心身医学
Online ISSN : 2189-5996
Print ISSN : 0385-0307
ISSN-L : 0385-0307
29 巻, 3 号
選択された号の論文の33件中1~33を表示しています
  • 原稿種別: 表紙
    1989 年 29 巻 3 号 p. Cover1-
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. App1-_7_
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 原稿種別: 目次
    1989 年 29 巻 3 号 p. Toc1-
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 204-
    発行日: 1989/04/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. i-xxxiii
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 238-239
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 笠原 嘉
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 240-241
    発行日: 1989/04/01
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  • 末松 弘行
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 242-
    発行日: 1989/04/01
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  • 久保木 富房, 野村 忍, 末松 弘行
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 243-250
    発行日: 1989/04/01
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    A girl at puberty suffering from anorexia nervosa shows mainly extreme emaciation and eating disorder.Criteria for the diagnosis of anorexia nervosa were defined by the Research Group for Intractable Disease of the Ministry of Health and Welfare of Japan as follows;1. Loss of more than 20% of standard body weight.2. A history of weight loss for more than three months.3. Age of onset less than 30.4. Female.5. Amenorrhea.6. Eating disturbance.7. Disire to reduce body weight.8. Hyperacitivity.9. Denial of the existence of disease.10. Absence of evidence of organic disease or endogenous psychiatric disease.A typical case is a patient who fills all of these ten criteria. The patient who fills criteria numbers 1,2,and 10 is termed as atypical case. The criteria of DSM-III and Feighner are utilized in Europe and America. Even now, the cause of anorexia nervosa is unknown. In is a general consideration that the etiology of anorexia nervosa is a reversible functional disorder at the hypothalamus influenced by the upper center. Then, taking account of the current of psycho-social factor and etiology of anorexia nervosa, the hypotheses of Freud, Bruch and Masterson are influential. Recently, the idea of psychosomatic family by Minuchin and Palazzoli comes into the lime-light from the familial systematic standpoint. Garner and Garfinkel regard anorexia nevosa as a multi-determined disorder.
  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 250-
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 山内 祐一, 内海 厚, 田中 恵子
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 251-260
    発行日: 1989/04/01
    公開日: 2017/08/01
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    Using a systematic questionnaire (Eating Disorder Questionnaire or EDQ) of our development, the eating behaviors of 117 obses patients with a variety of etiology were analyzed along with 601 cases of healthy control, so as to obtain an insight into the possible sociopsychological mechanisms. Calculation of the daily caloric intake was carried out over a consecutive 7-day period for 24 obese dianetics.The EDQ revealed that the patients counted the following behavioral reasons for their development of obesity : (1) overeating and (2) decreased physical exercise. Thus, an imbalance between the energy intake and its expenditure can be one of the major factors of the genesis of simple obesity.On analysis of the eating patterns, the following eating abnormalities were noted : (1) skipping meals ; (2) night eating ; (3) hasty eating ; (4) preference for and indulgence in sweets and noodles and (5) too frequent banquets.The following sociological peculiarities were also found responsible for developent of obesity among the adults : (1) businessmen working outside and (2) middle-aged house-wives. The fraction of patients whose obesity persisted from their childhood was as small as 16% in males and 15% in females. Thus, the probability of genetic contribution to the development of obesity can be relatively small. There seemed to be a general pathological trend of taking foods even in the absence of any appreciable hunger drive, or of tasty foods. They thus appeared to eat only because foods were then near at hand.It was concluded that there can be two major categories of factors favoring development of simple obesity : (1) a sociocultural factor of exceedingly easy accessibility to foods ; (2) psycho-behavioral problems that would encourage formation of irregular eating habits as well as abnormal lifestyle. The latter may probably be one of the compensatory expressions of anxiety state.
