|
| Division of Occupational Therapy - OT Connect Schizophrenia
Schizophrenia is characterized by derangement of thought processes, affect and behavior (Scully, 2001). Common Symptoms/Course of Disease Schizophrenia symptoms are categorized into 2 different categories:
Typically symptoms begin in adolescence and are followed by prodromal symptoms in days to a few months. The classic course consists of exacerbations and remissions. The patient can gradually recover after the first psychotic episode and function normally for a long time. However, when the patient relapses, the pattern of illness that occurs in the first five years after the diagnosis usually indicates the patient’s course. “A further deterioration in the patient’s baseline functioning follows each relapse of the psychosis. This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders” (Kaplan, p.484, 1998). Positive symptoms tend to become less severe over time, but the negative symptoms increase in severity (Kaplan, 1998). Age of Onset: The peak time of onset occurs in late adolescence and early adulthood (Kaplan, 1998). Sex Biases: Schizophrenia is equally prevalent in men and women. However, the onset is earlier in men. The peak onset age for men are fifteen to twenty-five years, while women’s onset is twenty-five to thirty-five years. The outcomes for female patients are better than the outcomes in male patients (Kaplan, 1998). Cultural Biases: In industrialized nations there are a much higher number of schizophrenic patients in the low socioeconomic groups. Prevalence increases among Third-World populations as contact with technologically advanced cultures increase (Kaplan, 1998). Current Medical Treatment:
Occupational Therapy Involvement Assessment Tools and Evaluations:
Group therapy is most commonly used and is most effective for building social skills; however, one-to-one contact should also be used to develop a client therapist relationship in the early stages of treatment. Occupational therapy interventions address the patient’s occupational performance areas of self-care, work, and leisure. Interventions also address performance components of motor, sensory-integrative, cognitive, psychological, and social functioning. The therapist must grade the activities to best meet the needs of the individual patient (Cara, 1998). Treatment Directions:
The expected outcomes of OT include increasing independence of the patient in all of the above-mentioned areas. Adaptive equipment can be used to increase independence at home and with self-care needs. Occupational therapy also takes into consideration the different types of symptoms that the patient may be experiencing. For example if a patient was experiencing positive symptoms occupational therapists will find activities that the patient achieves personal meaning and purpose out of. These activities will bolster the sense of personal achievement and mastery, which are successful in coping with hallucinations and other positive symptoms (Cara, 1998). Current News Update: Researchers have currently linked a retrovirus to some cases of schizophrenia. They do not know why the virus becomes active; however, this new discovery may help researchers what happens when it does become active. They hope to be able to interfere with the retrovirus and prevent it from becoming active. This could give doctors a new way to treat schizophrenia (Psychiatry Matter, 2002). Glossary: (Taber’s, 1997)
Resources
How OT Makes a Difference: Evidence-Based Practice Liberman, R., M.D., et.al. (1998). Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia. American Journal of Psychiatry, Vol 155, number 8. pp. 1087-1091. Eighty-four male patients with schizophrenia were assigned to receive 6 months of intensive, clinic-based treatment 3 hours per day, 4 days a week. Half of the patients received psychosocial occupational therapy that was led by three certified occupational therapists. Treatment consisted of expressive, artistic, and recreational activities. Patients were encouraged to individualize their interests and abilities through arts and crafts, discussion of feelings, and articulation of personal goals. The other half of the patients participated in skill training. This was also conducted by occupational therapists and three paraprofessionals that took turns leading the groups. This program followed the UCLA Social and Independent Living Skills Program that consisted of basic conversation, recreation for leisure, medication management, and symptom management. The results concluded that the patients receiving skills training showed a much higher improvement averaged across the 2-year follow-up period on the Independent Living Skills Survey, the Profile of Adaptation to Life, the Self-Esteem Scale and the Brief Symptom Inventory. This study has shown that generalization does occur with social skills training. This article goes on to say that this type of treatment can be conducted by paraprofessionals. However, it should be noted that there was an occupational therapist involved with the paraprofessionals and the social skills training groups. The patient I interviewed received occupational therapy services for schizophrenia. The patient stated that she just began occupational therapy treatment yesterday. This is the first time that the patient has been admitted to a mental hospital. She receives occupational therapy treatment once a day in a group setting in the mental hospital. The primary service provider is an COTA (Certified Occupational Therapy Assistant). This patient feels that her needs and wants are being addressed in therapy. She replied, “The occupational therapist is very helpful and nice.” So far for treatment she has participated in groups that assist with socialization. This is what the patient feels she needs the most help with. She also stated that the occupational therapist makes a goal for her to meet someone new every day in group. The patient replied to this, “I’m still working on that.” The patient also is receiving treatment from occupational therapy on trust. The patient replied that she understood the reasons why she needed to participate in therapy. She stated that occupational therapy helps her with her socialization skills and will help her get better so she can leave the hospital. She did not know what to say when asked if therapy was challenging for her. This is probably due to the fact that she has just begun her occupational therapy treatment. She stated that she benefits from occupational therapy treatment because she is getting help with socializing. She would also like to receive occupational therapy services for self-esteem issues. She did not have anything to add on recommendations for occupational therapy.
|
|||||||||||||||||||||||||||||||||||||
