心身症患者における病態認識と治療効果との関係に関する前向き研究  [in Japanese] A Prospective Study of the Relation between Subjective Perceptions of the Disease and the Effects of Treatment on the Patients with Psychosomatic Disease  [in Japanese]

心身症の治療では病名のみならず自覚的な病態認識も考慮すべき要素である.心療内科外来通院患者を症状の客観的因子である診断名,主観的因子である発症のきっかけの有無およびその内容(内的要因または外的要因)により分類し,初診時の患者の人格特性に(ミネソタ多面人格目録検査;MMPI)および6ヵ月回の治療による変化の差異を検証した.初診時のMMPIでは全体で第1,2,3,7尺度が中等度高値を示し,第1,2,3,7,0尺度が6ヵ月後に低下した.第27尺度は逸脱高値の人数加減少した.診断名,きっかけの内容による分類では,初診時のMMPIおよび6ヵ月間での変化のパターンに差はみられなかった.きっかけの有無による分類ではL,K尺度できっかけあり群がなし群に比べて有意に高値を示したが,変化のパターンに差はみられなかった.心身症では診断名に基づいた治療だけでは不十分で,主観的な病態認識も考慮した治療方針が重要となる.

Background : In discussing the treatment of psychosomatic diseases, it is necessary to mention not only the diagnoses but subjective perceptions of the disease. We investigated the relationship between subjective perceptions of the disease and the effects of treatment. Subject : Seventy-one outpatients who had been treated for 6 months at the department of psychosomatic medicine in a medium-sized municipal hospital. Method : Participants were brought under 2 chief categories, objective and subjective. Diagnoses formed the objective category and the subjective category included the trigger of onset (present or absent) and the details of it (endogenous or exogenous). The Minnesota Multiphasic Personality Inventory (MMPI) were assessed two times, before the treatment and 6 months later, and analyzed in each category. Results : Scales 1, 2, 3 and 7 in the first MMPI were medium-higher than other scales in whole patients, then scales 1, 2, 3, 7 and 0 significantly decreased by the 6th-month treatment. The numbers of the patients who showed 70 or higher T score decreased by the 6th-month treatment on scales 2 and 7. The trigger present group showed higher scores on scales L and K than the trigger absent group although there were no interaction effects. No group and interaction effects were found between other groups according to the categories of the diagnoses and the details of trigger. Conclusion : Patients with psychosomatic disease have a tendency to be worried about somatic disease, depres- sive, tense, anxious, paranoid, repressive and denying. These are considered to be secondary acquired characteristics as they can be improved by treatment. Patients who are repressive and attempt to show themselves to be good tend to be conscious of triggers of onset, while those who have poor coping skills and develop psychological problems tend to have no triggers nor awareness of them.