1. UNIVERSITI TEKNOLOGI MARA (UiTM) AZIMAH BINTI HASSAN
940507-02-5320 DIPLOMA IN OCCUPATIONAL THERAPY
2. DEFINITION OF SCHIZOPHRENIFORM Schizophreniform is
short-term type of schizophrenia that alters individuals
perception, thoughts, affect and behavior. Involves symptoms that
are present for less than six months. When symptoms persist longer
than six months, the diagnosis is typically changed to
schizophrenia. Retrieved from www.psychcentral.com
3. EPIDEMIOLOGY AGE RELATED DEMOGRAPHICS - According to DSM IV,
the onset occurs between the late teens and mid 30s SEX-RELATED
DEMOGRAPHICS - The prevalence is equally in men and women - The
onset is later in men than women In men, between the ages of 18 and
24. In women, between the ages of 24 and 35. RACE-RELATED
DEMOGRAPHICS - No racial differences in the prevalence of
schizophrenia have been positively identified
4. ETIOLOGY The etiology and pathogenesis of schizophrenia is
idiopathic, but it could be: Biochemical factor Genetic factor
Environmental factor
5. PATHOPHYSIOLOGY Increased ventricular size Changes in the
hippocampusAnatomic abnormalities Glutaminergic dysfunction
Serotonin abnormalities Neurotransmitter system abnormality
Over-activation of immune system Metabolic disturbance (insulin
resistance) Inflammation and immune function
6. SYMPTOMS OF SCHIZOPHRENIA POSITIVE SYMPTOMS Hallucinations
Delusions Disorganized speech Behavioural disturbances NEGATIVE
SYMPTOMS Absence of normal cognition Alogia Avolition Anhedonia
Social isolation
7. SYMPTOMS OF SCHIZOPHRENIA COGNITIVE DYSFUNCTION Attention
Memory Executive functions MOOD SYMPTOMS Seems cheerful or sad
without obvious reasons
8. DEMOGRAPHIC DATA Name : Mrs R Address : Kampung Permatang
Saga, Kepala Batas Age : 34 Years Old Sex : Female Race : Malay
Religion : Islam Marital Status : Married Job : Direct selling in
health products Date of Onset : 06/12/2014 @ 4.45pm Date of
Admission : 08/12/2014 @ 5.00pm Date of Referral : 28/12/2014
@3.30pm Reason of Referral : Return to work (work training)
Diagnosis : Schizophreniform disorder
9. PERSONAL HISTORY Pre-Morbid History Works as saleswoman in
health care products Able to socialize with her neighbours and
business partners Able to engage in leisure activity such as
surfing Internet Able to do household activity such as washing
clothes, kitchen preparation Post-Morbid History Social withdrawal
(keep herself in room) Disorganized speech & thought Mood
Disorder Unemployed
10. CASE HISTORY Admitted to psychiatric ward at 5.00pm on 8th
of December 2014 Brought to casualty by her husband and younger
brother The patient's symptoms at the onset of his illness included
auditory hallucinations of angels voice, suspiciousness, ideas of
reference and hostility, and moderately severe conceptual
disorganization. Patient tried to kill her son by throwing him into
the well Claimed that she heard fireflies told that her child is
influenced by Satan
11. MEDICAL HISTORY Admitted to psychiatric ward HSAH at 4.45
pm on 6th of December 2014 Used Form 3 - certificate of involuntary
admission - allows the patient to be held for two weeks - the
patient must be notified with a Form 30 Used Form 4 - certificate
of renewal , valid for 1 month, must be notified with Form 30
12. MEDICAL HISTORY Previously had been to Hospital Kepala
Batas to get treatment as her wrist injured due to suicide attempt
Had been prescribed with atypical antipsychotics; - Olanzapine 20mg
- Clozapine 5mg Had been responsive to Artane 2 mg as she
experienced moderate extrapyramidal syndrome (EPS) after 10 days of
hospitalization
13. EDUCATION HISTORY Attended primary school (Standard 1
Standard 6) at SK Lahar Kepar Attended secondary school ( Form 1
Form 5) at SMK Dato Onn Attended university in Diploma level at
UiTM Arau
14. WORK HISTORY previous work as tuition teacher past 7 years
past 4 months she works in direct selling business appeared
obsessed with direct selling wanted to learn more about religious
phrases that being used onto the material that she sell (VKAN
products: socks, underwear)
15. SOCIAL HISTORY Patient spent her time by browsing and
chatting in Facebook about IS and Jews Frequently spend too much
time online until she experienced sleep disorder and always argue
with her husband Sometimes met her business partners and often
return home at midnight
16. FAMILY HISTORY + 65y/o (passed away) 61y/o 38y/o (pt 34y/o
) 28y/o 26y/o 22y/o Patient is second from five siblings One of her
family members is having mental illness (schizophrenia) Stayed with
her husband and 2 kids, her mother and 2 younger brothers
17. SUBJECTIVE ASSESSMENT (done through observation on 29
December 2014) appeared hygiene and properly attired with hospital
attire has adequate eye contact able to cooperate during interview
