Recurrent large-group phenomena: studies of an adolescent therapeutic community.
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Acting Out↗
Biomedical subjects
D F Levinson
Publications and source records attributed to D F Levinson.
Ward tension and staff leadership in a therapeutic community for hospitalized adolescents.
Mental health workers on inpatient units spend a great deal of time trying to cope with interpersonal tensions that disrupt ward life. We have focused our attention on two aspects of this problem. The first is clarifying the nature of the social processes that underlie periods of increased tension and conflict on wards. The second is clarifying the kinds of staff leadership required to manage these tensions. We are sure that those who have worked on interactive treatment wards will recognize this situation: for a period of weeks or more there is an uneasy tension; patient cliques form and disruption occurs between cliques and with the staff. Often there is a climax of disruptive behavior, such as a day or weekend when a large number of patients break ward rules. Trouble seems to be contagious. Throughout the period staff members disagree about how to manage the patients and the disruption, and usually this disagreement is tinged with old philosophical or personal differences. No one feels very confident about taking leadership initiatives, and the formal leaders are blamed for various failures and lacks. Eventually, often after a climactic disturbance is resolved, ward life returns to "normal" and people feel much better about living and working on the ward. In this paper we review previous work on this kind of ward process and discuss some of the problems involved in conceptualizing it. We report on two period of ward observation that illustrate the sequence from low to high tension and back to relative calm. We then discuss our ideas about the kinds of staff leadership needed to manage different phases of this sequence and the problems of developing and integrating multiple ward leadership roles.
Adaptation, Psychological↗
Is akathisia associated with poor clinical response to antipsychotics during acute hospital treatment?
Previous studies have suggested that akathisia is associated with poor acute clinical response to antipsychotics and that low serum iron levels are associated with emergence of akathisia. To examine these relationships during routine clinical treatment, we studied patients with DSM-IV schizophrenia or schizoaffective disorder undergoing hospital treatment for acute psychotic exacerbations with doctor's choice medications. There were 34 subjects observed for at least 2 weeks. They were assessed at baseline and weekly by one rater with the Anchored Brief Psychiatric Rating Scale and by another rater with the Barnes Rating Scale for akathisia, with the two raters blind to each other's ratings. Serum ferritin and transferrin levels were obtained at baseline. Seventeen subjects developed akathisia. Subjects with and without akathisia did not differ in change in thinking disturbance or anxiety-depression scores over 2 weeks, or in serum ferritin or transferrin levels. We conclude that mild akathisia by itself is not strongly associated with initial response to low to moderate doses of antipsychotics in the acute clinical setting. Limitations of the study are discussed.
Acute Disease↗
Pharmacologic treatment of schizophrenia.
The literature on the pharmacologic treatment of schizophrenia and schizoaffective disorders is reviewed (116 references). All clinically active antipsychotic drugs share the ability to block postsynaptic dopamine receptors in the central nervous system. Their potencies vary, chlorpromazine and thioridazine being the least potent and fluphenazine and haloperidol the most potent. The adverse effects of the neuroleptics include acute dystonia, parkinsonian symptoms (extrapyramidal symptoms), akathisia, tardive dyskinesia, and tardive dystonia. When used at equipotent doses, all classic neuroleptics now available are equally effective in the treatment of schizophrenia. Choice of drug is based on adverse effects and patient response. The neuroleptics are effective in most acute exacerbations of schizophrenia and for the prevention or mitigation of relapse. Their effects are more pronounced on the positive symptoms of schizophrenia, such as hallucinations, delusions, disordered thinking, and paranoia, than on the negative symptoms, such as deficits in social interaction, emotional expression, and motivation. Strategies for acute and maintenance treatment and for the management of treatment-resistant patients are reviewed. The pharmacology and clinical use of the newer atypical neuroleptics, particularly clozapine, and their adverse effects are discussed.
Acute Disease↗