悪性腫瘍を合併した精神分裂病の二症例 : 診断と治療経過における問題点の医学哲学的検討

抄録

Two cases of schizophrenia (A : paranoid type, B : residual type according to the ICD-10 criteria) were studied, both of which were referred from a psychiatric hospital to the surgical and psychiatric departments of a University Hospital for the treatment of physical complications. Both patients were diagnosed with cancer and surgical treatment was recommended. Although case A underwent surgery along with the full informed consent requirement, case B was treated through proxy consent by her family due to impaired capacity. The difference in competence between these patients seemed to be related to their negative symptoms, for example apaty, abulia, withdrawal, and slowed thought of case B was more severe. In addition, this case study revealed that "reduction of restriction produced by phenomenological disturbances in subjective time in chronic disease" and "coordination of medico-cultural differences between psychiatry and other medical specialties" are necessary to improve the QOL of schizophrenic patients with physical complications. It is suggested that consultation-liaison psychiatry in a broad sense, including sufficient aspects of bioethics and philosophy of medicine, would be useful for the treatment of physical complications of psychiatric patients.