離院と自殺企図を繰り返す統合失調症患者に対する1対1作業療法の意義について

Significance of individual occupational therapy for a schizophrenic patient with suicidal and hospital escape behavior

要旨：離院と自殺企図を繰り返す統合失調症患者に対して，管理水準を維持しつつ回復を促進する方法として，1対1の作業療法を実施した．症例は47歳の男性である．幻聴と被害妄想，それら病的体験に基づく離院と自殺企図のため入院し，隔離室が使用され，治療は膠着状態となった．作業療法開始に際して，治療膠着状態から生じた孤立・疎外感に注目し，患者役割を担わせないよう配慮した作業環境を設定し，また患者の生活史にも着目して作業種目を選択した．その結果，患者は回復過程を進み幻聴に対する対処行動も獲得した．以上から，離院や自殺企図を繰り返す統合失調症患者に対する，導入期における1対1の作業療法の有用性が示唆された．

　The purpose of this case study is to discuss the occupational therapy setting for patients with schizophrenia who attempt suicide. In psychiatric hospitals, the management of risk is often reinforced to prevent patients from attempting suicide, which may cause inappropriate therapeutic environments such as a longer hospitalization. We developed an individual occupational therapy for a patient with schizophrenia who has attempted suicide, addressing both the reduction of suicide risks and the facilitation of better mental health outcomes. The case was a 47-year-old male. He was admitted involuntarily because of violence against a mental health staff and suicide attempts with psychopathology, auditory and persecutory hallucinations. After the admission, he was often secluded followed by absconding suicide attempts. Pharmacological treatments showed only partial effectiveness to his psychotic symptoms, resulting in longer hospitalization with occasional seclusions. The therapeutic environments let him play a "role as an inpatient" in the hospital. The occupational therapy was then administered. Activities for occupational therapy were chosen focused on his life history and the situation of estrangement and isolation. We set the individual therapy for the patient: just taking a walk by his side in the hospital yard. After several months, he was in the process of recovery. We arranged the occupational activities from walking to other types according to his condition at the time. He finally developed his own coping skills to auditory and persecutory hallucinations. The recovery process of this patient suggests that the individual setting of the occupational therapy may be important for the recovery of patients with schizophrenia who attempt suicide.