救急病院における自殺研究—服薬自殺未遂患者の検討

Research into Suicidal Patients Treated at An Emergency Hospital: a study of attempted suicides through drug overdosage

　【抄録】　3年間に都立広尾病院救急外来を受診した自殺および自殺企図患者255例中，薬物手段群は108例（42.4％）であった。薬物手段群では，①40歳未満の女性で，②神経症・人格異常圏であり，③過去に自殺未遂歴があることが多いという特徴があった。服薬物を内容別にみると，医師から処方された睡眠導入剤を中心とする向精神薬を用いたものが55.6％を占めた。市販薬では，プロムワレリル尿素剤の使用が目立った。精神分裂病圏の場合，幻聴や妄想などの病的体験に基づいて自殺企図したもの（病的体験群）と，社会復帰の過程で病気や将来を苦にして自殺を企図したもの（悲観群）に分けられたが，悲観群が過半数を占めた。躁うつ病圏の場合，訴えの少なさゆえに，精神科に依頼がされないまま退院となった例が4例あった。神経症・人格異常圏の患者の多くで情緒不安定，衝動的，他罰的な傾向を認め，治療者が患者に振り回され治療に苦心することが多く，医療者側の話し合いの場が心要とされた。

　In order to classify the psychopathology of people who had attempted suicide by drug over-dose, a study was made of cases presented at an urban emergency center.

　One hundred and eight (42.4%) of the 255 patients seen at the emergency center of Tokyo Metropolitan Hiroo General Hospital over a three-year period for attempted suicide had over-dosed on medication. 85.2% of this number were females, with 81.5% of the females under 40 years of age. 32.4% of the total number of those who had attempted suicide by drug overdose were given an ICD-9 diagnosis of neurotic disorder or personality disorder and 25% had made prior attempts. Only 14.3% of the those who had attempted suicide by methods other than drug overdose received these diagnoses, and only 12.2% had made prior attempts.

　Sixty (55.6%) patients had overdosed on prescribed tranquilizers, while 25% used over-the-counter drugs. Bromvalerylurea overdose was noted to be particularly common.

　14.8% of the cases were diagnosed as schizophrenic. Of these schizophrenics, there were those who had attempted suicide because of acute psychotic symptoms such as auditory hallucinations and delusions (symptomatic group, 37.8%), and those who had attempted suicide because of distress resulting from concern over the future of their condition (pessimistic group, 62.2%). There were four overdose patients with affective symptomatology who were discharged without being seen by a psychiatrist because they seemed to lack overt symptoms. Emotional instability, impulsiveness, and blaming others were seen in most patients with neurosis or personality disorders. These patients tended to manipulate their care givers to such an extent that it was difficult to treat them. The authors concluded that an interdisciplinary caseconference on suicide would greatly enhance the ability to care for these patients.