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Seishin Igaku Volume 60, Issue 1 （January 2018）

精神医学 60巻1号（2018年1月発行）

Japanese English

研究と報告

高齢統合失調症患者を対象とした抗精神病薬と脂質異常症治療薬に関する医療同意能力の比較およびデシジョン・エイドによる介入の試み—MacArthur Competence Assessment Tool for Treatmentを用いて Preliminary Study of Evaluating and Improving the Consent Capacity to Antipsychotic Treatment and Hyperlipemic Treatment in Older Patients with Schizophrenia: Using the MacArthur Competence Assessment Tool for Treatment 加藤佑佳 ¹ , 松田万祐理 ¹ , 澤田親男 ² , 原田倫治 ² , 山田美和 ² , 加嶋晶子 ² , 柏由紀子 ² , 細井哲 ² , 横田勲 ³ , 手良向聡 ³ , 成本迅 ¹ Yuka Kato ¹ , Mayuri Matsuda ¹ , Chikao Sawada ² , Tomoharu Harada ² , Miwa Yamada ² , Akiko Kashima ² , Yukiko Kashiwa ² , Satoshi Hosoi ² , Isao Yokota ³ , Satoshi Teramukai ³ , Jin Narumoto ¹ ¹京都府立医科大学大学院医学研究科精神機能病態学 ²三幸会北山病院 ³京都府立医科大学大学院医学研究科生物統計学 ¹Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan ²Sankokai Kitayama Hospital ³Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine キーワード： Older patients with schizophrenia , MacArthur Competence Assessment Tool for Treatment , Decision aid , Antipsychotic treatment , Hyperlipemic treatment Keyword: Older patients with schizophrenia , MacArthur Competence Assessment Tool for Treatment , Decision aid , Antipsychotic treatment , Hyperlipemic treatment pp.75-83

発行日 2018年1月15日 Published Date 2018/1/15

DOI https://doi.org/10.11477/mf.1405205526

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抄録　単科精神科病院入院中の高齢統合失調症患者7名を対象に，抗精神病薬と脂質異常症治療薬の医療同意能力の異同を調べた結果，脂質異常症治療薬に比して抗精神病薬で「論理的思考」「結果の推測」の成績が有意に高かった。デシジョン・エイドの使用によって各医療同意能力レベルや医療同意能力のどの要素が改善するのかを検討したところ，抗精神病薬治療で「疾患の理解」「代替治療の理解」，脂質異常症治療薬では「理解」「治療の理解」「治療のメリットとデメリット」「代替治療の理解」「治療の認識」で，有意に成績が改善した。高齢統合失調症患者のワーキングメモリーの弱さを補うことが，医療同意能力における理解の改善に影響している可能性が考えられる。

　OBJECTIVE：To clarify the difference between the consent capacity to antipsychotic treatment and hyperlipemic treatment, and the effect of the decision aid, the visual teaching material, on consent capacity.

　METHODS：We recruited older institutionalized patients with chronic schizophrenia under treatment or treatment plan of hyperlipidemia(n＝7). Baseline measures included the neurocognitive tests and brief psychiatric rating scale and the MacArthur Competence Assessment Tool for Treatment(MacCAT-T). The order of capacity assessment was randomly assigned to remove an order effect. We readministered the MacCAT-T with the decision aid one month later. The differences of the score in the MacCAT-T between treatments and improvement of the score of the MacCAT-T by using the decision aid were analyzed using t test. The study was approved by the Ethics Committee of Kyoto Prefectural University of Medicine.

　RESULTS：“Reasoning”. and “Comparison of the result” scores in the MacCAT-T were significantly higher in antipsychotic treatment than hyperlipemic treatment. Furthermore, “Understanding of the disease” and “Understanding of the substitute treatment” score in antipsychotic treatment, and “Understanding”, “Understanding of the treatment”, “Benefits and disadvantages of the treatment”, “Understanding of the substitute treatment” and “Recognition of the treatment” scores in hyperlipemic treatment were significantly improved by using the decision aid.

　CONCLUSION：Better reasoning in antipsychotic treatment may reflect that the treatment effect is easy to recognize in the antipsychotic treatment than hyperlipemic treatment. The decision aid may help their understanding of the treatment and the substitute treatment through the compensation of working memory deterioration.