長期入院統合失調症患者の生活機能と症状の関連

Relationship between functioning and psychiatric symptoms in long-term inpatients with schizophrenia

要旨：本邦の1年以上入院中の統合失調症患者は約13万人である．本研究の目的は長期入院統合失調症患者の生活機能と症状の関連を明らかにすることである．73名の入院患者を対象として生活機能の評価に精神科リハビリテーション行動評価尺度（以下，Rehab），精神症状の評価に陽性・陰性症状評価尺度（以下，PANSS）を用いた．結果，Rehab全般的行動はPANSS陰性尺度との間に相関を認め（r_s＝0.49，p＜0.001），生活機能が低いほど陰性症状が重度であると示唆された．Rehab逸脱行動はPANSS各得点との間に相関を認めなかった．逸脱行動ではなく全般的行動に焦点化した治療的介入は，長期入院統合失調症患者の陰性症状改善に寄与する可能性がある．

　In Japan, there are about 130,000 inpatients with schizophrenia who have been hospitalized for more than a year. They experience continuous psychiatric symptoms and reduced functioning. Several studies on the relationship between functioning and psychiatric symptoms have failed to reach a definite conclusion. This study aimed to examine the relationship between functioning and psychiatric symptoms in long-term schizophrenic inpatients. The participants were 73 inpatients with schizophrenia diagnosed using the ICD-10 who had been hospitalized more than a year. Functioning and psychiatric symptoms were measured using the Rehabilitation Evaluation Hall and Baker (Rehab) and the Positive and Negative Syndrome Scale (PANSS), respectively. A correlational analysis was conducted with these scores. The ethical review board of a psychiatric hospital approved this study. There was a significant correlation between total general behavior scores for the Rehab and the negative scale scores for the PANSS (r_s＝0.49, p<0.001). No significant correlation was observed between total deviant behavior scores for the Rehab and any of the PANSS scores. Long-term inpatients with schizophrenia who have lower functioning might have more severe negative symptoms. Occupational therapy focusing on patients' general behavior may be more crucial than other therapies focusing on deviant behavior, and could contribute to improving their functioning as well as psychiatric symptoms.