医療
Online ISSN : 1884-8729
Print ISSN : 0021-1699
ISSN-L : 0021-1699
21 巻, 2 号
選択された号の論文の17件中1~17を表示しています
  • 荒川 直人, 後藤 彰夫
    1967 年 21 巻 2 号 p. 145-150
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    In order to evaluate the effect of the pharmacological treatment for the patients of the schizophrenia objectively and quantitatively, the rating scale was devised. The scale is consist of the following 12 items:
    1. Abnormality in physical movement
    2. Abnormality in the frequency of speaking
    3. Abnormality in emotion
    4. Abnormality in interpersonal response
    5. Thinking disturbance
    6. Delusion
    7. Hallucination and “Ich Störungen”
    8. Hypochondria and neurotic complaint
    9. Attitude for his own disease
    10. Attitude for others
    11. Daily life
    12. Occupational and recreational therapy Each item is ranked from 4 to 0 in order of the degree of severity.
    In principle, the situations of selection and dose of medicines used by the physician are taken into the consideration. For example, when psychiatric affair is the problem, such detailed psychiatric classification as hallucination and “Ichstörung” are not considered, but their influence on the behavior is considered. As a whole, it requires complicated and generalized judgement for the evaluation rather than simple consideration. Therefore, the judgement is made by the physician and the items of judgement are always understood by the physician, therefore no particular explanation is required for the judgement. The difference of the objective judgements made by several physicians were compared, and r was lied between 0.73 and 0.93, and it is quite precise criterion of the judgement for this kind.
    Trial judgements using the scale for the judgement were made for 119 cases of the schizophrenia patients at 7 hospitals, and validity of the scale was proved to be sufficient.
  • 後藤 彰夫
    1967 年 21 巻 2 号 p. 151-158
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    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.
  • 石川 鉄男
    1967 年 21 巻 2 号 p. 159-164
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    The present status of the out-patients of the schizophrenia for the rehabilitation in September, 1962 was considered, also the status of the treatment at the main hospital throughout the nation, the status of my patients leaving the hospital, above all, the corelation between the treatment of the out-patients of schizophrenia and the rehabilitation have been reported. Since then, the life of the same group of patients have been investigated until July, 1965 continuously, and the results have been examined. As the result of the previous investigation it was found that the guidance for the out-patient is one of the important factors to reduce the ratio of re-hospitalization, but some of the rehabilitated outpatients coming to hospital for a long period rehabilitate well with abatement, or some patients rehabilitate successfully with having abnormal experience, and the rehabilitation of the schizophrenic patients should be done consibering the type of the rehabilitation for the psychiatrically abnormal patients, or relying on the possibility of change of character. However, later investigation showed that the ratio of re-hospitalization should be considered by a longer time of observation, but continuous coming to hospital prolonged the period to the re-hospitalization. Thus, until the second year of leaving the hospital, the ratio of re-hospitalization for the group of the long term out-patients is low, but it becomes rather higher after the second year, However, when such long term out-patients are rehospitalized again, the attitude of the patients and their family become positively, that is different from the rehospitalization of worse patients. Therefore, the results should not be evaluated on the same base. From these results, it may be understood that the guidance for the outpatients is surely supporting the, rehabilitation, and such guidance should be performed for a long term, which the author really felt.
  • 石川 鉄男, 渡辺 真
    1967 年 21 巻 2 号 p. 165-171
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    I Historical background
    The history of the psychiatric rehabilitation activity at the Konodai National Hospital began in 1945. At the time, agricultural works were the main subject, and the work had been organized gradually in 1948, and the kinds of works increased and recreational therapy was also adopted. In 1952, occupational therapy regulations were made, and a staffineeting for the rehabilitation activity was held once a week. Occupational therapy staff were gradually increased, and in 1957 open ward was made which was actually the place of work, and patients came from various wards of the hospital were observed and received guidance. Thus group work at the center was gradually developed, and this hospital, having 350 beds in the psychiatric department, and because of being a psychiatric department of general hospital, no budget for the work and recreation was given, and in spite of the serious efforts of the staff the same situation had been continued until 1960.
