総合病院における精神々経科の現状と将来

抄録

Recently, in a general hospital, there is a growing tendency to possess the department of psychiatry as well as others. The problems of the present conditions and the future of this department are warmly discussed. I think it is important that the driving force of these tendencies is the reform of a psychiatric treatment itself, mainly the pharmacotherapy and the activities of rehabilitation.
In the first place, it is told that such a department fills the role of a bridgehead of psychiatric treatments. Secondly, the patients with complications can receive the security for all-round medical treatment under the co-operation with other departments. Thirdly, this department has a leading part in the local activities of mental hygine in co-operation with public health centers. This role will be respected for the time being. Besides, in this connection, I have discussed the effectiveness of the differentiation in the activities of treatments, which is due to the tie-up with mental hospitals.
Next, the investigations in each of the fields are stated, First, I have stated my own experience in going to the public health center as a consultant, and our co-operating attitude toward the local activities of mental hygine, Secondly, the outpatient treatment is refered. According to the outpatient statistics in the department of psychiatry in a general hospital, we find many patients suffered from neurological diseases, organic psychosis, epilepsy and schizophrenia. On the other hand, we have found that in a psychiatric hospital, a high rate of schizophrenia is remarkable. There is, however, a disagreement about the classification of diseases, which has come of the relationship with local psychiatric hospitals, and the circumstances of local communities. I have touched on the co-operation with practitioners and hospitals except mental hospitals. I also have refered to the plan for the early detecting of mentally disordered people, the promotion of treatment, and the Day-Care-Center where we may be able to deepen out understanding of patients and our contact with the members of their family.
Thirdly, concerning the treatments at the hospital, it is mentioned that the kinds of new inpatients' diseases have the same traits as outpatients, and that in cities at least, there is the differentiation of medical functions between psychiatric hospitals and departments of psychiatry in general hospitals. In addition, I have mentioned the problem of cooperation with the local system of medical treatment and of a tie-up with psychiatric hospitals, in regard to short-term hospitalization.
In the forth place, I have refered to the co-operation with the other departments in the hospital. Especially in Konodai National Hospital, we can see that about ten per cent of the outpatients are those who are sent from the other departments. In many of these patients, there are neurosis, psychosomatic diseases, epilepsy, organic psychosis, and neurological diseases. At the same time, we can see that a half of the total number of inpatients at the department of psychiatry are treated at the other ones throughout the year. In view of these facts, the necessity of all-round treatments is emphasized. Making an additional remark, the comparison of the data on psychiatric hospitals is impressive.
In the fifth place, I have pointed out the conditions under which it is difficult to run the department of psychiatry in a general hospital. It is insisted upon that the understanding attitudes of managerial staff as well as the much efforts of psychiatrists is indispensable for the improvement in these conditions.
Finally, I have expressed my opinion about the problem of the separation of the department of neurolgy from psychiatry.