心療内科外来を受診した身体表現性障害患者の臨床的特徴  [in Japanese] The Clinical Features of Somatoform Disorder in Outpatients of Psychosomatic Medicine  [in Japanese]

目的:当科を受診した身体表現性障害の臨床的特徴を検討した.方法:対象は2001〜2002年に当科を初診し,ICD-10分類で身体表現性障害と診断された130例.診療録をもとに下位分類,発症誘因,受診歴,治療内容,転帰などを検討した.結果:下位分類では鑑別不能型が59人(45.4%)と最も多く,次いで自律機能不全19人(14.6%)であった.発症の誘因は対人葛藤が最も多く38人(29.2%),不明,身体疾患への罹患,心身の疲労と続いた.身体科受診歴は109人(83.8%)の症例にみられた.薬物療法の内訳は,抗不安薬のみの症例が57人(68.7%)であった.精神療法は支持的精神療法のみ90人(77.6%),環境調整の併用17人(14.7%)であった.転帰は,初診のみの群32人(24.6%),不変群54人(41.5%),改善群30人(23.1%),他科照会14人(10.8%)であった.初診のみの群では,他の転帰よりも誘因が「不明」である率が高かった.また,不変群の治療期間は,短期中断型と長期継続型の二峰性を示し,治療開始後初期の軽快歴と治療期間に関連性が認められた.改善群の主な誘因は,心身の疲労や対人葛藤であった.結論:当科は精神科外来に比べて,身体表現性障害の率は高く,身体表現性障害の患者にとって受診しやすくなっていると思われる.誘因が明らかな場合と転帰には関連性が認められた.誘因が明らかである場合は,心身相関の理解を得やすく,心療内科での治療継続につながると思われる.また,不変群における治療開始後の初期反応は,その後の治療期間にとって重要な因子である.改善群では多くの患者が治療開始後初期に軽快していたが,長期間経過した後に軽快したものもあった.

Objective, Methods: The purpose of this study was to clarify the clinical features of outpatients diagnosed as Somatoform Disorder (SFD) (F45) by ICD-10. In a retrospective study, 130 outpatients with SFD, who visited the psychosomatic outpatient clinic at a university hospital between January 2001 and December 2002, were examined through medical records on subtype diagnosis, trigger, modalities of treatment, and clinical outcome. Results: 1) Fifty nine (45.4%) were diagnosed as undifferentiated somatoform disorder, and 19 (14.6%) autonomic dysfunction. 2) The major trigger was interpersonal conflict (38, 32.8%), unclear (30, 25.9%), physical illness (21, 18.1%) and cumulative occupational fatigue (18, 15.5%) 3) Among the medicated patients, 57 (68.7%) of them were prescribed only anxiolytics and 11 (13.3%) anxiolytics and antidepressants. Concerning psychotherapy, 90 (77.6%) of the patients received only supportive psychotherapy, and 17 (14.7%) combined the intervention of environmental stressors. 4) The outcome was as follows: Thirty-two (24.6%) had dropped out after first consulting, 54 (41.5%) of the patients were unchanged, and 30 (23.1 %) showed improvement in symptoms. The percentage of "unclear" in the group drop-outs after first consulting is the highest of the three outcomes. The patients who were unchanged followed two clinical courses. Patients in one group stopped the treatment in short term, while patients in another continued in long term. The latter had improvements soon after first consulting, but they could not maintain those conditions. The major triggers in patients who showed improvement were 'cumulative occupational fatigue' and 'interpersonal conflict'. Conclusion: There is some sort of relationship between patients with obvious trigger and outcome. It seems that they could easily understand mind-body correlation and are expected to continue the psychosomatic treatment. It is important for unchanged patients to have improvement once soon after first consulting. Most of the patients had improvement soon after first consulting, while some patients required more than three months until their symptoms improved.