    In 1960, patients made their self-governing organization. The purpose of the organization is to make more therapeutic and effective activity under the poor dudget and personnel circumstances. The name of department was changed from occupational therapy to the department of social therapy. In 1963, because of extremely lack of nurses, centralized system of occupational therapy had to be discontinued. Since then, the works have deen guided in each ward, and the center of the rehabilitation activity was transfered to the self-governing activity, ; club activity, and psychotherapeutic group work. Since then, this system has been operating.
    II Therapeutic consideration for centralized system of occupational therapy Because of extreme lack of nurses, observation and guidance of the patient are not carried out sufficiently. The expansion of equipment, more skilled work, etc. are difficult because of poor budget, and it is difficult to assign a proper work for certain type of disease condition, In each section of the hospital, as the result, patients who need guidance were not treated and patients who had less problem were sent for working.
    III General status of the present rehabilitation activity
    The works are done in each ward under sufficient observation and guidance for rather disturbed patients, Less disturbed patients work in club activity, and group work, and the direction of the work is investigated in the staffineeting of social therapeutic group.
    IV Consideration for the activity doing in the self-governing activity
    A. Merit: Spontaneity, responsibility, social adaptation have been grown in contrast to the effects of occupational therapy and also the improvement of human relations may be expected.
    B. Problem: Since patients participate into the therapy and management, confusion arouse and the ward staff became overcautious and authoritative to the patients. Absolute lack of the ward staff and budget are the problem although the system operates on the more rational basis comparing with the previous system.
    Considering the rehabilitation program at this hospital, it seems to be disimproved, but it was a history of great progress, and conventional old preservative way of thinking was about to change in a direction of very positive mass psychotherapy. Howevcr, in order to expect more active development of this program, we have to dissolve the problems of the shortage of both human and economical sources.
  • 真下 弘
    1967 年 21 巻 2 号 p. 172-175
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    In regard to a kind of neurosis which is called School Refusal (socalled “school-phobia”), it is said that there is a tendency to increase in recent days.
    The factor in that outbreak is not simple. Interpersonal relationship in a family, as well as the moment of outbreak and the specific character of the sick child, is one of the important factors.
    The environment in which the child in question is brought up, and the inclination of the attitude in the family show phenomenal tendencies to over-protection and overinterference.
    The emotional entanglement between the parents, which is the motive of those tendencies (sometimes between the parents and grandfather-and-mother) and between the parents and the child (or, between the grandfather-and-mother and the child), especially the disposition and the role relation between the parents have a much influence on the formation of personality in addition to the disposition of the child.
    Consequently, the child fails to take in the images of their parents which should be the psychological support over again. As a result, enlarging their sever wound, the child is driven to bay and isolated gradually. On the other hand, his parents grow increasingly uneasy, and regard the child as wilfulness on account of his rejection. In spite of this attitude, the parents are at a loss how to bring up their child, and reveal their immature disposition. These attitudes of the parents produce the vicious circle that they are drawn about by their child against their will.
    On the occasion of treatment, if a case is serious, it is necessary to separate the child from his home (take to hospital) and to make him reconstruct his own self.
    Moreover, the members of the family is required the efforts to recognize the role with one another, to understand their own disposition and to admit the others' situation.
    In our hospital, we have the situation for the group guidance as well as the individual guidance for the family with the child in question.
    Through the interaction between the members of several families, they accomplished the following aims: improvement of the immature disposition of the parents, the reduction and rmmovement of the conflict in their home, the conquest of anxiety, finding out their own roles, and adjustment of the relation to the children.
    The treatment of the family with the child rejecting the school attendance is not accomplished by itself alone, It becomes meaningful when it keeps the close and imseparable connection with the treatment of the child, Besides, the effect of such a treatment can not be expected till we keep the connection with the school.
  • 目黒 克己
    1967 年 21 巻 2 号 p. 176-180
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    War neurosis is also called neurosis during the war, It is the general term of neurosis which has appeared in the army during the war.
    Total number of neuropsychiatric patients who entered in Kondodai Military Hospital between 1938 to 1945 was 10, 454, Concerning the rate of each disease, we found 54.4% in hysteria, 33.5% in neurasthenia and 12.1% in psychogenic reaction.
