EFFICACY OF OCCUPATIONAL THERAPY ON NEUROBEHAVIOURAL DEFICITS, ACTIVITIES OF DAILY

LIVING AND SOCIAL SKILLS IN SCHIZOPHRENIA: CASE STUDY

SNIGDHA SAMANTRAY, MASROOR JAHAN, K.S. SENGAR

OUTLINE OF THE PRESENTATION

Rational of the study Aim of the study Methodology Case report: Ms. S Intervention Results Conclusion

RATIONALE OF THE STUDY

Nowadays, schizophrenia is one of the most important disabling mental disorders in the world. The neurobehavioral deficits underlying schizophrenia places a considerable amount of limitation on the activities of daily living and social skills.

Occupational therapy is considered to be the most essential treatment for rehabilitation and mainstreaming of schizophrenic patients. A number of researches have been carried out in the west regarding the efficacy of occupational therapy, however there is a dearth of research in this sphere in the Indian context.

AIM OF THE STUDY

To assess the efficacy of occupational therapy on neurobehavioral deficits, activities of daily living (ADL) and social skills of schizophrenia.

METHODOLOGY

Sample

It was a single case study and the patient , Ms. S diagnosed with “undifferentiated schizophrenia” as per ICD-10 DCR criteria was chosen for the study from Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi.

Tools

Socio-demographic and clinical data sheet Arnadottir OT-ADL Neurobehavioral Evaluation (A-

ONE), Árnadóttir, 1990 Cognitive symptoms checklist (CSC), O’Hara et

al,1993 Social skills checklist (SSC), Bellack et al, 2004

Procedure

At first the socio-demographic and clinical details were recorded and Informed consent was taken from the patient selected for the study.

Then the baseline assessment was done. For this purpose first, the AONE was administered early in the morning by observing the patients daily activities in their wards. This tool was administered to assess the underlying neurobehavioral deficits and ADL of the patients.

Then cognitive symptoms checklist was administered to assess the underlying cognitive deficits in the patients. Following this the social skills checklist was administered observing the behaviour of the patients in the ward.

Then the intervention programme was started using an occupational therapy module specially designed to suit the need of the patient. For this purpose the patient was engaged in the female OT section of RINPAS. The intervention period was for three months during which the patient was under thorough supervision.

After the intervention programme, the post assessment was done to determine the effect of the intervention on the patient. For this purpose the AONE, cognitive symptoms checklist and the social skills checklists were re-administered upon the patient. Then the protocols of pre and post assessment were scored and subjected to analysis.

CASE REPORT: Ms. S

Sociodemographic details

Ms. S, 40 yrs old female, Hindu, graduate, unmarried, hailing from urban area of West Bengal, belonging to middle socioeconomic status, diagnosed with undifferentiated schizophrenia, with a long history of illness for the past 20 years, has been admitted in RINPAS female section since the last 1 year.

Symptoms (Ms. S)

Positive

Hallucinations (auditory) Delusions - paranoid Thought broadcasting

Negative

Emotional blunting Social withdrawal Lack of motivation

Phases of illness (Ms. S)

‘Prodromal’ period began in Ms. S’s early 20’s Recent acute phase leading to hospital admission Now in ‘4th phase/residual’ – following resolution of the

acute phase and previous ‘relapses’ Ms. S adheres well to her medication but response to

medications was poor.

Impact of illness on Ms. S’s Functional Ability

Attention: Ability to focus on specific aspects of the environment while excluding others (often distracted and unable to stay on task)

Executive functions: Planning and problem solving (deficits in planning, sequencing of actions)

INTERVENTION

Module

A module was designed to cater to the individual need of Ms. S. It included the following components:

Psychoeducation Activity scheduling Motivation enhancement Group meeting Activity analysis and occupational engagement. Positive reinforcement Constant supervision Feedback

Choice of Activity

The choice of activity for Mrs. S was knitting and embroidery.

She had immense interest in knitting and embroidery and since her adolescent days she had been stitching her own dresses. She always wanted to own her own boutique.

Activity Analysis – Graded approach

Stage 1 – Building therapeutic relationship : Explore Ms. S’s goals and ability and discuss safety issues

Stage 2 – Quick knitting tasks: ask Ms. S to make simple knitting

Stage 3 – Longer knitting tasks Once Ms. S can make simple knitting independently, she is asked to make comparatively more complicated knitting.

Stage 4 – knitting Independently with observation Ms. S makes simple knitting (as per stage 1) with no assistance from OT. Once mastered this, makes complex knitting without assistance.

Stage 5 – Kniting Independently Ms. S engages in knitting independently

Duration of intervention

Ms. S received occupational therapy for three months during which she attended OT regularly 9:30 am to12 noon.

RESULTS

Intervention results for AONE

DEFICIT DOMAIN AT THE TIME OF PRE-INTERVENTION

BEFORE INTERVENTION

AFTER INTERVENTION

Neurobehavioral deficits Motor apraxia (mild)

Organizing and sequencing problem (moderate)

Absent

Present (mild)

Activities of daily living Dressing (mild)

Grooming hygiene (moderate)

Communication (mild)

Absent

Absent

Absent

Intervention results for CSC

DEFICIT DOMAINS AT TIME OF PRE- INTERVENTION

% IMPAIRMENT PRESENT BEFORE INTERVENTION

% IMPAIRMENT PRESENT AFTER INTERVENTION

Attention and concentration

73 58

Executive functions 69 52

language 11 0

Intervention results for SSC

DEFICIT DOMAIN AT TIME OF PRE-INTERVENTION

BEFORE INTERVENTION

AFTER INTERVENTION

Initiates conversation Present (impairment) Absent

Has social contact with other people

Present (impairment) Absent

Maintains at least one close relationship

Present (impairment) Present

Express positive feelings

Present (impairment) Present

CONCLUSION

Thus, we can conclude from the findings of this study that occupational therapy is effective in schizophrenia for considerably improving neurobehavioral deficits, activities of daily living and social skills.

Occupational therapy being a client centred approach uses occupation as a therapeutic means to help patients achieve functional autonomy and thereby adding meaning and purpose to their life. However, further research needs to be done upon a larger population and patients suffering from other psychiatric disorders as well.

“The man, through the use of his hands as energized by mind and will, can influence the state

of his own health” -Reilly, 1962

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