心療内科におけるコンサルテーション活動について : 東大心療内科における研究

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Fifty-four cases were consulted on during a two-year period by a psychosomatic medicine consultation service. The present study was conducted in order to characterize these referrals. These were patients who were admitted to medical/surgical services exhibited psychosomatic symptomatology. The data base included patient information recorded on the consultation service records, patient charts, records of consultation conference and a clinical data sheet for psychosomatic medicine. The sex ratio was 0.7 male to 1.0 female, with an age range of 13-82 years old. 12 patients were diagnosed as "depressive reaction" while others had various psychosomatic symptomatology. Using DSM-iii-R criteria, 18 patients were diagnosed as somatoform disorder, 9 patients had various mood disorders, and 8 had adjustment disorder. 15 patients met the criteria for DSM-iii-R personality disorder. Severity of psychosocial stressors ranged from 2 to 5,and global assessment of functioning was 50 to 80. Only one consultation was required in 24 cases and less than three consultations in 35 cases. Most cases needed relatively short term consultation. 24 cases required less than one week while 40 cases required up to 1 month. Consultation requests were made largely from the medical service (38 cases) , and the remainder spanned the gamut of services. In 29 cases, the referring clinicians wanted some assessment regarding the relationship between physical symptoms (i. e., abdominal pain, chest pain, diarrhea, hypertension, dizziness, and numbness) and psychosocial factors. They also requested advice regarding treatment. The recommended treatments included psychosocial interventions. phar- macotherapy, and in some cases autogenic training or psychotherapy. In this article the general aspects of the treatment of 54 patients and detailed aspects of the treatment of 2 patients are described. The data of this study indicate that the availability of a psychosomatic consultation service is important in the general medical setting. Further study will identify those factors that will aid in the improvement of these consultation services.
日本心身医学会の論文
1993-12-01

心療内科におけるコンサルテーション活動について : 東大心療内科における研究

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