and group activity sessions (needs prompting)
18. General Appearance Neat and tidy with hospital attire
Hygiene Behaviour Anhedonia Inappropriate behaviour ; raised voice
when being asked during interview Mood Irritable and upset Speech
Coherence and fluency Sometimes appeared irrelevant Thought
Preoccupied , obsession, persecutory delusion , Perception Auditory
hallucination Cognitive Orientation : able to state person, place
and time correctly Attention and concentration : able to attend and
sustain group activity until the end with prompting Short term
memory: able to retrieve games rule Long term memory : able to
recall her previous history Insight Good MENTAL STATE EXAMINATION
(MSE)
19. OBJECTIVE ASSESSMENT (done through standardized assessments
on 29 December 2014) Mini Mental State Examination (MMSE)
Functional Ability Assessment (FAA) Depression Anxiety And Stress
Scale ( DASS ) Threshold Assessment Grid ( TAG )
20. DOMAIN COMMENT SCORE ORIENTATION Year, date, day, month =
Client able to state season. Place = Client recognize and know
where she is. 5/5 5/5 REGISTRATION Client can names 3 different
object (bed, apple, shoe) in the first trial 3/3 ATTENTION &
CALCULATION Client need to calculate 100 - 3 for 5 times. Client
able to answer ( 94 only ) 2/5 RECALL Client able to recall 3
objects correctly. 3/3 LANGUAGE Able to name object (pencil &
watch). Able to repeat Tidak mungkin dan tidak mustahil. Able to
follow instruction given ambil kertas dengan tangan kanan, lipat
dua dan letakkan di atas lantai. Client able to read tutup mata
anda and follow what it said. Client able to make a sentence.
Client able to copy picture exactly. 2/2 1/1 3/3 1/1 1/1 1/1 TOTAL
SCORE Interpretation, : mild to moderate cognitive impairment.
27/30 ( Source :
www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf )
21. A. LIVING SKILL SCORE COMMENTS Dressing 1 Independent in
dressing Eating 1 Behavior is socially appropriate Grooming/
Hygiene 1 Independent in all areas Domestic Skills 1 Independent in
all areas Time Management 1 Able to balance time with priorities
(leisure, work and rest) Money Management 1 Independent in all
areas (recognize money, assess change ,use of banking facilities,
budget for lifestyle) B. TASK ORGANISATION SCORE COMMENTS Attention
Span 1 Attends the task for more than 30 minutes Problem Solving 1
Solve problems independently Decision Making 1 Make decisions
independently Frustration Tolerance 1 Deals with simple and complex
tasks independently Memory Functioning 1 Independent in all areas
Good short term and long term memory (according to MSE) Verbal
Instructions 1 Follows all verbal instructions independently
Learning Ability 1 Learns simple and complex task without
difficulties
22. D. MOTOR TASK SCORE COMMENTS Balance 1 Balance allows
independent functioning ( sitting, walking, standing ) Coordination
1 Intermittent VM, FM, GM. C. PERSONAL / INTERPERSONAL ABILITIES
SCORE COMMENTS Communication Skills 3 Difficulties in 2 areas-
initiation, voice tone Good eye contact, listening and body
language Social Skills 2 Intermittent difficulties in 1 area poor
social interaction Passivity 1 Independent assertive functioning
Aggressions 2 Communicates aggression in some situations Self
Control 1 Regulates behavior appropriately to all situations Self
Concept 1 Difficulties in 2 area self confidence, role expectation
Reality Orientation 1 Independent in identifying Managing Stress 2
Can deal with minor stresses, occasinally not able to deal with
major stresses Initiative 1 Functioning allow independence
23. DEPRESSION ANXIETY AND STRESS SCALE ( DASS) Depression
Anxiety Stress Total Scoring 6 5 17 Interpretation 0-9 0-7 15-18
Normal Normal Mild RESULT : ( Source : Manual For DASS, 2nd Ed
(Sydney), Psychological Foundation, retrieved from
www.psy.unsw.edu.au/groups )
24. THRESHOLD ASSESSMENT GRID ( TAG ) Domains None Mild
Moderate Severe Very severe Safety Intentional self harm /
Unintentional self harm / Risk Risk of others / Risk to others /
Needs and disabilities Survival / Psychological / Social / TOTAL 3
3 1 (source : www.iop.kcl.uk/prism/tag)
25. CANSAS DOMAIN SCORE Accommodation 0 Food 0 Looking after
home 0 Self-care 0 Daytime activities 0 Physical health 0 Psychotic
symptom 2 (auditory hallucination, paranoid delusion, and
obsession) Information of condition and treatment 0 Psychological
distress 2 (she feels distress when people do not believe her
thought) Safety to self 2 (used to injure her wrist due to suicide
attempt) Safety to others 2 (used to throw her son into the well
due to homicidal attempt) Alcohol 0
26. Drug 0 Company 0 (patient has partner) Intimate
relationship 0 (patient has married) Sexual expression 0 (patient
claims that she has no problem) Child care 1 (patients children are