  • 玉井 一, 須藤 徹, 松林 直, 森 研二
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 261-267
    発行日: 1989/04/01
    公開日: 2017/08/01
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    This study was performed to investigate the relationship between psychological status and diabetic control in diabetic patients associated with eating disorder using various psychological tests. The subjects consists of 18 diabetics, 2 males and 16 females, who admitted to out hospital for treatment of diabetes mellitus from 1986 to 1987. The results of psychological tests and the identified types of eating behavior were follows : 1) Of the 18 patients including IDDM (n=7) and NIDDM (n=11), 7 patients (38%) showed high scores (>50 points) by SDS.2) Among the 18,the neurotic tendency by the CMI (III, IV) and the "Black list (B)" and "Eccentric (E) types" by the YG test were observed in 12 (66%) and 8 (44%), respectively.3) Low percentage of GCR in PF study was found in 9 patients (50%) and the number of patients complaining of bulimia, vomiting and anorexia was 7 (38%), 10 (55%), and 2 (11%), espectively.These 18 diabetic patients associated with eating disorder had been treated without psychosomatic approach, subsequently continued to be under poor control. Of these patients, 8 (44%) attained to good control by psychological therapy. Furthermore, it was very difficult to get good control of diabetes mellitus in diabetic patients with borderline personality disorder.
  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 267-
    発行日: 1989/04/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. App2-
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 坪井 康次
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 269-275
    発行日: 1989/04/01
    公開日: 2017/08/01
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    In this paper, the disturbance of interpersonal relationship and eating behavior of the neurotic patients with somatic complaints, so called somatizing patients, were discussed.It was said that they have a tendency not to express their emotions and psychosocial background. Then, they may be unable to have intimate relationship with others because of their personality characteristics and this is seen particularly in doctor-patient relationship.It might be also true that one's nehavior toward other persons reflects the characteristics of their interpersonal relationship in various situations. Especially, this fact is remarkable in eating situations, where interpersonal distance becomes close.Therefore, I tried to compare the eatin behavior at home, the attitude of communication with family, and awareness of emotional state, between somatizing patients with neuroticism and normal controls. The results were as follows.1) Irregularity of eating behavior was more frequently seen in neurotic oatients than in the control group.2) In the patient group, the attitude of communication with their family was negative, compared with control group.3) Patients with neuroticism tend to recognize themselves as calm, not-tense and not-irritable persons, as compared with normal controls.Moreover, a discussion was included as to one case, who was suffering from both irritable bowel syndrome and social phobia, and who felt very tense at eating situation such as together with his friends, in terms of his disturbance of interpersonal relationship and eating behavior.
  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 275-
    発行日: 1989/04/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 275-
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 生野 照子
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 277-283
    発行日: 1989/04/01
    公開日: 2017/08/01
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    Children tend to show symptoms related to "eating." The causes for eating-related symptoms in children are often associated with the parent-child relationship. The author recently studied the parent-child relationship in connection with the eating behavior, taking intp consideration the current social background in Japan.The subjects of this study were 14 children (aged under then years) who visited our department with the chief complaint of one of various kinds of eating disorder. The psychological backgrounds of these children were analyzed. In a half of them, there had been troubles with food intake already in the early infantile period ; the addition of parent-child mental conflicts to these disturbances resulted in the onset of eating disorder. In the remaining half of the children, no eating-related symptoms had occurred in the early infantile period, but a crisis in the parent-child relationship had appeared at some occasion and eating disorder was induced as a reaction to that stress.Before the onset of eating disorder, all children had been more or less controlled by their parents (or the desires of the children had often been refused by their parents). After the onset of eating disorder, the children in turn controlled the behavior of their parents.In the familes of these children, the educational, physical and self-sufficient aspects of eating had been emphasized at the dining table, with little attention paid to the emotional exchange among family members at the dining table. Thus, the mental aspect of eating had been narrowed in these families.This state of dining table nehavior can distort the parent-child and familial relationships under the influence of the current social factors ; it makes the dining table a place where children feel heavy pressure, suffering, passive status and frustration.The questionnaire survery about anorexia nervosa also disclosed that an unsatisfactory emotional parent-child exchange is relfected in the dining table behavior. Such an ambivalent situation between parent and child produces an ambivalent parent-child relationship, resulting in ambivalent, morbid eating habits.
