精神科デイケアの有効性に関する日本と欧米の比較
精神科デイケアに関して既に70年近い歴史を有し，豊富な研究結果が蓄積されている欧米に比べ，日本の研究はまだ少ない。しかし1980年代より日本においても統合失調症（精神分裂病）患者を対象とした，デイケアの有効性に関するいくつかの研究が報告されている。欧米では種々の精神疾患に対してデイケアが試みられており，総合的な精神機能の回復のみならず，感情障害や反社会的行為，薬物依存等に対する効果も報告されているが，日本では統合失調症における陰性症状（感情鈍麻や引きこもり）の改善が中心である。外来治療との比較においては，日本欧米ともに精神症状の改善に対するデイケアの優越性が示されているし，入院治療との比較でも...
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| Published in | 日本公衆衛生雑誌 Vol. 50; no. 6; pp. 485 - 494 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本公衆衛生学会
2003
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0546-1766 2187-8986 |
| DOI | 10.11236/jph.50.6_485 |
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| Abstract | 精神科デイケアに関して既に70年近い歴史を有し，豊富な研究結果が蓄積されている欧米に比べ，日本の研究はまだ少ない。しかし1980年代より日本においても統合失調症（精神分裂病）患者を対象とした，デイケアの有効性に関するいくつかの研究が報告されている。欧米では種々の精神疾患に対してデイケアが試みられており，総合的な精神機能の回復のみならず，感情障害や反社会的行為，薬物依存等に対する効果も報告されているが，日本では統合失調症における陰性症状（感情鈍麻や引きこもり）の改善が中心である。外来治療との比較においては，日本欧米ともに精神症状の改善に対するデイケアの優越性が示されているし，入院治療との比較でも欧米でほぼ同等の効果が報告されており入院の代替的機能を担うと考えられている。再入院率を効果の指標とした研究では，日本の研究を中心に有効性が指摘されているが，長期間の再入院防止効果の持続には否定的な報告も多い。これらは従来のデイケアの限界性を示しているともいえるが，陰性症状に有効とされる，新しい抗精神病薬が最近相次いで開発されており，これらの薬物との組み合わせによってデイケアの治療効果が今後増大する可能性があり，今後の研究成果が期待される。 |
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| AbstractList | 精神科デイケアに関して既に70年近い歴史を有し，豊富な研究結果が蓄積されている欧米に比べ，日本の研究はまだ少ない。しかし1980年代より日本においても統合失調症（精神分裂病）患者を対象とした，デイケアの有効性に関するいくつかの研究が報告されている。欧米では種々の精神疾患に対してデイケアが試みられており，総合的な精神機能の回復のみならず，感情障害や反社会的行為，薬物依存等に対する効果も報告されているが，日本では統合失調症における陰性症状（感情鈍麻や引きこもり）の改善が中心である。外来治療との比較においては，日本欧米ともに精神症状の改善に対するデイケアの優越性が示されているし，入院治療との比較でも欧米でほぼ同等の効果が報告されており入院の代替的機能を担うと考えられている。再入院率を効果の指標とした研究では，日本の研究を中心に有効性が指摘されているが，長期間の再入院防止効果の持続には否定的な報告も多い。これらは従来のデイケアの限界性を示しているともいえるが，陰性症状に有効とされる，新しい抗精神病薬が最近相次いで開発されており，これらの薬物との組み合わせによってデイケアの治療効果が今後増大する可能性があり，今後の研究成果が期待される。 |
| Author | 清原, 千香子 吉益, 光一 |
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| Copyright | 2003 日本公衆衛生学会 |
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| References | 11) Herz MI, Endicott J, Spitzer RL. Brief hospitalization: A two year follow up. Am J Psychiatry 1977; 134: 502-507. 37) Mason JC, Louks JL, Burmer JC, et al. The efficacy of partial hospitalization: A review of recent literature. International Journal of Partial Hospitalization 1982; 1: 251-269. 52) Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999; 156: 1563-1569. 5) 染谷俊幸，安西信雄，池淵恵美，他．精神分裂病の陰性症状と社会適応経過．精神医学 1986; 28: 1229-1236. 13) Sledge WH, Tebes J, Rakfeldt J, et al. Day hospital/crisis respite care versus inpatient care, Part1: Clinical outcomes. Am J Psychiatry 1996; 153: 1065-1073. 28) 塚原敏正，加藤元一郎，笠原友幸，他．デイケアの有効性に関する検討—再入院率を指標として—．精神科治療学 1994; 9: 1371-1377. 34) Wiersma D, Kluiter H, Nienhuis FJ, et al. Cost and benefits of hospital and day treatment with community care of affective and schizophrenic disorders. Br J Psychiatry Suppl 1995; 27: 52-59. 42) Tollefson G, Sanger TM. Negative symptoms: A path analytic approach to a double-blind, placebo-and haloperidol-controlled clinical trial with olanzapine. Am J Psychiatry 1997; 154: 466-474. 55) Boath E, Cox J, Lewis M, et al. When the cradle falls: the treatment of postnatal depression in a psychiatric day hospital compared with routine primary care. J Affect Disord 1999; 53: 143-151. 40) Horvitz-Lennon M, Normand ST, Gaccione P, et al. Partial versus full hospitalization for adults in psychiatric distress: A systematic review of the published literature (1957-1997). Am J Psychiatry 2001; 158: 676-685. 33) Creed F, Mbaya P, Lancashire S, et al. Cost effectiveness of day and inpatient psychiatric treatment: results of a randomized controlled trial. BMJ 1997; 314: 1381-1385. 