taking care by her mother) Basic education 0 (able to read, write
and understand Bahasa Malaysia) Telephone 0 (patient able to to use
handphone ; make calls and send instant messages) Transport 1
(patient able to use public transport) Money 0 (patient able to
budget her money) Benefits 0 (patient has no problem in financial
assistance) Spiritual 2 (patient believes that her son is
influenced by Satan and makes attempt to kill him)
27. OCCUPATIONAL THERAPY DOMAIN
28. Activity of daily living (ADL) Personal hygiene : Patient
able to look after her self care independently Instrumental
activity of daily living ( IADL ) Meal preparation and clean up :
Patient able to perform domestic skill independently Money
management : Patient able to use banking facilities ATM and manage
budget for lifestyle independently Time management : Patient spends
too much time online and often return home at midnight Education
Patient attends to university until diploma level AREAS OF
OCCUPATION
29. Rest and sleep Patient unable to balance her biological
clock until she had sleep disorder Work Patient works as saleswoman
in health products Leisure Leisure exploration Patient likes to
cook and trying new recipes Leisure participation Patient spends
her leisure with cooking and taking her children for a walk Social
participation Patient lacks of social participation with others as
she exhibits inappropriate behaviour and often raise her voice when
something is wrong
30. CLIENT FACTORS Mental functions Attention patient able to
attend the activity with prompting Memory able to retrieve short
and long term memory (according to FAA ) Perception presence of
auditory hallucination Emotional unable to cope during stress
(according to DASS ) Experience of self and time has poor self
esteem, self concept Sensory functions and pain No problem
Neuromusculoskeletal and movement related functions Gait pattern
shuffling type walking due to medication Balance and coordination
good balance & coordination (according to FAA). Good control of
voluntary and involuntary movement able to do activities involving
crossing the midline, bilateral movement, and gross-motor control.
Good in endurance patient not easily fatigue when performing
exercise (during warm up and group activity). Cardiovascular,
hematological, immunological, respiratory functions No problem
31. Voice and speech functions No problem Digestive, metabolic,
endocrine and system functions No problem Genitourinary and
reproductive functions No problem Skin and related structure
functions No problem BODY STRUCTURE CATEGORIES No Problem VALUES,
BELIEFS AND SPIRITUALITY Patient believed that she was spied by the
Jews and they had made attempt to kill her
32. Sensory perceptual skills Patient presents with auditory
hallucination Motor and praxis skills Has no problems in motor
skills, able to initiate the activity Emotional regulation skills
According to DASS, patient has mild stress with no depressed and
anxiety Cognitive skills Attention and concentration : able to
attend and sustain the activity until the end Memory functioning :
retrieval of short and long term memory independently Problems
solving : able to provide solution for situation given
independently Decision making : able to prompt with prompting
Orientation : able to state person, time, place independently
Follow verbal instruction : able to follow verbal instructions in
Malay language Communication and social skills Communication skill:
able to speak and understand Malay language Social skill : lack of
social interaction with inappropriate tone voice PERFORMANCE
SKILLS
33. PERFORMANCE PATTERNS CLIENTS PATTERNS EXPLAINATION ROLES
Patient unable to perform her roles as a mother and a saleswoman as
her symptoms become severe (auditory hallucination, paranoid)
ROUTINES Patient wakes up and take a bath at 6.30 am Patient
participates in rehab programs during daytimes Patient takes her
meals at consistent time Patient takes her bath before dinner and
sleeps at 10pm HABITS Patient always make dua before she enters
rehab department RITUALS Patient always perform her rituals at
particular time . She does praying and fasting
34. CONTEXT AND ENVIRONMENT Cultural Patient always greet
staffs when she enters rehab department Patient always shake hands
before return to ward Personal Patient is a 34 year s old woman
with diploma level Patient has 2 children Temporal Previous work as
a tuition teacher and saleswoman Currently patient is unemployed At
the age of 35, patient supposes to strive hard in her career,
enjoys great family time while having good relationship with family
members. Virtual Patient uses Facebook account to discuss about
current news of Islam with the preachers Contact her business
