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急性期精神病患者のための開放型一般病棟と精神科専門病棟の比較

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Abstract

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Background

As international healthcare policy has moved away from treating people with severe mental illness in large inpatient psychiatric institutions, beds for people with acute psychiatric disorders are being established in specialised psychiatric units in general hospitals. In developing countries, however, limited resources mean that it is not always possible to provide discrete psychiatric units, either in general hospitals or in the community. An alternative model of admission, used in the Caribbean, is to treat the person with acute psychosis in a general hospital ward.

Objectives

To compare the outcomes for people with acute psychosis who have been admitted to open medical wards with those admitted to conventional psychiatric units.

Search methods

We searched The Cochrane Schizophrenia Group's study‐based register (April 2007). This register is compiled from searches of BIOSIS, CINAHL, The Cochrane Library, EMBASE, LILACS, MEDLINE, PsycINFO, PSYNDEX, Sociofile, and many conference proceedings.

Selection criteria

We would have included all relevant randomised or quasi‐randomised trials, allocating anyone thought to be suffering from an acute psychotic episode to either acute management on general medical wards, or acute management in a specialist psychiatric unit. The primary outcomes of interest were length of stay in hospital and relapse.

Data collection and analysis

We extracted data independently. For dichotomous data we would have calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention‐to‐treat basis based using a fixed effects model.

Main results

We didnt identify any relevant randomised trials.

Authors' conclusions

The Caribbean practice of treating people with severe mental illness on general medical wards has been influenced by socio‐economic factors rather than evidence from randomised trials. This practice affords an opportunity for a well designed, well conducted and reported randomised trial, now impossible in many other settings.

一般語訳

急性期精神病患者のための開放型一般病棟と精神科専門病棟の比較

精神病は、誤った感覚を認識させたり(幻覚)、大多数とは異なる方法で世の中を見せたりする(妄想)思考の障害である。精神病は、患者を非常に苦しめる原因となる。精神病で入院治療を必要とする人の大半は、精神科の専門病棟で治療を受けている。しかし、カリブ海を中心とした発展途上国の一部では、精神病患者が糖尿病や心臓病などの精神疾患以外を抱える患者たちと一緒に、一般病棟に入院をして治療を受けるシステムが生まれている。精神病を抱える患者は抗精神病薬で治療を受け、回復するにつれて他の人の看護を手伝うことが期待されている。

このレビューでは、一般病棟での治療と精神科病棟での治療のランダム化された試験を比較することを試みたが、選択基準を満たす試験は見つからなかった。一般病棟に入院をしている患者の方が回復が早く、その後の仕事や教育に復帰ができることを示唆する論文が発表されているため、この2つの治療法(一般病棟への入院と精神科病棟への入院)を比較したランダム化比較試験を行い、このような結果になるかどうかを確認することは有益であろう。

(このレビューの平易な要約は Janey Antoniou of RETHINK, UK 1www.rethink.orgが作成した)