心身医学

Psychosomatic diseases (PSD) are strongly related to human behaviors, which need to be explained at four different explanatory levels : physiological, psychological, cultural and evolutionary. However, to date PSD have been investigated only at the first three levels. To investigate PSD at the evolutionary level, we decided to analyze the behavioral traits of patients suffering from PSD. We conducted interviews with inpatients suffering from peptic ulcers. On the basis of these interviews we isolated the following characteristics of these patients. (1) Willingness to care for others. (2) Willingness to oblige others. (3) Proneness to be let down by others. (4) Methodical, and pursuit of completeness. These characteristics indicate that patients suffering from peptic ulcers are altruistic and compulsive. Altruism is a behavior that decreases individual fitness, therefore this topic has been controversial in sociobiology. Barkow has pointed out that human beings pursue prestige in order to gain self-esteem which is a prerequisite for good mental health. Hill has argued that altruistic behavior promotes prestige and therefore increases an individual's sociocultural and biological fitness. If this argument is correct, then patients suffering from peptic ulcers may be individuals who have in vain pursued prestige altruistically.

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In a previous paper we have reported that patients with peptic ulcers (PU) are both altruistic and compulsive. In this paper we have attempted to validate these findings using a questionnaire. Subjects : 76 male businessmen (healthy controls), 66 male PU patients (PU group) and 55 male patients suffering from other diseases (other group). Age range of all subjects were 30-59 years. The Questionnaire : The questionnaire contained 10 items concerning altruism and 11 items concerning compulsiveness. In this study, altruists were defined as those who answer yes to the following three questions. (1) I think I am altruistic, (2) I have been told that I am altruistic, and (3) I have often been exploited by others. Results : (1) Patients with PLT had higher scores for both altruistic behavior and compulsives in comparison with the non-patient control group. (2) Altruism was also higher in patients with other diseases in comparison with the non-patient control group. (3) At every age group, the ratio of altruists in PU patients was over 30% and each ratio is higher than in the non-patient control group. (4) Within PU patients group, subjects defined as altruists were more compulsive than others. Discussion : Based on the above findings we have constructed a synthetic model which takes into account the genetic, physiological, psycho-social and evolutionary factors regarding the foundation of psychosomatic disease. In this model we hypothesized two hierarchies. One is high hierarchy whose members are seeking power to gain self-esteem. The other is low hierarchy whose members are seeking appreciation to gain self-esteem. As a result, some of patients with PU may belong to low hierarchy and may have altruistically pursued prestige to no avail.

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The patients with chronic viral hepatitis tend to fall in an unstable mental state in the long-term follow-up period because of its low healing rate. In addition, the appearance of neuropsychiatric symptoms induced by interferons as the treatment for chronic viral hepatitis is becoming an important issue in IFN-associated adverse reactions. In the present study, to understand and analyze the psychological state in patients with chronic liver disease, Minnesota Multiphasic Personality Inventory (MMPI) was performed in 39 patients with chronic liver disease, 28 diabetic and 18 healthy subjects. It was revealed that patients with chronic liver disease were more neurotic, depressive and hypochondriac than diabetic and healthy people and that the disturbed neuropsychological state was observed more frequently in patients with liver cirrhosis than those with chronic hepatitis.

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In Japan some authors have said that alexithymia is opposite to neurotic personality and that alexithymia is specifically found among patients suffering from psychosomatic disorders, though there have been no valid reports. The purpose of this paper is to answer these two problems. Problem A. Is alexithymia opposite to neurotic personality? The Eysenck Personality Questionnaire (EPQ) and the Schalling-Sifneos Personality Scale-revised version (SSPS-R) were administered to a total of 522 employees in some companies and university students to assess neurotic and alexithymic personalities, respective]y. Spearman's rank-order coefficient between the neuroticism scores of the EPQ and SSPS-R scores was 0.00 (p<0.01).Thirty-five patients suffering from anxiety disorders (panic disorder and generalized anxiety disorder) and 35 healthy controls were assessed using SSPS-R. All the anxiety patients and 20 controls were assessed by Beth Israel Hospital Psychosomatic Questionnaire (BIQ). The average SSPS-R score among the patients was 7.5 (SD 2.5) and that among the controls was 7.0 (2.4). The average BIQ score among the patients was 4.0 (1.9) and that among the controls was 4.4 (1.7). There is no significant difference of alexithymic trait between neurotic patients and control subjects. These results show that alexithymia is not a personality trait opposite to a neurotic one. Problem B. Is alexithymia specifically found among patients suffering from psychosomatic disorders? Subjects were 94 patients suffering from peptic ulcer (38) and bronchial asthma (56) and 94 healthy controls. Alexithymic trait was assessed by SSPS-R. The average SSPS-R score among the patients was 8.8 (2.6) and that among the controls was 8.3 (2.7). The difference was not statistically significant. The severity of psychosocial stressors among 55 patients suffering from peptic ulcer and bronchial asthma was assessed according to the Axis IV of DSM-III-R. Twenty patients had had no stressors for a year before diagnosed, while 12 had had more than "moderate" stressors. The average BIQ and SSPS-R scores among the 20 patients having no stressors were 4.1 (1.6) and 8.8 (2.7). Those among the 12 patients having stressors were 4.2 (1.4) and 8.9 (2.4), respectively. There is no significant difference between the patients who have had stressors and those having no stressors. These results show that it is not the case that the patients suffering from bronchial asthma and peptic ulcer, which are often called as "psychosomatic disorder, " are more alexithymic. Among the patients psychosocial stressors have nothing to do with the degree of alexithymic trait. Conclusions. Alexithymia is not opposite to neurotic personality. It is not specifically found among patients suffering from psychosomatic disorders.

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