입원중 정신과에 자문 의뢰된 노인 환자에 대한 고찰

A Study of Medically-Ill Elderly Patients Referred for Psychiatric Consultation During Hospitalization

Through the review of charts and consultation papers of patients who were referred for psychiatric consultation between July 1, 1988 to June 30, 1989 at the Seoul National University Hospital, we tried to find out the overall clinical characteristics of the elderly group (Age 60 and over) in comparison with those of the young group (Age 15—19) and the results were as follows * 1) The overall psychiatric consultation rate was 0.98 %. The rate of psychiatric consultation in the elderly group(l.21%) was significantly higherCp^10.0071) than in the young group(0.98 % ). This was the opposite of the reports from foreign countries. 2) Among the total consultation cases, the proportion of the elderly group was 22.9 %，which was significantly higher than those in other papers in Korea. We think this reflects the increasing proportion of elderly patients among the total number of patients in general hospital. 3) As a whole the elderly group were accompanied by a greater number of physical disease than the young group(0=0.01). Though the difference between the two groups was not significant in diseases of metatabolic and endocrine system, diseases in cardiovascular system and skeletomuscular system were somewhat higher in the elderly group. The two groups showed no difference in both total number of days hospitalized and the number of days in hospital at the time of consultation. The rate of psychotropic drug use at the time of consultation was significantly higher in the Department of Neurology than in the other departments (p=0. 00106). 4) The overall difference in referral sources was not significant statistically between two group. The Department of Internal medicine was the most frequent source- about half- which was a little less than the previously reported rate in Korea. We think this result was due to the increase in utilization of psychiatric consultation by the other departments. 5) Organic mental disorder was exceedingly more common in the elderly group (p 二 0.001) and the psychotic disorder, anxiety disorder, somatization disorder, personality disorder and psychosomatic disorder were more common in the young group, although not significant statistically. 6 ) The overall distribution of reasons for referral was not different in two groups. The most frequent reason was somatic symptoms without organic evidence, followed by previous psychiatric history and depression. 7) Psychotropic medication was most frequent as a recommandation in both groups. Though not statistically significant, recommendations of psychotropic medication and transfer to psychiatric unit were more frequent in the elderly group. There was no significant difference in diagnostic actions recommended between the two groups except that there was no recommendation for psychological test in the elderly group.