精神障害構造と作業療法モデル

Models of occupational therapy in connection with the structure of psychiatric disorders

要旨：障害構造や治療・援助に関するモデルを示すことは，常に相半ばする功罪をもっているが，リハビリテーションの概念の共有と実践にとって，モデルのないことによる混迷の方が，今は問題が大きい．本稿では精神障害領域における疾患・障害構造モデルと作業療法モデルの試案を提唱した．障害分類については，他の身体障害と基本的に同様な視点で実践することの利点を考え，国際障害分類に準じた．作業療法モデルは，医学的な心身のリスク管理を要する状態，個人生活レベルの能力障害，生活環境や社会との接点にみられる障害に対応して示した．リハビリテーションの概念を共有するプロセスのきっかけになるものと考える．

　It is necessary to have merits and demerits to indicate a structure model of psychiatric disorders and a therapeutic model. Nevertheless, the confusion of no model is a more serious problem than not having an indicating model. It is important to indicate a structure model of psychiatric disorders and a therapeutic model to have a rehabilitation idea in common. The purpose of this paper is to propose a structure model of psychiatric disorders and models of occupational therapy.

　The structure model succeeded in showing the image of a mutual influence between disorders, an interaction between environment and disorders, and a relative independence between disorders. From the advantage to treat equally psychiatric disorders and physical disorders, in this structure model, I use "the International Classification of Impairments, Disabilities and Handicaps (ICIDH) "as a classification of disorders.

　On models of occupational therapy, I propose three types of models: "OT medical model" ; "OT autonomy model" ; and "OT environmental model" The "OT medical model" shows a model for a state required a medical control of physical risk. The "OT autonomy model" shows a model for disabilities. The "OT environmental model" shows a model for handicaps in the living environment.

　This structure of psychiatric disorders and three models of occupational therapy will provide a starting-point for having a rehabilitation idea in common.