| Summary: | 碩士 === 國立臺灣大學 === 園藝學研究所 === 94 === Clients who are mentally illed with prolonged hospitalization are usually degenerated in cognitive function due to their symptoms or lack of sensory stimulation. Cognitive impairment in schizophrenia clients are obvious especially in attention, memory and executive function. Neurochemical analysis shows that decreased neurotransmitters serotonin, dopamine and glutamate is related to the incidence of schizophrenic disorder. Medication is an essential treatment, yet residual symptoms need further collaborate therapy. If provided with multiple sensory stimulation, the withdrawal patients may get interested in their living environment. In this study conducted at a public psychiatric center, chronic schizophrenia patients were guided to do horticultural activities for a period of 4 months by the OT. The horticulture program provides just right challenge to clients'' thinking process and endurance. Through patients'' planting and caring for vegetables and flowers various skills and responsibility are scheduled into patients'' daily life, such as watering, seed sowing, transplanting, propagation, compost preparation, soil disinfecting, repotting, plant feeding, plant pruning, weeding, ground fertilization, insecticide spraying, harvesting, and general cleaning of horticulture equipment / tools ). In addition, harvest cooking and landscape introduction were programmed to enhance patients'' cognitive function and get improved rehabilitation.
The study was conducted twice, namely in spring-summer and autumn-winter of 2005. Each had an 1.5 hr class twice a week for the whole period with the first program lasting 16 weeks and 32 classes and the second program lasting 18 weeks and 36 classes. The subjects, chronic schizophrenic patients resided at Bali Mental Hospital, Taipei are devided to activity group and control group. For evaluation, three quantitative instruments are used, includingACL ( Allen cognitive level test ) , MMSE ( Mini-Mental State Examination ) and CDT (Clock Drawing Test ). In addition COTE and horticultural activity questionnaire are used as quality assessment tools. These tools are used to test cognitive function, and each can be operated within10 minutes regularly. ACL is a manual operating test which contains several structured patterns. MMSE is a 5 portion questionnaire. CDT is a drawing test that marks numbers. In ACL test, the t-test analysis shows that singnificant improvement is obtained with the activity group. ( 0.50±0.86，p<0.05 ) , In MMSE, t-test analysis shows singnificant score change ( 4.11±5.35，p<0.05 ) and CDT shows singnificant change as well ( 0.42±0.69 ，p<0.05 ). In COTE, patients showed progress in various
Cognitive function related items, i.e.‘concentration’,‘learning ability’,‘decision making’,‘follow direction’and‘problem solving’.The rehabilitation peaked at the third months of the horticultural program. The cognitive capability increased from level 2 ( average ) to level 3 ( good ). At the end of each study the patients claimed to fell relaxed and satisfied.
As compared with ordinary people, clients with psychiatric problems would show more functional decline. Beside medicttion, rehabilitation program that prevent patients from deterioration is a more important treatment for psychiatric patients. Horticulture therapy aims to maintain and enhance the patients'' present ability and thus reduce the medicine expenditureand related costs.
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