disorders and other mental disorders (P<0.05). Besides, patients with previous recurrent admit, longer duration of illness, comorbidity (Physical or Mental) had longer stay (P<0.05). Single and divorced patients had longer stay than married patients (P<0.05) and patients under insurance policy stayed more time than other patients.

Negative symptoms in schizophrenia are among the most important barriers against rehabilitation of such patients. Apply of appropriate drugs for reducing such symptoms and take help from psychosocial treatments, especially social skills training in accompany with other facilities of community psychiatry can play key role in resolution of this problem. In this paper after some discussion about negative symptoms and grasping a better insight about them and their current treatments, we will survey a research as regards the prevalence of such symptoms in one hundred schizophrenic patients hospitalized in Razi psychiatric center and their relation with variables such as age, sex and longitudinal duration of illness. One hundred, randomly chosen, schizophrenic patients, half male and half female, from acute and chronic wards, were estimated with SANS Questionnaire as regards to their negative symptoms. Then, the relation of these findings with aforementioned variables has been surveyed. Prevalence of negative symptoms has been from 86% to 99% and severe ones too from 30% to 55%. No patient was free from such symptoms. As regards to quantity and severity, these percentiles are definitely more than ones which had been printed in Kaplan-Sadock textbook of psychiatry. The most sever ones were in chronic female ward, and the least sever ones in the acute female ward. No statistical relation has found between negative symptoms and age, sex and duration of illness. Extensive prevalence of negative symptoms among schizophrenic patients in this center and their severity show the unfortunate circumstances of such patients and necessitates appropriate therapeutics methods for reducing such symptoms and increasing their capacities for more independent living in family and community.

The present research is an analytic – descriptive study. We have done this study in order to identify the pathways to the psychiatric office in two different cities. We also have evaluated demographic findings, referral sources and the rate of visit by practitioners and traditional healers in all of the subjects. The subjects were selected through random sampling. We have studied 1000 patients in Tehran and 2000 patients in Sirjan. The most of the all subjects were referred to the psychiatric office by their family and relatives. 2.8% of the patients in Tehran and 16.8% of the patients in Sirjan have gone to traditional healers before visiting by psychiatrist. During second year of study in Sirjan, the rates of referral cases have increased by specialists, relatives of the patients and medical and non-medical centers. Increasing of knowledge of mental health to people in society and in medical centers by psychiatrists has special and important role in proper management of psychiatric patients.

This research was conducted to determine some characteristics of Iranian adolescent (<20 yrs.) addicts, including their sex, age of onset, type of abused drug, root of administration, history of cessation, family situation, socio-economic situation, psychiatric symptoms, attempted suicide, and perceived cause of being addict. Among 500 clients of an outpatient addiction treatment center in Tehran, 65 persons whose ages were not more than 20 year old, were selected and the above mentioned factors were extracted from their records. Of them 98.46% were male. The least age of onset was 8. The most frequent abused drugs were opium and or heroin (79.99%). The most common root of administration was smoking (43.18% for opium and 57.14% for heroin). Seventy-six and ninety three percent of subjects had a history of cessation for at least one time. Disadvantaged socio-economic status (73.84%) and dysfunctional familial relations (60.00%) were also seen among them. All of the subjects had psychiatric symptoms (anxiety and / or depression) at the time of interviewing, while 21.53% of those had a history of admission in a psychiatric ward. Among the latter group, 28.57% also had a history of attempted suicide. The subjects’ most common perceived cause for initiating use of drug was emotional familial problems (61.53%). The relative large contribution of youth among Iranian addict population (13%), especially along with an absolute high rate of cessation history in them (76.93%),indicating and early onset pattern of addiction in Iran. This requires serious preventive measures that seemingly should be promoting the youth socioeconomic status, emotional-familial state and mental health. More analytic studies are necessary to confirm these descriptive findings, especially for determining the risk and protective factors of addiction in adolescence.

A rural approach towards psychosocial problems, which is identified by preserved psychosocial orders, believe in utopia and having community without even one person involved by minimal psychosocial problems (Specially social damages). This approach would like to move towards complete social control over the damages and will be afraid (panic or phobic reactions) when confront with few psychosocial problems. Within this frame work, the interventional objectives are as follows: 1) Cut the roots of any damages (eradication) even at the individual or familial level, as soon as possible. 2) Total abstinence in the society. 3) Increase in powers of key persons for damage control. 4) Use of people participation under the authority of key persons for more control. B-In contrast, urban approach towards psychosocial problems identified by reorganization of the orders and accepting psychosocial problems inspite of any prevention plans, It seems to act partial control over psychosocial problems and will not be afraid (panic or phobic) when confronted with psychosocial problems. Within this framework, the interventional objectives are as follows: 1) It would like to limitate social problems and damages, more. 2) Tolerate them. 3) Increase of individual and community power for implementation. 4) Increase of community participation and professional institutes in prevention programs. 5) Produce prevention levels in order to confront with social damages (Such as primary, secondary and tertiary) and also more not only toward a health protective state but also health promotives, one. So, in comparison with each other, it is clear that there are several differences in their goal setting. Consequently, the different objectives will be reflected in their strategies too. In the article, there are more explanations about the strategies.