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精神科會診工作：綜合分析
The Psychiatric Consultation Service: Clinical Analysis
摘要
三軍總醫院精神科在七十三年度全年接受院內其他各科病房之會診人數共262人（男性161人，女性101人），會診率為1.08%，其中內科部的會診率為1.82%，外科部的會診率為0.77%，而神經內科的會診率則為7.16%。74%的個案在住院10天內接受會診。精神科的診斷以各種型式的憂鬱症（23.3%），器質性腦徵候群（19.8%），及焦慮性精神官能症（14.5%）為主，與國內外報告大致相符。會診的理由則為須要做診斷或鑑別診斷（49.1%），請求對治療的建議（40.5%），及有精神病的過去病史（9.3%）等。個案之原科身體疾病的診斷，內科病人以藥物中毒之自殺（11.1%），腸胃疾病（10.7%），心臟病（6.9%），及癌症（5.7%）為主；而外科病人則以頭部外傷合併器質性精神症狀（6.1%），及食道灼傷之自殺（5.7%）最為常見。精神科醫師的治療建議有33.6%個案以藥物合併心理治療，28.2%只用藥物治療，而13.7%只給予心理治療，17.2%的個案則僅做診斷評估。對全院67位非精神科住院級醫師之問卷調查則顯示在會診的理由上，他們所最關心的問題和認為最常會診的精神疾病大致與本研究所敘述者相符合。而66%的原科醫師認為會診對他們很有幫忙，幫忙的層次多在於診斷與治療層面均有（68%）。對精神科醫師的治療建議，有49%的醫師認為執行起來有時會有困難，可能主要在於心理治療及家庭問題的處理上，而57%的醫師對會診工作感到還滿意。另外，有53%的醫師認為雖然不少住院病人有精神問題，但很少需要會診，是否表示其關心的問題層面不同，或需要會診精神科的標準較嚴之故。綜合本文之分析，對未來綜合醫院之精神科機構所能提供的廣泛性和協調性會診功能，將使病人照顧的醫療品質之提高，及對臨床教學及其他研究之參考有所助益。
並列摘要
Two hundred and sixty-two cases, 161 males and 101 females, referred for psychiatric consultation from all non-psychiatric departments of Tri-Service General Hospital in 1984 were studied. The consultation rate of referral was 1.08% for the whole year and 1.82% and 0.77% respectively for the medical and surgical patients. For the Neurology section, the rate was up to 7.16%. 74% of the cases who referred for psychiatry evaluation were consulted within ten days after admission. Depression of various manifestations (23.3%), organic brain syndrome (19.8%), and anxiety neurosis (14.5%) were the three largest groups in psychiatric diagnosis of these patients. This finding was similar to the other studies in the literature. Necessitate for diagnosis and differential diagnosis (49.1%), request for therapeutic recommendations (40.5%), and the past history of mental illnesses (9.3%) were the three main reasons for psychiatric consultation. As for the medical diagnoses, the drug-overdose suicide (11.1%), gastroenteral diseases (10.7%), heart disease (6.9%), and cancer (5.7%) took the most parts in medical patients, and, the head injury complicated with organic mental syndrome and poison-induced corrosive injury of esophagus were the most frequently seen in surgical patients. 33.6% of the cases were intervened with drugs only, 32.6% were suggested for combined drug and supportive psychotherapy, 13.7% with psycho-therapy only, and 17.2% were referred for psychiatric evaluation only. In questioning 67 referring non-psychiatric residents, all the answers indicated that their concerns limited in the most frequent disease in their related fields were compatible with our findings. In addition, 66% of questioning residents considered the psychiatric consultation was helpful to them, and 57% was satisfied with the consultation service. It was also worth to know that 53% of the residents thought that although many psychological problems seen in their patients, they were still not alerted to refer these patients. This is the different viewpoint among non-psychiatric doctors who may have more strict criteria for asking psychiatric consultation. This analysis is presented in the hope that it may advance the future clinical teaching and researches in this field, and further upgrade the medical care quality of all in-patients.