衝動的な暴力から措置入院となった統合失調症と自閉スペクトラム症を呈する困難事例に対する急性期作業療法

Occupational therapy for a difficult case of schizophrenia and autism spectrum disorder in the acute phase which included forced hospitalization due to impulsive violence

要旨：今回，幻覚妄想状態で警察官に暴力を振るい，当院の精神科急性期病棟に措置入院となった統合失調症と自閉スペクトラム症を併せ持つ対象者に，筆者は多職種チームの一員として関わった．本介入において，筆者は個別作業療法を通して対象者と関係性を構築し，暴力の制止を試みた．その上で，集団作業療法と統合失調症の心理教育を実施し，自宅退院に繋げた．本介入から，措置入院者への多職種チーム医療に作業療法士が参加することによって，対象者と同等な立場で関わることで関係性を構築し，対象者の特性や大切にする思いといった情報を多職種チームに提供することで，より対象者らしい生活の再開に向けた支援が可能になると考える．

　As a member of a multi-professional team, I intervened in a client with schizophrenia and autism spectrum disorder who was admitted to our psychiatric acute ward after violently attacking police officers in a hallucinatory state. Through individual occupational therapy I established a relationship with the client and tried to stop the violence. The client progressed to group occupational therapy and psychological education for schizophrenia, which eventually led to discharge from the hospital. The intervention indicates that involvement of occupational therapists in multidisciplinary teams for inpatients can lead to building a relationship through patient empathy. In addition, by providing information such as client characteristics and thoughts that they value, to the multidisciplinary team, it is possible to assist the clients in their return to normal life.