古橋 功一

BACKGROUND: The novel coronavirus disease (COVID-19) pandemic has no end in sight. Currently, the emphasis is on policies aimed at easing movement restrictions and maintaining socio-economic activities. However, infection control in psychiatric hospitals has been challenging. There have been reports on the impact on mental health and outpatient/inpatient treatment environments in the field of child psychiatry. An outbreak of COVID-19 was experienced in a child and adolescent psychiatric ward, and considering that there have been few similar reports, it was deemed meaningful to accumulate such experiences. CASE PRESENTATION: Three COVID-19-positive cases, all 14-year-old girls, were confirmed in a cluster among seven hospitalized patients in a child and adolescent psychiatric ward. Two patients presented symptoms of upper respiratory inflammation and one was asymptomatic. The main psychiatric diagnoses were post-traumatic stress disorder in one patient and autism spectrum disorder in the other two patients. The entire hospital ward was designated as a red zone (contaminated area), and infection control measures were adopted, such as halting group activities, wearing masks, and maintaining distance between patients. Additionally, it was necessary to use the infection control ward as it was difficult to ensure patient compliance. CONCLUSION: Infection control in COVID-19 clusters at child and adolescent psychiatric wards is difficult due to patient characteristics and symptoms. Restricted activities and care also result in psychobehavioral consequences, regardless of infection status. To achieve both infection control and a better treatment environment, it is necessary to make careful preparations while learning from these experiences.

＜Key Point＞・主訴の背景には、発達障害特性がある可能性を念頭におく必要がある・発達障害患者のうつ状態は、二次障害として整理すると理解しやすい・心理社会的要因への介入は、発達障害特性の考慮が欠かせない(著者抄録)

Schizophrenia is chronically progressed disease with a functional decline and adequate treatment is needed for respective clinical stages. Duration of psychosis before treatment is called DUP (duration of untreated psychosis) and may be an important predictor of outcome. Furthermore, the early phase of schizophrenia including DUP is considered a critical period, in which long-term outcome is predictable. Therefore, that shows the importance of early detection and intervention for schizophrenia and relapse prevention during a critical period. The atypical antipsychotics now play the leading role in pharmacotherapy of schizophrenia. They clearly decrease adverse effects, and may prevent the relapse and improve long-term outcome. However, better pharmacotherapy needs the viewpoint of adherence and we do not have to remember the importance of psychosocial therapy.