慢性落痛を主訴に山形大学医学部精神神経科と山形県立中央病院精神科を受診し, DSM-III-Rで「身体表現性疼痛障害」の診断基準を満たす患者48名について, 心理検査として「痛みについての質問票」, CMI, MMPIを施行し, その心理特性と治療予後について考察を加えた。1)これら対象に関し, 精神科での診察時の特徴から, 心理的特徴としてのアレキシサイミア傾向の有無について検討した。その基準として, (1)不安, 抑うつ, 攻撃性などの感情表現に乏しい, (2)身体症状に対するこだわりの強さ, (3)精神療法的介入の困難さ, の3点について検討し, すべてを満たすものをアレキシサイミア群, (1)(3)のいずれにも該当しないものを非アレキシサイミア群, その他を中間群とした。その結果, 14名がアレキシサイミア群, 21名が非アレキシサイミア群, 13名が中間群と分類された。2)対象者全員に「痛みについての質問票」の記入を依頼したところ, 48名中46名が質問項目のII-4,5,III-1,2,3のいずれかで高得点を示した。CMIは40名に施行し, I領域が4名, II領域が14名, III領域が10名, IV領域が12名という結果であった。MMPIは28名に施行し, 8名が正常プロフィール, 9名が"conversionV"プロフィール, 9名がその他の神経症スケールの高値を示し, 1名はその他の病的プロフィールを示した。3)「痛みについての質問票」で精神症状を示すIII1,2,3の得点総計を, 身体的苦痛を示すII-4,5の得点総計で割った値(アレキシサイミア傾向スコア)を比較したところ, アレキシサイミア群の平均値は非アレキシサイミア群の平均値に比べ, 有意に低かった。同様に, CMIでIII, IV領域に属するものの数を比較したところ, アレキシサイミア群の数が, 非アレキシサイミア群の数に比し, 有意に少なかった。MMPIの"AlexithymiaScaIe"をアレキシサイミア群と非アレキシサイミア群で比較したが, その平均値に有意差は認められなかった。4)治療の予後をアレキシサイミア群, 非アレキシサイミア群で比較したところ, 非アレキシサイミア群の方が薬物療法や精神医学的治療に対する反応がよかった。5)各種心理検査, 治療の結果から分かるとおり, 慢性落痛と診断される患者の心理機制は一様ではなく, それぞれの特性に応じた治療技法を考える必要がある。「痛みについての質問票」の結果から得られる「アレキシサイミア傾向スコア」は, 慢性疼痛患者の中でのアレキシサイミア傾向を有する患者の判定に有用であり, 治療法の選択や予後の判定に補助的に用いることが可能と考えられた。

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The present study aims to assess the effects on mood of a free dynamic dance accompanying high speed music (Kachaashii, an Okinawan folk dance which is usually performed in an exciting atmosphere) . Forty-eight females (ages : 25-63,average : 44.0) were divided at random into 2 groups, Dance and Control groups. Dance group performed Kachaashii, while the other was given a rest period. Both groups took pre- and post-tests of POMS. GLM analysis made it clear that Kachaashii had significant effects on each of the 6 states of POMS. In other words, Dance group and Control group responded differently to the tests. Dance group scored higher on Vigor, while scoring lower on the rest of POMS, namely Tension, Depression, Anger, Fatigue, and Confusion. Therefore, it is tenable to say that Kachaashii is effective enough to increase Vigor, to relax Tension, to alleviate Depression, to soothe Anger, to decrease Fatigue, and to ameliorate Confusion. In addition, the Dance group performed differently on POMS before and after the dance : Vigor scores increased significantly, while Tension, Depression, Anger, Fatigue, and Confusion scores declined significantly. The Control group did not record much changes.

