東日本大震災による放射能事故の被災地にある診療所での精神科医療—5年間の経験から

Psychiatric Service in the Area of Radiation Accident: 5-years' clinical experience after the Great East Japan Earthquake

抄録

　福島県川内村では，東日本大震災の原発事故による全村避難の1年後に帰村を開始し，空白になった精神科医療サービスを再建すべく，村の診療所に月1回の心療内科外来を開設した。4年間で54回診察を行い，受診者はのべ951人（平均73.3歳）であった。診断はPTSDが少ない一方，遷延する慢性ストレス状態が多く，放射能事故の特性と考えた。受診者には高齢者が多く，認知症も目立ち，震災を期に地域の人口減少・高齢化が進んでいることを反映していた。川内村では，帰村者の高齢化率は40.3％に達し，高齢化の進む日本の将来の姿とも言える。連続的かつ継続的な精神科医療支援のためには，コンパクトな診療所モデルが有効と考えた。

　Background：All residents of Kawauchi village in Fukushima prefecture were evacuated to distant areas after the radiation accident at the Fukushima No. 1 nuclear power plant in March 2011. We provided psychiatric medical service at the evacuation center and subsequently, temporary housing；one year after the disaster, some of the residents began to go back to the village. At the same time, to revive the provision of psychiatric medical service in this area, we started a psychiatric clinic service provided once a month at the village, 18 km from the nuclear power plant.

　Methods：We examined the medical records maintained by the psychiatric service at the Kawauchi village clinic from April 2012 to April 2016, and assessed the numbers, age, gender, and diagnosis, at onset before or after the disaster of the patients.

　Results：We conducted outpatient examinations 54 times every 4 weeks during the 4-year period. The total number of patients was 951, the number of outpatient of each examination is increasing, and the mean age of the patients was 73.3 years. As to the ICD-10 diagnoses, all the patients with schizophrenia (F2) were already attending a hospital before the disaster, while, most patients with dementia (F0), mood disorder (F3), stress disorder, anxiety disorder and somatoform disorder (F4) and insomnia(F5)developed their illness after the disaster. There were no patients diagnosed as having PTSD, although there were many cases of chronic stress disorders, as an effect of the radiation accident. Elderly patients were predominant, and many had dementia, which seems to reflect population decline and aging of the community after the disaster.

　Conclusion：The percentage of the population aged 65 years or older at Kawauchi village was 40.3%，which is representative of the future ultra-aging society model of Japan. To provide continuing psychiatric medical support to rural villages, the “compact clinic model” is effective.