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Abstract

第113巻第7号

Visual Presentation of Psychiatric Clinical Decision-making by “Graphic Assessment Sheet for Diagnoses and Treatments”
Toshio OTA1, Sumiko YOSHIDA2, Sousuke TSUNASHIMA3, Takao TOTSUKA1, Takafumi WATANABE1, Ryoichi TOYOSHIMA1
1 Department of Neuropsychiatry, Saitama Medical School
2 National Center Hospital of Neurology and Psychiatry
3 Sojinkai Musashino Hospital
Psychiatria et Neurologia Japonica 113: 662-671, 2011
Accepted in revised form: 2 April 2011.

 Psychiatrists often have to treat patients even when the clinical information is insufficient to make a definite diagnosis. This is the case especially when we are treating first -visit outpatients or inpatients who have just been admitted. One of the causes of information insufficiency is a delay in obtaining clinical information on the patient,and another is a lack of characteristic manifestations of the disease because of an immature developmental stage. Even in such situations, however, clinicians have to make reasonable judgements using the information that is available at that time. The framework for making judgements on such occasions, or “the framework of decision-making under imperfect-information conditions”, is becoming more and more important in psychiatric clinical practice in Japan for the following reasons. First,team members in charge of a patient became very heterogeneous in terms of their career and motivation after the start of the new post-graduate clinical training system in Japan several years ago,resulting in a higher risk of miscommunication. Secondly, the need for precise explanation to patients and their families has become crucial in recent years as the result of various social changes. Ota T,one of the authors,once put forward the framework of decision-making under imperfect-information conditions on the basis of Bayesian statistics. In the present paper, in consideration of the above background, we devised a sheet for visualizing the above framework so that relevant staffcould share the clinical decision-making process. Specifically,we visually arranged on a sheet of paper the components and variables of the framework, so that the staffcould communicate with each other explicitly and precisely about the estimated probability of each possible disease,merits and demerits of each treatment option, etc. We employed the sheet on treating patients in our acute psychiatric ward,2 of whom are presented in the paper. Discussions were made on the usefulness, limitations, and remaining problems.

Keywords:psychiatry, imperfect-information condition, clinical decision-making, visualization, Communication>
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