循環器疾患に対する全人的アプローチ(内科領域における全人的医療)(第31回日本心身医学会総会)

抄録

Psychosomatic medicine is often referred to as the core of holistic medicine and a psychosomatic approach (PSA) plays a major role in the holistic approach to various circulatory disorders. However, there are questions as to "to what disorder", "by whom" and "what kind of" approaches should be applied. In order to answer these questions, the author tried to classify the patients in terms of the indication of PSA. Two-hundred and fifty-one outpatients with cardiovascular symptoms who have visited the Department of Psychosomatic Medicine in Tohoku University Hospital from 1987 to 1989 were classfied into the following groups. A. Cases with psychosomatic problems 1. Psychological factors affecting the diseases 2. The diseases affecting psychological states 3. Cardiac symptoms without specific diseases B. Cases with coexisting somatic and psychological problems C. Cases without psychosomatic problems Group A (n=157) needed certain PSA which should be carried out by psychosomaticists. Group B (n=77) needed either a liaison-psychiatric approach by both internists and psychiatrists or PSA by psychosomaticists. Group C (n=17) did not particularly needPSA but needed somatic approach by internists. Various approaches such as brief psychotherapy, autogenic traning, transactional analysis, behavior modification and pharmacotherapy were applied to the group A according to the subgrouping. In this study, 93% of the patients definitely or relatively needed PSA because of the specialty of our department. Although the rate may be low, there also seem to be some patients who need PSA in other institutes specializing circulatory diseases. It was thought necessary, from the standpoint of holistic medicine, to determine the indication of PSA as well as the diagnoses.