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健常成人男性のNK細胞活性を測定して高値群, 中間群, 低値群に分け, その3群について心理・行動特性, ライフイベントストレス, 仕事状況, 疲労度とウイルス抗体価を調べ, 比較検討した。低値群は, 消極的で内向的な心理・行動特性をもち, 多くのライフイベントストレスを抱え, 生きがいが少なかった。多忙で, 仕事のことがいつも気になる割合が高かった。また, 疲労感が強く, 精神的, 身体的疲労度も高かった。一方, 高値群は秘極的, 外向的で神経質性が低く, タイプA行動様式をとる割合が高かった。長時間労働にもかかわらず, 責任が重いと思っている割合は少なく, 職場での人間関係上のストレスを感じている者も少なかった。また仕事に満足している割合も高かった。疲労については, 高値群は精神的, 身体的疲労度は中間群と比べ変わらなかったが, 疲労感は強かった。3群間でウイルス抗体価に有意な違いはなかった。これらより, 健常成人男性のNK細胞活性は, 心理・行動特性やストレス対処行動, 生きがい, 慢性疲労と関連性があることが示唆された。

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We assessed the usefulness of the Tokyo University Type Egogram (TEG) as a measure of ego state involvement in the onset of obesity and a predictor of the effects of weight reduction program. The TEG profiles of young obese patients were slightly characteristic, while the TEG profiles of all obese subjects and of middle-aged obese patients were the same as the profiles for healthy individuals. Thus, no psychological characteristics specific to obese individuals were revealed by the TEG. When the association of TEG patterns and increase levels in the body mass index (BMI) were examined, males showed no particular relationship between the TEG scales and the BMI. However, young females with a BMI over 28 had higher gradients of from A to FC and AC, strongly suggesting a tendency for self-negation. Middle-aged subjects with a BMI over 32 had an opposite relationship between FC and AC. Our servey of the history of disease and eating habits in individual subjects revealed that eating disorders tended to develop after strict diet control in young people. It seems likely that binge-eating, which is viewed as a problem from the viewpoint of psychosomatic medicine, is related to the magnitude of the patient's desire for weight loss and not related to the BMI. When the correlation between TEG scales and the percentage of weight loss was positively correlated with NP, A and FC in males and negatively correlated with AC in males, suggesting the usefulness of the TEG in predicting the effects of weight reduction programs in males. In females, however, the positive correlation between FC and the percentage of weight loss in young females was the only correlation observed.

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大学生のストレス過程に対するタイプA構成要素の予測性を検討した。主成分分析により, タイプAの構成要素として4因子を抽出した。第1因子は攻撃性因子, 第2因子は熱中性因子, 第3因子は時間的切迫感因子と解釈したが, 第4因子は明確な意味づけが困難で, 内的整合性がみられなかったために分析から除外した。ストレス反応を予測する重回帰分析の結果, 心理的ストレス反応については, 男子の場合, 日常苛立ち事と時間的切迫感因子が正の関連を示し, 女子の場合, 日常苛立ち事と攻撃性因子が正の関連を示したのに対して, 熱中性因子は負の関連を示した。身体的ストレス反応については, 男女とも日常苛立ち事, 時間的切迫感因子および攻撃性因子が正の関連を示した。いずれの重回帰モデルにおいても, 日常苛立ち事が強い関連性を示した。日常苛立ち事を予測する重回帰分析の結果, 男女とも攻撃性因子と時間的切迫感因子が正の関連を示した。本研究により, ストレス反応の予測には日常苛立ち事が最も有効で, 日常苛立ち事の予測には攻撃性と時間的切迫感が有効であることが示唆された。また, 女子にのみ熱中性が心理的ストレス反応を抑制することが推測された。