    The percentage of hysteria during the sencond World War was 54.4% in Japan, 45.1% in U. S. S. R. and 18% in U. S. A. The rate of hysteria in the United States armed force during the first World War was 30%.
    Speaking about the prognosis of war neurosis in our country after 20 years, 25% of them have not recovered as yet. In the group of this kind we find that the primitive reactions disappeared, and the type of illness moved to the symptoms of disturbance of the autonomic nervous systems in every case.
  • 村瀬 孝雄
    1967 年 21 巻 2 号 p. 181-186
    発行日: 1967/02/20
    公開日: 2011/12/02
    ジャーナル フリー
    1. About Self-Image: In recent clinical psychology, there is a tendency to take seriously of the self image, for which the individual has perceived on the occasion of understanding the personality, adjustment and behaviour of an individual concerned. It has clinically proved that it's significant to know the self which is perceived by a patient himself (it is called self-concept or self-image) for the prediction of his behaviour and the improvement of personality by means of psychotherapy. Following this tendency, the attempt to measure the self-image operationally and statistically has also developed.
    2. The Aim of Development of Konodai Self-Image Scale: On the basis of recognition of the shortcomings and the limit in many self-measurement methods, we have made out the new one where we have laid stress on the following points. (1) This should be the measure that we can get. a patient to express the various aspects of his realization experienced by himself as frankly as possible (2) It should be useful rather for clinical understanding of an individual and tratment in a direct sense than for the tool of research. (3) To minimize the restriction based on the framework which is set up by testers in advance. (4) To make much of the clinical validity rather than statistical and mathematical accuracy.
    3. The Process of Making the Scale: Adopting the merits of S-D Method (Semantic-Differential Method……the method to measure and synthesize the sense differentiated by the use of many adjective-pairs scales), which is known as an excellent method in the image-measurement, we have finally selected 75 pairs of adjectives from more than 100 ones which were picked up by our experience. Each of these adjective-pairs constructs a scale which is divided in 7 stages on the line with the two poles of antonyms.
    4. The Various Dimensions of the Scale and the Representative Items: All of the scales have provisionally been arranged in 10 dimensions for convenience, I. natural fluidity (natural-unnatural) II. activeness (active-inactive) III. security (securescared) IV. strength (strong-weak) V. pureness (pure-impure) VI. brightness (bright-gloomy) VII. existential feeling (with a foothold-without a foothold) VIII. relatedness with others (frank with others-reserved) IX. impulsiveness (exhaled-pentup) X. regard to self (positive-me-negative-me).
    5. The Method of Practice: It is written clearly that the purpose of the scale is strictly to find out a clue with which an examinee himself can understand his own inner world in company with a tester. On this occasion, it :is necessary that the confidential relationship is established between a tester and an examinee. We have aimed to grasp the more differentiated self-image, utilizing the signs by which we can apprehend the two points mentioned below: how vivid an experience of conscious self percept is, and in which respect will he wish for his change and improvement?
    6. The Practice in the Application of Self-Image Scale: (1) Applying the scale to three groups, namely the normal group, the neurotic group and the schizophrenic group, we have had the following results, Between the respective groups, there have been found statistically significant differences. But, it is more profitable to use this scale as an auxiliary means for psychotherapeutic approach than as the screening test. The traits of the selfimage in the schizophrenic group (new 20 cases of rather highly educated patients) are lacking in brightness, security, relaxed feeling, activeness and feeling of contentment, and show the negative image corresponding with the clinical view. (2) As to the cases who take psychotherapy in succession, we have caught the movement of self-image accompanied by the process of the treatment, and have tried to compare the measured selfimage with the self-image and the change of behaviour informed at the therapy-situation.
    7. It has been cleared that the scale is available for a patie
  • ―内科医と精神科医の協力をめぐつて―
    望月 昂, 大熊 文男
    1967 年 21 巻 2 号 p. 187-191
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    At the department of internal medicine in our Hospital, we experienced psychosomatic approach with the cooperation of psychiatrist for about 3 years, and the following are summarized as the result of the discussion:
    1) Doctors of internal medicine should expect to the psychiatrists not only “psychiatric” but also “psychosomatic” cooperations, and the psychiatrists should have interests to the psychosomatic medicine as well.
