耳鼻咽喉科における心身症の割合と心理相談の現状(シンポジウム:皮膚科・眼科・耳鼻咽喉科における最新の心身医療トピックス,2009年,第50回日本心身医学会総会(東京))  [in Japanese] Need for Clinical Psychologists in Otolaryngology(Symposium/Recent Topics of Psychosomatic Medicine in Dermatorogy, Ophthalmology and Otolaryngology)  [in Japanese]

耳鼻咽喉科にはめまい,耳鳴り,咽喉頭異常感などを主訴に来院する患者が多い.この中には心身症の割合は少なくない.耳鼻咽喉科医は薬物治療,外科的治療,処置などが中心となり心理社会面での介入は一般的には行わない.このような場合に臨床心理士と共同で治療を行うことが有用である.そこで,耳鼻咽喉科医と臨床心理士とのチーム医療の現状について検討を行った.2004年10月〜2006年7月まで当科を受診し主治医が心身医学的治療が必要と判断し,臨床心理士に依頼した44例について検討を行った.身体科としての病名はメニエール病以外のめまいが最も頻度が高かった.カウンセリング平均回数は6.4±6.7回であった.44例中31例(70.5%)で改善を認めた.耳鼻咽喉科においてこれまで医師のみの診察で限界を感じていた症例に対して臨床心理士による心理治療を導入することにより多くの症例で予後が改善した.

Otorhinolaryngologists are usually not keen on taking care of patients with psychosomatic disorders, since their clinical course is greatly affected by psychosocial factors. Most doctors find it difficult to take care of these patients during the limited time spent in the outpatient clinic. In addition, otorhinolaryngologists think that their specialty is not taking care of patients with psychosomatic disorders but performing surgical treatment. It is reasonable to assume that collaboration with a clinical psychologist specializing in psychological disorders is required. We conducted a statistical analysis by using data from 44 patients who required psychological intervention. Meniere disease was the most frequent diagnosis. Psychological counseling was conducted in all cases, and the average number of counseling sessions was 6.4±6.7 (for a duration of 214.8±162.5 days). The prognosis was improved in 31 patients (70.5%). The collaboration of doctors with clinical psychologists is beneficial, especially to patients for whom administration of the conventional treatment is difficult.