19) Marshall M, Crowther R, Almaraz-Serrano A, et al. Systemic reviews of the effectiveness of day care for people with severe mental disorders. 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Disability and Rehabilitation 2000; 22: 423-426. 39) Reisch T, Thommen M, Tschacher W, et al. Outcomes of cognitive-behavioral day treatment program for a heterogeneous patient group. Psychiatr Serv 2001; 52: 970-972. 10) Washburn S, Vannicelli M, Longabaugh R, et al. A controlled comparison of day treatment and inpatient hospitalization. J Consult Clin Psychol 1976; 44: 665-675. 32) Sledge WH, Tebes J, Wolff N, et al. Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs. Am J Psychiatry 1996; 153: 1074-1083. 30) Endicott J, Herz MI, Gibbon M. Brief vs standard hospitalization: The differential costs. Am J Psychiatry 1978; 135: 707-712. 2) Davis JE, Lorei TW, Caffery EM. An evaluation of the Veterans Administration day hospital program. Hosp Community Psychiatry 1978; 29: 297-302. 47) 池淵恵美，安西信雄．デイケア治療論の今日的課題．精神医学 1995; 37: 908-919. 4) McDonnell D. An evaluation of day center care. Int J Soc Psychiatry 1977; 23: 110-119. 18) Weldon E, Clarkin JE, Hennesy JJ, et al. Day hospital versus outpatient treatment: A controlled study. Psychiatric Quarterly 1979; 51: 144-150. 1) 清水順三郎．地域におけるリハビリテーション・サービス．精神看護学②．東京：メヂカルフレンド社，2000; 258-263. 29) Yoshimasu K, Kiyohara C, Ohkuma K. Efficacy of day care treatment against readmission in patients with schizophrenia: a comparison between outpatients with and without day care treatment. Psychiatry and Clinical Neurosciences 2002; 56: 397-401. 35) Fink E, Heckerman C, McNeill D. An examination of clinical biases in patient referrals to partial hospital settings. Hosp Community Psychiatry 1979; 30: 631-632. 41) Beasley CM, Tollefson G, Tran P, et al. Olanzapine versus placebo and haloperidol. Neuropsychopharmacology 1996; 14: 111-123. 45) 立山萬里，鈴木健文．分裂病の陰性症状の治療と社会復帰．臨床精神薬理 2001; 4: 351-359. 20) Vitale JH, Steinbach M. The prevention of relapse of chronic mental patients. Int J Social Psychiatry 1965; 10: 85-95. 43) Tran PV, Hamilton SH, Kuntz AJ, et al. Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J Clin Psychopharmacol 1997; 17: 407-418. 12) Creed F, Black D, Anthony P, et al. Randomised controlled trial of day patient versus inpatient psychiatric treatment. BMJ 1990; 300: 1033-1037. 23) Oka K, Maeda M, Hirano T, et al. Multicenter study on the effect of day care therapy on schizophrenia: A comparison of day care patients with outpatients. Psychiatry and Clinical Neurosciences 1999; 53: 505-510. 38) 大熊輝雄．現代臨床精神医学．東京：金原出版株式会社，2000; 356-357. 22) 大山博史，小泉 毅，永長昌之，他．精神分裂病の生活障害に及ぼすデイケアの効果．臨床精神医学 1997; 26: 907-917. 26) 武田俊彦，大森文太郎．慢性精神分裂病患者に対するデイケアの再入院防止効果．精神神経学雑誌 1992; 94: 350-362. 17) Grizenko N, Papineau D, Sayegh L. A comparison of Day treatment and outpatient treatment for children with disruptive behavior problems. Can J Psychiatry 1993; 38: 432-435. 24) Ettlinger R, Beigel A, Feder S. The partial hospital as a transition from inpatient treatment: A controlled follow-up study. Mt Sinai J Med 1972; 39: 251-257. 14) Michaux M, Chelst M, Foster S, et al. A controlled comparison of psychiatric day center treatment with full time hospitalization: An interim report. Curr Ther Res 1970; 12: 627-638. 8) Herz MI, Endicott J, Spitzer RL, et al. Day versus inpatient hospitalization:a controlled study. Am J Psychiatry 1971; 127: 1371-1382. 6) 鈴木敦子，大沼祐子，藤井由美子，他．デイケア患者の改善度評価の試み．社会精神医学 1984; 7: 67-73. 54) Droes RM, Breebaart E, Ettema TP, et al. Effect of integrated family support versus day care only on behavior and mood of patients with dementia. Int Psychogeriatr 2000; 12: 99-115. 