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Aims: Although somatic diseases in psychiatric patients are increasing with the increase of the aged population, psychiatric wards in general hospitals in Japan have progressively been decreasing. The purpose of this cross-sectional study was to clarify whether psychiatric beds in general hospitals play sufficient roles in medical comorbidities of psychiatric patients or not.
Methods: This was a cross-sectional study performed all over Tokyo during the 2-month period from April to May 2007. The total number of patients who require admission due to both somatic and psychiatric diseases was investigated with their demographic and clinical characteristics.
Results: The total number of patients admitted to psychiatric beds in general hospitals for the above-mentioned reason was 326, while the number of patients who could not be admitted to them despite the same reason was 88. The rate of surgical diseases in the latter group was higher than that in the former group. In the latter group, diseases requiring orthopedic surgery (22%) and abdominal surgery (22%) were the most frequent, followed by gastrointestinal and hepatic diseases (8%), and gynecological diseases (7%). Patients who had attempted suicide were included more in the latter group than in the former group. Even in the former group, general hospitals could not respond to 34% of requests for emergency admission.
Conclusion: Psychiatric beds in general hospitals do not necessarily function for medical comorbidities in psychiatric patients, especially in severe and emergency cases. Not only the quantity but also the quality of psychiatric wards in general hospitals should be reconsidered.
ALTHOUGH SOMATIC DISEASES in psychiatric patients are increasing with the increase of the aged population, psychiatric wards in general hospitals in Japan have progressively been decreasing. For example, 9.3% of psychiatric beds in general hospitals in Japan disappeared during the 3 years from 2002 to 2005.1 In such a situation, the limitation of access to medical care in psychiatric patients may increase.
Although some studies have examined medical comorbidities among psychiatric inpatients, results have not been from population-based designs, but from hospitals only.2,3 Another study was population-based, but focused on mortality among psychiatric outpatients.4 Few cohort studies have thus been performed in which the severities of both somatic and psychiatric diseases are equivalent to the level of admission required.
The purpose of this cross-sectional study in Tokyo was to clarify whether psychiatric beds in general hospitals play sufficient roles in medical comorbidities of psychiatric patients or not. Such epidemiological data in Tokyo, where there are approximately 12 million inhabitants, might contribute to public policy not only in Japan but also in other countries.
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The authors thank Dr Hirotsugu Kikumoto, Dr Ichiro Masudomi, Mr Ichiro Yoshida, and Ms Yukiko Masuda (Tokyo Metropolitan Government), Dr Kunitoshi Hato (Japanese Association of Mental Health Services), Dr Kunihiro Isse and Dr Mitsuru Nakamura (Tokyo Metropolitan Toshima General Hospital), Dr Takao Nishimura and Dr Hikaru Furuta (Tokyo Metropolitan Fuchu General Hospital), Dr Hiroshi Suwa (Tokyo Metropolitan Ebara General Hospital), Dr Mitsuo Suyama (Tokyo Metropolitan Bokuto General Hospital), Dr Hiroshi Umezu (Tokyo Metropolitan Matsuzawa Hospital), Dr Yoshihiro Yahiro (Tama Saisei Hospital), Dr Naohiro Fujimura (Tokyo Musashino Hospital), Dr Hiroshi Mitsushio (Ohme-City General Hospital), Dr Hirokatsu Kono (Kyosai Tachikawa General Hospital), Dr Masahiro Shintani (Tokyo Metropolitan Hiroo General Hospital), Dr Takashi Takeuchi (Tokyo Medical and Dental University Hospital), Dr Joichiro Shirahase (Keio University Hospital), Dr Ken Inada (Tokyo Women's University Hospital), Dr Amane Tateno (Nippon Medical School Hospital), Dr Shuichi Katsuragawa (Toho University Omori Medical Center), Dr Tsuyoshi Akiyama (Kanto Medical Center NTT EC), Dr Hiroki Kocha (National Hospital Organization Tokyo Medical Center), Dr Tomomichi Kameyama (Tokyo Teishin Hospital), Dr Jin Habu (JSDF Central Hospital), Dr Yukako Seki and Dr Kobun Imai (International Medical Center of Japan), Dr Kazunori Nakajima (Sanraku Hospital), Dr Takeo Muraki (JR Tokyo General Hospital), Dr Yosuke Ichimiya, Dr Yoichiro Matsubara, and Dr Ryo Kumagai (Juntendo Tokyo Koto Geriatric Medical Center), for collecting the data.
This work was supported by a grant from the Ministry of Health, Welfare, and Labor of the Japanese Government (Research on Psychiatric and Neurological Diseases and Mental Health, H19-009).