Gaining Insight and Empowerment Through OT
Norma-Christine Cassanes, Bsc, Bsc OT, OTR CASE HISTORY: Mr. T is a 19-year-old male born in Cambodia. He fled to Thailand when he was 8 years old and immigrated to
Canada with his mother and older brother five years ago. He attended a school for immigrants in Montreal but found it difficult
both academically and socially. He failed all of his classes and consequently dropped out without getting his high school leaving
certificate. He stayed close to the Montreal Oriental community with who he could communicate and where he felt accepted and
comfortable. Prior to his last hospitalization he lived at home, did not work or go to school.
CLINICAL CONSIDERATIONS: He was first brought to the emergency by the police in November 1995 in a psychotic state sec-
ondary to cocaine/crack abuse and hospitalized for three weeks. He was admitted to the emergency in July 1996 and again in
September 1996. In October 1996, his latest hospitalization, he was brought in by his mother and older brother, in a psychotic
state secondary to drug abuse. He was delusional with visual and auditory hallucinations, incoherent, confused, restless, agitated,
potentially explosive, uncooperative. The diagnosis was schizophrenia with paranoia and delusions secondary to substance abuse.
His family was afraid of him and did not want him to come home. He was put on medication (Haldol) and hospitalized in the psychiatric ward where his behaviour remained the same. He continued to demonstrate poor impulse control and a blunt affect.
One month into his hospitalization, following an explosive reaction towards the nursing staff when he was prevented from leavingthe hospital, closed treatment was ordered by the courts. His clothes were taken away as were all smoking and "outings" privi-leges. He was confined to "high care".
The initial interview was carried out while he was in "high care". He presented himself as cooperative, coherent, shy and ner- vous. He appeared to have stunted development, limited intellectual capacity and social skills. This was likely attributed to his poorintegration in a culture and a society that he could not adapt to and had difficulty understanding.
TREATMENT/APPROACH: The initial goals were to establish a trusting relationship and maintain the interest he had demon-
strated in Occupational Therapy. This served as a motivator to modify his behaviour and get out of "high care". As long as he
behaved adequately and was compliant, he was permitted to attend OT. He began to understand that he had control over his release
from "high care" and he modified his behaviour accordingly. He was transferred to the ward after 12 days. His clothes, smoking
and "outing" privileges were returned to him. This was a turning point for him. He became more relaxed, smiled spontaneously,
socialized with other people on the ward and adopted a less robotic appearance.
The drawings that he had done in the initial OT evaluation were used to explore his difficulties and gain insight into his feel- ings about his present, past and future. Drawing and painting remained his preferred activity. His artwork was revealing in termsof its attention to detail and its emotional content. It facilitated communication. He liked to talk about his drawings and what theyrepresented and meant to him.
He learned quickly and easily engaged in the activities that were presented to him. The activities included woodburning, stained glass, clay and group projets. Each project improved his self-esteem, assurance and motivation. When he was ready toaddress his living arrangements and his discharge plans, the options that he had were discussed. Budgets and cost of living exer-cises were prepared. He was now able to establish concrete goals. He demonstrated realistic expectations and quickly understoodhis budget restrictions.
Mr. T gained a better understanding of his situation, the role that drugs played in his hospitalizations and the role that he has in his rehabilitation. He wants to live at home and understands how his behaviour needs to change. He agreed to participate in the Rehab Program and be followed at the Day Hospital. It was arranged for him to visit and meet with the OT in charge of the program.
OUTCOME: Mr. T was discharged after 10 weeks of hospitalization and referred to the Rehab program and Day Hospital for fol-
low-up. Mr. T continued to attend the program for one year and to live at home. He was abstaining form drug use and continued
to comply with his medication and treatment plan.
He recently decided to go back to day school to finish high school.
With gratitude toGloria Aronoff, OT atJGH in Montreal ABOUT THE AUTHOR:
Cassanes, Bsc OT,
OTR, is an
Publication supported by a private grant.


Microsoft word - 20140120extract from miuclinical protocols.doc

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