Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：日本うつ病学会・日本認知療法・認知行動療法学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Little is known about how behavioral health (BH) conditions affect health care costs of patients with cancer in Japan. OBJECTIVE: The purpose of this study is to evaluate the magnitude of general medical claims expenditures for individuals with cancer who use or do not use BH services in Japan. METHODS: The study used a health insurance claims database for more than 3 million enrollees in Japan. All health plan enrollees (18 y or older) who had tumors without metastasis or metastatic solid tumors defined by the Charlson Comorbidity Index were included in the study (n = 20,260). Measurements included total claims expenditures for BH and medical services. RESULTS: The proportion of enrollees using BH services was 12.8%. BH service users accounted for 17.7% of total health service spending. Mean annual cost of total health care services were 1.5 times higher in BH users than those with no BH use, whereas the median was 1.8 times higher. Mean annual medical cost alone for BH users was 1.3 times higher than that for non-BH users, whereas the median was 1.5 times higher. CONCLUSIONS: The findings suggest the importance for the Japanese medical system to address BH needs of patients with cancer and introduce fiscal efficiencies to cancer care. Strategic implementation of effective integrated care services for patients with cancer should be considered in Japan.

DOI： 10.1016/j.psym.2020.06.008

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To evaluate the magnitude of general medical claims expenditures (ie, medical service use) for individuals who use and do not use behavioral health (BH) services in the Japanese free-access medical insurance system to determine if BH patients use substantially more health services, as has consistently been reported in the United States. STUDY DESIGN: Retrospective comparison of Japanese occupation-based total health services use for enrollees with and without comorbid BH conditions. METHODS: The study used a health insurance claims database for more than 3 million enrollees in Japan. All health plan enrollees (18 years and older) who had at least 1 diagnosis of a chronic medical condition were included in the study (N = 192,613). Measurements were total claims expenditures for BH and medical services. RESULTS: The proportion of enrollees using BH services was 14.3%. BH service users accounted for 21.1% of total health service spending. Annual total costs of BH service users were 1.6 times higher than those of non-BH users. Annual medical costs of BH users were 1.3 times higher than those of non-BH users. CONCLUSIONS: The results of this Japanese cohort study show that patients with concurrent BH conditions and chronic medical illnesses have substantially lower total health care costs than numerous studies have demonstrated in US populations. This is perhaps in part due to the integration of medical and BH claims payment and care delivery in Japan, an approach that the US health system may wish to consider testing.

DOI： 10.37765/ajmc.2020.43488

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The Japanese Psycho-Oncology Society and Japanese Association of Supportive Care in Cancer recently launched the clinical practice guidelines for delirium in adult cancer patients. The aim of the guidelines was to provide evidence-based recommendations for the clinical assessment and management of delirium in cancer patients. This article reports the process of developing the guideline and summarizes the recommendations made. METHODS: The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multidisciplinary members, formulated nine clinical questions. A systematic literature search was conducted to identify relevant articles published prior to through 31 May 2016. Each article was reviewed by two independent reviewers. The level of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development and Evaluation system. The modified Delphi method was used to validate the recommendation statements. RESULTS: This article provides a summary of the recommendations with rationales for each, as well as a short summary. CONCLUSIONS: These guidelines will support the clinical assessment and management of delirium in cancer patients. However, additional clinical studies are warranted to further improve the management of delirium.

DOI： 10.1093/jjco/hyaa003

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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DOI： 10.1176/appi.neuropsych.18020024

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PHYSICIANS POSTGRADUATE PRESS  

Objective: No highly effective pharmacologic interventions to prevent delirium have been identified. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the prevention of delirium.
Methods: We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more. Seventy-two patients were randomly assigned using the sealed envelope method to receive suvorexant (15 mg/d; 36 patients) or placebo (36 patients) every night for 3 days. The primary outcome measure was incidence of delirium as determined by the DSM-5. Trained psychiatrists assessed for delirium.
Results: We found that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (0% [n/N = 0/36] vs 17% [6/36], respectively, P = .025). Comparison by log-rank test also showed that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (chi(2) = 6.46, P = .011). Analysis of variance revealed a tendency for main effect of treatment (F = 3.79, P = .053) on the sleep-wake cycle disturbance score (item 1) of the Japanese version of the Delirium Rating Scale-Revised-98 (DRS-R-98-J). There were no significant differences in adverse events.
Conclusions: Suvorexant administered nightly to elderly patients admitted for acute care may provide protection against delirium. Larger studies are needed to show the potential of suvorexant to improve the circadian core domain of delirium. (C) Copyright 2017 Physicians Postgraduate Press, Inc.

DOI： 10.4088/JCP.16m11194

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CAMBRIDGE UNIV PRESS  

Background: There is little expert consensus as to which drugs should comprise the first-line pharmacological treatment for delirium. We sought to assess experts' opinions on the first-line oral and injection drugs for delirium associated with a diverse range of clinical features using a rating-based conjoint analysis.
Methods: We conducted a cross-sectional study. We mailed a questionnaire to all consultation-liaison psychiatrists/educators certified by the Japanese Society of General Hospital Psychiatry.
Results: Of 136 experts (response rate: 27.5%), more than 68% recommended the use of risperidone or quetiapine administered orally for hyperactive delirium, except in patients with comorbid diabetes and renal dysfunction. More than 67% recommended the use of haloperidol administered intravenously for hyperactive delirium if an intravenous line has been placed. No oral or injection drugs were recommended by over half of experts for treatment of hypoactive delirium with any clinical features.
Conclusions: In the absence of a definitive treatment trial, there are both areas of agreement and a lack of consensus regarding the first-line drug. Efforts are needed to routinely collect information that would allow a comparison of the effectiveness and safety of various drugs in real-world clinical practice.

DOI： 10.1017/S1041610215002446

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Language：English   Publisher：AMER MEDICAL ASSOC  

DOI： 10.1001/jama.2015.8522

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：QUADRANT HEALTHCOM INC  

BACKGROUND: The financial and treatment challenges of complex patients must be addressed with adequate assessment and evaluation. The INTERMED complexity instrument (INTERMED) has been developed for this purpose, but to date has not been used retrospectively. The current study represents a retrospective validity investigation of INTERMED with patients with substance use disorder comorbid with other psychiatric and medical conditions (triple diagnoses). Such patients were expected to generate high complexity scores on the INTERMED instrument.
METHODS: Information on 66 patients with triple diagnoses was submitted to the INTERMED complexity grid. These data were subjected to cluster analysis and other analytic procedures.
RESULTS: Total INTERMED scores reflected elevated complexity for patients with triple diagnoses. As a group, they represented a single cluster of complex patients.
CONCLUSIONS: The validity of the INTERMED complexity assessment was corroborated in relation to retrospective data. In addition to elevations in the biological domain that hospital personnel typically confront, findings related to coping deficiencies and problems in living conditions were noteworthy in requiring comprehensive interventions.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Psychiatric Association  

Principal components analysis applied to the Delirium Rating Scale-Revised-98 contributes to understanding the delirium construct. Using a multisite pooled international delirium database, the authors applied confirmatory factor analysis to Delirium Rating Scale-Revised-98 scores from 859 adult patients evaluated by delirium experts (delirium, N=516
nondelirium, N=343). Confirmatory factor analysis found all diagnostic features and core symptoms (cognitive, language, thought process, sleep-wake cycle, motor retardation), except motor agitation, loaded onto factor 1. Motor agitation loaded onto factor 2 with noncore symptoms (delusions, affective lability, and perceptual disturbances). Factor 1 loading supports delirium as a single construct, but when accompanied by psychosis, motor agitation’s role may not be solely as a circadian activity indicator.

DOI： 10.1176/appi.neuropsych.13110345

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Increasing awareness of mental illness's impact on medical and psychiatric health has accelerated global efforts to integrate medical and behavioural health services. As the field of integration has advanced, numerous integrated programmes have been implemented. In examining the impact of these programmes, it is important to maintain a standardized vocabulary to describe the various components of their integration. Additionally important is examination of how these programmes impact elements of patient care and the healthcare system. Specifically, what value do they bring? This article will discuss the importance of carefully assessing the value integrated services bring to patients, and questioning whether they do so in ways in which today's segregated world of medical and behavioural health cannot. This article will also explore the various settings in which medical and behavioural integration can bring added value.

DOI： 10.3109/09540261.2014.964189

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objective: Deliriumin the intensive care unit (ICU) is recognized as a major public health problem. Few Japanese outcome studies have been reported. The purpose of the study was to investigate the hospital outcomes of ICU delirium in a Japanese general hospital.
Methods: Patients were drawn from consecutive admissions to an ICU at a tertiary care university hospital. Delirium assessments were conducted using the Intensive Care Delirium Screening Checklist (ICDSC). The following information was recorded: age, sex, the reason for ICU admission, the ICDSC scores, the COmplexity PRediction Instrument (COMPRI) scores, the length of stay (LOS) in the ICU, the total hospital LOS, hospital outcomes and social worker's consultation.
Results: Of the 126 patients who were evaluated, 35 (27.8%) developed delirium during the ICU stay. Older age and biopsychosocial vulnerability assessed by the COMPRI were risk factors of ICU delirium. ICU delirium was a predictor of increased mortality and associated with prolonged ICU and hospital LOS. ICU delirium was an independent risk factor for having social worker's consultation after ICU discharge.
Conclusions: ICU delirium is associated with worse outcomes including mortality and LOS in Japan. ICU delirium is independently associated with further social worker's consultations, suggesting that early proactive social worker's intervention may be beneficial for the patients with ICU delirium. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.genhosppsych.2014.09.006

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Language：English   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

DOI： 10.1016/j.jpsychores.2014.06.018

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER MEDICAL ASSOC  

IMPORTANCE No highly effective interventions to prevent delirium have been identified.
OBJECTIVE To examine whether ramelteon, a melatonin agonist, is effective for the prevention of delirium.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, rater-blinded, randomized placebo-controlled trial was performed in intensive care units and regular acute wards of 4 university hospitals and 1 general hospital. Eligible patients were 65 to 89 years old, newly admitted due to serious medical problems, and able to take medicine orally. Patients were excluded from the study if they had an expected stay or life expectancy of less than 48 hours.
INTERVENTIONS Sixty-seven patients were randomly assigned using the sealed envelope method to receive ramelteon (8 mg/d; 33 patients) or placebo (34 patients) every night for 7 days.
MAIN OUTCOMES AND MEASURES Incidence of delirium, as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).
RESULTS Ramelteon was associated with a lower risk of delirium (3% vs 32%; P = .003), with a relative risk of 0.09 (95% CI, 0.01-0.69). Even after risk factors were controlled for, ramelteon was still associated with a lower incidence of delirium (P =.01; odds ratio, 0.07 [95% CI, 0.008-0.54]). The Kaplan-Meier estimates of time to development of delirium were 6.94 (95% CI, 6.82-7.06) days for ramelteon and 5.74 (5.05-6.42) days for placebo. Comparison by log-rank test showed that the frequency of delirium was significantly lower in patients taking ramelteon than in those taking placebo (X-2 = 9.83; P =.002).
CONCLUSIONS AND RELEVANCE Ramelteon administered nightly to elderly patients admitted for acute care may provide protection against delirium. This finding supports a possible pathogenic role of melatonin neurotransmission in delirium.

