2018 Volume 58 Issue 8 Pages 678-687
It is important to examine psychosomatic patients from different angles. I usually diagnose them from the following 4 directions : gynecological diagnosis, mental diagnosis (DSM-Ⅳ), psychosomatic diagnosis and oriental (Kampo) diagnosis. We examined 11,647 cases of psychosomatic patients whom we treated between 1976 and 2016. Only 2 or 3% of the new patients of Sapporo University Hospital were psychosomatic patients from 1976 to 1993, but we treated 20 to 40% of the total number of new patients in our clinic from 1995 to 2016. Those patients who have been diagnosed by gynecology are 3,190 cases, 27.4% of climacteric syndrome, 2,086 cases, 17.9% of vegetosis, 1,866 cases, 16.0% of pelvic congestion syndrome, l,077 cases, 9.2% of premenstrual syndrome, 860 cases, 7.4% of dysfunctional uterine bleeding, 438 cases, 3.8% of senile colpitis, 420 cases, 3.6% of dysmenorrhea, 244 cases, 2.1% of postpartum depression, 212 cases, 1.8% of sexual disorder, 207 cases, 1.8% of secondary amenorrhea and 1,057 cases, 9.1% of others. From the psychosomatic viewpoint, they can be sorted into the following four groups : ①somatic type (S-type, 5,928 patients, 50.9%), ②depressive type (D-type, 2595 patients, 22.3%), ③neurotic type (N-type, 1,906 patients, 16.4%), and ④psychosomatic type (P-type, 1,218 patients, 10.5%). When they have been diagnosed by DSM-Ⅳ at our clinic from 1995 to 2016, there have been 7,216 cases, 68.0% of somatoform disorders, 2,105 cases, 19.8% of mood disorders, 371 cases, 3.5% of panic disorders, 339 cases, 3.2% of anxiety disorders, 101 cases, 1.0% of eating disorders, 82 cases, 0.8% of adjustment disorders, 56 cases, 0.5% of sleep disorders, 26 cases, 0.2% of premenstrual dysphoric disorders, 20 cases, 0.2% of bipolar disorders, 14 cases, 0.1% of developmental disorders and 277 cases, 2.6% of other cases. 8,534 cases, 73.3% were treated by oriental (Kampo) diagnostic medicine. 2,515 cases, 21.6% were treated by hormone therapies. Many S-type patients were treated by Kampo therapy and counseling therapy rather than other types. Many D-type patients were treated with antidepressants and tranquilizers rather than other types. 9087 cases, 78.0% of all cases were improved. Prognoses of S, P and D-types were better than N-type. At the end of this paper we presented 4 cases in order to prove that “therapeutic self” and “spirituality” were of great importance for the treatment of psychosomatic patients.
