title: The impact of a changed environment on arousal levels of patients in a secure extended rehabilitation facility.
abstract: OBJECTIVE
  This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility.
  
  
  METHODS
  Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility.
  
  
  RESULTS
  Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit.
  
  
  CONCLUSIONS
  The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.
authors.affiliation: Department of Psychiatry, University of Melbourne, Heidelberg, VIC 3084, Australia. jamesso@unimelb.edu.au
authors.forename: James
authors.initials: J
authors.lastname: Olver
authors.forename: Mervyn
authors.initials: M
authors.lastname: Love
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Daniel
authors.forename: Trevor
authors.initials: T
authors.lastname: Norman
authors.forename: Daniel
authors.initials: D
authors.lastname: Nicholls
mesh_terms: D000368:Aged; D000374:Aggression; D001143:Arousal / Q000502:physiology*; D004777:Environment; D005260:Female; D006272:Health Facility Environment; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation* / Q000628:therapy; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012559:Schizophrenia / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D012866:Skilled Nursing Facilities