長崎における精神科医療の歴史 - 石田昇の足跡をたどりつつ -

いま、長崎県における精神科医療の展開に関する歴史を、長崎大学医学部精神神経科学教室の初代教授である石田昇の成果を中心に振り返りつつある。完成させるには今しばらくの情報収集が必要であり、その途中経過として、ここには研究ノートの形で紹介してみたい。現在、長崎県下には３９ケ所の精神科病院があり、総数で８,４１５ベッドが精神科疾患の患者のために準備されていて、入院患者数は７,０５９人である（図１）。彼等の平均入院日数は４４０.９日（図２）であり、利用率は８３.５％（図３）になっている（いずれも、平成１４年６月末現在のデータ）。長崎県の人口と比較したとき、ベッド数は万対５５.２床（図４）、入院数は万対５１.７人となる。全国の動向と比較したとき、全国でベッド数が万対２８.０床、万対在院患者数が２６.０人、そして平均日数は３６４日であり、いずれもその数値が大きく全国を上まっている。医療全体に関わる統計データで、西日本地区が東日本に比して全体的に高い数値をみており（病院数・病床数が多い、個人当たりの医療費が高いなど）、精神科医療では更にその傾向が顕著である。しかし、長崎は同傾向が更に著しくなっているのである。いつの頃から、このような傾向が目立ってきたのであろうか。長崎の精神科医療に関するハードの面が充実していること自体は歓迎すべきであろうが、実際はその内容が問われるべきであることも事実である。ここでは、長崎県における精神科医療の全般について広く言及するゆとりはなく、まずはその展開に大きく寄与した故石田昇教授の足跡をたどりながら、若干の考察を試みてみたい。I intend to reflect on the history of the development of psychiatric care in Nagasaki Prefecture with a focus on the achievements of Dr. Noboru Ishida, the first professor of the Department of Neuropsychiatry, Nagasaki University School of Medicine. There is insufficient space here to cover all of his achievements and more information still needs to be collected, so in the interval I will tentatively present this information in the form of research notes. There are currently 39 mental hospitals in Nagasaki Prefecture with a total of 8,415 beds prepared for patients with psychiatric disorders ; 7,059 patients are currently admitted. The average duration of their stay is 440.9 days with a facility utilization rate of 83.5% (for both, current data was as of the end of June 2002). With reference to Nagasaki Prefecture\u27s total population, beds number 55.2 beds per 10,000 people and admittances total 51.7 patients per 10,000 people. In terms of trends nationwide, there are 28.0 beds per 10,000 Japanese and the average duration of stay is 364 days, so both of these numbers for Nagasaki surpass those nationwide. In statistical data related to medical care overall, western Japan has higher numbers than eastern Japan (more facilities and beds, higher medical expenses per person, etc.) ; in psychiatric care, these trends are even more marked. However, they are even more exaggerated in Nagasaki. At what point did trends like these become so striking? That Nagasaki has good facilities and services for psychiatric care should be welcomed, but the actual content of that care should be examined. While there is insufficient space here to refer to psychiatric care as a whole in depth, I have sought to discuss this topic somewhat while following in the footsteps of the late professor Noboru Ishida, who contributed largely to its development

精神障害における QOL

QOL あるいは生活の質といった用語が、健康に関わる分野でしばしば耳にされるようになった。医療・保健・福祉の提供者にとって、この概念が広がり、当事者（患者）が自らの健康を保持増進するための方策について主体的に考え参画するきっかけとなることは極めて望ましいことである。通常は、慢性の身体疾患に罹患している人たちにとって話題となることが多いが、精神障害に苦悩する当事者にとっても有用な発想であるはずである。残念ながら、精神障害の当事者からは信頼性ある QOL 評価が得られるかという問題が大きく立ちはだかっており、日本国内での研究や実用化が著しく遅れている。本稿では、精神障害の分野での QOL 研究の現状をレビューし、著者らがこれまでに検討してきた結果の要約を紹介し、本領域のさらなる発展を期待したい。The term Quality of Life (QOL) is starting to be frequently heard in various health-related disciplines. For medical, health, and welfare providers, the fact that this concept is growing and encouraging proactive participation of the concerned parties (the users or patients) to advance care of their own health is quite desirable. This has normally been considered a problem for individuals chronically suffering physical / somatic disorders, but it should also be an effective mindset for those who are suffering mental disorders. Unfortunately, difficulties have arisen in attempts to obtain reliable QOL evaluations from individuals with mental disorders, and research and practical application in Japan is greatly lagging. In this paper, after reviewing the current state of QOL research in the field of mental disorders, the authors introduce a summary of results of investigations until now, and expectations for further developments in this field

Prosopagnosia with Acquired Colour Blindness

A 71-year-old male complained of a sudden attack of colour blindness and prosopagnosia. The colour blindness was red-green defect. Left homonymous hemianopsia was confirmed by red-target perimetry. Brain scanning suggested the lesion was to be in the right inferior occipital region. The symptoms disappeared spontaneously in three weeks. A 35-yearold male presented prosopagnosia and achromatopsia. These cases suggested that acquired colour blindness of central origin may exist and that the non-dominant hemisphere may play a specific role in the process of colour discrimination

Stigma in response to mental disorders: a comparison of Australia and Japan

BACKGROUND: There are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries. METHODS: A household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia. RESULTS: Personal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public. CONCLUSION: Stigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country

Public beliefs about causes and risk factors for mental disorders: a comparison of Japan and Australia

