OCCUPATIONAL THERAPY & SCHIZOPHRENIA

Occupational Therapy & Schizophrenia

Occupational Therapy & Schizophrenia

Introduction

The high relapse 'rates and poor social and community functioning of adequately medicated schizophrenic patients has prompted health professionals who work with them to assess the influence of psychosocial treatment on the course of schizophrenia (Anthony & Liberman, 2000). A large percentage of studies evaluating the impact of different treatment media on schizophrenic patients have methodological deficits which severely limit the interpretation and application of their results. The major deficits are lack of specific diagnostic criteria, no control of degree of patient pathology or level of chronicity and no control of medication. These are particularly important because it has been suggested that schizophrenic patients' receptivity to psychosocial intervention is influenced by their current level of psychopathology or by the particular subtype of schizophrenia they belong to (May, 2005).

Patients with the more acute subtype of schizophrenia are thought to be more likely to respond to psychosocia1 intervention than those with a chronic condition characterizcd by high levels of negative symptoms such as avolition, apathy, anhedonia, alogia, social withdrawal and affective flattcning (Crow, 1998). Occupational therapy journals from a number of countries, the American Journal of Occupational Therapy, the Ausfrnlian Occupational Therapy Journal, The British Occupational Therapy Journal, the Canadian Journal of Occupational Therapy, the New Zealand Journal of Occupational Therapy, the Occupational Therapy Journal of Research and Occupationnl Therapy in Mental Health were scrutinized to identify treatment media used with schizophrenic patients. The treatment methods found fit into four loosely defined, often overlapping categories: sensory integration, activity group therapy, social skills training and living skills training.

Sensory Integration

The theory of sensory integration was developed by Ayres in the 1950s for use with neurologically disabled children (Ayres, 2001). According to Ayres (2003) the taking in and organization of sensory information for use in relating to the environment is called sensory integration. Sensory integrative dysfunction hinders an individual's ability to interact effectively with the environment and perform normal day to day tasks. Ayres (2001) stated that by providing the individual with controlled sensory input via the vestibular system, muscles, joints and skin they will spontaneously make adaptive responses that interpret those sensations. Ayes has recommended numerous activities to provide tactile, proprioceptive and vestibular input. These include direct sensory stimulation such as brushing, rubbing and vibration of the skin as well as games using equipment such as scooter boards, net hammocks, bolster swings and suspended inner tubes (Ayres, 2003).

King (2001) hypothesized that many of the deficits found in schizophrenic patients such as perceptual dysfunction, abnormal posture and poor body image and motor planning are the result of poor sensory integration and contribute to severe emotional stress and a predisposition to hallucinations. King (2001) drawing on the work of Ayres published the first of many articles by occupational therapists on sensory integration in schizophrenia. In this early study, 15 hospitalized chronic schizophrenic patients participated in noncompetitive activities such as ball games, jumping and marching. This was congruent with the treatment principles recommended by ...