統合失調症の差別と戦いたい！精神科医が語ります。26分動画

Good evening. I'm Haga Takahiro, a psychiatrist. Today, I'd like to discuss with you what mental illnesses are most discriminated against, and what we can do to change this situation. Thank you for your attention. Let me start by saying that when I say "discrimination," I don't mean the same thing as society as a whole; I'm referring to the differences in treatment and the lines drawn in the medical field, particularly when it comes to arranging admissions. I'm not saying this applies to all medical institutions across the country. However, after working as an internist for about 10 years and now also providing home visits, I've felt that things are tough and that the name of this disease makes things all at once difficult. To conclude, I think it's schizophrenia. It's not that it's the most discriminated against, but rather that it's the most feared. When looking for an admission, you might not be accepted, or the shutters will come down at the door. In that sense, I feel that schizophrenia presents an exceptionally high barrier to entry. Why does this happen? There are several reasons. First of all, when a patient with a psychiatric illness becomes unwell and is hospitalized, they are often concentrated in a "psychiatric hospital." It's not typical for a patient's respiratory condition to lead to a hospital that only treats respiratory illnesses. Patients are usually treated at a general hospital. However, the number of psychiatric beds at general hospitals is steadily decreasing. The number of general hospitals without psychiatric wards is on the rise. There are structural reasons for this. General hospitals often treat illnesses whose conditions change on a weekly basis and whose treatment is completed within a short period of time. With the DPC system, scores are high during the initial stages of hospitalization, but the output declines as the hospital stays prolonged. In other words, "treating patients quickly and seeing the next patient quickly" is compatible with the overall operation of the hospital. Meanwhile, psychiatric hospitalizations tend to be on a "monthly" basis. While individual differences exist, even depression can last from a few weeks to several months, and schizophrenia is even more so. Having a patient whose condition changes monthly within an organization whose treatment schedule changes weekly throws off the rhythm of the hospital as a whole. As a result, psychiatric inpatients are consolidated into psychiatric hospitals. This isn't the patient's fault, but a systemic issue. And this leads to the next problem: consolidating psychiatric services into psychiatric hospitals dramatically reduces the opportunities for general practitioners to interact with schizophrenia patients. People become afraid of things they don't interact with. This is a natural human response. For example, many doctors have experience prescribing antidepressants for depression. Sleeping pills and anti-anxiety medications are also sometimes prescribed by internal medicine and surgery physicians. Many doctors also use mood stabilizers in the field of epilepsy. Therefore, there's a certain degree of shared intuition about "this medication should be prescribed in this dosage, and its side effects are likely to be these." However, general practitioners rarely have the opportunity to properly administer antipsychotics to young schizophrenic patients as their "primary physician." Without experience, it can be frightening to know the strength of risperidone 6mg or the significance of olanzapine 10mg. Everyone is afraid of unfamiliar drugs. Furthermore, the fear is amplified when we only hear fragmentary information such as, "I heard lithium is dangerous," "I heard antipsychotics make you gain weight," or "I heard that patients' conditions suddenly worsen and they become violent." When I worked at a general hospital, we would sometimes receive transfer requests from nearby psychiatric hospitals for physical illnesses such as "I have a broken bone," "I have abdominal pain," or "I have pneumonia." From a medical perspective, this was a fairly standard consultation. However, the doctor in charge would say, "It says schizophrenia, so can you examine me at a psychiatric clinic?" or "I can't take responsibility if something happens on our ward." Even when I explained, "His medication is stable and he seems to be stable," "He has no history of violence," and "He's actually apathetic and troubling," they would respond, "But what if at some point his positive symptoms explode and he becomes violent on the ward?" The important truth here is that many general hospitals "don't have psychiatric wards." This means that if delirium or agitation were to occur, there is no in-house care for patients. There are no isolation rooms, and the staff is not used to it. That's why people feel like they don't want to receive it. Again, this anxiety arises not from personal malice, but from a lack of systems and experience. Howeve...