Schizophreniform; one of schizophrenia's subtypes that exhibits same particular symptoms.

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
individual’s 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 angel’s 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
(patient’s 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
CLIENT’S
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 du’a 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
 Patient’s 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. PATIENT’S 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 patient’s recovery efforts
• Don’t stand in the way of her recovery process
( Glover, 2007 )

42. FRAME OF REFERENCE
• PSYCHOEDUCATION APPROACH
- To promote patient’s 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 person’s 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 patient’s 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 patient’s 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 patient’s 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 therapist’s 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 patient’s 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 therapist’s 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 patient’s 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 )
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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 patient’s 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