生育歴の聴取は初診ですべてやりきる必要はない、名古屋市千種区の児童精神科医が解説

 

こんにちは、名古屋市千種区　児童精神科専門クリニック、医療法人永朋会　和光医院、加藤晃司です。

 

今回は、生育歴の聴取は初診ですべてやりきる必要はない、について解説します。

 

０歳からの生育歴の聴取は児童精神科では必ずやらないといけないことですが、それを初診ですべてやる必要はないと思います。

 

まず保険診療で時間はかけれないですし、最初は主訴にひもづく箇所だけをさらっと確認しておけば十分です。

 

病態水準を予測しておかないと、すぐに対応した方がいいのか、時間をかけてもいいのか、分からないからです。

 

病態水準、つまり病気の重たさは、生育歴を聞くことである程度予測できます。

 

本人の様子も大事ですが、それまでの過程の方がさらに重要です。

 

例えば、うつ状態だったとしても、生育歴が悪いのと、そうではないのでは、治療方針も異なってきます。

 

大人の方の場合、養育者がこれないことが多いですので、本人からの聞き取りとなりますが、それでもだいたいのことは分かりますし、目の前の本人との連続性がどの程度あるのかはその場にいれば、感覚的にわかります。

 

発達障害の診断だけでなく、すべての精神疾患にとって病態の判定は必要ですので、やり方を知らないと病態水準を決めることができません。

 

今は病態水準の概念すら日本では消えそうになっていますので、標準化できることではないですし、教えるにも時間がかかるので、もう後輩たちに伝えていくことはできないかもしれません。

 

児童精神科は、そのあたりトレーニングされていますので、大人の方の治療でもお役にたてると思います。

 

何かお困りのことがありましたら、当院へご相談ください。

 

 

当院ホームページはこちらより

https://wako-psy-clinic.com

ご予約は公式ライン、ホームページから可能です。

友達追加はこちらから↓

https://lin.ee/HorvYiv

当院インスタグラムはこちら

https://www.instagram.com/wako_iin/

 

子どものためのメンタルクリニック

医療法人永朋会　　和光医院

児童精神科・精神科・心療内科

 

〒464-0092  愛知県名古屋市千種区茶屋が坂1丁目12番2号

電話　：　052－712-1777

地下鉄名城線「茶屋ヶ坂」駅 1番出口より徒歩3分

地下鉄名城線「砂田橋」駅 1番出口より徒歩10分

 

 

 

Initial Psychiatric Assessment: No Need to Complete a Full Developmental History in the First Visit

Explained by a Child Psychiatrist in Chikusa Ward, Nagoya

Hello, this is Dr. Koji Kato, a child psychiatrist at Wako Clinic, Medical Corporation Eihoukai in Nagoya.

 

Today, I would like to discuss why it is not necessary to complete a full developmental history during the first psychiatric consultation.

 

1. Developmental History is Essential in Child Psychiatry, but Not All at Once

In child psychiatry, obtaining a comprehensive developmental history from infancy onward is crucial. However, there is no need to cover everything in the first visit.

 

There are two main reasons for this:

 

✅ Time Constraints in Insurance-Based Consultations

Medical consultations in insurance-based healthcare settings have limited time per session. Covering every detail in a single visit is often impractical.

 

✅ Prioritizing Chief Complaints & Relevant History

In the initial consultation, it is more important to focus on the patient’s primary concerns and related background. A full developmental history can be gathered gradually over multiple sessions.

 

📌 A selective approach helps ensure efficient and focused care without overwhelming the patient and their family.

 

2. Understanding the Severity of the Condition (病態水準: Pathological Level)

One key reason for taking a developmental history is to estimate the severity and prognosis of the patient’s condition.

 

🔹 Why is this important?

Knowing whether a condition requires immediate intervention or whether it can be managed over time is critical for developing an effective treatment plan.

 

🔹 Developmental History Helps Predict Severity

✔ Mental health conditions vary in severity. Some require urgent intervention, while others allow for gradual support.

✔ The patient’s current symptoms may be similar across cases, but the developmental background significantly influences treatment approaches.

✔ For example, two patients presenting with depressive symptoms may require entirely different treatment strategies depending on their developmental history.

 

📌 In psychiatric evaluation, understanding the patient’s background is often as important as assessing their present condition.

 

3. Developmental History in Adult Psychiatric Cases

While child psychiatry emphasizes developmental history, it is equally relevant in adult psychiatric evaluations.

 

✅ Even in adult cases, gathering a developmental history helps assess mental health trajectories.

✅ When guardians are unavailable for interviews, information from the patient alone can still provide significant insights.

✅ Observing the patient’s behavior in real-time allows clinicians to intuitively assess the continuity of past and present conditions.

 

📌 Understanding past developmental patterns helps guide diagnosis and treatment across all age groups.

 

4. The Declining Awareness of Pathological Level (病態水準) in Psychiatry

In Japan, the concept of pathological level (病態水準)—which refers to the depth and severity of a psychiatric condition—is becoming less emphasized.

 

🔹 Why is this a concern?

✔ Many practitioners lack training in structured evaluation methods, making it difficult to determine the severity of conditions.

✔ Without proper assessment, treatment plans may be generalized rather than tailored to individual needs.

✔ The complexity of psychiatric diagnosis cannot always be standardized, making it difficult to pass on this skill to younger generations.

 

📌 In child psychiatry, clinicians are trained to assess developmental trajectories and mental health conditions comprehensively. This expertise is valuable not only for children but also for adults.

 

5. Conclusion

✅ Developmental history is essential in child psychiatry, but it does not need to be fully covered in the first visit.

✅ Prioritizing chief complaints and relevant history allows for a more efficient and targeted assessment.

✅ Understanding developmental background helps predict the severity of psychiatric conditions and guides treatment planning.

✅ In adult psychiatric cases, developmental history remains crucial, even when gathered retrospectively.

✅ A structured approach to evaluating mental health severity is becoming less common, making child psychiatric expertise increasingly valuable.

 

🔹 If you have concerns about psychiatric conditions, whether for children or adults, our clinic is here to help.

 

If you need guidance, feel free to consult Wako Clinic, Medical Corporation Eihoukai, in Nagoya.