心療内科の立場から(2) : Consultation-liaison psychosomatic medicineを中心として(第24回日本心身医学会総会)(General Hospital Psychiatryと心療内科)

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With regard to consultation psychiatry, it has two major roles. One is the consultation given to treat psychiatric problems in general clinical departments such as internal medicine, pediatrics and pynecology. This role is usually played by psychiatrists both in the West and in Japan. This kind of consultation, i. e., consultation given by psychiatrists for psychiatric problems is widespread even in our country.The other is the consultation undertaken to deal with psychosomatic disorders in a general clinical setting. In the United States consultation psychiatry practiced by psychosomatists with psychiatric training is firmly established. The main role played by American psychosomatists with psychiatric trainign is, in fact, this kind of consultation. But in Japan psychosomatists with training in internal medicine, pediatrics or gynecology perform this work since Japanese psychiatrists have had little interest in consultation with psychosomatic patients. To put it in a defferent way : in Japan it is psychosomatists who were ofiginally medical doctors, who have systematized consultation for psychosomatic diseases, treatment which would normally have been undertaken by psychiatrists.The second subject I would like to take up is the role of liaison psychiatry practiced by a team of professionals, and area of liaison psychiatry which is led by psychiatrists in cooperation with physicians, pediatrists, gynecologists, nurses, social workers, counsellors and psychologists. This work is carried out by psychiatrists in the United States whereas such a system is still almost unheard of in Japan. Psychiatrists and psychosomatist, howevfer, are starting to assume that role in Japan.However a departure from psychodynatics had been attempted in Japan fairly early, for example by Ikemi, and others who created the framework of a system of therapy consisting of 3 pillars : autogenic training, transactional analysis and behavoir therapy.90% of patients receive autogenic training first. Patients with neuromuscular disturbances such as tics or writer's cramp receive biofeedback training. Patients with anxiety and compulsive neurotic complaints receive behavior therapy mainly systematic desensitization. Cases which have deep ionner conflict receive treatment by transactional analysis and Gestalt therapy.By entending this further, Ishikawa, et al attempted to integrate these three psychosomatic therapies based on cybernation therapy.In other works, early psychosomatic medicine or consultation-liaison psychiatry in Japan had been strongly oriented toward psychodynamics byt very soon divorced itself from its influence and crew into a more comprehensive, total approach, which provails at present in American consultation-liaison psychiatry which incorporates not only psycho-analysis but also psychotherapy and behavior therapy.
日本心身医学会の論文
1983-12-01

心療内科の立場から(2) : Consultation-liaison psychosomatic medicineを中心として(第24回日本心身医学会総会)(General Hospital Psychiatryと心療内科)

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