partners through instant messages and call Physical Patients usual
environments are at psychiatric ward and her house Patient stays in
her fully furnished house which is near to hospital Social Patient
able to socialize with other patients by providing prompting
35. ACTIVITY DEMANDS (MEAL PREPARATION)
36. Tools and materials Knife, can opener, bowl, spoons,
plates, chopping board Space demands Washing place sink Sandwich
making place - large, open spaces with adequate lighting. Social
demands The place must be clean as hygiene is important in our
community Able to follow sequence of making the sandwich. Able to
share the objects and materials with others. Sequencing and timing
STEPS : PREPARATION : - Therapist choose a menu for patient
(sardine sandwich) - Patient list down the ingredients needed and
choose all the ingredients and utensil for meal preparation MAKING
SANDWICH : - Open sardine can with can opener and pour into the
bowl - Peel and chop onion into small pieces and put it into the
bowl filled with sardine - Prepare 2 plates, one for main serving
purpose and another one for putting the bread - Take a slice of
bread , and spread the well-mix sardine onto the bread and serve it
onto the main plate SERVING - Patient set up the table by placing
plate, cutlery and glass for breakfast CLEAN UP - After finish
eating, therapist instruct patient to clean dining and preparation
table with the utensils - Patient washes and wipes the dishes
37. Required actions and performance skill able to estimate
quantity of materials needed for meal preparation able to follow
instruction on meal preparation need good fine motor skills. need
good eye hand coordination. Required body functions frustration
toleration emotional stability and consciousness Required body
structures both upper limbs (fingers, wrist, arms )
38. PATIENTS ASSETS Patient is adhering to medication Patient
has good moral support from her family Patient is compliance and
motivated to treatment Patient has being identified with specific
interest in cooking and meal preparation
39. PROBLEMS IDENTIFICATION Patient exhibits the presence of
psychotic symptoms Patient lacks of communication skills
(inappropriate voice tone) Patient lacks of social skills
(self-imposed isolation) Patient lacks of motivation due to
avolition
40. FORMULATING AIMS SHORT TERM GOAL To reduce psychotic
symptoms through physical fitness activity To promote communication
skills through social skill training To facilitate social skills
through To enhance self motivation through LONG TERM GOAL To
maintain ADL and leisure independently To facilitate work return
through work training
41. MODELS Recovery Model Recovering from a mental illness
requires a commitment to wellness, a commitment to see a life
beyond the impact of mental illness ( Glover , 2007 ) Believe in
her ability to recover Work as though recovery is always a reality
Provide environments that support patients recovery efforts Dont
stand in the way of her recovery process ( Glover, 2007 )
42. FRAME OF REFERENCE PSYCHOEDUCATION APPROACH - To promote
patients knowledge of and insight into her illness and enable her
to cope effectively thereby improving prognosis - Evidence suggests
that psycho educational approaches are useful as part of treatment
programs for people with schizophrenia (compliance with medication
improved, decreased relapse and readmission rates, had positive
effect on persons well-being, treatment brief and inexpensive)
(Pekkala and Merinder,2000)
43. REHABILITATION APPROACH - Rehabilitation describes the
restoration of functioning physical, mental and health -
Psychosocial rehabilitation refers more specifically to the
restoration of psychological and social functioning, and is
frequently used in the context of mental illness (King et al, 2007)
Based on 2 core principles that people are: Motivated to achieve
independence and self-confidence through competence and mastery Are
capable of learning and adapting to meet their needs and achieve
their goals
44. COGNITIVE BEHAVIOURAL APPROACH Cognitive behavior therapy
has been found in controlled studies to be affective form treatment
for schizophrenia and depression problem. Cognitive approach for
schizophrenia focused on the clinical observation that psychotic
symptom often seems to result from negative patterns of thinking
and behaving. ( Jacqueline, 1993)
45. Problem 1 Patient exhibits presence of psychotic symptoms
Aim To reduce psychotic symptoms and provide awareness (auditory
hallucination, obsessions and delusions) Intervention Technique /
Modalities Cognitive Behavioural Therapy (Psychoeducation) Method
Patient is placed in a comfortable and wide space area Provide
briefing about psychoeducation and its purpose Educate client about
patients condition Duration 15 20 minutes Rational Psychoeducation
