ABSTRACT
Aggressive behavior has been identified as a significant concern and occupational hazard in psychiatric inpatient settings. Several factors, including lax or unclear ward structure, have been identified as contributing to the exhibition of aggressive behavior. Token economies are effective in increasing ward structure and reducing aggressive behavior. This study evaluated the effects of rehabilitation programming, based on Gordon Paul's social learning approach (SLA), on rates of aggressive and self-injurious behaviors in a group of cognitively impaired, chronic psychiatric inpatients, compared to three long-term wards of similar patients. While no differences were found between the two groups prior to implementing SLA procedures, lower rates of aggression and self-injurious behavior were observed at one and two years on the Paul-derived ward. These results support the use of Paul's approach with multiply-impaired psychiatric inpatients in reducing patient aggression.
Subject(s)
Aggression/psychology , Behavior Therapy/methods , Cognition Disorders/rehabilitation , Mental Disorders/rehabilitation , Self-Injurious Behavior/rehabilitation , Adult , Chronic Disease , Cognition Disorders/psychology , Cognition Disorders/therapy , Female , Hospitalization , Hospitals, Psychiatric , Hospitals, State , Humans , Male , Mental Disorders/therapy , Middle Aged , Program Evaluation , Self-Injurious Behavior/prevention & control , Token Economy , Treatment OutcomeABSTRACT
Serial evaluation of intelligence tests performed with long-term patients in psychiatric hospitals frequently reveal deterioration in cognitive functioning. Despite early success in the amelioration of cognitive symptoms of schizophrenia, little effort at cognitive remediation is currently directed to long-term psychiatric patients. In contrast, in the brain injury rehabilitation community, cognitive remediation is strongly supported despite mixed results in clinical literature. Within this context, individuals with brain injury in psychiatric hospitals may have little prospect of receiving cognitive remediation services. Utilizing performance on intelligence testing spanning 20 years, the following study evaluates changes in cognitive functioning of a severely brain injured individual, who had been replaced in a long-term psychiatric hospital and treated in an intensive behavioural rehabilitation programme. Results found that the patient demonstrated a significant improvement in overall verbal and nonverbal cognitive functioning during treatment. These improvements were maintained for a 1-year period. It was suggested that the use of 'low tech', small group interventions, within intensive behavioural rehabilitation programmes, may lead to the recovery of cognitive functioning for individuals who are significantly post-injury.
Subject(s)
Behavior Therapy , Brain Injuries/psychology , Brain Injuries/rehabilitation , Cognition/physiology , Adult , Cognitive Behavioral Therapy , Humans , Intelligence Tests , MaleABSTRACT
Brain-injured individuals often experience problems with aggression which can prevent full community reintegration. Two cases involving individuals (one 4 years, one 17 years post-injury) who had been placed in a state psychiatric hospital due to aggressive and/or self-injurious behaviours are discussed. Utilizing medication dosages and behavioural acuity indicators over a 2 year period, the authors demonstrate the efficacy of lithium carbonate in treating aggressive behaviours. Lithium, in concert with other medications, not only led to a decrease in the frequency of aggressive outbursts and in the need for restrictive and costly behaviour control techniques, but also allowed for a significant reduction in the use of neuroleptic medication in one case. The authors conclude that the use of lithium, within the context of an intensive, behavioural rehabilitation programme, may yield positive effects in the control of aggressive behaviour even in long-term post-injury cases.