DOI： 10.1001/jamapsychiatry.2013.3320

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS INC  

The internal consistency reliability of a measure can be a focal point in an evaluation of the potential adequacy of an instrument for adaptation to another cultural setting. Cronbach's alpha (alpha) coefficient is often used as the statistical index for such a determination. However, alpha presumes a tau-equivalent test and may constitute an inaccurate population estimate for multidimensional tests. These notions are expanded and examined with a Japanese version of a questionnaire on nursing attitudes toward suicidal patients, originally constructed in Sweden using the English language. The English measure was reported to have acceptable internal consistency (alpha) albeit the dimensionality of the questionnaire was not addressed. The Japanese scale was found to lack tau-equivalence. An alternative to alpha, "composite reliability," was computed and found to be below acceptable standards in magnitude and precision. Implications for research application of the Japanese instrument are discussed.

DOI： 10.1177/1073191112444921

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

ObjectiveAttention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting.
MethodsA prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events.
ResultsAmong 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global ImpressionsImprovement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1week in more than half of the patients (54%).
ConclusionsIn the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk. (c) 2013 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

DOI： 10.1002/gps.3999

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Purpose: Few studies looking for an effective biomarker to predict delirium have been performed. This study was designed to investigate whether a change in inflammatory status, indicated by blood natural killer (NK) cell activity, predicts delirium.
Methods: This prospective study, performed in 4 university and 1 general hospital from September, 2011 to October, 2012, included 29 patients. Eligible patients were 65-89 years old, newly and emergently admitted. Patients were assessed daily, up to 7 days, for occurrence of DSM-IV-defined delirium. The main outcome measure was change in blood NK cell activity between the first and second mornings after admission.
Results: The mean change in blood NK cell activity on the second morning, compared to the first morning, in patients developing delirium (n = 9) was significantly greater than that in patients without delirium (n = 20) (6.0% [SD 8.4] vs. -1.4% [9.0], respectively, t = 2.10, P = 0.045). Significant difference between the groups was still found after adjusting for age, the history of previous delirium, and the Clinical Dementia Rating score (F = 6.63, P = 0.017). Of note is that 8 of 9 (89%) patients developing delirium had increased blood NK cell activity, as did only 8 of 20 (40%) patients without delirium, giving measurement of this parameter, for distinguishing the two groups, a sensitivity of 89%, specificity 60%, positive predictive value 50%, negative predictive value 92%, positive likelihood ratio 2.22, and negative likelihood ratio 0.19. When combining this predictor with another predictor, a Delirium Rating Scale-Revised-98 severity score of 5 or more at baseline, positive and negative likelihood ratios were 7.80 and 0.24, respectively.
Conclusion: Increase in blood NK cell activity may be associated with developing delirium. Further studies including larger numbers of patients are needed to justify the preventive use of drugs for patients meeting criteria for both predictors. (C) 2013 The Authors. Published by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.pnpbp.2013.09.008

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS INC  

Objective: This study was undertaken to investigate non-psychiatric physicians' diagnoses of hypothetical patients in clinical scenarios with comorbid medical and psychiatric disease in Japan. Methods: The non-psychiatric physicians were asked to diagnose eight clinical scenarios describing several typical behavioral health problems in the medical settings. Results: A total of 155 non-psychiatric physicians participated. Many physicians had problems correctly diagnosing depression and hypoactive delirium with medically ill patients. Conclusions: It is time to incorporate new efficient and effective approaches, such as collaborative care system and proactive delirium prevention programs, to improve overall behavioral health diagnosis and treatment, rather than relying on the rapid recognition of behavioral health problems in primary care/general medical settings.

DOI： 10.2190/PM.47.1.f

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BACKGROUND: Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. AIMS: The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. METHOD: In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. RESULTS: It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. CONCLUSION: It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.

DOI： 10.1027/0227-5910/a000268

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objective: To confirm the existence of the proposed three-core symptom domains in delirium by analyzing a dataset of nondemented adults using selected core symptoms as measured by the Delirium Rating Scale-Revised-98 (DRS-R98) scale. Methods: Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of proposed delirium core symptoms were conducted in a pooled international dataset of 592 delirious and nondelirious patients using DSM-IV criteria from 14 studies with comparable methodologies. Using DRS-R98 categorization, 445 had either subsyndromal or full delirium and comprised the delirium group. The dataset was divided into three independent random subsamples to perform a stepwise analysis. First we performed EFA in 100 cases to delineate latent factor loadings of DRS-R98 items selected to represent the three-core domains (circadian, higher level thinking, and cognitive). These items were then assessed using CFA-modeling (n = 246) followed by a CFA-validation (n = 246). Reliability and goodness of fit of these two CFA were assessed statistically. Results: DRS-R98 items representing the proposed delirium core symptoms loaded onto one factor in the EFA, supporting their core nature. The two CFA confirmed the nature of this core factor as comprising three core domains where DRS-R98 items each loaded with high values (>0.7) onto their corresponding core domain (circadian, higher level thinking, and cognitive) with good fit and reliability). Attention was DRS-R98 item with the highest loading in CFA, followed by thought process, and then by sleep-wake cycle and motor behavior. Conclusions: Our EFA and CFA confirm and validate the proposed three-core domains of delirium, where symptoms were highly related to the domain that they were hypothesized to represent. These domains are consistent with delirium being a state of impaired consciousness, and should be considered necessary to assess whether in clinical or research settings.

DOI： 10.1016/j.psym.2012.06.010

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Language：English   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/pcn.12004

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Aim: Antipsychotic medications have frequently been regarded as the treatment of choice for delirium. This study examined the clinical efficacy of risperidone for the treatment of delirium in cancer patients, combined with a repeated assessment of underlying medical severity levels. Methods: The study included consecutive referrals of 29 delirious cancer patients (mean age, 68.9 +/- 12.5 years; male, 69%) to the psychiatric consultation service. Risperidone was given orally once per day (mean dosage, 1.4 +/- 1.3 mg/day). Study participants were assessed using quantitative standardized scales of cognitive function, delirium, and physical impairment at baseline and at the end of the study (seventh day). Results: Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. The reduction of delirium severity occurred in 79% of the patients. Changes in delirium severity were unrelated to age, gender, general cognitive dysfunction, or to severity of attendant medical conditions. In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. Conclusions: Risperidone with routine clinical management is effective in the treatment of delirium in advanced cancer patients, independent of changes in the underlying medical condition.

DOI： 10.1111/j.1440-1819.2012.02346.x

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DOI： 10.1111/j.1440-1819.2012.02369.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Objective: There is no consensus definition for the phenotype of subsyndromal delirium (SSD), a subthreshold state to full delirium. Without an a priori definition we applied advanced analytic techniques to discern SSD.
Method: We pooled Delirium Rating Scale Revised-98 (DRS-R98) data from 859 DSM-IV diagnosed nondemented delirious adults and nondelirious controls collected by investigators in 7 countries. Discriminant analyses defined an SSD group that was then compared to Nondelirium and Delirium groups.
Results: SSD (n = 138) had intermediate DRS-R98 item seventies between Delirium (n = 497) and Nondelirium (n = 224) groups, where groups significantly differed on all DRS-R98 items (ANOVA p<.001) except delusions. Discriminant analysis found SSD phenomenologically closer to Delirium than Nondelirium. Using full multinomial logistical regression, SSD was distinguished from Nondelirium by temporal onset, sleep-wake cycle, perceptual disturbances, motor retardation, delusion, affective lability, and all cognitive items; SSD was similar to Delirium in thought process, language, motor agitation or retardation, sleep-wake cycle, all cognitive items, fluctuation and physical disorder. The multivariate model correctly classified 94.2% of Nondelirium, 75.4% of SSD and 97.2% of Delirium subjects. Binary logistic regression of six core domain symptoms (sleep-wake cycle, thought process, language, attention, orientation, and visuospatial ability) together were found as highly differentiating of SSD from Nondelirium, which correctly classified almost 80% of SDD.
Conclusions: SSD is intermediate in severity between nondelirious controls and full syndromal delirium, but its phenotype is more like delirium. Core domain delirium symptoms present at milder severity in SSD should be evaluated further for utility in detecting and managing SSD, preventing delirium, and possible inclusion in DSM-V. (C) 2012 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpsychores.2012.04.010

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Objective: The aim of this study was to examine the attitudes among Japanese nurses together with their perceived need for training in relation to understanding the nature of suicidal behavior and preventive strategies.
Methods: The Understanding Suicidal Patients scale together with additional questions reflecting training and the psychiatric treatment of suicide attempters were administered.
Results: A total of 323 nurses attended this study. Overall, the nurses thought patients who attempted suicide were not treated well. The nurses who worked in the psychiatric unit or had the experience in psychiatric nursing had more favorable attitudes toward suicidal patients and viewed themselves as having more relevant skill training in dealing with suicidal patients than those who did not. The nurses who worked at emergency care/intensive care unit were less likely to understand suicidal patients, and were less inclined to be sympathetic and to verbally interact with suicidal patients concerning their problems. The nurses who have confidence in the psychiatric care of suicidal patients, confidence in their own skills, and have a need for more training had the more positive attitudes.
Conclusions: The results suggest that less favorable attitudes may to some extent be the result of lack of knowledge regarding suicidal patients. Future studies should focus on the evaluation of educational experiences on attitudes and skill acquisition of nurses. (C) 2011 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.genhosppsych.2011.02.005

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Objective: The intent of this study was to establish the inter-rater reliability and the internal consistency of the Japanese version of the INTERMED. Methods: The study included a series of patients referred to psychiatric consultation service or palliative care service. The study participants were independently scored using the INTERMED by the raters. Results: The INTERMED-Japanese version had high inter-rater reliability (intraclass correlation coefficient=0.98) and high internal consistency (alpha=.89). All four domains (biological, psychological, social, and health care domains) were positively correlated. Based on a cutoff score of 20/21, a kappa of 0.79 was found. Conclusions: The INTERMED is an easy and useful proactive biopsychosocial screening tool, which could be a reasonable utility under the current Japanese health care situations. Future studies focusing on the INTERMED utility in improving health care delivery for patients with complex biopsychosocial care needs has to be demonstrated in various medical settings in Japan. (C) 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpsychores.2010.02.006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