refers to the process of educating patients about their conditions
and useful truths about life in general (Fischer, 2011) Precaution
Activity should be conducted at a neat and wide space room Ensure
patient in the state of mentally stable TREATMENT
IMPLEMENTATION
46. Problem 2 Patient lacks of social skills (self-imposed
isolation) Aim To promote social skills through social skill
training Intervention Technique / Modalities Music Therapy (Musical
Chair) Method This activity must be done in a convenience
environment. Therapist must select between 6 to 8 patients to
perform activity. After patients selection the therapist need to
give brief instruction about the activity. After patient
understands the needs, the therapist can start the activity. Give a
reward to the winner and get the feedback from patient. Rationale
Music has nonverbal, creative and emotional qualities. These are
used in therapeutic relationship to facilitate contact,
socialization, self-awareness learning, self expression,
communication and personal skills. Canadian Association for Music
Therapy, 1994. Precaution Ensure patients safety and health
requirements Ensure the location is carried out at purpose
buildings or special playing fields
47. Problem 3 Patient lacks of communication skills Aim To
facilitate communication skills through social skill training
Intervention Technique / Modalities Social Skill Training (Role
play) Method Introduction : Members are welcomed, ice breaking
activity Warm up : Physical exercise, verbal and non-verbal games
Action : Activity begin and end with the use of music. Patient
selects one of the papers , read the situation and then act based
on the situation chosen. Finally, repeat the process. Wind- down :
Closure activities and therapists comments Post group : Discussion
and reflection Rationale Social skills training, when carried out
with high intensity and sufficient duration, has been shown to
improve the capacities for personal effectiveness among persons
with schizophrenia, thereby facilitating social skills. Retrieved
from www.chizophreniabulletin.oxfordjournals.org Precaution Aware
of patients mood and behavior. Ensure the instructions given are
easy for the patient to understand
48. Problem 4 Patient lacks of motivation due to avolition Aim
To enhance self motivation Intervention Technique / Modalities
Social Skill Training (Role play) Method Introduction : Members are
welcomed, ice breaking activity Warm up : Physical exercise, verbal
and non-verbal games Action : Activity begin and end with the use
of music. Patient selects one of the papers , read the situation
and then act based on the situation chosen. Finally, repeat the
process. Wind- down : Closure activities and therapists comments
Post group : Discussion and reflection Rationale Social skills
training, when carried out with high intensity and sufficient
duration, has been shown to improve the capacities for personal
effectiveness among persons with schizophrenia, thereby
facilitating social skills. Retrieved from
www.chizophreniabulletin.oxfordjournals.org
49. Problem 5 Patient is unemployed due to hospitalization Aim
To facilitate work return through domestic activity Intervention
Technique / Modalities Domestic activity (cooking and food selling)
Method Stage 1 Building therapeutic relationship with patient.
Explore patients goals. Discuss safety issues in kitchen Stage 2
Quick cookery tasks for patient to prepare small meal Stage 3
Longer cookery tasks when patient can prepare a small meal
independently, she prepares a larger meal Stage 4 Cooking
independently with observation, patient prepares meal with no
assistance from OT. Once mastered this, prepares main meal without
assistance. Stage 6 Preparing, serving and packaging food for food
selling Rationale Cooking offers opportunities to satisfy
physiological needs, hunger, esteem needs if receives praise,
mastery needs learning new skills, self- actualization needs or
enjoyment. (Finlay ,2004 )
50. REASSESSMENTS (Reassessments was carried out on 7 January
2015)
51. DOMAIN COMMENT SCORE ORIENTATION Year, date, day, month =
Client able to state season. Place = Client recognize and know
where she is. 5/5 5/5 REGISTRATION Client can names 3 different
object (bed, apple, shoe) in the first trial 3/3 ATTENTION &
CALCULATION Client need to calculate 100 - 3 for 5 times. Client
able to give 5 answers correctly 5/5 RECALL Client able to recall 3
objects correctly. 3/3 LANGUAGE Able to name object (pencil &
watch). Able to repeat Tidak mungkin dan tidak mustahil. Able to
follow instruction given ambil kertas dengan tangan kanan, lipat
dua dan letakkan di atas lantai. Client able to read tutup mata
anda and follow what it said. Client able to make a sentence.
