hirakawa akihiko

Since 2001, psychiatrists started full-time work at the Emergency Critical Care Center (ECCC) in Kansai Medical University Takii Hospital (KMU Hospital). Psychiatrists also started somatic and mental treatment of suicidal patients in cooperation with emergency physicians. Since 2007, KMU Hospital has become one of the facilities of strategic research for preventing suicide, and psychiatric social workers have participated in assisting in the psychological and social support for suicidal patients together with emergency physicians and psychiatrists. KMU Hospital also received the assignment to investigate the reasons for attempted suicides in Osaka since 2010, and from then on psychiatric social workers began full-time work at the ECCC in KMU Hospital. As a result, collecting information, mental support to family, and social work intervention have become possible at an early phase after the patients have been admitted. We think that the important roles for the psychiatric social worker in the ECCC comprise the following 4 roles: First, sympathizing with suicidal patients; second, empowering coping skills when the patient is in a crisis situation; third, solving the patient's psycho-social issues on the basis of suicide attempts by using social resources; and fourth, assuring long-range support by constructing a coordinated system with the patient's family, close relations, and related organizations.

症例は43歳女と48歳男で、いずれも抗うつ薬による治療中に躁状態となり、自殺企図に至った。両例とも抗うつ薬の使用が躁転と長引く病像に関与していた可能性が示唆された。抗うつ薬を使用する際にはBipolar spectrumに留意し、躁転した場合には抗うつ薬の中止と気分安定薬の投与が必要であると思われた。今回の2例ではいずれもバルプロ酸が有効であった。