Depression has actually has wide variety of types including endogenous depression, depressive state caused by developmental disorders, personality disorders and even alcohol dependence. Therefore, mental health physicians should not take workers in depressive state as simply having (endogenous) depression. This article reviews how we should deal with developmental disorders and personality problems in workplace. Both disorders are of spectrum nature, where there are no clear boundaries between what they call normal and abnormal, something vague in terms of clinical diagnosis. Moreover, there is no magic bullet against both disorders. The clinicians should interact with occupational physicians communicating how this worker doing in the workplace in an active environment, not only how he/she act in the medical environment.
Recently, the use of community transition for psychiatric inpatients with schizophrenia has been accelerated. However, achieving successful transition support for refractory patients is sometimes difficult due to the absence of a trusting relationship which is caused by the patients' psychiatric symptoms. We herein report a case of treatment-resistant schizophrenia, for whom we successfully introduced community transition support by a multidisciplinary team through individual occupational therapy. The patient was a woman with catatonic schizophrenia, who presented with severe negativism when symptoms were in the acute phase. In the chronic phase, her symptoms prominently decreased, yet she kept rejecting help and intervention for her daily life. By utilizing individual occupational therapy, which has no direct relation with regular transition support, this patient was able to establish a trusting relationship with the occupational therapist, and other members of the multidisciplinary team were thus able to subsequently join the sessions. Training to carry out the activities of daily life was gradually added to this patient's therapeutic regimen, and finally she was successfully discharged from the hospital and thus was able to return home. The role of the occupational therapist successfully carrying out community transition support is discussed through a review of this case.