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Seishin Igaku Volume 54, Issue 12 （December 2012）

精神医学 54巻12号（2012年12月発行）

Japanese English

研究と報告

慢性期病棟の入院患者の特性―BADO（患者基本記録）を用いた急性期病棟との比較 Comparative Analysis of Psychiatric lnpatients in Chronic and Acute Wards of a Japanese Hospital Using a Basic Documentation System 岩井一正 ¹ , 森脇久視 ² , 平川淳一 ³ , 伊藤卓 ³ , 大森徹郎 ³ , 堀内智博 ³ , 鹿島直之 ⁴ , 津崎佳世子 ³ , 今井桂子 ³ , 古谷圭吾 ³ , 真島智 ³ , 遠藤希世 ³ , 椎名貴恵 ³ , 佐藤晃子 ³ Kazumasa IWAI ¹ , Kumi MORIWAKI ² , Junichi HIRAKAWA ³ , Takashi ITO ³ , Tetsuro OMORI ³ , Toshihiro HORIUCHI ³ , Naoyuki KASHIMA ⁴ , Kayoko TSUZAKI ³ , Keiko IMAI ³ , Keigo FURUYA ³ , Satoru MAJIMA ³ , Kiyo ENDO ³ , Takae SHIINA ³ , Akiko SATO ³ ¹神奈川県立精神医療センター芹香病院 ²東京女子医科大学東医療センター精神科 ³平川病院 ⁴町田まごころクリニック ¹Kanagawa Prefectural Hospital Organization Kanagawa Psychiatric Center Kinko Hospital, Yokohama, Japan ²Department of Psychiatry of Tokyo Women's Medical University, Medical Center East ³Hirakawa Hospital ⁴Machida Magokoro Clinic キーワード： Long-stay patients , Hospitalization for social reasons , Chronic schizophrenia , Routine data , Basic Documentation , BADO Keyword: Long-stay patients , Hospitalization for social reasons , Chronic schizophrenia , Routine data , Basic Documentation , BADO pp.1209-1218

発行日 2012年12月15日 Published Date 2012/12/15

DOI https://doi.org/10.11477/mf.1405102334

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抄録

　慢性期病棟の長期在院者の実態把握を目的に，1施設の急性期との病棟比較を，ドイツ精神心理神経学会が主導する患者基本記録Basic Documentation（BADO）によるルーチンデータを用いて行った。急性期病棟75例，慢性期病棟115例のうち，特に統合失調症圏について，背景因子，疾病関連因子，転帰を検討した。その結果，回復性の転帰に向かって流れる急性期病棟と，非回復性に停滞する慢性期病棟のコントラストが浮き彫りになった。後者は，病床削減に向けて喧伝されている「社会的入院」とは異なり，生物学的，心理的，社会的次元にわたる深刻な障害が主体であった。今後の慢性期入院医療は，「慢性重症性」を標語として解決をさぐる準備が必要と思われる。

　The long-duration of hospitalization in Japanese psychiatric hospitals is mainly attributed to insufficient social support and community-based programs. Despite the attempts to establish these services, long-duration hospitalization remains a major issue. In this study, we aimed to compare the actual conditions of patients in the chronic wards (CWs) and acute wards (AWs).

　In 2008, data for a 3-month period were collected from a private psychiatric hospital in a suburb of Tokyo, using a psychiatric basic documentation system (DGPPN-BADO). Sociodemographic factors, treatment processes, and outcomes of a sample comprising of 115 CW patients and 75 AW patients were analyzed, especially with regard to schizophrenia and related disorders. Schizophrenia and related disorders accounted for 78.3% (n＝90) and 54.7% (n＝41) of the cases in the CW and AW, respectively. Compared to AW patients, CW patients were significantly older, more likely to be single, less educated more frequently rehospitalized, and more physically impaired. Scores for Global Assessment of Functioning (GAF), which is measurement of psychosocial functioning, and Clinical Global Impressions (CGI), which is measurement of severity of illness were almost equal for the CW patients at the time of this study and the AW patients at the time of admission. CW patients received polypharmacy and higher chlorpromazine-equivalent doses significantly more often than AW patients did. The CW patients had been in the ward for an average of 9.2 years up to the index period, and only 13.3% of the patients were discharged after 1 year. In contrast, most AW patients (90.2%) were discharged after an average of 90.3 days with more improvement in GAF and CGI scores.