Occupational therapy assessment in general psychiatric care

• The overall aim of this thesis was to develop an Instrument to Investigate psychiatric patients' occupational performance In order to identify their need of occupational therapy service. A literature review and analysis of different concepts used to describe the patient's activity resulted In the construction of new concepts which subdivide the activity Into elementary parts; operations, single actions, generated actions, action sequences and simultaneous actions.Occupational therapists (n = 38) In general psychiatric care collaborated In a study of the agreement level when deciding whether patients (n = 10) should be Included In, or excluded from, occupational therapy service. The results Indicate the imJ?Orlance of studying In more detail the screening process and the development of screening mstruments.One instrument, the Occupational Case Analysis Interview and Rating Scale (OCAIRS), was identified. The instrument, which gives Information about patients' adar.tive occupational functioning, was translated Into Swedish and tested for interrater reliability In two different studies. The result showed that the second version of the instrument had good lnterrater agreement.In order to investigate whether a patient's adaptive occupational functioning is related to diagnoses of schizophrenia or mood disorders, a study was made on three groups of inpatients: patients with schizophrenia (n = 18), major depression (n = 20) and bipolar disorders (n = 22). To examine the patient's occupational functioning OCAIRS was used. The result Indicated that the patient's adaptive occupational functioning was related to psychiatric diagnoses. Patients with schizophrenia and with bipolar disorders had great difficulties In adapting to everyday occupation and were In need of intervention from the occupational therapist. Patients with maJor depression, however, do not seem to have the same need of intervention.By Interviewing 145 patients, the predictive values of OCAIRS was calculated. OCAIRS seems to predict Inclusion and exclusion Into occupational therapy, seems to select which patients are In immediate need of treatment, and seems to identify those who need a new assessment later on. However, the results Indicate a need to Investigate how the rating of the different components In OCAIRS influence the occupational therapist when judging the patient's need of occupational therapy.

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