Background: Delirium is a common neuropsychiatric disorder in medical and surgical inpatients of all ages. It is associated with increased long-term mortality, longer length of hospital stay, poor functional recovery, and increased likelihood of nursing home placement. Objective: The aim of this study was to investigate the reliability and the validity of the Japanese translation of the Delirium Rating Scale, Revised-98 (DRS-R-98). Method: Psychiatric-consultation patients were assessed to compare groups of delirium, dementia, and non-delirium. Results: Mean Total and Severity scores significantly distinguished delirium from the other groups. The scale had high interrater reliability and high internal consistency. Mean Severity scores during delirium differed from the posttreatment scores. Stratum-specific likelihood ratios showed that the DRS-R98-J is a reliable diagnostic tool. Conclusion: This study indicates that the Japanese version of the DRS-R-98 has high reliability and validity, and is a useful tool for assessing delirium among Japanese medically ill populations. (Psychosomatics 2010; 51: 425-431)

DOI： 10.1176/appi.psy.51.5.425

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Objective: The goal of this clinical study was to examine the frequency and clinical features of pervasive developmental disorder (PDD) relative to suicide attempts by adolescents.
Method: Ninety-four adolescent patients tinder age 20 participated in this study; it was a consecutive study of individuals who had attempted suicide and had been hospitalized for inpatient treatment.
Results: Twelve of the 94 subjects (12.8%) were diagnosed with PDD. The ratio of males in the PDD group was higher than that in the non-PDD group (P=.017). There was a significant difference between the two groups regarding the rate of patients having mood or anxiety disorder (P=.037).
Conclusion: This study indicates that PDD should always be a consideration when dealing with adolescent suicide attempts. (C) 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.genhosppsych.2008.12.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

Aims: Although somatic diseases in psychiatric patients are increasing with the increase of the aged population, psychiatric wards in general hospitals in Japan have progressively been decreasing. The purpose of this cross-sectional study was to clarify whether psychiatric beds in general hospitals play sufficient roles in medical comorbidities of psychiatric patients or not.
Methods: This was a cross-sectional study performed all over Tokyo during the 2-month period from April to May 2007. The total number of patients who require admission due to both somatic and psychiatric diseases was investigated with their demographic and clinical characteristics.
Results: The total number of patients admitted to psychiatric beds in general hospitals for the above-mentioned reason was 326, while the number of patients who could not be admitted to them despite the same reason was 88. The rate of surgical diseases in the latter group was higher than that in the former group. In the latter group, diseases requiring orthopedic surgery (22%) and abdominal surgery (22%) were the most frequent, followed by gastrointestinal and hepatic diseases (8%), and gynecological diseases (7%). Patients who had attempted suicide were included more in the latter group than in the former group. Even in the former group, general hospitals could not respond to 34% of requests for emergency admission.
Conclusion: Psychiatric beds in general hospitals do not necessarily function for medical comorbidities in psychiatric patients, especially in severe and emergency cases. Not only the quantity but also the quality of psychiatric wards in general hospitals should be reconsidered.

DOI： 10.1111/j.1440-1819.2009.01978.x

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The authors examined the factors associated with referral errors in which the presence of delirium was ostensibly not recognized by medical staff personnel. Medical records of 541 University hospital patients consecutively referred for psychiatric consultation were scrutinized for extant delirium. The data indicated that a greater likelihood of a missed diagnosis was associated with younger age; referrals outside of family practice service; orientation as to person, place, and time; and a history of bipolar affective disorder or psychosis. The ramifications of failure to diagnose existing delirium include increased morbidity and mortality, longer length of hospital stay, and increased healthcare costs.

DOI： 10.1176/appi.psy.49.2.104

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

The authors investigated psychiatric consultation in two hospitals, one in the United States, the other in Japan. They examined similarities and differences, and drew inferences on possible cross-cultural values and/or temporary cultural conditions. As compared with the Japanese consultation patients, the Americans had more mood disorders, including anxiety and chemical-dependency problems, in respective diagnostic classifications. Patients in the United States also showed more acute as well as more serious chronic conditions. These differences may relate to disorder base-rates in the respective countries. In general, psychosocial problems emerged as ascendant in Japan, as compared with chemical-dependency difficulties among American patients. The results are discussed in terms of current conditions in Japan that affect the mental health professions, together with attempts by Japanese clinicians to protect collective mores by ascribing causation for disorders to the individual, rather than the societal conditions often invoked in the United States.

DOI： 10.1176/appi.psy.48.6.517

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objective: This study evaluates patient characteristics that might predict a missed diagnosis of delirium prior to being seen by a psychiatric consultant.
Method: Study participants were assessed using quantitative standardized scales of cognitive function, delirium and physical impairment.
Results: Referring service personnel missed the diagnosis of delirium in 46% of psychiatric consultations. Two factors were associated with their failure to identify delirium accurately: use of a past psychiatric diagnosis to explain delirium symptoms and the presence of pain. Symptoms of delirium and quantitative scale scores did not distinguish between patients with whom diagnosis had been missed and those with accurate diagnoses.
Conclusion: The consulting physicians of patients with delirium often incorrectly turn to past psychiatric diagnoses and/or are distracted by the presence of pain and, thus, fail to accurately diagnose delirium. (C) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.genhosppsych.2007.05.006

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Language：English   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

DOI： 10.1176/ps.2007.58.3.413

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Language：English   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

DOI： 10.1176/jnp.2007.19.1.90

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Language：English   Publisher：BLACKWELL PUBLISHING  

Several countries, such as the USA, inadvertently created a different behavioral health payment system from the rest of medicine through the introduction of diagnostic-related group exemptions for psychiatric care. This led to isolation in the administration and delivery of care for patients with mental health and substance abuse disorders from other medical services with significant, yet unintended, consequences. To insure an efficient and effective health-care system, it is necessary to recognize the problems introduced by segregating behavioral health from the rest of medical care. In this review, the authors assess trends in behavioral health services during the last two decades in the USA, a period in which independently managed behavioral health care has dominated administrative practices. During this time, behavioral health has been an easy target for aggressive cost cutting measures. There have been no clinically significant improvements in the number of adults receiving minimally adequate treatment or in the percentage of the population with behavior health problems receiving psychiatric care with the possible exception of depression. While decreased spending for behavioral health services has been well documented during this period, these savings are offset by costs shifted to greater medical service use with a net increase in the total cost of health care. Targeting behavioral health for reduction in health-care spending through independent management, starting with diagnostic procedure code or diagnostic-related group exemption may not be the wisest approach in addressing the increasing fiscal burden that medical care is placing on the national economy.

DOI： 10.1111/j.1440-1819.2006.01500.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

OBJECTIVE: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists.
DESIGN: Retrospective cost trends and 24-month cohort analyses.
SETTING: A Midwest health plan.
PARTICIPANTS: Over 250,000 health plan enrollees during 2000 and 2001.
MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications.
MAIN RESULTS: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted.
CONCLUSIONS: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.

DOI： 10.1111/j.1525-1497.2005.40099.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING ASIA  

The present study examines the characteristics of post-transplant patients compared with non-transplant patients seen by consultation psychiatrists. Medical records of 541 consecutive psychiatric consultation patients at a university teaching hospital in 2001 were reviewed. Of the 541 patients who were evaluated, 67 were post-transplant patients. Post-transplant psychiatric consultation is different in some aspects from other psychiatric consultation. Post-transplant patients suffer complicated medical, psychiatric, and social burdens.

DOI： 10.1111/j.1440-1819.2005.01326.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

The purpose of this study was to examine the factors affecting the timing of psychiatric consultations and length of stay in the current managed care era. It also assessed the relationships between the timing of consultations and demographic/clinical characteristics. Medical records of 541 consecutive psychiatric consultation patients at a university teaching hospital in 2001 were reviewed for demographic characteristics, lengths of stay, number of days from admission to consultation, specialty services requesting consultations, reasons for the referral given by the referring physicians, and all five axes of DSM-IV Earlier consultations independently predicted shorter lengths of stay. Delayed consultations were seen more often in women; surgical patients; those seen with a request to assess depression; and those seen with a diagnosis of adjustment disorder delirium, or no psychiatric disorder Delay in psychiatric consultations continues to be associated with longer lengths of stay in the current managed care environment. It is now possible that early detection strategies for high-risk patients with behavioral health problems in the medical setting, such as use of the INTERMED, may lead to reduction in delayed psychiatric consultations and thus shorter lengths of stay.

DOI： 10.1176/appi.psy.45.6.470

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Language：English   Publisher：BLACKWELL PUBLISHING ASIA  

Several reports emphasize the importance of differentiating between psychosis in schizophrenia and the psychotic form of narcolepsy. The failure to identify narcolepsy leads to the labeling of patients as refractory to standard treatments for schizophrenia and retards consideration of intervention for narcolepsy in which psychosis can improve with psychostimulant treatment. Psychosis in patients with narcolepsy can occur in three ways: (i) as the psychotic form of narcolepsy with hypnagogic and hypnopompic hallucinations; (ii) as a result of psychostimulant use in a patient with narcolepsy; and (iii) as the concurrent psychosis of schizophrenia in a patient with narcolepsy. The present case report describes a difficult-to-treat patient who likely had concurrent schizophrenia and narcolepsy. It then summarizes the literature related to the treatment of the three types of patients with psychosis associated with narcolepsy.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

A total of 496 patients were examined for suicidal ideation during the acute hospital period and at 3, 6, 12, and 24 months' follow-up after suffering either stroke, traumatic brain injury, myocardial infarction, or spinal cord injury. A total of 7.3% of patients had suicidal ideation during the in-hospital evaluation (acute-onset suicidal ideation), and 11.3% developed it during the chronic 3 to 24 month rehabilitation period (delayed-onset suicidal ideation). Compared with delayed-onset suicidal patients, acute-onset suicidal patients had more predisposing risk factors (i.e., personal psychiatric history and alcohol abuse/dependence) and less social support (i.e., lower frequency of being married). Both acute and delayed-onset suicidal ideation, however, were strongly associated with the existence of major depression and impaired social functioning. These findings suggest that the detection and appropriate treatment of depressive disorders and social isolation may be the most important factor in preventing suicide both during the acute and chronic period following life-threatening physical illnesses.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PSYCHIATRIC PRESS, INC  

Suicide is one of the leading causes of death in the community. The risk of suicide is greater among patients with physical illnesses than among the general population. This study was undertaken to evaluate the clinical characteristics and correlates of suicidal ideation in patients with acute life-threatening physical illnesses and to assess the duration of suicidal ideation. The study included a consecutive series of patients admitted with stroke, traumatic brain injury myocardial infarction, or spinal cord injury (n = 496). Study participants were administered a semistructured psychiatric interview as well as a series of standardized quantitative scales of mood, cognitive function, physical impairment, social ties, and social functioning. Follow-up evaluations of up to 24 months were also carried out. This study found that 36 (7.3%) patients with acute medical illness had clinically, significant suicidal ideation. The suicidal ideation occurred mostly among patients with major depression and sometimes in those with minor depression. About 25% of patients with major depression and acute physical illnesses developed suicidal ideation. After the improvement of depressive disorders, suicidal ideations were ameliorated. These findings suggest that the detection and treatment of depressive disorders is the most important factor in preventing suicide among this patient population.

