認知機能障害を呈した地域在住統合失調症者に対する作業機能障害に焦点を当てた評価および介入

Assessment and intervention on the classifications of occupational dysfunction in a community-living client with schizophrenia presented with cognitive dysfunction

要旨：就労を希望する地域在住統合失調症者に対し，社会的転帰を改善する目的で，作業機能障害および生活スキルや環境，内的動機付け，認知機能障害の評価を行った．各種状態の関連性を解釈し，作業機能障害の影響要因と考えられた認知機能障害に対して認知機能リハビリテーションの手法による介入に加え，生活スキルの支援，環境支援を行った．その結果，作業機能障害の改善がみられ，目標としていた就労継続支援A型での就労につながった．認知機能障害を呈する統合失調症者の社会的転帰を改善するうえで，生活スキルや環境，内的動機付け，認知機能障害といった各種要因を解釈しながら作業機能障害の評価に基づく支援を行うことの有用性が示唆された．

　This practical study aimed to improve the social outcomes in a client with schizophrenia who hoped to gain employment. The client was assessed for occupational dysfunction, life skills and environment, internal motivation, and cognitive impairment. After interpreting the relationship between each factor, the interventions based on cognitive rehabilitation techniques, life skills training, and environmental support were applied to improve the cognitive impairment that was assumed to cause the occupational dysfunction. As a result, the client's occupational dysfunction improved, and he was able to meet his goal and obtain an employment contract for continuous employment type A (paid employment). Conducting an occupational therapy practice based on the assessment of occupational dysfunction while interpreting factors, such as life skills, environment, internal motivation, and cognitive impairment, is useful to improve social outcomes in community-living clients with schizophrenia presented with cognitive dysfunction.