Psychosocial Intervention in Schizophrenia

Abstract

The occupational therapy psychosocial intervention (OTPI) approach based on cognitive rehabilitation among clients with schizophrenia is discussed in this chapter. Schizophrenia clients have cognitive impairments in executive functions (Morrice and Delahunty, Schizophr Bull 22:125–137, 1996). This deficit is defined as the “negative syndrome” (Crow 1980) and, in treatment-resistant schizophrenia, the syndrome exhibits a great intensity that influences daily life. For these clients, it is demonstrated that psychopharmacologic treatment combined with psychosocial interventions is more effective than the sole use of psychopharmacologic treatment. This strategy improves cognitive aspects and social functioning and consequently counteracts the deterioration caused by the illness (Huxley et al., J Nerv Ment Dis 188:187–201, 2000). Thus, occupational therapy enables these clients’ improvement in executive functions.

Occupational therapy intervention combined with appropriate medication is associated with improvement in clients’ condition.

(Buchain et al. 2003)

Appendices

The Case Study of José

Keywords

Instrumental activities of daily life (IADL), rehabilitation, schizophrenia

Introduction

The theme of this case study concerns improvement in IADL , autonomy to restructure his daily life, and being able to engage in new daily activities.

The students’ tasks include:

• Finding information about occupational therapist (OT) treatment in schizophrenia

• Definition of cognitive deficits and executive functions

• Cognitive rehabilitation

Overview of the Content

Major goals of the actual intervention are:

• 1. Improvement of performance in activates of daily life

• 2. Maximization of independent functioning

• 3. Maximization of the efficient independent living

• 4. Improvement of interpersonal relationships

Learning Objectives

By the end of this section, the student should be able to:

• Use a literature review to solve the case study based on cognitive rehabilitation

• Be able to apply clinical reasoning based on the occupational goal intervention (OGI) method in a specific case study and similar clinical situations

• Write a scientific report on a case of cognitive rehabilitation

The Background History of Clinical Case Study

Personal Information

José is 50 years old. José is married and lives with his wife and a daughter of 22 years. José has been retired since he became ill. He used to work for many years as an electrician for the telephone company. Currently, he does not perform housework or professional activities and has difficulty getting out of his house.

Medical Information Including Prognoses

When José was 24 years old, he was diagnosed with schizophrenia. At that time, he had many positive symptoms (auditory hallucinations and persecutory delusions). Throughout the years, despite drug treatment, he remained with social isolation and gradually abandoned many daily activities as a result of his illness. He was hospitalized three times over the years and has been submitted to cognitive behavioral therapy and social skills training, but no palpable improvement in function or social participation was noted. At present, he maintains medication treatment. He was referred to occupational therapy because his daughter will leave home and he will need to be responsible for tasks at home.

Occupational Therapy Interventions

The cognitive–functional rehabilitation program used with José was based on the “occupational goal intervention” (OGI) developed by Katz and Keren (2011) . The improvement of the cognitive aspects, specifically executive functions in order to enable him to occupational performance was the main goal of treatment of José. The proposed tasks were accomplished through the use of the proposed method of OGI stages. José had as objectives in his treatment planning been able to take to himself the responsibilities: do the supermarket to the house, prepare the afternoon snack, and clean his laundry (washing, ironing, and save). The sessions took place respecting the stages of OGI. For example, in relation to tasks related to shopping and snack preparation:

• Task 1:   Describe your eating routine.

• Task 2:   Preparation of a food described in the previous step.

• Task 3:   Preparation of a list of grocery shopping. Grocery shopping. Choose the products (quality and quantity) and perform the payment at the supermarket checkout. Store all products in place.

• Task 4:   Preparation of the afternoon snack including the organization of the place and preparation of the food with the products purchased on the market.

The Student’s Report

The following guiding questions have been identified in developing possible solutions to José:

• What are the major concepts and their definitions used in the case?

• What cognitive functions are involved in the performance of tasks exemplified?

• What are the important issues and goals of the treatment program to choose from José’s history and needs?

  What is the research-based evidence for the selection of the method that will be used?

• Which assessments can contribute to develop the occupational therapy program?