医療観察法病棟での生活能力訓練の実践

Practical report on training focused on instrumental activities of daily living in the Medical Treatment and Supervision Act

要旨：今回，精神症状に伴う暴力の問題で，青年期から精神科入退院を繰り返し，医療観察法入院処遇となった統合失調症患者に関わる機会を得た．本報告の目的は，事例報告と合わせて，医療観察法病棟でのIADL訓練を主とした生活能力訓練の意義について考察することにある．事例は，薬物療法を基盤に，プログラム時間外での日常的なIADL訓練やショートケアを模したグループへの参加といった生活能力訓練に取り組んだ．その結果，社会的機能が改善し施設入所に至った．病棟内で日常的に生活能力訓練が実施可能な環境を整えることは，対象者の能動性をひき出すとともに，退院後の生活イメージを検討・共有していくための有効な手段となり得る．

　We had the opportunity to undertake rehabilitation for a patient with schizophrenia who received inpatient treatment under the Medical Treatment and Supervision Act following repeated psychiatric hospitalizations for violent behavior associated with psychiatric symptoms. This report discusses the instrumental activities of daily living (IADL) training used in our hospital together with a description of the case details. Following pharmacotherapy, the patient underwent IADL training, which involved daily training outside of program hours and participation in a group simulating day-care. This resulted in improvement in the patient's social functioning. Creating an environment in a hospital ward in which daily IADL training is feasible could not only encourage patients to be active in their training, but also be an effective means for examining and sharing an image of life after discharge.