精神分裂病の作業療法の治療要因と社会生活能力との関連

Relation between the therapeutic factors of occupational therapy for schizophrenia and social life capability

要旨：作業活動の特性を活かした治療的な関わりを，作業療法の「治療要因」と定義し，患者が作業療法過程で各治療要因をどの程度経験しているかを調査する自己記入式評価票(OT治療要素経験尺度)を新たに作成した．本尺度を精神分裂病患者57名のデータに基づいて因子分析したところ，『人・物や作業活動との関係』，『興味・動機づけ』，『体力と生活リズムの回復』，『活動による鎮静・気分転換』という4因子構造が明らかになった．さらに治療形態や精神症状との関連では，治療形態では大集団に所属する者が，精神症状では陽性症状の落ち着いている者が，共に『体力と生活リズムの回復』因子をより強く経験していた．また社会生活能力に関連する要因として，『体力と生活リズムの回復』および自尊心が抽出された．これらの結果は概ね臨床の印象とも一致し，作業療法のどのような要素が回復と関連しているのかを数量的に確かめていく指針となりうることが示唆された．

　This research was carried out in order to clarify the structure of therapeutic factors in the occupational therapy process. Furthermore, the relation between the extracted factors and social life capability was examined.

　Investigations were performed in 57 schizophrenic patients at a free-standing psychiatric hospital.

　The results were as follows :

　1) Four factors: the relation with people or activities, interest and motivation, recovery of physical strength and a life rhythm, and feeling settles down and feeling conversion by activity, were obtained from factor analysis.

　2) Patients in large groups felt "recovery of physical strength and life rhythm" more strongly than those in other groups.

　3) Patients, in whom the scores of positive symptoms evaluated by BPRS were lower, felt "the relation with people or activities" and "recovery of physical strength and life rhythm" more strongly.

　4) The therapeutic factor of "recovery of physical strength and life rhythm" and self-esteem related to social life capability.

　These results correspond with general clinical impressions, and have proved useful in confirming, quantitatively, which therapeutic factors in the occupational therapy process correspond with recovery.