BACKGROUND: Surveys of the public in a range of Western countries have shown a predominant belief in social stressors as causes of mental disorders. However, there has been little direct cross-cultural comparison. Here we report a comparison of public beliefs about the causes of mental disorders in Japan and Australia. METHODS: Surveys of the public were carried out in each country using as similar a methodology as feasible. In both countries, household interviews were carried out concerning beliefs about causes and risk factors in relation to one of four case vignettes, describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. In Japan, the survey involved 2000 adults aged between 20 and 69 from 25 regional sites spread across the country. In Australia, the survey involved a national sample of 3998 adults aged 18 years or over. RESULTS: In both countries, both social and personal vulnerability causes were commonly endorsed across all vignettes. The major differences in causal beliefs were that Australians were more likely to believe in infection, allergy and genetics, while Japanese were more likely to endorse "nervous person" and "weakness of character". For risk factors, Australians tended to believe that women, the young and the poor were more at risk of depression, but these were not seen as higher risk groups by Japanese. CONCLUSION: In both Japan and Australia, the public has a predominant belief in social causes and risk factors, with personal vulnerability factors also seen as important. However, there are also some major differences between the countries. The belief in weakness of character as a cause, which was stronger in Japan, is of particular concern because it may reduce the likelihood of seeking professional help and support from others

Psychosomatic Health Status of Children Exposed to the Chernobyl Accident

Childhood victims were investigated focussing on the psychosomatic disorders. The subjects were some of the 3834 children who evacuated from the Chernobyl zone to Kiev (evacuees) and 200 children who have been living in Kiev since prior to the accident (comparison group). A psychological test administered to 504 evacuees aged 12-14 years at the time of the accident and the comparison group indicated that the frequencies of neutroticism, high level of anxiety and conflicts were significantly higher in the evacuees than in the comparison group (p<0.001). Another psychological test administered at puberty to the 504 evacuees and 200 other evacuees exposed to the accident at 4-6 years of age indicated that the psycho-emotional portrait of evacuated teenagers significantly changed with time since the accident. The effects of the Chernobyl accident on the health of the vegetative dystonia observed in 1987-1990 and 1990-1995 were higher in the evacuees than in the comparison group, although they were not statistically significant. Furthermore, a significant (p<0.001) association of the vegetative dystonia with peptic and cardiovascular disorders was observed. The present study indicates that the vegetative dystonia is still highly prevalent among childhood victims and deems to support that the vegetative dystonia may be a precursor of several diseases such as cardiovascular and peptic disorders. It should be emphasized that a health promotion program to produce a change in psychological and social problems after the Chernobyl accident is necessary to decrease the health impact among Ukrainian people

Responsivity of Negative Symptoms to Typical Neuroleptic Drugsin Schizophrenia

The psychopharmacological management of schizophrenia consists primarily of neuroleptics. These drugs have successfully changed the scenario of psychiatry since the 1950s. They have mainly been used for controlling positive symptoms in schizophrenia, but on closer look it is evident that positive and negative symptoms both respond to neuroleptics in the acute and chronic stages of schizophrenia separate reports are cited for acute and chronic stages with an aim to quantitate the response. The early as well as recent studies support these obervations with few exceptions. However, greater responsivity has been observed in the acute stages of schizophrenia

精神保健の知識と理解に関する研究 ―福祉専門職志向大学生と２０代地域住民との比較検討―

ヴィネット呈示によるうつ病および統合失調症の事例に関する認識は、夫々が学生群で３６.４％と５４.８％で、２０代住民群では２８.５％と２５.５％であり、前者の学生群でやや高い認識度であった。うつ病圏に関してはほぼ近似した認識が出来ているが、統合失調症圏では十分な認知が出来ていないといえるが、一方では両群間における精神保健福祉の理解に対するモティベーションの差を示唆しているのかも知れない。ただ、現時点でこの理由を明確に説明できる要因は不明である。更に、うつ病と統合失調症に対する偏見差別の有り様についても両群間に違いがあった。すなわち、より自分との関係が近くなればなるほど、両群とも関わりに回避傾向は増すのだが、その程度は学生群が２０代住民群より若干少ない傾向にあった。地域の人々の偏見差別に関する意識について、学生群はうつ病例や統合失調症例のいずれにおいても社会の人々は差別する人がそうでない人より多いと認識していたが、２０代住民群はうつ病事例においては差別されることは少ないと認識しており、やはり両群間に違いが見られた。これらの点については、様々な要因から今後更に検討していく必要があろう

精神保健に関する知識と理解に関する研究 ―福祉専門職志向入学生の特徴―

われわれは福祉専門職教育課程の大学学部に入学して直ぐの学生における精神疾患に対するイメージを調査した。調査対象者（113名）は精神保健を受講する直前に、うつ病と統合失調症に関する所定の調査表に、個別に回答した。うつ病および統合失調症の事例について夫々36.4％および54.8％が適切に認識し、病因や経過および転帰についてもほぼ妥当に理解していた。しかし、そうした事例の治療法や治療薬に対する認識や、精神保健福祉に関係した情報知識への関心は必ずしも高くなく、今後こうしたことについて本格的に学び、知識を蓄積することで、適切な認識がより増えていくことを期待したい。偏見や差別に係る項目については、被験者個人における偏見意識はさほど強烈でないものの、身近なテーマとなると否定的態度になる傾向がうかがえ、地域集団としての社会的見解を聞くと更に否定的な言辞すなわち強い偏見が示唆された。彼らが将来、福祉専門職になった時、自分の中にあるこうした気持ちとどのように向き合っていくのか、また一般社会にあるこうした認識をどのように受け止め、専門家として対応し改善させていくのか、今後こうした点に考慮しつつ教育プログラムを開発していく必要性が示唆された