DOI： 10.1176/appi.psy.42.5.382

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PSYCHIATRIC PRESS, INC  

This study compares the treatment of patients with comorbid medical and psychiatric illness admitted to a high-acuity (Type IV) integrated medicine and psychiatry inpatient program with patients having psychiatric symptoms on general internal medicine wards (IMWs). More patients in the Type IV program had agitation, suicidal ideation, or psychosis as psychiatric admission behaviors when compared to IMW patients. Medical symptom improvement was comparable in the two settings, whereas, psychiatric symptoms improved pd more in the Type IV Program than on the IMWs despite more significant illness and comparable lengths stay Integrated care on the Type IV unit allowed shorter total lengths of stay for medical patients with serious psychiatric illness than would have occurred had the traditional sequential approach to care been used The integrated Type IV medicine and psychiatry treatment program represents an efficient and effective process improvement in the way that medical patients with comorbid medical and psychiatric illness can be treated.

DOI： 10.1016/S0033-3182(99)71230-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

There has been increasing recognition of the importance of integrating physical and psychiatric cave under growing economic pressure. We conducted a survey of staff perception on psychiatric services in four general hospitals. The purpose of this study was to see differences among the staff in their recognition and expectation of the role of the psychiatric department and the need for psychiatric and other staff to work more closely together. Although 81% of psychiatrists recognized their role in acute psychiatry, only 42.6% thought that acute psychiatry was the most important role of psychiatry. Mooed disorders were recognized as a psychiatric category in 95.2% of psychiatrists and 54.8% of nonpsychiatrist physicians. Overall satisfaction with psychiatric services in psychiatric and other staff were 54.0% and 68.2%, respectively. Although 85.7% of psychiatrists answered that they supported staff in other departments that have psychiatric or psychological problems, only 53.5% of those staff in other departments were satisfied with their support. Staff in other departments expected psychiatric staff to establish consultation hotlines and to visit other departments regularly. Our results suggest that there are discrepancies between psychiatric and other staff in their perception of psychiatric services, and it is our belief that those gaps must be bridged for better collaboration in general hospitals. (C) 1999 Elsevier Science Inc.

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：ELSEVIER SCIENCE BV  

The Japanese National Health and Welfare Task Force Panel for the Role of General Hospital Psychiatry reported that a high priority in the general hospital setting is to establish a system of integrated medical and psychiatric treatment programs. Although there are some integrated medical and psychiatric treatment programs in Japan, the concept of high acuity type IV programs has not been tried. To facilitate the establishment of the high quality integrated medical and psychiatric treatment programs in Japan, it would be helpful for Japanese psychiatrists and their primary care colleagues to analyze a model case of the type IV program in the USA.
To establish the need and the benefit from establishing type IV treatment units, it is necessary to compare demographic, clinical and administrative characteristics and outcomes of patients with combined medical and psychiatric illness treated in a type IV program to patients treated on general medicine wards. The integrated type IV program represents an efficient and effective process improvement in the way that medical patients with combined medical and psychiatric illness can be treated. Involvement of both internal medicine and psychiatry facilitates a high acuity environment that increases the value of patient care. By adding the capabilities inherent in the type IV program, patients can be expected to have comparable improvement in medical illness and greater improvement of psychiatric illness than that provided on internal medicine wards yet to have similar lengths of stay even when more severe psychiatric illness is present. Such treatment reduces the cost of care for these complicated patients since concurrent rather than consecutive care can be provided.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BAYWOOD PUBL CO INC  

Objective: psychiatric patients presenting with polydipsia are often difficult to treat with standard psychiatric interventions. Pharmacological intervention was attempted in these patients based on the hypothesis that angiotensin II, a potent dipsinogen, may be involved in the drinking behavior of patients with polydipsia. Beta-blockers inhibit renin release land thus indirectly angiotensin II) by blocking beta receptors in the kidney. Methods: Three patients were identified as excessive water drinkers during their hospital admissions. All three patients were eunatremic but polydipsic at the time of study. Two of the three had histories of hyponatremia and required emergency medical treatment on more than one occasion. No patients had been controlled by strict fluid restriction. Trials of propranolol were initiated to control their water drinking. Results: After starting propranolol, two patients responded quickly. In one patient, fluid intake decreased from 2650 +/- 647 to 1577 +/- 361, p < .001. In the other, fluid intake decreased from over 7000 mi before starting propranolol to around 3000 mi. The mean noon body weight of the third patient, in whom it was not possible to document fluid intake or urine volume before and after administering beta-blocker, was 72.6 +/- 2.6 Kg and 66.0 +/- 1.0 Kg, respectively (p < .0001). Conclusions: These results suggest that propranolol may be useful for the treatment of polydipsia in patients with schizophrenia. Its efficacy could be related to inhibition of the renin-angiotensin system. Additional research using the controlled pharmacotherapeutic trials is required to confirm these findings.

DOI： 10.2190/QPWL-14H7-HPGG-A29D

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Although the need for an emergency psychiatry system is increasing in Japan because of a shift to providing psychiatric care from hospitalization to community-based services, little attention is being given to what the general population expects from the health care system. To ascertain the expectations of the general population about how emergency psychiatric cases should be handled, the authors distributed a questionnaire to 1000 people containing 12 characteristic psychiatric emergency cases. The results showed that most expected psychiatric care to be rendered in a general hospital. This was different from the opinion held by most mental health professionals who felt that mental health hospitals should be the core hospitals of emergency psychiatry. Although there was a higher expectation for police officers or paramedics to provide emergent psychiatric care, the general population expected less from public health centers which now provide mental health service in the community. To connect emergency psychiatry with the community the general hospital must play a larger role in the system through training programs for general hospital psychiatrists as well as nonpsychiatrist professionals, paramedics, and police officers. (C) 1997 Elsevier Science, Inc.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

The validity of observed depression as a criteria for major or minor depression was assessed among 301 patients with acute stroke. Patients who acknowledged a depressed mood or loss of interest (standard depression) were compared to patients who denied depression but were 'observed' to be depressed (non-standard depression) for the clinical correlates of depression. Although standard and non-standard major depressions had some clinical correlates such as increased frequency of female gender and prior psychiatric history, standard major depression patients had a significantly higher frequency of left hemisphere lesions than the non-standard major depression patients. These results support the validity of 'observed' depression as a criteria for major depression but also suggest the possibility that failure to report depressed mood may identify a condition with a different etiology than depression that is recognized and acknowledged. Observed depression, however, was not validated among patients with minor depression since there were no clinical or phenomenological differences from non-depression.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILLIAMS & WILKINS  

The clinical correlates of suicidal thoughts were examined among a group of 301 patients with acute stroke. A total of 20 patients (6.6%) had suicidal thoughts. Previous history of stroke was associated with suicidal thoughts. Suicidal thoughts, however, were not related to severity of physical impairment. Most patients with suicidal thoughts met criteria for major depression. Other risk factors included younger age, poor social support, sensory deficit, and impaired cognitive function. Patients with suicidal plans had depression characterized by social withdrawal and brooding and self blame. Early identification of risk factors including the existence of depression may lead to effective therapeutic intervention.

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DOI： 10.1176/jnp.8.4.442

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Three hundred one patients were examined for suicidal plans during the acute hospital period following stroke and at 3, 6, 12, and 24 months' follow-up. It was found that 6.6% of patients developed suicidal plans during the initial in-hospital evaluation (acute-onset suicidal plans) and 11.3% of patients developed suicidal plans at 3, 6, 12, or 24 months' follow-up (delayed-onset suicidal plans). The development of both acute and delayed-onset suicidal plans was strongly related to the existence of depressive disorders, especially major depression, and to a prior history of stroke. Acute-onset suicidal plans were also related to premorbid alcohol abuse. Acute-onset suicidal patients had more anterior lesion location and delayed-onset suicidal patients had more posterior stroke lesions. Delayed-onset suicidal plans were not related to alcohol abuse but tended to be associated with greater physical impairment and poorer social support during the acute poststroke period. These data suggest that the etiology of these two types of suicidal plans may be different with acute onset related to biological mechanisms and delayed onset related to psychological mechanisms.

DOI： 10.1017/S1041610296002931

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE PUBL CO INC  

Two hundred thirty-eight patients admitted consecutively to a critical cave unit through an emergency room were assessed prospectively for the presence of delirium. Thirty-eight patients (16%) developed delirium. Delirium occurred with equal frequency in all disease categories. The presence of abnormal head imaging which required medical intervention did not predict the development of delirium. The median delay between admission and the development of delirious was 4 days, however, one-fourth of the patients were delirious on the day Of admission. The patients with abnormal head imaging who required medical intervention had a higher frequency of onset of delirium on the first day compared with patients without. The delirium lasted a median of 5 days and resolved within a week in over 70% of patients. These results confirm that delirium is frequently present in patients who require acute critical care after emergency room evaluation. In this population, serious medical disease is a better predictor of the development of delirium than the presence of abnormal brain imaging which required medical intervention. Although delirious patients have longer lengths of stay, the presence of delirium does not predict higher mortality, as has been reported in other populations. This could be because delirious patients admitted to the critical care unit through the emergency room have fewer premorbid medical problems predisposing them to poor outcome.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILLIAMS & WILKINS  

Sixty patients with spinal cord injury were examined to assess major depression during the in-hospital period and at 3- and 6-month follow-up. Thirteen patients had depression during the initial in-hospital evaluation (acute onset depression) and eight had depression first diagnosed at either 3- or 6-month follow-up (delayed onset depression). Acute onset depression was related to the severity of impairment and premorbid history of psychiatric disorder, suggesting a psychological reaction to impairment or premorbid vulnerability as a possible mechanism for developing depression. Delayed onset depression was not related to severity of physical impairment but was associated with more rostral spinal injury, suggesting the possibility that neurophysiological response to injury more proximal to the brain may play a role in delayed onset depression. These data also suggest that the etiology and pathophysiology of these two types of depression may be different.

