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Schizophrenia Bulletin 1999 25(3):457-465;
© 1999 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

Treatment-Resistant Schizophrenia and Staff Rejection

Uriel Heresco-Levy, M.D., Marina Ermilov, M.D., Bronia Giltsinsky, M.D., Michael Lichtenstein and Dana Blander
Director, Women's Psychiatry Division, Ezrath Nashim-Herzog Memorial Hospital Jerusalem, Israel
Senior Psychiatrist, Department of Psychiatry, Ezrath Nashim-Herzog Memorial Hospital Jerusalem, Israel
Psychiatry Resident, Department of Psychiatry, Ezrath Nashim-Herzog Memorial Hospital Jerusalem, Israel
Research Assistants, Department of Psychiatry, Ezrath Nashim-Herzog Memorial Hospital Jerusalem, Israel

Reprint requests should be sent to Dr. U. Heresco-Levy, Psychiatry Department, Ezrath Nashim-Herzog Memorial Hospital, PO Box 35300, Jerusalem 91351, Israel

This study examined the relationship between characteristics of patients suffering from treatment-refractory schizophrenia and staff rejection and criticism. Subjects were 30 inpatients with treatment-resistant schizophrenia and the 29 staff members treating them. Measures included assessment of the patients' symptoms and aggression risk profile using the Positive and Negative Syndrome Scale (PANSS) and assessment of staff attitudes toward these patients using the Patient Rejection Scale (PRS). Nursing staff completed the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). PRS ratings did not correlate with patients' demographic and treatment characteristics. Significant correlations existed, however, between increased staff rejection and higher scores for PANSS cognitive factor and NOSIE manifest psychosis factor. Negative symptoms, although preponderant in the patient sample, were not significant predictors of staff rejection on the PRS. Older nursing staff tended to view patients as more irritable and manifestly psychotic. These findings suggest that disorganized behavior and impaired cognition dysfunction areas are more likely to be associated with high levels of rejection among staff working with treatment-resistant schizophrenia patients. Incorporation of the relatively new concepts of cognitive dysfunction and treatment resistance in staff training programs and multidisciplinary team reviews may greatly benefit schizophrenia patients and the staff treating them.

Keywords: Schizophrenia / treatment resistance / cognitive dysfunction / staff rejection


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