東邦大学医療センター大森病院における小児科医,臨床心理士,精神科医による連携医療

type:TOHO University Scholarly Publication

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目的:子どもの心の問題においてプライマリケアを担う小児科医の臨床心理士,精神科医との連携の状況を明らかにする.対象および方法:過去18年間に東邦大学医療センター大森病院小児科で臨床心理士との連携による診療後に精神科医の介入を要した外来・入院患者の臨床像を後方視的に検討した.結果:患者は受診時年齢5歳から15歳の45例(男児19例,女児26例),主訴は身体症状28例,行動の問題13例,精神症状4例であった.小児科では10例が起立性調節障害,7例が身体表現性障害と診断され,臨床心理士によるカウンセリングや遊戯療法が行われた.その後精神科を受診した主な理由は,行動の問題24例,精神症状17例,身体症状4例であった.精神科では16例が広汎性発達障害と診断され,長期間の観察の後に統合失調症と診断された児が3例存在した.転帰を確認することができた30例のうち21例は現在も精神科に通院していた.まとめ:本研究において患者が精神科医に紹介された主な理由は,行動の問題または精神症状であり,それらが全体の91%を占めた.心因性疾患や発達障害の診断は小児科医では困難なことがあり,33例において精神科を受診した後に精神科医の検討により診断が変更になった.適切な紹介が行われるために小児科医,臨床心理士,精神科医によるカンファレンスを定期的に行った.Objective: Pediatricians have a role in primary care of children's mental health issues. The purpose of this study was to clarify the collaboration of pediatrician with psychologists and psychiatrists. Material and Methods: This study was conducted to monitor the pediatric outpatients and inpatients who were diagnosed with mental health issues while they visited pediatricians and psychologists over an 18-year period (1998 - 2015) at the Toho University Omori Medical Center. They were followed up by psychiatrists for treatment. Results: In total, 45 (19 boys and 26 girls) patients with psychological and/or psychiatric problems were enrolled in this study. The age of the patients ranged from 5 to 15 at the initial visit. Twenty-eight patients (62%) had physical symptoms, 13 (29%) had behavioral problems, and 4 (9%) had mental symptoms as the chief complaints. Ten patients (22%) were diagnosed with orthostatic dysregulation and 7 (16%) with somatoform disorder by pediatricians, and they were referred to psychologists for counseling and recreational therapies. After the psychological treatments proceeded at the pediatric clinic, all patients had consultations with psychiatrists. The reasons for consultation were behavioral problems for 24 patients (53%), mental symptoms for 17 (38%), and physical symptoms for 4 (9%). Sixteen patients (36%) were diagnosed with pervasive developmental disorder. Three patients (7%) were diagnosed with schizophrenia after long-term observation. Twenty-one out of the 30 patients who had recognized clinical outcomes are still continuing treatments with psychiatrists. Summary: In this study, the chief reasons for which the patients were referred to psychiatrists were behavioral problems or mental symptoms, and they accounted for 91% of all reasons. Occasionally, general pediatricians have difficulty in diagnosing psychogenic or developmental disorders. Thirty-three patients received different diagnoses from psychiatric assessments. For appropriate understanding, periodic conferences by pediatricians, psychologists, and psychiatrists will be useful.