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DOI： 10.1176/jnp.6.3.237

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Consultation-liaison (C-L) psychiatry has been developing for the past 10 years as a new clinical service field in Japan. Although this kind of service had been practiced previously, it was not recognized as an independent clinical field. Still in the developing phase, clinical research in C-L psychiatry has been reported, although its quality has been variable. The authors describe the development and a typology of C-L psychiatry (seven types) in Japan. This article reports time spent on C-L psychiatry activity in a general hospital. Although C-L psychiatry requires much time and labor, hardly any of the C-L psychiatry services are reimbursed in the Japanese insurance system. The authors propose a ''new department'' as one option to continue providing C-L psychiatry service to general hospital patients and for further development of C-L psychiatry in Japan.

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Language：Japanese   Publisher：(一社)日本がん看護学会  

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OBJECTIVE: The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. METHODS: This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. The decision to take medication was left to the discretion of each patient. The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days. RESULTS: Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0%; odds ratio [OR] = 0.48;, 95% CI, 0.29-0.80; P = .005). Similar results were found among 422 patients with delirium (39.9% vs 66.3%; OR = 0.36; 95% CI, 0.22-0.59; P < .0001). CONCLUSIONS: Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice.

DOI： 10.4088/JCP.19m12865

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00974&link_issn=&doc_id=20190902130091&doc_link_id=10.15106%2Fj_naika124_1975&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_naika124_1975&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)星和書店  

身体疾患治療現場でのうつ病の有病率は高い。うつ病が合併することで、身体疾患の臨床予後ばかりではなく、医療経済的にも悪影響が生じる。そのため、身体疾患治療現場でのうつ病治療システムの構築が進められている。身体疾患治療場面でうつ病のスクリーニングを行い、精神科に紹介するといった方策では効果は認められていない。精神医療の関与ならびにケースマネジメントを含んだ協働ケアの効果が報告されている。"効果的な"協働ケアを行うことで、臨床・医療経済的な予後の改善にもつながることが知られている。(著者抄録)

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Language：Japanese   Publisher：(株)ワールドプランニング  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本自殺予防学会  

自殺の重要な危険因子である自殺未遂について、サーベイランスシステムを用いた実態把握が国際的な課題となっている。わが国における自殺未遂の実態は、警察庁の「自殺統計」における"自殺者の自殺未遂歴の有無"や、消防庁の「救急・救助の現状」における"自損行為による救急搬送人員数"を主な指標としており、その手法は統一されていない。そこで、神奈川県川崎市では、効果的な支援の提供に向け自殺未遂の実態を体系的かつ明確に把握することを目的に、帝京大学医学部附属溝口病院が主管施設となり、健康福祉局ならびに消防局、3つの三次救急医療機関である川崎市立川崎病院、日本医科大学武蔵小杉病院、聖マリアンナ医科大学病院が協同で、川崎市内で発生した自損行為による救急搬送事例を前方視的に調査した。本稿では、"自殺企図"や"故意の自傷"に分類した結果を示すとともに、そこから見えてきた自殺未遂の実態把握の課題や意義について考察する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)じほう  

＜Key Points＞・薬剤がせん妄の直接因子となることが多い。・脳内アセチルコリン、ドパミン、グルクロン酸、ノルアドレナリン、GABAなどに影響を与える薬剤は危険性が高い。・多剤併用などではせん妄の危険性は増大する。・漫然と投与されているベンゾジアゼピン系薬剤は、せん妄の危険性を増大させる。・medication reviewを含めた多面的評価がせん妄予防に重要であり、薬剤師の貢献が期待される。(著者抄録)

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Language：Japanese   Publisher：(一社)日本睡眠学会  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(株)ワールドプランニング  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

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Language：Japanese   Publisher：(株)じほう  

せん妄は一般臨床で頻繁に認められる症候群である。せん妄は急性に出現する意識・注意・知覚の障害であり、症状は変動性であることが特徴である。一過性の病態と考えられていたが、いったん発症すると持続して身体予後や医療経済的予後に悪影響を及ぼすことがわかっている。せん妄の評価にあたっては発症に寄与する因子を背景因子、促進因子、直接原因に分ける考え方が臨床的に有用である。せん妄が発症した場合には、直接原因となる器質因が必ず存在している。特に、せん妄の原因となる薬剤(主にオピオイド、ステロイド、ベンゾジアゼピン系薬剤、抗コリン薬)に注目する必要がある。(著者抄録)

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Language：Japanese   Publisher：(株)へるす出版  

ヘリウムガスは無色,無味,無臭の気体であり,安全性が高い特性を利用して気球や小型飛行船の浮遊用ガスとして利用されている。近年,インターネットを通じて自殺手段が簡単に検索できる状況であり,ヘリウムガスを使用した自殺方法がネット上で話題となっている。われわれは,自殺企図によるヘリウムガス吸入で心肺停止をきたした症例を経験したので報告する。症例は30歳代の男性。ベッド上でビニール袋を被った状態で意識がないところを発見された。救急隊接触時は心停止であり,病院到着時も心停止であった。心肺蘇生を継続して心拍再開を得られた。頭部CTでは脳皮髄境界の不明瞭化を認めた。集中治療管理の甲斐なく来院後15時間で永眠された。近年,インターネットやマスコミを通じて自殺手段に関する情報を入手する傾向にあり,過去に練炭による一酸化炭素中毒での自殺や入浴剤とトイレ用洗剤による硫化水素での自殺が急増した時期がある。わが国ではヘリウムガスでの自殺例の報告はまだ少ないが,今後増加する可能性が考えられる。(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

＜ポイント＞せん妄症例をみたら,発症に寄与する因子を直接原因・背景因子・促進因子に整理するのが有用である.せん妄の直接原因として,特に使用薬剤の評価が大切である.促進因子への介入はせん妄予防において重要であるが,発症後にも非薬物療法として行う必要がある.せん妄の薬物療法として,抗精神病薬が勧められる.(著者抄録)

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Language：Japanese   Publisher：(株)星和書店  

患者の暴力に接する医療関係者は多い。とくに、救急医療や精神科医療では暴言・暴力に接したことのない医師者はほとんどいない。暴力の予防には、患者の情報を収集しておくのが最も効果的といわれている。最も暴力の危険性が高い患者は、過去に暴力の既往がある患者である。救急医療ならびに初診患者では困難であるが、これらの情報を外来スタッフ全体で共有しておくのが大切となる。患者評価により暴力の危険性が高まった場合には、まずはディエスカレーション法を試みる必要がある。ディエスカレーション法を行っても、自分が危険を感じた場合にはその場から避難するのも大切である。(著者抄録)

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Language：Japanese   Publisher：(株)エムイー振興協会  

「退院患者向け状態確認コール」システムを開発し、その臨床応用を開始した。本稿では、その概要を紹介し、臨床実用化への期待を述べた。(著者抄録)

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Language：Japanese   Publisher：医歯薬出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00060&link_issn=&doc_id=20161018010013&doc_link_id=issn%3D0039-2359%26volume%3D259%26issue%3D3%26spage%3D275&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D259%26issue%3D3%26spage%3D275&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)へるす出版事業部  

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Language：Japanese   Publisher：医歯薬出版(株)  

アルコール離脱症状の治療にはベンゾジアゼピン系薬剤が使用されてきた。しかし、身体疾患治療現場では、離脱症状は軽度であることが多い。介入がなくても2〜7日で自然に軽快することが多い。また、身体疾患治療現場で薬物介入が必要なアルコール離脱症例は、5〜20%程度と見積もられている。したがって、不必要なベンゾジアゼピン系薬剤による離脱症状予防・治療により、鎮静、転倒、呼吸抑制、せん妄などの好ましくない状況の危険性が高まる。しかし、臨床的に大きな問題となる振戦せん妄に至る症例は離脱症状を認める症例の5〜10%存在し、その予防は臨床上非常に重要である。現在、多くの抗痙攣薬でアルコール離脱症状治療研究が行われている。抗痙攣薬ではカルバマゼピンとガバペンチンが現在のところ効果が確認されている薬剤である。ベンゾジアゼピン系薬剤の使用が好ましくない場合に選択肢としての薬剤となるばかりでなく、今後のアルコール離脱治療の中心薬剤となる可能性がある。今後のさらなる臨床研究がまたれる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00060&link_issn=&doc_id=20160315020007&doc_link_id=%2Faa7ayuma%2F2016%2F025611%2F008%2F1151-1154%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2016%2F025611%2F008%2F1151-1154%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：医歯薬出版(株)  

せん妄は一過性の症状ではなく、臨床的にも医療経済的にも予後を悪化させる。医療経済面では、在院日数の長期化、人件費の増加、施設への入所増加などで医療消費が高額となる。年間医療費は糖尿病や転倒などよりも高額であることも指摘されている。現在までのところ、せん妄が発症してしまった症例に対しての薬物・非薬物による介入では臨床的・医療経済的なアウトカム改善を示唆する高いエビデンスは存在していない。せん妄の薬物での予防による臨床的・医療経済的なアウトカム改善効果は可能性は示唆されているものの、高いエビデンスがあるとはいえない。現在、老齢患者に対する非薬物療法的予防が臨床的・医療経済的に効果があることが示されている。今後の老齢化の進展に伴い、医療経済面からもせん妄予防に積極的に取り組むべきである。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00060&link_issn=&doc_id=20160315020008&doc_link_id=%2Faa7ayuma%2F2016%2F025611%2F009%2F1155-1158%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2016%2F025611%2F009%2F1155-1158%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本認知・行動療法学会  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00974&link_issn=&doc_id=20150330050031&doc_link_id=issn%3D0022-1961%26volume%3D115%26issue%3D4%26spage%3D673&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D115%26issue%3D4%26spage%3D673&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00974&link_issn=&doc_id=20141210080098&doc_link_id=issn%3D0022-1961%26volume%3D114%26issue%3D6%26spage%3D1218&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D114%26issue%3D6%26spage%3D1218&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

身体疾患治療現場での精神疾患有病率は高い。しかし、身体科医への教育・早期発見・早期治療を促すといった方策のみでは精神疾患のアウトカム改善は望めない。身体科医、ケースマネージャー、精神科医がチームとして関わる共同治療により、精神疾患の改善・総医療費の改善が認められるだけでなく、身体疾患の改善もみられる。身体疾患に伴う鬱病の治療と、鬱病アウトカム改善に必須のものについて述べた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02373&link_issn=&doc_id=20150522060002&doc_link_id=10.11258%2Fjjghp.26.368&url=https%3A%2F%2Fdoi.org%2F10.11258%2Fjjghp.26.368&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本臨床救急医学会  