    2) With the cooperation of psychiatrists, many psychiatric patients may be found among the patients of internal medicine as the neurosis, psychosomatics even psychotics showing somatic symptoms as their main symptoms.
    3) Psychological resistance of the patient shown against the examination of psychiatrist could be a step to approach to the patient, so the doctor of internal medicine should study about the corelationship between psychological and physical conditions, and the doctor should know the understanding of disease by the patient, degree of want of therapy, and relationship between the doctor and the patient in order to treat the resistance of the patient properly.
    4) In order to perform adequate treatment with the cooperation of internal medicine and psyehiatric medicine, the both should be combined at the point of psychotherapeutic attitude, and daily exchange of communication should be kept on closely.
  • 大熊 文男, 山口 昇一
    1967 年 21 巻 2 号 p. 192-197
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    A psychosomatic studying group belonged to the C. N. S. center of the Konodai National Hospital studied 20 cases of primary juvenile hypertension patient younger than 35 years old visiting the department of circulatory organs in our hospital for a year from January, 1965 to January, 1966. These patients were clinically examined by the psychiatrist at the psychosomatic center, and as psychological examination CMI (Cornell Medical Index), KSCT (Kataguchi's sentence complation test), and R-T (Rorschach test) were given. Characteristic tendency and psychophysical factors concerning to hypertensional patients were discussed on the basis of the data obtained in the case studies of the patients.
    1) Concerning our cases, consistent character tendency was not found as other researchers often reported. For example, schizophrenic type and epileptic-like symptom are found.
    However, number or cases showing characteristic abnormality which itself become the problem were noted. Patients with such remarkable personality deviation can not judge things whatever the deviation is, and they also can not control their emotion properly, so that they easily become neurotic. Then, according to the result of CMI, about 80% of the patients studied revealed neurotic or similar states, This might verify the above descriptions.
    2) Ten cases out of 20 cases were found to be hypertension by chance and the rest of 10 cases were those who came hospital with complaints due to their illness. Reviewing the corelation with genetic factor, group of genetically positive was found in the former and negative in the latter. Therefore, the patients. group having negative geneticofactor, had complaints and no psychological problem can be extracted as a subtype. It may be practical to distinguish this group from a group having clear psychological problems.
    3) There are some periods without complaints . in hypertension, so the time. of onset is very difficult to determine, thus the corelation . between the induction of hypertension and psychological problem may not be determined directly.
    Among our cases, two patients were found to be hypertension without psychological factor at that time but later the patient suffered from the psychological problem, and the symptom became aware, then hypertension was re-found. These two cases suggest that the time of induction of hypertension and corelationship between the induction and psychological problem should be discussed with the most careful manner.
  • 佐々木 司郎, 村瀬 孝雄
    1967 年 21 巻 2 号 p. 198-203
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    We will make a report on the outline of the experience that we have been in charge of the open ward in the department of psychiatry for two years, which has been established on the basis of a new idea.
    1. Features of This Ward: (1) This ward is situated in the same building that the other various departments. There is no constructional distinction between this ward and the other departments. It possesses the bathrooms and the washingplace in common with the department of orthopedics. (2) The degree of physical and psychological opening in this ward is about the same as others. (3) This is the ward where men and women are hospitalized together. (4) On account of taking in the patients suitable to opening, the rate of schizophrenics is low, and in the most part of the patient, we find those who are not in severe and agitated conditions, and do not give much annoyance to other patients in comparison with the other psychiatric wards. (5) The Patients with the compilcation of other diseases are preferentially hospitalized. We have the close co-operation with other departments, (6) This is the co-operative ward with the National Institute of Mental Health, The psychiatrists, the psychologists and the social workers in this institute take a hand in the treatment of the patient at this ward directly, and exchange the opinions in the close relationship with us. (7) The clinical psychologists take part in the medical treatment actively.
    2. The above features have brought forth the all sorts of new problems and experiences which have never been found in the traditional management of psychiatric wards. We have considered about the next two points of them: first, concerning the treatment in the hospital of the mild cases of mental disorder; secondly, about the co-operative system with the psychological staffs of the institute.
