小児・思春期を対象とする心身医療専門外来の現況 : 地域のニーズに沿う心身医療の提供とその限界について  [in Japanese] The Current Status of Psychosomatic Outpatient Care for Children and Adolescents : Provision and Limitations of Psychosomatic Services that Meet Community Needs  [in Japanese]

目的:近年の地域ニーズに沿う小児・思春期心身医療のあり方とその限界について検討する.対象と方法:最近8年間,九州大学病院心療内科とその関連病院にて筆者が担当した小児心身医療専門外来の受診者を対象とした臨床的解析.総数425名(男性249名,女性176名.初診時平均年齢13.9±10.2歳).すべての対象者に研究協力の同意を得ている.結果と考察:治療ニーズは発達障害が最も高く45%を占めている.また,成人受診も含め年々増加している.障害児を抱える母親の42%は神経症レベルにあり要治療であった.社会ニーズは,カウンセリングと母親のメンタルサポート,福祉・教育との連携と情報共有である.地域ニーズは,不登校,反社会性の行動障害や成人の就労支援への医療的評価と対応である.心身医療へのニーズは拡大しているが,現行の保険診療制度ではこれらの領域の専門指導料は保証されておらず,質の高い医療提供を維持するには限界がある.結論:小児・思春期領域の心身医療体制の早期充実を図ることは,社会の病理現象の健全化に貢献し,家族の精神衛生に関わる医療費の節約につながると思われた.

Objective: The status and limitations of psychosomatic medicine services designed to meet community needs in recent years were evaluated. Subjects and methods: Patients seen during the past eight years by the author in the outpatient facilities of the Departments of Psychosomatic Medicine, Kyushu University Hospital and its affiliated hospital underwent clinical analysis. A total of 425 patients (249 males, 176 females, mean-age at first visit 13.9±10.2 years) were studied. Consent to study participation was obtained from all patients or their guardians. Results and discussion: Treatment needs were highest for developmental disorders, which comprised 45% of the studied patients. This rate has been on the rise annually, including adult patients. Regarding the mothers of patients with developmental disorders, 42% presented with findings suggestive of neurosis requiring treatment. Social needs included counseling and mental support for mothers of patients, and liaison and information sharing with welfare and education personnel. Community needs included medical assessment and approaches to helping patients with truancy or antisocial behavioral disorders manage such problems, and to helping adult patients obtain jobs. While the need for psychosomatic medicine is expanding, there are limitations in the maintenance of quality medical care provided under the current health insurance treatment system, which does not ensure the coverage of professional guidance fees in this field. Conclusion: Expediting enhancement of the psychosomatic medicine service system for children and adolescent patients can contribute to addressing the socio-pathological phenomena for improved soundness and to reducing medical expenses associated with family mental health.