救急医療現場に精神・行動の問題を合併した症例が搬送される機会は多い。身体疾患の治療とともに精神科医が並行して治療していくのが理想だが、現実的には精神科専門医療が利用できない医療施設も多い。このような現実から、救急医療スタッフを対象に、精神科医がいない状況での精神・行動の問題をもつ患者への標準的初期診療のための教育コース(Psychiatric Evaluation in Emergency Care:PEEC)が開発された。PEEC教育コースは、救急医療から精神医療へのつなぎを目的の一つとしている。現在のコンサルテーション・リエゾン精神医学の主要テーマは、身体疾患治療現場における精神・行動の障害のマネジメントと他(多)職種との連携である。コンサルテーション・リエゾン精神科医はPEEC教育コースの展開に積極的に関与し、医療の質の向上ならびに救急スタッフと精神医療スタッフの連携に努めたい。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J03405&link_issn=&doc_id=20140911390013&doc_link_id=%2Fda2jjsem%2F2014%2F001704%2F013%2F0575-0578%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fda2jjsem%2F2014%2F001704%2F013%2F0575-0578%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(株)アークメディア  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01552&link_issn=&doc_id=20140613160008&doc_link_id=%2Fao1clphd%2F2014%2F004306%2F008%2F0853-0858%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao1clphd%2F2014%2F004306%2F008%2F0853-0858%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(株)星和書店  

出血傾向がありその治療を受けている患者に対し、向精神薬の処方を余儀なくされることは臨床上しばしば経験することである。その際臨床医が配慮すべきことは、患者の出血傾向を助長しないことであり、臨床医は出血傾向をきたしうる向精神薬について知識を有しておく必要がある。出血傾向をきたしうる向精神薬としては、特に選択的セロトニン再取り込み阻害薬(selective serotonin reuptake inhibitor:SSRI)が臨床上重要であり、本稿ではSSRIを使用する際に配慮を要する点を中心に述べた。また、抗血小板薬や抗凝固薬(warfarin)を内服している患者も、出血傾向のある患者として考慮しなければならず、本稿では、かかる場合のSSRI使用の留意点についても言及した。(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

日本では,自殺率が高止まりを続けていることから,自殺対策基本法と自殺総合対策大綱が施行・策定され,厚生労働省は,自殺未遂者対策に関連して救急医療従事者を対象とした自殺未遂者ケアのための研修会を実施している。筆者らは,2012年1月から2013年3月の期間に当該の研修会に参加した224名を対象に質問紙を用いた調査を行い,自殺予防対策に関する正しい知識と適切な態度を問うた。その結果,回答者の多くに,80%以上の正答率が示され,知識の設問に比して態度の設問において有意に高い正答率が得られた。また,自殺の予防可能性については97.0%が好ましい回答を示した。一方で,自殺と精神疾患の関連に関する理解の不足や自殺念慮を確認することへの躊躇などが明らかになった。今後,自殺を低減させていくためには,専門教育・専門職生涯教育における自殺予防の導入,そして効果的な自殺予防教育プログラムの開発が必要と考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00749&link_issn=&doc_id=20140128110008&doc_link_id=10.11477%2Fmf.1405102636&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1405102636&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(株)星和書店  

身体疾患にうつ病が合併すると、身体疾患の予後ならびに医療経済面での悪化がみられる。したがって、身体疾患に伴ううつ病の早期発見(特にスクリーニングを用いて)・早期治療が推奨されている。しかし、スクリーニングでうつ病を発見し、治療を行っても、うつ病の改善は望めない。身体疾患に伴ううつ病治療は早期発見・早期治療といった安易な方策では改善せず、体系立ったシステムの構築が必須となる。この分野でのスクリーニングによる早期発見・早期治療での有益性は認められず、薬剤の副作用を含めた不利益も認識しておくべきである。(著者抄録)

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：(株)星和書店  

せん妄は術後に頻繁にみられる症候群であり、身体予後悪化の独立危険因子の1つである。一過性の病態と考えられていたが、いったん発症すると持続して身体予後・医療経済的予後に悪影響を及ぼすことがわかっている。しかし、日常臨床でのせん妄発見率は低く、診断・治療が遅れることにより、より複雑な病態となり、ケアの低下・ケアの複雑性が増す。せん妄の発見には、評価尺度を使用するなどの積極的な発見方法をとらない限り見逃しを減らすことは不可能である。せん妄の評価尺度には問題点もあるが、限界を知りながらでも評価尺度を使用する必要がある。ここでは、主だったせん妄評価尺度の特徴について述べる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：神奈川県精神医学会  

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Language：Japanese   Publisher：(一社)日本心臓血管麻酔学会  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(株)医学書院  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J03141&link_issn=&doc_id=20120705110014&doc_link_id=10.11477%2Fmf.1689101057&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1689101057&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)ワールドプランニング  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(株)南山堂  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(株)総合医学社  

＜point＞●過活動型せん妄だけでなく、低活動型せん妄にも着目。見逃さない。●せん妄症例は予後が悪化。●せん妄症例をみたら、直接原因の検索を(特に、せん妄発症時)。●せん妄の治療には、抗精神病薬で対応。原則、ベンゾジアゼピン系薬剤は使用しない。(著者抄録)

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

2010年12月に依頼し、2011年5月までに回答のあった総合病院精神科427施設を対象として調査を行った。救命救急センターが設置されている施設は125(29.3%)施設であった。入院病床ありが入院病床なしに比べると有意に救命救急センター設置の割合が高かった。リエゾンナースが配置されているのは37施設であった。臨床研修指定病院の指定は371施設(86.9%)だった。後期研修医は222施設で0人だった。後期研修医は病床のない施設ではほとんどいなかった。また、183施設(42.9%)が入院治療が可能であった。11〜50床の施設が85施設あり、51〜100床が44施設、101床以上の施設が27施設あった。精神科医師数は病床ありで7.7人であり、病床なしでは1.2人であった。mECTを実施しているのは104施設(24.4%)で、入院病床ありの施設で多く導入されていた。精神作業療法は、入院病床ありでは78施設で行われていたが、入院病床なしでは1施設でしか行われていなかった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02373&link_issn=&doc_id=20121106060008&doc_link_id=10.11258%2Fjjghp.24.59&url=https%3A%2F%2Fdoi.org%2F10.11258%2Fjjghp.24.59&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(有)フジメディカル出版  

せん妄は症候群であり、直接原因として身体疾患の存在を認める"medical emergency"のサインである。背景因子として、高齢、認知症の存在が挙げられるが、認知症とせん妄が合併した場合には鑑別が困難となる。現在のところ、せん妄の治療に対するエビデンスをもった治療方法はなく、老齢者の場合には特に体系的な予防介入が大切である。(著者抄録)

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Language：Japanese   Publisher：(株)星和書店  

脊髄損傷後の救命医療は格段の進歩を遂げている。それに付随して、脊髄損傷後の社会への"適応"に対するケアの重要性が増している。ここでは、1980年代初頭まで主流(現在でも頻用されている)であったステージ・セオリーについて述べ、問題点の整理を行う。また、脊髄損傷後によくみられるうつ病、不安障害、物質依存、自殺問題を中心にレビューを行う。特に、脊髄損傷症例のうつ病、アルコール症の評価は大切であり、受傷直後からの精神科的、社会的な介入が大切となる。精神・心理的ならびに社会的な介入が、その後の社会的予後も左右するため、積極的な関与が必要である。(著者抄録)

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J00755&link_issn=&doc_id=20110127070003&doc_link_id=10028060226&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10028060226&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

日本におけるコンサルテーション・リエゾン精神医学と救急医療との関係は非常に深く、救急医療の発展とともに産まれ、発展してきたといっても過言ではない。その救急医療との関わりには様々なスタイルがある(一般的に精神科リエゾンは病棟に精神科医が常駐し、精神疾患に対応する方法を指すことが多い。それに対し精神科コンサルテーションは身体科医からの依頼により精神疾患に対応する方法をいう)。bio-psycho-socialな問題を抱えた複雑な症例が多い救命救急センターでは、リエゾン精神医療が推奨され実践的と捉えられている。臨床場面において、自殺企図患者のケア、せん妄をはじめとした精神症状の緩和など多くの課題があるが、確立した効果的な介入方法は、いまだない。いくつかの身体救急疾患においての臨床研究では精神科介入による様々な利益が示されており、今後臨床に導入されていくであろう。総合病院における精神科医のマンパワー不足も深刻化しており、とくに救急領域では高齢化を含めてpsycho-socialな面で複雑な症例が増加しているため、多職種を巻き込んだ効果的なコンサルテーション・リエゾン・チームの構築が必要である。救急医療現場では、臨床ならびに研究において、自殺患者の再企図予防、急性身体疾患に伴う様々な精神症状の治療など課題が多い。精神医療が救急医療にさらに強く関与していく必要がある。(著者抄録)

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Language：Japanese   Publisher：(株)メディカ出版  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J04197&link_issn=&doc_id=20100128120003&doc_link_id=%2Fao7emcai%2F2010%2F002302%2F007%2F0129-0134%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7emcai%2F2010%2F002302%2F007%2F0129-0134%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

2008年10月時における総合病院の実態を把握するため、399施設の結果を集計し検討した。その結果、精神科が設置されている総合病院は、救急医療、緩和医療など、活発な医療が提供されている施設が多く、一般医療との連携が重要となる領域で精神科の果たす役割は大きいと思われた。精神科医をはじめとするスタッフは、入院治療が可能な施行に較べて、入院病床をもたない施設では少なかった。精神科救急医療や合併症治療は入院治療が可能な施設を中心に行われていたが、専門的な治療病棟を有している施設はまだ少なかった。総合病院の精神科スタッフが充実するとともに、他の診療科との連携が今以上に適切に評価される診療報酬体系の整備が必要と思われた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J02373&link_issn=&doc_id=20101012090009&doc_link_id=10.11258%2Fjjghp.22.55&url=https%3A%2F%2Fdoi.org%2F10.11258%2Fjjghp.22.55&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(株)医学書院  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J00749&link_issn=&doc_id=20091112170003&doc_link_id=10.11477%2Fmf.1405101518&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1405101518&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)医学出版  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(一社)日本救急看護学会  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)アークメディア  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01552&link_issn=&doc_id=20090212220034&doc_link_id=%2Fao1clphd%2F2008%2F0037s1%2F034%2F0269-0273%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao1clphd%2F2008%2F0037s1%2F034%2F0269-0273%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)星和書店  