    (1) The patients with neurosis or early schizophrenia and so on, who have not fall into remarkable personality disorder, express seriously their complicated morbid suffering and their worries about the life to the staffs, and ask for the help of them. At the same time, they are extremely sensitive to the responses of the staffs, On the occasion of the treatment of these patients, the effort to come into contact with them under a delicate sense is required of us, This effort should be accompanied by the respect for the individual patient's inner needs and feelings, and besides the empathic understanding of their internal feeling and viewpoint. There are the patients who show ambivalence, such as dependent feeling and hostility to the staffs, or who feel severely hurted by the staffs' trivial conducts. We have come across the difficult problem how the staffs should deal with their own feeling when they get in touch with these patients, It will also be the subject from now on to treat all of the patients in the ward as a social psychological group, and compatibly to understand deeply each individual. Moreover, we feel that we have to try not to allow the acceptance of a patient to fall into the mere passive indulgence and permitting, and that we have to take a determened attitude toward the ‘freedom and order’ problem which is often difficult to be solved in the open ward, In regard to a clinical psychologist, his concerning has aided the solution of various psychological problems mentioned above, and has contributed to the development and the exchanges of our thought by speaking out and acting on from a standpoint free from the traditions and the customs.
    (2) The principal work co-operated with the staffs in the National Institute of Mental Health has been the psychotherapeutic contact with schizophrenic patients. The staffs in this ward have learned the following from the institute; that is to say, the approach based on the patience, the sincerity and the skill toward the patient's inner world which is beyond conjecture leads him to express his unexpectedly complicated and significant internal
  • 高室 昌一郎
    1967 年 21 巻 2 号 p. 204-208
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    Recent exploding development of the psychotropic drugs makes the concrete concept of “pharmacotherapy”, and contributes to the psychiatric medicine, although the effect of those psychotropic drugs is that for the symptoms, and it is neither for the basic personality disturbance due to the endogenous cause, nor for inner conflict due to the psychological disease, thus, the effect is not considered to be the creative one. This will be the limit of the present status of the pharmacotherapy of psychiatric patients.
    Reviewing the pharmacotherapy in the psychiatric department of our hospital, we have to treat many patients within a limited short period, therefore, the treatment has to be depended on drugs, and thus the pharmacotherapy is the first choice as the matter of fact. In addition, time for somatic and psychological treatment are not sufficient, and they are not favorably influenced on the effect of drugs.
    The presently practisizing pharmacotherapy and psychological treatments should be metholologically discussed.
    It is not only the problem at our hospital, but also an problem of the psychiatry in our country.
  • 渡辺 位
    1967 年 21 巻 2 号 p. 209-215
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    Division of children's began the activity in this department and independent ward was built in 1950, however, the division and the ward had to be closed because of various problems in 1960.
    Since then, as child's patients increased, hospitalized children increased. Among them psychogenic patients, particularly school re usal have increased. For such cases, it is effective in most cases that the patients are hospitalized in order to separate from their home.
    Most of the patients were absent from school, so their studying grade is lower than the average, and some patients remain in the same year grade. Then, their grades became worse by being hospitalized, and they do not want to go to school any more.
    Therfore, it is advised that when such patients are hospitalized, place of study should be made in order to prevent lowering the studying habit and grade, to be in the air of school, to have close human relationship with teachers, and to be effective to heal the feeling of dislike of school.
    Under such circumatamces, divisional school of neighboring primary and junior high schools was established in this hospital in 1905 by great sponsorship and guidance of the educational office of the Chiba-ken, and the educational committee of Ichikawa City.
    The school is consist of 1 class of each primary and secondary schools, and numbers of the 1 class members are limited to 15 students. One full-time teacher in the primary school and one full-time and eight part-time major teachers in various fields are provided.
    In these classes, children's patients who can attend the class are having study, From May of 1965 to April of 1000, 35 students (22 school refusal) attended, and 17 students at the present time (August, 1000) are attending;the school.
    The therapeutic significance of the school in the hospital is a kind of the social rehabilitation and the effect is largely expected. Numbers of kids school refusal are increased, and they need to be hospitalized, so that psychiatric medical facility and educational facility in the hospital should be combined together and such combination is really desired.
