Résumé
Objective：To investigate the living conditions of patients who had experienced childhood onset of higher brain dysfunction and determine their problems with respect to diagnosis, school re-enrollment, and employment.Subjects and Methods：A retrospective investigation was performed in 196 subjects (122 men and 74 women) enrolled in the seven supporting centers in Japan for patients with higher brain dysfunction who were injured (or developed primary diseases) and diagnosed with higher brain dysfunction under 18 years old, and were not older than 40 at the time of investigation.Results：Primary diseases included traumatic brain injury (109 patients), cerebrovascular disease (35), encephalitis/encephalopathy (27), brain tumor (17), and brain hypoxia (8). Forty-two patients (21％) were diagnosed with higher brain dysfunction ≥1 year after brain damage and 64 (33％) started receiving support ≥1 year after brain damage. Of those who were re-enrolled in schools, 6％ left high schools and 17％ left colleges before graduation, mainly because of maladjustment to school life. Thirty-three (47.8％) among 69 patients who were ≥20 years were employed at the time of investigation, and 19％ were living on remuneration alone.Conclusion：To resolve problems in patients with childhood-onset higher brain dysfunction, it is necessary to establish early diagnosis as well as collaboration systems among medical, educational, and welfare institutions to support these patients.
Résumé
Objective：To investigate the living conditions of patients who had experienced childhood onset of higher brain dysfunction and determine their problems with respect to diagnosis, school re-enrollment, and employment.Subjects and Methods：A retrospective investigation was performed in 196 subjects (122 men and 74 women) enrolled in the seven supporting centers in Japan for patients with higher brain dysfunction who were injured (or developed primary diseases) and diagnosed with higher brain dysfunction under 18 years old, and were not older than 40 at the time of investigation.Results：Primary diseases included traumatic brain injury (109 patients), cerebrovascular disease (35), encephalitis/encephalopathy (27), brain tumor (17), and brain hypoxia (8). Forty-two patients (21％) were diagnosed with higher brain dysfunction ≥1 year after brain damage and 64 (33％) started receiving support ≥1 year after brain damage. Of those who were re-enrolled in schools, 6％ left high schools and 17％ left colleges before graduation, mainly because of maladjustment to school life. Thirty-three (47.8％) among 69 patients who were ≥20 years were employed at the time of investigation, and 19％ were living on remuneration alone.Conclusion：To resolve problems in patients with childhood-onset higher brain dysfunction, it is necessary to establish early diagnosis as well as collaboration systems among medical, educational, and welfare institutions to support these patients.
Résumé
Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.
Résumé
The purpose of this study was to investigate the occurrence of gastrointestinal complications and intestinal stasis after a videofluoroscopic examination of swallowing. Of 121 inpatients who underwent videofluoroscopic examinations from October 2008 to March 2009 and September to October 2009, we analyzed 33 patients who underwent abdominal X-ray four days after their videofluoroscopic examination. Six of 33 patients (18.2%) suffered gastrointestinal symptoms. Three patients had diarrhea, two had vomiting, and one had abdominal distention. The incidence of gastrointestinal complications after videofluoroscopic examination was estimated to be two of 33 patients (6.1%) because we assumed that two of the six patients' condition was related to their videofluoroscopic examination and that the other four were related to other factors. One of two patients with a poor general condition developed pneumonia after vomiting. There was no relationship between the incidence of gastrointestinal complications and the patient's background. Intestinal stasis as detected by X-ray was identified in 25 of 33 patients (75.8%). There was more barium sulfate intake in the patients who had intestinal stasis than the patients who had no intestinal stasis. There was no relationship between intestinal stasis and the incidence of gastrointestinal complications. Our findings suggest that the risk of gastrointestinal complications after videofluoroscopic examination is low except in patients with a poor general condition.