米国でのプライマリーケア現場でのうつ病治療において、最も大きなバリアとなっているのは、一般身体医療と精神医療の保険システムが異なることである。医療費の出所が異なるために、プライマリーケア医と精神医療専門家の共同治療ならびにマネジメントが困難となっている。現在までの研究で、プライマリーケア現場でのうつ病治療の成功には、多面的介入が必要とされているが、なかでも精神医療専門家の関与ならびにケースマネジメントが必須であることがわかっている。現在、一般医療保険の中で、うつ病のケースマネジメントが"購入"可能となってはいるが、現実には普及していない。共同治療も、リサーチレベルから実際の医療への導入は遅れており、現在その効果・効率性についての検討が行われているのが現状である。(著者抄録)

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Language：Japanese   Publisher：日本医科大学医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J04260&link_issn=&doc_id=20081125420003&doc_link_id=10.1272%2Fmanms.4.175&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.4.175&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本精神科救急学会  

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Language：Japanese   Publisher：(株)星和書店  

パニック障害の生涯有病率は1.5〜5%と、決して稀な疾患ではない。パニック発作では突然、激しい身体症状が現れるため、患者はまず一般診療科を受診することが少なくない。また、パニック障害には循環器疾患の併発を高率に認めることが知られており、治療期間を通して定期的な身体チェック、諸検査を行っていく必要がある。本稿ではまず、パニック発作、パニック障害と身体疾患の鑑別について概説した。次いで、薬物療法(特に抗不安薬療法)を行う際の身体チェックについて、禁忌事項の確認を含めて検討した。さらに、抗不安薬を一定期間にわたって連用する場合の注意点、出現する可能性の高い副作用を検討し、これらを防止、または早期発見するためのルーチン検査の項目、およびそれらの検査間隔について検討した。(著者抄録)

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Language：Japanese   Publisher：(一社)日本心身医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00677&link_issn=&doc_id=20070828190019&doc_link_id=%2Fcv6jpsym%2F2007%2F004709%2F022%2F0822-0822%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcv6jpsym%2F2007%2F004709%2F022%2F0822-0822%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Language：Japanese   Publisher：(株)羊土社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J03286&link_issn=&doc_id=20070613150008&doc_link_id=%2Fai4resic%2F2007%2F000904%2F009%2F0527-0533%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai4resic%2F2007%2F000904%2F009%2F0527-0533%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)アークメディア  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J01552&link_issn=&doc_id=20070619050006&doc_link_id=%2Fao1clphd%2F2007%2F003606%2F005%2F0731-0735%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao1clphd%2F2007%2F003606%2F005%2F0731-0735%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：医歯薬出版(株)  

身体疾患の存在は自殺の危険因子であることが知られている。しかし、身体疾患が動機のように思われる自殺であったとしても、うつ病などの精神疾患が合併していることが多い。重度の身体疾患患者が自殺念慮を訴えた場合には、うつ病、痛みをはじめとした身体症状、自立性の喪失、ソーシャルサポートの欠如など複数の要因が絡みあっていることが多く、患者のニードに合わせたケアの提供が必要となる。したがって、病院内では単なる精神科疾患スクリーニングだけではなく身体・心理・社会的な面に焦点をあてスクリーニングを行い、必要な医療サービスを提供していく方法の構築が必要となる。プライマリケア現場での自殺予防、とくにうつ病の治療も重要であるが、"患者・家族への教育""プライマリケア医へのガイドラインの配布・教育""プライマリケア現場でのうつ病スクリーニング"を行うだけでは治療成績を上げることはできず、ケースマネジメントと精神医療の関与が必須とされている。今後、これらを含めたあらたなシステムの構築が必要となる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00060&link_issn=&doc_id=20070424210005&doc_link_id=%2Faa7ayuma%2F2007%2F022103%2F006%2F0225-0228%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2007%2F022103%2F006%2F0225-0228%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

Web of Science

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)日本評論社  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)星和書店  

うつ病ないしうつ状態にみられる精神病像に関して概観した。うつ病にみられる妄想は14%前後にみられ必ずしも稀ではない。妄想としてはうつ病の三大妄想のほかにコタール症候群(否定妄想)、オセロ症候群(嫉妬妄想)、関係被害妄想などが知られている。これらの妄想状態は原発性の病的体験や人格変化を前提とせずに抑うつ気分から発生したと了解される妄想的観念であり、真正妄想とは区別される。近年用いられる操作的診断基準では、気分に一致した精神病像に該当すると考えられる。気分に一致しない精神病像は統合失調感情障害ないし統合失調症圏に属し、病理性が異なる可能性が高いと思われる。いずれにしても加齢とともに増加する傾向があるために高齢化が進むわが国では特に重要な病態と考えられる。(著者抄録)

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Language：Japanese   Publisher：ライフサイエンス出版(株)  

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Language：Japanese   Publisher：(株)星和書店  

米国の医療保険制度において,一般身体医療と精神医療は別々のマネジメント組織(マネジド・ケア会社)が運営しているために様々な問題が露呈している.精神医療マネジメントは一般医療マネジメントよりも厳しく,受療制限などによる医療費抑制の締め付けが強い.さらには,別組織のマネジメントのため,身体疾患と精神疾患の同時治療が困難となっている.精神疾患患者の身体疾患医療費は高額であることが指摘されているが,支払いシステムが解離しているために統合した治療を行うことができない.精神医療への強い締め付けも加わり,結果的には精神疾患の改善は阻害され,全体でみると医療費の高騰につながっている点も指摘されている.医療マネジメント組織による受療や治療方法に関する医療費抑制策は手厳しいが,適応外処用に関しては医師の判断に委ねられていることが多い.米国食品医薬品局(FDA)も,適応外使用に関しては規制していない.現在,適応外使用による安全性が問題提起され,今後の薬剤監視体制の強化も提言されている(著者抄録)

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Language：Japanese   Publisher：(株)メディカルレビュー社  

在宅介護から施設介護への移行は,多くの要因が複雑に絡み合っているが,認知症者の状態,介護者ないしは介護家族の状態,かかりつけ医や介護支援のシステムの機能などの3つの要因の役割が大きいため,その条件を検討した.在宅介護から病院入院ないし施設介護への移行のタイミングをエビデンスに基づいて結論づけることは困難であるが,以下のことは原則的にいえるのではないかと筆者は考えている. 1)身体機能の著しい低下ないし身体的合併症や身体疾患に罹患した場合には,かかりつけ医と相談して病院入院を考える, 2)昼夜の逆転,せん妄,多動,徘徊,暴言・暴力など介護破綻をきたす恐れのある行動障害が出現した場合には早期に対応する, 3)介護負担感(介護疲労)が慢性化して蓄積していると判断される場合にも対応を考える.2003年6月に厚生労働省老健局長の私的研究会である高齢者介護研究会が,「2015年の高齢者介護-高齢者の尊厳を支えるケアの確立に向けて」を発表した.わが国に合った支援システムの構築が進展することを期待したい(著者抄録)

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Language：Japanese   Publisher：三重医学会  

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Language：Japanese   Publisher：日総研出版  

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Language：Japanese   Publisher：(株)医学書院  

失恋を誘因とし飛び降り自殺を図った18歳女性の入院治療について報告した.本例は自殺企図の直接的な誘因の背景に,長年にわたる自殺に至る強い心理・社会的準備因子が存在した.これは思春期の自殺企図の臨床では決して珍しくはないが,強い準備因子が認識されることは多くはなく,現実の臨床現場において積極的に介入される機会は少ない.思春期自殺企図の再企図予防のためには,まず精神障害の有無を慎重に判断し対処していくのが最も重要であるが,それに加えて長年にわたる強力な心理・社会的準備因子について認識し,積極的に介入していくことが臨床上必要である

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00749&link_issn=&doc_id=20060313390013&doc_link_id=10.11477%2Fmf.1405100237&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1405100237&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)日本評論社  

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Language：Japanese   Publisher：(株)ワールドプランニング  

病的嫉妬ないし嫉妬妄想は心理的嫉妬-病的嫉妬-妄想的嫉妬-嫉妬妄想という広いスペクトルの一部を構成する.そしてアルコール依存症,老年期認知症,気分障害(躁ないしうつ病),パラノイア,統合失調症など広範な精神疾患を背景に出現するが,老年期精神障害では出現頻度が高い.代表的な疾患でみられる嫉妬妄想について概観した.加齢に伴う精神機能の衰退,性機能を含む身体的な諸能力の衰え,社会心理的状況の変化により病的嫉妬形成の素地が準備されていると考えられる.アルコール性嫉妬妄想で提言された「逆説的性障害」のほか,想定されているいくつかの発生機序について言及した.病的嫉妬ないし嫉妬妄想によって暴力行為や犯罪に及ぶケースがあるため,病的嫉妬については臨床的に細心の注意が必要であることを強調した.超高齢化社会を迎えつつあるわが国において,病的嫉妬ないしは嫉妬妄想はますます重要な疾患となると考えられる(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2005&ichushi_jid=J02464&link_issn=&doc_id=20051206180005&doc_link_id=%2Faj2rsizd%2F2005%2F001611%2F006%2F1261-1268%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faj2rsizd%2F2005%2F001611%2F006%2F1261-1268%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)星和書店  

わが国では究極的な高齢化が進行しており,これに伴って高齢者の精神障害が増加している.高齢者では,加齢の影響のほかに身体的,社会心理的に様々な要因が複雑に絡んで非定型的な精神病像を呈することはよく知られている.しかし高齢者の示す精神症状ないし病像を正確に評価して把握することは治療を構築するうえで不可欠と考えられる.本稿では認知症ないし類似の病態として,うつ病(血管性うつ病),せん妄(特に低活動性せん妄),軽度認知障害(MCI)について精神病像の鑑別という臨床的視点から最近の知見を含めて簡潔に概観した.この高齢化の傾向は今後もますます進むと予想されるが,一方で,早期に確実に診断し治療戦略を立てていくことが臨床には要請されている.臨床的に解決を迫られている課題は多く残されている(著者抄録)

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

緩和ケアを受ける患者は多様な苦痛をもつが,そのなかで実存的苦痛は最も対応困難な精神医学的問題の一つである.がん患者の緩和ケアへの精神科医の参加の実態を調査するとともに,実存的苦痛が大きな問題となった2例(52歳男性,膵がん,19歳女性,卵巣がん)を呈示し,文献検討を行って,支持的精神療法,特に深い共感的関係の形成が重要なこと,そのための方法,Franclの理論の応用などについて考察した

