精神医学60巻6号

2018年06月発行

特集 医療・医学の課題としての身体合併症

心疾患領域との協働

著者： 和田健¹

所属機関： ¹広島市立病院機構広島市立広島市民病院精神科

ページ範囲：P.629 - P.637

はじめに
　急性心筋梗塞を含む冠動脈疾患やうっ血性心不全などの心疾患患者にはうつ病が合併しやすく，その予後にも影響することが近年知られるようになった^{17,19,23,25,34)}。心疾患患者の予後やQOLを改善するために，合併したうつ病を適切に評価し，治療的介入を行っていく重要性が指摘されている^14,36)。また逆にうつ病，双極性障害，統合失調症などの精神疾患患者は，心疾患に罹患しやすく，生命予後に影響するとの報告^10,13,37)もみられる。したがって，精神疾患患者に合併した心疾患の管理，治療も患者の高齢化を背景に今後ますます重要な課題となることが予想される。このような臨床的課題を解決していくためには，精神科医と循環器内科医との連携・協働が必須であり，看護師や理学療法士，ソーシャルワーカーなど多職種を含めたチーム医療，集学的医療が，入院および在宅医療の場で提供されなければならない。
　本稿では，心疾患とうつ病をはじめとする精神疾患との臨床的関連性について文献的考察を行い，コンサルテーション・リエゾン精神医学の視点から，リエゾン精神科医がどのように循環器内科医やその他の多職種と協働し，患者の治療およびケアにおいて機能していくべきかを述べたい。

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