医療観察法病棟における治療意欲の乏しい統合失調症患者に対する作業療法の有用性

Occupational therapy for patients with schizophrenia who resist treatment in a forensic psychiatric ward in Japan

要旨：医療観察法病棟において，殺人未遂事件を起こした統合失調症とADHDの対象者に関わる機会を得た．対象者は統合失調症の病識が乏しく，事件の内省が困難であり，医療観察法病棟の入院治療に対する意欲が持てず，介入は難航した．しかし，筆者と革細工や病棟行事の実行委員を担った体験を通して成功体験を重ね，その後の治療には自発的に参加するようになった．ここから，作業療法は医療観察法病棟での入院治療に意欲の乏しい対象者に対して，MDTによる社会復帰に向けた治療の導入部分を担い，作業を介して対象者と関係性を結び，自己効力感を高めることができ，主体的な治療への参加を可能にすると考えられた．

　Occupational therapy was carried out on a patient in a forensic psychiatric ward in Japan who suffered from schizophrenia and ADHD who had attempted murder. Intervention was difficult due to the client's poor self-awareness of his condition, difficulty reflecting on the case, and lack of motivation for inpatient treatment. However, by gaining successful experiences through leather work and being a member of the executive committee of the ward events, he began to voluntarily participate in the subsequent treatment. Occupational therapy could be responsible for the introduction of treatment by a multi-disciplinary team for clients who lack motivation to be hospitalized in forensic psychiatric wards, and occupational therapy may assist in establishing relationships with the clients, enhance their self-efficacy, and increase participation in independent treatment through occupation.