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2005&ichushi_jid=J00060&link_issn=&doc_id=20050223060010&doc_link_id=issn%3D0039-2359%26volume%3D212%26issue%3D7%26spage%3D706&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D212%26issue%3D7%26spage%3D706&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(株)南山堂  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(株)世論時報社  

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Language：Japanese   Publisher：(株)世論時報社  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)医学書院  

入院患者に対する治療計画を敏速かつ包括的に行うための多次元的評価尺度であるINTERMEDの日本版を作成し,その導入効果を事例(68歳,女性.2型糖尿病で自己管理能力が低く,治療抵抗及び被害感がある)を通して紹介した

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2004&ichushi_jid=J00266&link_issn=&doc_id=20040319360008&doc_link_id=0404387&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F0404387&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER PSYCHIATRIC PRESS, INC  

Web of Science

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

DSM-IVの診断基準と譫妄の臨床的特徴を参考にして,11項目,3系列からなるDSTを作成した.精神科にコンサルトされた患者108名にこのDSTを適用し,精神保健指定医による精神医学的診断と比較することによりDSTの感度・特異度を算出した.精神保健指定医によって譫妄と診断されたのは59名で,そのうち58名はDSTでも譫妄と評価されたためDSTの感度は98%であった.DSTで譫妄と評価されたが精神科医による診断では非譫妄とされた偽陽性ケースは49名中12名で,DSTの特異度は76%であった.DSTの記載時間は殆どの場合5分以内であることから,日常的に行われる譫妄スクリーニングに有用と考えられた

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Language：Japanese   Publisher：(株)診断と治療社  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)日本評論社  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

慢性呼吸器疾患を伴ううつ病とその関連因子および内科外来への影響を調査した.対象は,外来慢性呼吸器疾患を伴ううつ病患者114例(男性78例,女性36例・平均年齢69.8歳)であった.15例(13%)がHADSの点数で20点以上の大うつ病,42例(37%)が11点以上19点以下の閥値下うつ病と診断されたが,担当内科医が抑うつ的もしくは不安が強いと判断した症例は大うつ病症例で5例(33%),閥値下うつ病症例で20例(48%)で,適切な治療は行われていなかった.自覚的な呼吸困難感では大うつ病症例は非大うつ病(閥値下うつ病,非うつ病)症例に比し有意に強く,閥値下うつ病症例は非うつ病症例よりも強い傾向であった.救急外来利用頻度では大うつ病症例は非大うつ病症例に比し有意に高かった.一般外来における身体疾患に伴ううつ病の発見・治療を含む精神科医と身体科医の連携システムの構築が必要と考えられた

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

看護スタッフの為の譫妄評価スケール(DRS-J)を,その作成プロセスと共に報告された.まずTrzepacz PTらによって考案されたDelirium Rating Scale(DRS)を,それを基に作成されたLevenson JLらによるNurses Delirium Rating Scale(NDRS)を基に,11項目からなる看護スタッフ用譫妄評価スケール(DRS-J)を作成した.譫妄に関連する複数のパラメータを定量化したこのDRS-Jを用いたところ,精神保健指導医及び,看護スタッフの評価においては,譫妄群はその他(精神分裂病群・痴呆群・その他の正常コントロール群)の群に比較して,有意に高い得点を得られた.従って,DRS-Jは,看護スタッフにとって,譫妄を評価できる尺度であることが示唆された

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

従来の報告と比較検討して,高次救急救命センター(CCM)に入院された精神疾患患者の実態調査を行い,consultation-liaison service(CLS)を担う精神科医の役割と必要性・有益性について検討した.その結果,CCMにおいてCLSを実施したところ平均入院期間の短縮・精神科未治療症例に対する精神医療の介入と紹介が可能となった.精神科医の役割として身体科医との連携体制,短期間での正確な精神状態の把握,前医との詳細な情報交換,入院長期化での適切な精神的ケアが可能な環境作り,再自殺防止の為の援助・教育が重要であると思われた.尚,本人の意思と関係無く精神科救急対応が必要となる点について,人権に配慮し地域資源と円滑に連携を図れる精神科救急医療ネットワークの構築が必要であった.CCMにおけるCLSはその中心的役割を担っていくと思われた

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Language：Japanese   Publisher：(株)南山堂  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2001&ichushi_jid=J04037&link_issn=&doc_id=20011026100010&doc_link_id=10.15106%2FJ04037.2002097996&url=https%3A%2F%2Fdoi.org%2F10.15106%2FJ04037.2002097996&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)星和書店  

イギリス,フランス,アメリカ・アイオワ州,カナダ・ブリティッシュ・コロンビア(BC)州の4ヵ国における強制入院について概説し,我が国の措置入院のあり方について考察した.イギリスの精神保健法の場合,民事条項と刑事条項とがあり,後者では裁判所が認定医の勧告裏に強制入院命令権を発動する.フランスでは独自のセクトゥール制のもと人権には最大限の配慮がなされる一方,第三者申請入院と措置入院手続きを有している.更に,触法患者については地域医療刑務所と処遇困難者病棟という施設を用いて対応している.アイオワ州においては全ての強制入院は裁判所命令で決定されているが,BC州では医師の裁量権に負う強制入院となっている.ただし,同州においても触法患者の扱いは裁判所命令によって専門施設収容がなされている

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Language：Japanese   Publisher：(株)へるす出版  

精神科臨床のみならず一般臨床の現場でも,自殺企図患者に遭遇するのは少なくない.看護スタッフから得られる情報は,治療面においても重要な鍵となることが少なくない.自殺の一般的知識(とくに自殺の原因・要因),自殺企図症例に対する面接方法,ならびに安全の確保の仕方について述べた

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2001&ichushi_jid=J01536&link_issn=&doc_id=20010621280014&doc_link_id=0107255&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F0107255&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：(公社)日本精神科病院協会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER PSYCHIATRIC PRESS, INC  

Web of Science

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Language：Japanese   Publisher：日本精神病院協会  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2001268087

Language：Japanese   Publisher：東京精神医学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：(株)東京医学社  

予防的介入によりせん妄の発症は減少する.せん妄症例への非薬物的治療は治療セッティングにより効果に差がある.現在のせん妄症例への薬物療法は,エビデンスよりも,臨床経験に基づくものが多い.本邦における臨床研究(controlled study)は少ない

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

救急専属医の燃えつき,鬱症状,QOLを調査した.約10〜20%の救急医が燃えつきに注意する必要があり,20%以上の救急医が鬱病評価尺度により,"鬱病"と判定された.又,燃えつき,鬱症状,QOLは互いに相関していることが示された.燃えつき,鬱病を予防する労働環境として,適切な休息が必要であることが示唆された.職場と関連したストレス(distress)ならびに鬱症状は,医師個人に悪影響を与えるばかりでなく,医療の質をも左右する為,労働環境・医療システムの整備に目を向けていく必要性が示された

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Language：Japanese   Publisher：金原出版(株)  

身体的苦痛が著しく心理的に共感しうる状況であったとしても,治療可能な精神科疾患が存在することは少なくない.婦人科悪性疾患の精神医学的問題の頻度は他の部位の癌とほぼ同等に存在すると考えられ,適応障害,大うつ病,せん妄等が多い.このような問題はQOL,身体治療に大きな弊害となることも少なくないにも関わらず,治療されていない場合が多く,精神科疾患のスクリーニングと精神科コンサルテーションが必要である.また婦人科領域の悪性腫瘍の場合,治療後の性機能の変化が大きく,精神症状に関与することもあり今後,重要な課題となり得る

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Language：Japanese   Publisher：(株)文光堂  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2000&ichushi_jid=J00060&link_issn=&doc_id=20000807040027&doc_link_id=%2Faa7ayuma%2F2000%2F019406%2F028%2F0588-0590%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2000%2F019406%2F028%2F0588-0590%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：医歯薬出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2000&ichushi_jid=J00060&link_issn=&doc_id=20000807040015&doc_link_id=%2Faa7ayuma%2F2000%2F019406%2F016%2F0555-0559%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2000%2F019406%2F016%2F0555-0559%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)日本評論社  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

総合病院の中で,精神科病棟(届け出精神病床)を有する施設は21%にしかすぎない.しかし,総合病院における精神科日常臨床において,入院が必要と判断される症例は多い.そこで一般病床において,cluster beds(決まった内科或いは外科病棟に精神疾患症例を集中させ,精神科治療を行う)に入院した100症例についての検討を行った.cluster bedsであろうと大多数の気分障害症例ならびに広範囲にわたる精神科疾患の入院治療が可能であり,総合病院に搬入されることが多い自殺未遂症例の初期治療は可能である点が示された.つまり,cluster bedsをもつことで,総合病院精神科の役割を担うことが可能である点が示された

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：日本ストレス学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

精神科入院中に電気痙攣療法を施行された患者の内,痛みを主訴,又は主要な症候の一つとしていた5人の患者について,その経過をレトロスペクティブに検討した.全ての症例で疼痛症状は改善した

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=1999&ichushi_jid=J01397&link_issn=&doc_id=19990712360008&doc_link_id=%2Fad3msuie%2F1999%2F004807%2F008%2F0763-0766%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F1999%2F004807%2F008%2F0763-0766%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本ストレス学会  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(公社)日本医師会  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(株)南山堂  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

一般的に,自殺未遂者は重症の精神症状を合併している為,センター転出後も引き続き精神科的な治療が必要となるケースが多いと考えられる

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=1996&ichushi_jid=J00060&link_issn=&doc_id=19960724400013&doc_link_id=%2Faa7ayuma%2F1996%2F017803%2F012%2F0199-0203%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F1996%2F017803%2F012%2F0199-0203%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(株)金子書房  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)永井書店  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(株)自然科学社  

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Language：Japanese   Publisher：真興交易(株)医書出版部  

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Language：Japanese   Publisher：(株)へるす出版  

75歳の女性で長男夫婦と同居後はサークル・町会の会合などによく出席していた。半年前より不眠を訴え,発語と食事摂取が減り,夜間に訳のわからないことをいいながら徘徊することが多くなり痴呆とされてきた。ある日誤って腹に鋏を刺し,救急センターに搬入され,痴呆による事故とされ老人病院へ転送されるところ,精神科医の問診をうけ長谷川19点,CTで脳萎縮があり,やはり老年性痴呆と考えられた。しかしある日看護スタッフが本人が皆に迷惑をかけているというのを聞き,取り越し苦労が重なり計画的に自殺を計ったことがわかった。クロミプラミンの点滴投与で落着き,精神科病棟で治療し4週で抑うつ気分も軽快し,長谷川スケールも28点となって退院した

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：東京精神医学会  

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Language：Japanese   Publisher：東京精神医学会  

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