  • 渡辺 位
    1967 年 21 巻 2 号 p. 216-223
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    Schoolrefusal (Schoolphobia), considered as one of the children's neurosis, become current problems not only for child psychiatry, psychology and education, but also the problems in the society sometimes mass communication media discussing.
    Neurosis and neurotic behavior in childhood is not many in number; but no other problem than the schoolrefusal became so big problem in the society.
    This is because the problem arose in a school, the place of education.
    The first report concerning the schoolphobia appeared in 1941 by A, M, Johnson, and since then the problem has been studied by various investigators.
    In Japan, although Sumi, Takagi, Yamamoto, etc, reported excellent investigations on schoolrefusal, the psychological mechanism of this symptom is not the same so that what type of neurosis it belongs to is still the subject of discussion.
    We examined many cases of schoolrefusat, and classified this symptom in 3 groups, I-III, not on the basis of overt phenomenon “dislike to go to school”, but on the basis of the fundeamental features.
    Group I is a group of patients who are hypersensitive, too shy to be watched and sometimes show autistic tendency. Before the symptom appears, the character of the patient is timid, introvert and nervous, and the patient has characters of schizothym (Kretschmer). Most of the patient had relatives having autistic or isolated character, or schizophrenia.
    Group II is a group of patients who have character such as poorly controled emotion, maddy, attacking and resisting tendencies, and characteristically timid, exaggeration, selfish and not cooperative.
    It should be noted that in many cases of this group their family gave too much control or over-protective attitude which should have given unfavorable influences to the children.
    Patients belong to Group III do not have so serious problems as those of former Groups. Motivation of going to school may be disturbed owing to their earier experience.
    Thus, the cause of schoolrefusal is closely related to the characteristic nature of the children.
    Very often the patient's family is also the cause of problem; their parents are not adequate as the member of the family. Then, in this case, the character of children as well as attitude of their patients become the problem.
  • 山上 竜太郎
    1967 年 21 巻 2 号 p. 224-228
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    The author holds periodic staff family meeting once a month for the family treatment of the schizophrenic patients in a male closed ward.
    The meeting is held for the purpose of getting understanding the staff of the hospital and therapeutic purposes to the family of the patients, and it is also expected that the staff gets acquainted with the family environment of the patients and gets deeper understanding of their symptoms. The author had noticed that the family of the schizophrenic patient had family problem frequently which gave negative result for the treatment and their rehabilitation.
    The meeting is an effective means to dissolve the problem as a group therapeutic method.
    The family problems found at the meeting are as follows:
    1) Extreme subjectivity for understanding the patients' disease.
    2) So-called double bind communication.
    3) Over-protection.
    4) Psychopathic personality of the parents, especially the father.
    5) Rejective attitude toward the patient for fear of destroying the family prestige
    In order to make the family understand the problem, Hobbs' group centered therapeutic approach rather than direct talking to the family was found effective as an educational method.
  • 湯原 昭
    1967 年 21 巻 2 号 p. 229-234
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    The number of narcotic addicts in Japan have been increasing gradually after the world war II, becoming major social problem, and in 1963 narcotic regulational law was revised, mainly giving heavier punishment and compulsory hospitalization of the narcotic addicts, thus the countermeasure for the narcotic addiction called the attension. The numbers of compulsory hospitalized narcotic addicts during 3 years, for the time of the revision of regulation, July, 1963 to 1965; 86 in 1963, 155 in 1964 and 153 in 1965, and the age distribution at the time of hospitalization was 30's and 20's in 1963, and it moved to higher, 36's and 46's in 1964 and 1965. The patients' occupations were jobless and medical workers in most cases, Narcotics they used were heroin in 1963, and in 1964-1965 heroin was reduced and medical narcotics increased. The cause of addiction was injection for pain in most cases. Thus concerning the pattern of narcotic addiction changed before and after the revision of regulation, heroin addicts are reduced, instead medical narcotic addicts occupy most cases. Medical narcotic addicts and heroin addicts are clinically and statistically compared. The obtained results are:
    1) Sex of the patient : Sixteen male and 4 female patients in medical narcotic addicts, 32 male and 10 female heroin addicts, and male patients occupy about 80%. The age is distributed 20's in heroin addicts and 30's and 40's in medical narcotic addicts. Medical workers were involued in 50% in the medical narcotic addicts Jobless occupies the next higher percentage, and their unstable feeling for the outer circumstances is shown, which might lead to the narcotic addiction. Most patient of heroin addicts were jobless, not well educated and had problem in their surroundings.
