Anna is a 45 year old lady who experienced her first episode of Psychosis in her late 30s. She holds a high level position in accounting and has had several episodes off sick in recent years. She has recently been off work for six months with no return date planned as yet. Anna lives with her teenage son and husband of 20 years.
Reason for referral
Anna was referred to occupational therapy by her Psychiatrist as there had been a significant deterioration in her activities of daily living, self care and mood. She often returned to bed for the rest of the day once she had taken her son to school. She had begun to put on weight, had lost interest in her personal appearance (something that was previously of great importance to her) and had become less concordant with her medication resulting in an increase in positive symptoms.
Occupational therapy Assessment
Anna was assessed at home using a variety of standardised and non standardised tools. These included formal assessments such as the Assessment of Motor and Processing Skills (AMPS). These assessments were supplemented with informal interviews with Anna, an environmental assessment and further observation of functional tasks.
This assessment identified that:
- Anna had conflicting feelings about returning to work – she worked in a very high pressure, performance /results driven company and had found it very difficult to return to work on previous occasions. She did not enjoy her job but as the main earner she felt a sense of duty to return;
- Anna had previously worked long hours and had not had much balance in the structure to her day focusing mainly on work and then tasks at home making it difficult to identify activities she was interested in;
- Anna was experiencing significant levels of fatigue and concentrating the little energy she had on her son – she had started taking her son to school (although when she worked he had got the bus) finding it hard to say no to his requests as she was not working;
- Anna felt overwhelmed by the number of tasks needing to be achieved at home (she had previously done the majority of household chores) – she felt overwhelmed by each task and would go back to bed as a means of avoidance.
Occupational Therapy Treatment Plan
Anna was initially offered 12 weekly Occupational Therapy Treatment sessions which focused on:
- Encouraging Anna to add more structure and meaning to her day, identifying a balance of activities in her day and finding ways to challenge the urge to return to bed if things were overwhelming;
- Identifying tasks Anna needed to undertake to enhance her wellness and structure these into a weekly plan such as taking medication, getting out of the house every day, washing, listening to music and identifying and breaking down any barriers to achieving these;
- Identifying ways to set and engage in meaningful goals including a strategy to address her home environment by breaking the tasks down room by room, task by task;
- Helping Anna feel more confident in her role as a mother, re-establish some boundaries and have some protected time with her son;
- Applying the stress vulnerability model of psychosis to highlight what situations increased Anna’s stress and reduce her vulnerability to these;
- Enabling Anna to look at future career options weighing up the pros and cons of returning to work against retraining/alternative career path etc.
On completion of her Occupational Therapy Treatment sessions Anna had been able to:
- Stay out of bed during the day;
- Develop a daily wellness checklist thus improving her concordance with medication and increasing her personal care;
- Gain confidence in her role as mother and improve her relationship/quality of time spent with her son;
- Make an informed decision that she did not wish to return to her previous job and identify a new career path attending a course on setting up your own business;
- Improve her home environment and enjoy spending time there;
- Create more balance and structure to her day such as participating in a Pilates class, cooking a main meal in the evening and spending time with friends.