咽喉頭熱傷により嚥下障害をきたした統合失調症の1例

Rehabilitative management of dysphagia caused by laryngopha-ryngo-burn in a patient with schizophrenia : a case report

　精神科病院入院中に咽喉頭熱傷による摂食・嚥下障害を呈した統合失調症症例に，言語聴覚士が集中的な摂食・嚥下リハビリテーションを施行し，良好な経過を得た．本症例の摂食・嚥下機能が比較的早期に改善し，安全な経口摂取が可能になった要因として，①救急病院での適切な処置，②病院間の連携，③嚥下造影検査の反復，④症例の年齢，⑤精神症状への対応，⑥言語聴覚士を中心とした職種間連携，が考えられる．

　精神疾患症例では精神症状の動揺や抗精神病薬の種類・量が摂食・嚥下機能にも影響を与えることがあり，摂食条件の決定や介助方法を症例に応じて慎重に判断していく必要がある．精神疾患症例に対する摂食・嚥下リハビリテーションに際しては，言語聴覚士が精神科医療に対する正しい知識や理解をもち，他職種との連携を綿密にはかりながらリハビリテーションを行うことが重要である．

　Swallowing functions are likely to be affected by psychological manifestations and the type/dose of anti-psychotic agents; therefore, the management approach to dysphagia in psychopathic cases should be determined cautiously.　Here we report a case of male schizophrenic patient having dysphagia caused by severe laryngopharyngo-burn with hot water, who subsequently received an emergency tracheotomy due to the advancing upper airway obstruction.　An intensive dysphagia rehabilitation program by the multidisciplinary team led by a speech-language-hearing therapist (SLHT) was undertaken during the immediate post-remission period and resulted in a relatively swift improvement in his swallowing function.　Possible reasons for this fast recovery are presented and discussed, including such factors as appropriate treatment during the acute phase, inter-hospital cooperation, repeated reviews with the video fluorography, young age, psychological condition, and SLHT-led multidisciplinary cooperation.