    2) The first use of narcotics was for physical pain as in the other cases. However, some patient used narcotic for not so severe pain. Other than such physical pain, psychological motivations such as unstable feeling, curiosity became the moment of using narcotics. Most patients used narotics for 1- 5 years by such motivation. Most patients of heroin addiction used heroin by curiosity and their friends shot first narcotics.
    3) Observation at the time of the hospitalization was that most patients had traces of injection and induration. Few cases showed lack of nutrition. As the subjective symptom, they had gastrointestinal pain but it disappeared soon, and no abnormality was found by detailed physical examination.
    4) Narcotics were not given at all immediately after the hospitalizaion, and only 30% of the patients showed abstinence symptoms. They were diarrhea, vomitting, nausea, nasal discharge and general fatigue in a slight to middle degree. Only 12% of the patient showed abstinence symptom in the heroin addiction. No objective and subjective abstinence symptoms was observed in 70 to 80% of the both addiction.
    5) Twenty six per cent of the patients of heroin addiction had experienced waking agents. Whereas only ten per cent of the patients of medical narcotic addiction had experienced the waking agents. Eleven patients of heroin addiction in younger generation had a sleeping agent, hyminal, in addition to the narcotics, but no such case was found in the medical narcotic addicts.
    6) Personality characteristics; 9 “Willenlose”, 5 “Geltungsbedürftige”, and 3 hyperthymia, and 3 had no particular problem. In the heroin addiction, on the other hand, 17 “Willenlose”, 10 explosive character, 3 hyperthymia and 12 had on particular problem. As a whole, “Willenlose”, hyperthymia and “Geltungsbedürftige” occupied in most cases.
    7) Narcotics used by them were morphine hydrochloride, opiat and opisco, and opisco, and some patient used more than 1 narcotics.
    8) The process after the hospitalization had no problem for the medical narcotic addicts, while the patients of heroin addiction agitated other pa
  • 真下 弘
    1967 年 21 巻 2 号 p. 235-236
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    Generally, it seems that medical social work aids the patients economically, but “Psychiatric social work” calls attention in the field of psychiatric therapy. However, the work is sometimes misunderstood as approaching to the patient expecting mitigating the psychiatric disorder by psychotherapeutic approach. Psychiatric social work dissolve the suppressed patient psychologically, and find the way to aid the patient in the field of medical organi zation. In this case, psychosocial relation should be emphasized.
    At this hospital, psychiatric social work is done in the organization of general hospital, and the informational exchange between the members of other fields and mutual understanding may be necessary.
  • 吉村 正
    1967 年 21 巻 2 号 p. 237-240
    発行日: 1967/02/20
    公開日: 2011/10/19
    ジャーナル フリー
    When psychiatric treatment is finished, a lot of patients should be discharged from the hospital.
    The degrees of recovery among psychiatric patients appear various and complicated. For example, the one can be employed in former placement, the other happens to live only on unproductive life in community. It is important that not only one physician but many physicians investigate the cases of recovery for psychiatric patients.
    We examined one hundred and two patients for one year from June, 1966 to June, 1966.
    In June and December, relatively a number of patients were discharged from the hospial.
    Of course, it is natural that discharged patients mainly consist of occupational ward and open ward.
    As for discharged patients, 20 agers or 30 agers appear more than other ages.
    As such a generation indicates human productive period, so patients and their families want to be discharged.
    Diagnosis is as follows; schizophrenic 50, atypical psychosis 8, psychopath 8, psychogenic reaction 7, manic-depressive disease 7, alcoholism 5, neurosis 5, etc.
    As for occupations, farmer 24, student 12, public employee 8, etc.
    Regarding treatment, drug therapy 63, work therapy 32, electro-shock-therapy 4, intensive psychotherapy 3, etc.
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