精神官能症病房老年病患之臨床分析

Clinical Analysis of Elderly Inpatients in the Neurotic Ward

目的：了解精神官能症病房中老年病患的臨床特徵、診斷、住院目的、治療所面臨的困難與預後等，期能對老年精神疾病患者的特性有進一步認識，俾能增進對他們的精神醫療服務。方法：本研究取北部某醫學中心醫院精神科精神官能症病房中曾住院的65歲以上的老人當研究組，並以65歲以下之成年人當對照組，藉由病歷回顧與主治醫師諮詢的方式，分析兩組病患在住院原因、診斷、病程、治療模式、治療困難原因與預後上之差異。結果：老年病患的診斷以憂鬱症最多（41.4%），有73%的病患在60歲以後才發病；老年病患較常合併身體疾病，但較少有藥物濫用。老無病患一年內的心理社會壓力以跟家人衝突與身體疾病為主。治療上，老年病患有更高比率使用安眠藥，並合併更多的藥物副作用，而且接受更多的其他生理疾病的治療。出院時39%的老年病患有中度或顯著的病情改善，高社經背景與教育程度的預後較佳。治療困難主要為個性上的問題。結論：本研究的結果顯示老年精神疾病患者常於老年期發病，且於住院前呈現持續生病的狀態，老年患者有較高之身體共病與藥物治療之副作用。低社經背景的患者短期治療預後較差，治療上必須克服治療者與患者間的文化差異及治療者的反移情作用。

Purpose: Through analyzing the clinical course, diagnosis, purpose of admission, treatment difficulties and outcome of psychogeriatric patients admitted in the neurotic ward of a general hospital, we expert to understand more about those patients and improve psychiatric services. Methods: The sample consisted of 41 in-patients over the age of 65 as study group and other 41 inpatients under age of 65 as a reference group. The subjects were analyzed by the items of admission reasons, diagnosis, clinical course, treatment modalities, treatment difficulties and treatment outcome. The differences between the two groups were analyzed. Results: Depressive illnesses were most commonly diagnosed in elderly patients (41.4%). Most patients (73%) firstly experienced psychiatric illness after the age of 60. Elderly patients had more physical illnesses but less substance abuse. The main psychosoical stresses before admission within one year were conflict with family and physical illness. In treatment, elderly patients were prescribed more hypnotics and experienced more side effects from psychotropic drugs. Besides, they received more physical treatment outside the psychiatric field. While discharged, 39% patients had moderate or marked improvement. A high socioeconomic status and education could predict a better treatment outcome. Treatment difficulties were mainly personality problems. Conclusion: The elderly inpatients usually experienced psychiatric illness in old age and remained ill before admission. They had more physical comorbid and more side effects from drug therapy. Low socioeconomic status predicts a poor short-term outcome. Psychosocial treatment should deal with the issue of patients' cultural background and therapists' countertransference.