16) Linn MW, Caffey EM, Klett CJ, et al. Day treatment and psychotropic drugs in the aftercare of schizophrenic patients. Arch Gen Psychiatry 1979; 36: 1055-1066. 44) Leucht S, Pitschel-Walz G, Abraham D, et al. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research 1999; 35: 51-68. 48) 大山博史．精神分裂病の陽性症状群と陰性症状群に及ぼすデイケアの効果．精神医学 1999; 41: 635-642. 53) Bateman A, Fonagy P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry 2001; 158: 36-42. 31) Guillette W, Crowley B, Savitz SA, et al. Day hospitalization as a cost effective alternative to inpatient care: A pilot study. Hosp Community Psychiatry 1978; 29: 525-527. 7) 池内慶公．慢性精神分裂病の臨床症状に対するデイケアの効果．精神神経学雑誌 1991; 93: 515-526. 50) Kluiter H, Giel R, Nienhuis FJ, et al. Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial. Am J Psychiatry 1992; 149: 1199-1205. 51) Davidson L, Tebes JK, Rakfeldt J, et al. Differences in social environment between inpatient and day hospital-crisis respite settings. Psychiatric Serv 1996; 47: 714-720. |
| References_xml | – reference: 1) 清水順三郎．地域におけるリハビリテーション・サービス．精神看護学②．東京：メヂカルフレンド社，2000; 258-263. – reference: 53) Bateman A, Fonagy P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry 2001; 158: 36-42. – reference: 25) Husted J, Wentler SA. The effectiveness of day treatment with persistently mentally ill in rural areas. Disability and Rehabilitation 2000; 22: 423-426. – reference: 48) 大山博史．精神分裂病の陽性症状群と陰性症状群に及ぼすデイケアの効果．精神医学 1999; 41: 635-642. – reference: 55) Boath E, Cox J, Lewis M, et al. When the cradle falls: the treatment of postnatal depression in a psychiatric day hospital compared with routine primary care. J Affect Disord 1999; 53: 143-151. – reference: 13) Sledge WH, Tebes J, Rakfeldt J, et al. Day hospital/crisis respite care versus inpatient care, Part1: Clinical outcomes. Am J Psychiatry 1996; 153: 1065-1073. – reference: 3) Edwards D, Yavis R, Mueller D. Evidence for efficacy of partial hospitalization:Data from two studies. Hosp Community Psychiatry 1979; 30: 97-101. – reference: 41) Beasley CM, Tollefson G, Tran P, et al. Olanzapine versus placebo and haloperidol. Neuropsychopharmacology 1996; 14: 111-123. – reference: 36) Paker S, Knoll JL III. Partial hospitalization: An update. Am J Psychiatry 1990; 147: 156-160. – reference: 8) Herz MI, Endicott J, Spitzer RL, et al. Day versus inpatient hospitalization:a controlled study. Am J Psychiatry 1971; 127: 1371-1382. – reference: 33) Creed F, Mbaya P, Lancashire S, et al. Cost effectiveness of day and inpatient psychiatric treatment: results of a randomized controlled trial. BMJ 1997; 314: 1381-1385. – reference: 5) 染谷俊幸，安西信雄，池淵恵美，他．精神分裂病の陰性症状と社会適応経過．精神医学 1986; 28: 1229-1236. – reference: 54) Droes RM, Breebaart E, Ettema TP, et al. Effect of integrated family support versus day care only on behavior and mood of patients with dementia. Int Psychogeriatr 2000; 12: 99-115. – reference: 14) Michaux M, Chelst M, Foster S, et al. A controlled comparison of psychiatric day center treatment with full time hospitalization: An interim report. Curr Ther Res 1970; 12: 627-638. – reference: 39) Reisch T, Thommen M, Tschacher W, et al. Outcomes of cognitive-behavioral day treatment program for a heterogeneous patient group. Psychiatr Serv 2001; 52: 970-972. – reference: 51) Davidson L, Tebes JK, Rakfeldt J, et al. Differences in social environment between inpatient and day hospital-crisis respite settings. Psychiatric Serv 1996; 47: 714-720. – reference: 15) Guy W, Gross M, Hogarty GE, et al. A controlled evaluation of day hospital effectiveness. Arch Gen Psychiatry 1969; 329-338. – reference: 50) Kluiter H, Giel R, Nienhuis FJ, et al. Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial. Am J Psychiatry 1992; 149: 1199-1205. – reference: 34) Wiersma D, Kluiter H, Nienhuis FJ, et al. Cost and benefits of hospital and day treatment with community care of affective and schizophrenic disorders. Br J Psychiatry Suppl 1995; 27: 52-59. – reference: 21) 高野佳也，加藤元一郎，塚原敏正，他．デイケアに通所した精神分裂病例の精神症状の改善について．精神医学 1995; 37: 369-376. – reference: 37) Mason JC, Louks JL, Burmer JC, et al. The efficacy of partial hospitalization: A review of recent literature. International Journal of Partial Hospitalization 1982; 1: 251-269. – reference: 12) Creed F, Black D, Anthony P, et al. Randomised controlled trial of day patient versus inpatient psychiatric treatment. BMJ 1990; 300: 1033-1037. – reference: 19) Marshall M, Crowther R, Almaraz-Serrano A, et al. Systemic reviews of the effectiveness of day care for people with severe mental disorders. Health Technol Assess 2001; 5: 1-75. – reference: 49) 下野正健，伊藤智美，深町伊久子，他．デイケアの溢路と解決策—福岡県精神保健福祉センターのデイケアのあり方—．精神科デイケア研究ふくおか 2002; 20: 85-88. – reference: 47) 池淵恵美，安西信雄．デイケア治療論の今日的課題．精神医学 1995; 37: 908-919. – reference: 2) Davis JE, Lorei TW, Caffery EM. An evaluation of the Veterans Administration day hospital program. Hosp Community Psychiatry 1978; 29: 297-302. – reference: 17) Grizenko N, Papineau D, Sayegh L. A comparison of Day treatment and outpatient treatment for children with disruptive behavior problems. Can J Psychiatry 1993; 38: 432-435. – reference: 4) McDonnell D. An evaluation of day center care. Int J Soc Psychiatry 1977; 23: 110-119. – reference: 43) Tran PV, Hamilton SH, Kuntz AJ, et al. Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J Clin Psychopharmacol 1997; 17: 407-418. – reference: 29) Yoshimasu K, Kiyohara C, Ohkuma K. Efficacy of day care treatment against readmission in patients with schizophrenia: a comparison between outpatients with and without day care treatment. Psychiatry and Clinical Neurosciences 2002; 56: 397-401. – reference: 30) Endicott J, Herz MI, Gibbon M. Brief vs standard hospitalization: The differential costs. Am J Psychiatry 1978; 135: 707-712. – reference: 35) Fink E, Heckerman C, McNeill D. An examination of clinical biases in patient referrals to partial hospital settings. Hosp Community Psychiatry 1979; 30: 631-632. – reference: 27) 浅野弘毅．デイケアの効果と評価—再入院防止効果を中心に—．臨床精神医学 1993; 22: 61-67. – reference: 52) Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999; 156: 1563-1569. – reference: 9) Herz MI, Endicott J, Spitzer RL. Brief hospitalization of patients with their families: Initial results. Am J Psychiatry 1975; 132: 413-418. – reference: 26) 武田俊彦，大森文太郎．慢性精神分裂病患者に対するデイケアの再入院防止効果．精神神経学雑誌 1992; 94: 350-362. – reference: 24) Ettlinger R, Beigel A, Feder S. The partial hospital as a transition from inpatient treatment: A controlled follow-up study. Mt Sinai J Med 1972; 39: 251-257. – reference: 18) Weldon E, Clarkin JE, Hennesy JJ, et al. Day hospital versus outpatient treatment: A controlled study. Psychiatric Quarterly 1979; 51: 144-150. – reference: 40) Horvitz-Lennon M, Normand ST, Gaccione P, et al. Partial versus full hospitalization for adults in psychiatric distress: A systematic review of the published literature (1957-1997). Am J Psychiatry 2001; 158: 676-685. – reference: 20) Vitale JH, Steinbach M. The prevention of relapse of chronic mental patients. 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| Snippet | 精神科デイケアに関して既に70年近い歴史を有し，豊富な研究結果が蓄積されている欧米に比べ，日本の研究はまだ少ない。しかし1980年代より日本においても統合失調症（精神... |
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| SubjectTerms | デイケア 再入院率 治療効果 総合失調症 |
| Title | 精神科デイケアの有効性に関する日本と欧米の比較 |
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