Abstract
A multilateral study was carried out on 33 patients (21 men and 12 women) admitted to four hospitals for more than ten years for the treatment of epilepsy. The patients were aged 45.3±10.3 years and stayed in hospitals for 18.6±6.5 years on the average. The patients were analyzed to draw an outline of the clinico-psychiatric as well as the socio-psychiatric aspects and geographical differences, and the following findings were obtained. In the clinicopsychiatric assessment, the reasons for hospitalization, incidence of attacks, classification of attacks, presence or absence of personality disturbance, intelligence tests, intra-ward life criteria and CT findings of the head were studied. As a result, a good portion of the patients were found to have the so-called“limbic disorders”ranging from a complicated partial attack to a secondary generalized attack or Lennox-Gastaut syndrome. It was also assumed that deterioration of intelligence levels were due to extended admission and that personality disturbance tended to change from the state of“labil-explosiv”to that of“stabil-enechetisch”with the involvement of a limbic disorder. In the characterization of socio-psychiatric aspects of the problem, educational backgrounds strongly suggested a poor life environment, while occupational backgrounds indicated a difficulty in finding jobs or staying on jobs for an extended period of time because of the affected intelligence and distrupted personality. It was also disclosed that a few cases had been hospitalized for an extended period of time though their clinical attacks were adequately controlled and they adequately adapted themselves to the open-ward environment with demonstrated capability to handle simple work without difficulty. In family relationships, there were twice as many from neglected families as those from cooperative families: In general, familial ties with patients were fragile, and parents in advanced ages, death of parents and/or prevalence of nuclear families became apprarent in the background. In a comparison of patients hospitalized in the Tokyo Metropolitan area with those in local urban area, the former included many patients with epilepsy due to limbic foci and the latter predominantly included those afflicted with serious intelligence deterioration and Lennox-Gastaut syndrome who were intractable to therapeutic workup. With respect to the family background, many of the former came from nuclear families while many of the latter were from multigeneration-families. Between the two there differences in reasons for hospitalization, and closer family ties were more prevalent among patients from local urban hospitals. Based on our survery results, we made some reference to measure taken to minimize extended hospitalization.