  • 野添 新一, 眞辺 豊
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 285-292
    発行日: 1989/04/01
    公開日: 2017/08/01
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    From a viewpoint of behavioral science, there are mainly three problems in relation to eating behavior, as summarized in the following.1) The latest increase of processed foodstuffs is gradually changing our eating habits and influencing our health or the onset and process of our diseases.2) Eating behavior is playing an important role to reduce a stress, consequently an abnormal eating behavior is easily learned.3) The development of the theory about eating behaviors and it s treatment techniques is strongly expected.In this paper, we proposed the mechanism of development and treatment techiniques about anorexia nervosa from the viewpoint of behavioral science.Furthermore, we reported a case study using an operant conditioning technique and discussed a few problems which were observed in a course of treatment.1. Mechanism of development of anorexia nervosa from the behaviorak point of view.Anorexia nervosa can be understood as a mainfestation of abnormal eating behavior which has been continuously reinforced, according to operant principles, by reward of attention and anxiety reduction because it serves to avoid a stressful-life situation by means of the disease state.2. Behavioral therapy of anorexia nervosa-especially about operant conditioning technizues-1) Extinction of reinforcing factors.2) Positive procedures for reshaping a desirable eating behavior by operant management.3) Procedures for reshaping a desirable adaptive behavior by self-control techniques or soial skill-training.4) Behavioral counselling.3. Case report The patient was a 31-year old female and was out of work. She had a 16 years' history of the disease and it was very severe.Her symptoms almost recovered after two years' treatment centering upon operant conditioning. She is still in good condition 18 months after her discharge.4. Results Out of 110 cases treated with the above-menioned behavioral approach, our therapy was not completed because of their escape from the hospital in nine cases and because of suicide in 1 case. The remaining 100 patients were received behavioral therapy for periods between a month ad 24 months and it was successfully completed.Twenty three cases had a relapse of the disease and 13 of them were readmitted.Four out of 23 relapsed cases recovered spontaneously from a disease state.
  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 292-
    発行日: 1989/04/01
    公開日: 2017/08/01
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  • 野上 芳美
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 293-298
    発行日: 1989/04/01
    公開日: 2017/08/01
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    Binge eating syndrome is the main representative of abnormal eating behavior, and it is typically displayed among bulimia patients. Apart from the core binge eating syndrome which is seen in normal weight bulimia and bulimic anorexia nervosa, binge eating syndrome can be observed in many instances such as borderline schizophrenia or schizophrenia in its prodromal phase, so-called situational bulimia, obesity, and high risk group of people who require reducing their weight. All the instances showing binge eating syndrome should be referred to as "binge eating spectrum." The purpose of this paper is to confirm that the basic structure of the syndrome in that the syndrome which is hypothesized in anorexia nervosa and bulimia nervosa, can be commonly seen through this "spectrum." A case of schizophrenia who displayed binge eating, and two cases of situational bulimia patients were illustrated. Also, it was indicated again that these cases had dietary restraint due to desire to be slim, and showed loss of selfcontrol under the stressful situations. In addition, the author's previous prevalence study on binge eating with a high risk female student and normal female student population was reviewed. There were significant correlations between the rate of binge eating and the score of Eating Inventory (Factor 1 and 2). The case study and the survey revealed that self-control of eating and failure of such self-contrl are important factors among the people who are exhibiting binge eating behavior.
  • 北川 俶子
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    1989 年 29 巻 3 号 p. 301-306
    発行日: 1989/04/01
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    This research was conducted in order to take hold of the actual state of eating behaviors and body weight in female students of junior and senior high schools and women's universities. The contents of study included, (1) the change of body weight and secondary amenorrhea, (2) EDI by Garner, (3) dieting, (4) bulimia.The results revealed that, (1) female students weight with secondary amenorrhea ranged within in slightly low level of standard weight. Their secondary amenorrhea rates was 1.1 percent in senior high school students and 0.8 percent in university students, (2) "drive for thinness" and "body dissatisfactions" were scored vert high, (3) 42 percent of the girls were dieting, (4) 3.3 percent of the girls fulfilled the DSM-III criteria for the diagnosis of bulimia.
