緊張病性昏迷をきたした統合失調症患者に対する作業療法の実践

Occupational therapy for a catatonic schizophrenic patient with stupor characteristics

要旨：緊張病性昏迷をきたした統合失調症患者に対して，急生期昏迷状態から作業療法(以下，OT)を実施した．入院当初の昏迷状態期に，拘縮等の二次障害の予防を目的として，他動的関節可動域運動により身体的に介入を行った．昏迷からの離脱後，被害妄想，対人恐怖が一過性に表面化したが，OT介入は中断せず声かけを継続した．被害妄想，対人恐怖がやや軽快した後，変化が少なく繰り返しの多い創作活動を，マンツーマンでの個室対応という枠組みの固定した環境で行った．症例は安心感を持ち，楽しんで活動できた．この経過から，急性期からの身体への関わりや経過と疾患特性を踏まえたOTが，緊張病患者の回復に貢献することが示唆された．

　Occupational therapy for acute schizophrenia patients is rare, as acute patients are very vulnerable to subtle changes in their surroundings. This case report describes an acute schizophrenic patient with catatonic stupor symptoms who underwent occupational therapy in order to prevent secondary diseases such as deep vein thrombosis and contracture.

　First, passive range-of-motion exercises were done on the bed ridden patient in the intensive care unit by an occupational therapist (OTR). The OTR simultaneously inquired after the patient's condition at every therapy session, even though the patient was not able to respond verbally. The occupational therapy focusing on physical conditions prevented secondary diseases and also built a relationship between the OTR and the patient.

　The OTR next introduced finger knitting in an occupational therapy session because the patient complained of difficulty in finger dexterity. The finger knitting was carried out in the patient's private room under direct supervision of the occupational therapist. The occupational activity and therapy settings were effective in improving finger movement and developing an interpersonal relationship, respectively.

　The patient's improvement suggests that occupational therapy for catatonic schizophrenia should be focused on patients' physical conditions, and that the therapy setting should be appropriately adjusted to patients' mental conditions.