Mental Health Survey in Primary Care

采用初级保健心理健康调查问卷，对初级保健中的抑郁症进行问卷调查。受试者是302名在三天内去初级保健诊所就诊的患者。问卷由抑郁症诊断问卷(IDD)和达特茅斯库珀功能健康评估表组成。根据《精神疾病诊断和统计手册》第三版修订版(DSM-III-R)，在275名反应满意的患者中，重度抑郁症的患病率为6%，重度和轻度抑郁症的患病率均为13%。在6个月的随访中，54%的重度抑郁症患者恢复了状态。在国际比较研究中，美国和以色列的抑郁症患病率分别为13%和3%。这说明家庭医生和精神科医生都应该重视初级保健中的精神卫生保健。为了确定家庭的情绪表达是否与精神分裂症的病程有关，进行了一项队列研究。研究对象为52例符合DSM-III-R诊断标准的精神分裂症患者，由一名有资格的评定者通过坎伯韦尔家庭访谈法对患者家属的EE进行评估。生活在高EE家庭的患者9个月复发风险为58%，显著高于低EE家庭的患者。在控制混杂因素，如简明精神病学评定量表(BPR)中的精神症状、药物依从性和病程时，这一发现是正确的。在为期两年的跟踪研究中，也观察到了这一发现。EE研究在日本开展精神病患者社区护理方面前景看好。需要对精神分裂症进行有效的家庭心理社会干预。

Mental health survey in primary careA questionnaire survey was conducted for depression in primary care. Subjects were 302 patients who visited primary care clinics during three days. A questionnaire consisted of Inventory to Diagnose Depression (IDD) and Dartmouth COOP Functional Health Assessment Charts. In 275 patients who responded satisfactorily, prevalence of major depression was 6 % according to Diagnostic and Satistical Manual of Mental Disorders, Third edition revised (DSM-III-R), and 13% for both major and minor depression. During 6-month follow-up, 54 % of patients with major depression recovered from the state. In the international comparison study, prevalence of major depression was 13 % in USA and 3 % in Israel. These suggests that mental health care in primary care should receive more attention among not only family physicians but also psychiatrists.A cohort study was carried out in order to determine whether Expressed Emotion (EE) of families was related to the course of schizophrenia. Subjects were 52 schizophrenic patients diagnosed according to the DSM-III-R.Families' EE was evaluated through Camberwell Family Interview by a certified rater. Nine-month relapse risk of patients who lived in high EE households was 58 %, significantly larger than in low EE households. The finding was true when controlling confounding factors, such as psychiatric symptoms in Brief Psychiatric Rating Scale (BPRS), drug compliance, and duration of the illness. In the two-year follow-up study, the finding was also observed. EE study is promising in developing community care for the mentally ill in Japan.A effective family psychosocial intervention for schizophrenia is required.