Client able to copy picture exactly. 2/2 1/1 3/3 1/1 1/1 1/1 TOTAL
SCORE Interpretation, : mild to moderate cognitive impairment.
30/30 ( Source :
www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf ) S im -m S
impr
52. A. LIVING SKILL SCORE COMMENTS Dressing 1 Independent in
dressing Eating 1 Behavior is socially appropriate Grooming/
Hygiene 1 Independent in all areas Domestic Skills 1 Independent in
all areas Time Management 1 Able to balance time with priorities
(leisure, work and rest) Money Management 1 Independent in all
areas (recognize money, assess change ,use of banking facilities,
budget for lifestyle) B. TASK ORGANISATION SCORE COMMENTS Attention
Span 1 Attends the task for more than 30 minutes Problem Solving 1
Solve problems independently Decision Making 1 Make decisions
independently Frustration Tolerance 1 Deals with simple and complex
tasks independently Memory Functioning 1 Independent in all areas
Good short term and long term memory (according to MSE) Verbal
Instructions 1 Follows all verbal instructions independently
Learning Ability 1 Learns simple and complex task without
difficulties
53. D. MOTOR TASK SCORE COMMENTS Balance 1 Balance allows
independent functioning ( sitting, walking, standing ) Coordination
1 Intermittent VM, FM, GM. C. PERSONAL / INTERPERSONAL ABILITIES
SCORE COMMENTS Communication Skills 1 Able to initiate conversation
with normal voice tone Good eye contact, listening and body
language Social Skills 1 Able to socialize with other patients
independently Passivity 1 Independent assertive functioning
Aggressions 1 Able to control agressions when her roomates tear her
magazine Self Control 1 Regulates behavior appropriately to all
situations Self Concept 1 Self confidence and role expectation have
improved Reality Orientation 1 Able to identify and discriminate
real thought Managing Stress 1 Able to deal with minor and major
stresses Initiative 1 Functioning allow independence im im
54. DEPRESSION ANXIETY AND STRESS SCALE ( DASS) Depression
Anxiety Stress Total Scoring 6 5 10 Interpretation 0-9 0-7 0-14
Normal Normal Normal RESULT : ( Source : Manual For DASS, 2nd Ed
(Sydney), Psychological Foundation, retrieved from
www.psy.unsw.edu.au/groups ) Show improve -ment
55. PROGNOSIS Medical Based on nursing report, patient is
compliance with the medication Rehabilitation Based on Occupational
Therapy (OT) aspect, patient prognosis is good where: Patient shows
improvement in her condition (appropriate behaviour and thought)
Patient able to follow and cooperate with rehab programs Patient is
motivated to change her condition (volition towards work
return)
56. Be aware of patients mood and emotion and behavior. Do not
allow to stand in front of the patient. Away from the patient if
the patient is aggressive. Look for the effect of the medication.
Never leave the patient alone. Prevent of patient from relapsing.
Watch out for fatigue and psychosis symptoms. Aware of any sharp
and dangerous objects. Avoid activity that can promote injury or
dangerous to patient. Be aware of skin irritated, redness or
allergic when perform activities. Make sure the instruction given
are easy for the patient to understand. Use the simple and clear
language. PRECAUTIONS /CONTRAINDICATIONS
57. FUTURE PLAN Continues occupational therapy programme : 1.
Group therapy 2. Cognitive training 3. Psycho education 4. Job
placement / work training
58. REFERENCES Occupational Therapy and Mental Health 3rd ed.;
Creek, J.; U.S.A; Churchill L; 2002 M. Gelder, R. Mayou, J. Geddes
(1999). Psychiatry. Oxford University Press. Mental Health concepts
And Techniques for the Occupational Therapy Assistant 3rd ed.;
Early, M.B.; U.S.A; Lippincott W&W; 2000 Reed, Kathlyn L.
(1991). Quick Reference to Occupational Therapy. An Aspen
Publication. Pocket Guide to Treatment in Occupational Therapy
Franklin Stein, Ph.D., OTR/L, university of south Dakota,: Becky
Roose, M.S. , OTR/L, Medilink, Iowa