  • 高木 俊一郎
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 306-
    発行日: 1989/04/01
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  • 中野 博, 玉井 一
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 307-
    発行日: 1989/04/01
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  • 中島 弘子
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 307-
    発行日: 1989/04/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 307-
    発行日: 1989/04/01
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  • 粟生 修司, 西野 仁雄, 大村 裕
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 309-318
    発行日: 1989/04/01
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    Many neurotransmitters, hormones and metabolites have been shown to be involved in pathophysiology of anorexia nervosa (AN). By central and/or peripheral administration in experimental animals, the majority of these bioactive substances are also known to affect feeding. A few of them such as noradrenaline (NA), dopamine (DA), corticotropin releasing factor (CRF) and glucocorticoids (GC) are considered as causal factors of AN. Central administration of NA or DA induces feeding, while in AN, NA and DA mechanisms are impaired. Plasma concentration of CRF and GC that suppress feeding, however, is elevated in AN. Other substances, which may be secondary factors of the disease, behave differently : CSF or plasma level of feeding suppressors (e.g. serotonin, somatostatin, glucagon, estrogen etc.) is reduced ; and that of a feeding stimulant (growth hormone) increases in AN.To elucidate neuronal pathophysiological mechanisms leading to the development of the disease, understanding of central catecholaminergic mechanisms in the primate feeding control is important. Therefore, neuron activity of the hypothalamus, amygdala and orbitofrontal cortex during operant feeding task was analyzed and catecholaminergic involvement in modulation of feeding related neuron activity was investigated in awake monkeys. In the hypothalamus and the orbitofrontal cortex, β-adrenergic receptors were involved in regulation of bar press related firing rate decrease, while DA modulated bar press related firing facilitation. The hypothalamic DA system also modulated cue signals to excitation. In the amygdala, β-adrenergic and DA system regulated reward related firing rate decrease and increase, respectively. These data suggest that the dopaminegic transmission is involved in initiation of motivated food acquisition behavior, while α-adrenergic receptors modulate reward mechanisms. The β-adrenergic system participates in the regulation of food acquisition in a different manner from that of the DA system.In AN, dysfunction of the DA and β-adrenergic systems may cause disturbance of adaptive control of food acquisition, and dysfunction of the α-adrenergic mechanisms may result in abnormal reward-sensation or lack of suitable recognition of the reward.
  • 篠田 知璋
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 318-
    発行日: 1989/04/01
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  • 深町 建
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 321-324
    発行日: 1989/04/01
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    I have proposed the concept that main pathogenesis of eating disporders results from nonplastic restraint of the higher brain on hypothalamic control of food intake. To release the hypothalamic function from this pathological regulation of the cereberal cortex, patients with eating disorders were admitted to take a low-calorie-diet, starting from 800 Cal/day, and strictly restricted to get in contact with the circumstances outside the hospital by means of letters, telephons, visits and so on ("Behavior Restriction Therapy"). The restriction was removed according to an increase of food intake and weight gain.In the process of therapy, constant stimuli were provided to patients in the therapeutic frame, in which the therapist tried to maintain an emotionally steady attitude toward them and gave active support to their healthy mind, through stable and proper comments without being affected by perpetual and entrapping incitation of their ill mind. Daily amount of caloric intake was kept constant according to the therapeutic master plan, so that the patients could receive metabolically constant signal from feeding. Thus, constancy not only in psychological stimuli but also in bodily sensation was evaluated as one of the most important factors for the cure of the disorders. The way of therapeutic constancy made it possible for the patients to resuscitate their own bodily perception including humger and satiating sensation, which reinforced development of normal feeding behavior governed by the hypothalamus, not by the cortex.A 20-year old college girl, complaining of bulimia and vomiting, was shown as a case example in the process of improvement in abnormal feeding. It can be concluded that recovery from eating disorders may only be possible in restoration of unrestrained and regular feeding behavior. Once the patients learn to realize how they can release bodily functions depending on the hypothalamus from their ill-mind, they are consequently potentiated to call up vivid emotions and behave freely, as characterized in the adolescents, without any restraint from over-meddling of the higher brain.
  • 野添 新一
    原稿種別: 本文
    1989 年 29 巻 3 号 p. 325-
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 329-
    発行日: 1989/04/01
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  • 原稿種別: 付録等
    1989 年 29 巻 3 号 p. 330-
    発行日: 1989/04/01
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  • 原稿種別: 表紙
    1989 年 29 巻 3 号 p. Cover2-
    発行日: 1989/04/01
    公開日: 2017/08/01
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