スーパー救急病棟における措置入院患者の現状と課題

Current Status and Issues of Involuntary Admission in the Super Emergency Ward

抄録　昭和大学附属烏山病院は精神科救急入院料算定病棟(スーパー救急病棟)を2病棟有し，措置入院患者を多数受け入れている。今回筆者らは2010年から2014年の5年間に当院スーパー救急病棟に入院した全患者2,326例の診療録を調査し，措置入院患者392例の臨床的特徴について検討を行った。その他の群と比較し措置入院群においては，男性の比率が高率で平均年齢が低く，入院回数が少なかった。隔離室とHaloperidol点滴の使用率が高い一方で，ECTの使用率，自宅退院率は低かった。診断的には，F1圏，F2圏，F6圏が高率で，F3圏，F4圏，F8圏が低かった。措置入院の中には医療観察法の要件を満たすものも認められ，措置入院が司法精神医療の一部を担っている実態が示された。

　Showa University Karasuyama Hospital is an acute care psychiatric hospital and has two wards, called super-emergency wards, which charge special fees and accept patients of psychiatric emergencies, including involuntary admitted patients. In this study, we investigated clinical characteristics of the involuntarily admitted patients by performing retrospective chart reviews of all 2326 patients who were admitted to the two super-emergency wards between the years 2010 and 2014. In total, 392 patients were involuntarily admitted, and when compared to patients who were admitted voluntarily or with legal guardian consent under the Mental Health and Welfare Law, there were significantly more males than females, the average age was younger, and number of previous hospitalizations was less. Moreover, involuntary admission was associated with higher rate of isolation room usage, haloperidol infusion, lower rate of electroconvulsive therapy performed and home-discharge. In lights of diagnosis, F1, F2, and F6 of ICD-10 criteria were at high rates whereas F3, F4, and F8 were at low in involuntarily admitted patients, in comparison to patients admitted voluntarily or with legal guardian consent. Furthermore, several cases met the criteria for Medical Treatment and Supervision Act, highlighting the issues of involuntary admissions covering part of forensic psychiatry practice.