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Primary alveolar hypoventilation syndrome, although rare, usually results in long term mechanical ventilatory support because of its chronic hypoxic and hypercapnic pathophysiology. A 58-year-old female was admitted for the evaluation of general exhaustion and marked weight loss with BMI 13.1. The patient presented serious desaturation with excessive daytime somnolence and morning headache despite normal pulmonary and neuromuscular function. After pneumonic involvement, the patient became controlled under transtracheal ventilation for two years. The patient gradually developed depressive with suicidal idealing due to discomforts and poor QOL caused by lasting tracheostomy. The phrenic nerve pacing was not attempted because preoperative assessability and CPAP trial did not bring any improvement for desaturation. Altemative to BiPAP application improved mean oxisaturation 91% up to 94% and revealed marked reduction of hypoxic episodes during sleep. After efficacy of BiPAP was confirmed by ambulatory oximetric monitoring, tracheostomy was closed two years later. The closure of tracheostomy brought improvement of QOL associated with recovery of self-esteem. The case encourages us that undesirable symptoms, such as depression, paradoxically may break clinical deadlock and provide therapeutic success.

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This article demonstrates the clinical application and the efficacy of two relaxation methods such as progressive muscle relaxation and autogenic training in the general hospital psychiatry. During the months between April through July 1993,ten patients were treated with these relaxation methods. Out of the ten patients, two were treated at the emergency service, four at the outpatient clinic of psychiatry and four were referred from the medical/surgical ward. Their symptoms were hyperventilation attack, panic attack, neurotic insomnia, agoraphobia and chronic pain and so on. As a result, nine patients out of ten (90%) were effectively treated with these relaxation methods. One patient with no improvement was suffering from insomnia. These methods should be more applied in the clinical settings of general hospital psychiatry for the following reasons. First, these relaxation techniques are simple and useful methods which are easily employed in general hospital psychiatry. Second, physically ill patients are likely to suffer from adverse reactions of psychotropic medications. Third, these methods can produce a rapid improvement especially for anxious patients with panic attack and/or hyperventilation syndrome. In this article, the modified methods of autogenic training and progressive muscle relaxation, which are more easily applicable in general hospital settings, are also demonstrated.

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症例は18歳で発症した45歳の神経性食欲不振症患者。発症7年後, 下剤の大量乱用による体液の喪失のために高C1血症性代謝性アシドーシスとなり, さらに骨軟化症による歩行障害が出現するまで, 本格的治療を受けることを拒否していた。本症が下剤乱用, 過食, 嘔吐を繰り返す病態を有することが明らかにされた後, 患者は, 説得によってようやく一般精神療法を含む心身医学的治療を受けることに同意し, 入院した。3年間の入院治療の結果, 軽快に至ったため退院となったが, 退院後12年目に, 混合性代謝性酸-塩基障害, 慢性腎不全, 左腎萎縮を併発し, さらに呼吸困難が加わったため再度入院となった。臨床データから, 低K血症性腎症のため, 血液中のpHの上昇を代償できなくなっていた。その結果, 持続する代謝性アルカローシスを代償するためにPCO_2>55mmHgとなり, 中枢性呼吸性障害に進展したと考えられる。

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We reported the case of a 58 year old man who began to have attacks of bronchial asthma 2 years jpreviously. In spite of repeated hospitalization following the first attack, it was not possible to control his attacks effectively because conventional therapy for bronchial asthma was not effective and because he erratically demanded treatment that he desired. Therefore, he was admitted to our department of psychosomatic medicine. We started our psychological treatment after asthma attacks remitted following treatment with theophylline, β_2-stimulant inhalation, minor tranquilizers and the regular administration of beclomethasone dipropionate inhalation. The patient revealed that his wife has died in a traffic accident 6 months before the onset of asthma attacks, and that he was feeling lonely. So we provided opportunities for him to ventilate his feelings. The psychological interview with him also revealed that besides asthma attacks, he often experienced hyperventilation attacks and anxiety attacks and that he was unable to distinguish these attacks one from another. So we educated him to discriminate between these different types of attacks. As a result of these interventions there was a remission of his symptoms. Several psychosocial factors are responsible in most cases of late onset bronchial asthma, therefore, psychosomatic treatment is appropriate for such patients.

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