身体症状を主訴に一般内科で受診した神経症の臨床的検討 : 一般内科診療における全人的医療実践上の留意点について

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In our medical department at a middle-sized hospital with a large number of patients (340 beds, 808.9 outpatients per day in 1989), time spent for each patient is limited. This condition is unsatisfactory for comprehensive medical care. In the present study, neurotic patients who visited our department were examined in order to clarify the important points to be noted in practicing comprehensive medical care in general medical field.The subjects were 75 patients who were diagnosed as neurosis by the department of psychiatry after they visited the medical department for January 1985 to December 1989. They comprised 25 men and 50 women, with the mean age of 46.4±19.4 years. They complained of various physical symptoms including general malaise, anorexia, headache, palpitation, dyspnea, abdominal pain, disturbed defecation and chest pain. On the other hand, main mental symptoms included insomnia, anxiety, depression and irritation. In particular, insomnia was an important 22 clue to understand the patient's mental state. Physical diseases such as hypertension, diabetes, chronic pancreatitis, bronchial asthma, chronic hepatic disorder, peptic ulcer and pulmonary emphysema were found in 30 of 75 patients. Of these 30 patients, 21 exhibited a correlation among symptoms of the physical disease, psychic symptoms and psychogenic factors. The main mental factors were problems, involved in the family, arising from the composition of family members who are living together, problems related to occupation, anxiety about illness and death or disease of relatives. It is concluded that the following three points should be noted in practicing comprehensive medicine in a primary care : to make a good doctor-patient relationship through careful interview and full, close physical examination, to examine the presence or absence of insomnia and to pay special attention to the composition of family members living with the patient.
日本心身医学会の論文
1992-04-01

身体症状を主訴に一般内科で受診した神経症の臨床的検討 : 一般内科診療における全人的医療実践上の留意点について

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