小児期における摂食障害 : その特徴と心身医学的治療アプローチ(シンポジウム:思春期の心身症と心身医学的発想,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Anorexia Nervosa in Early Childhood : Its Characteristics and Psychosomatic Approach(Symposium/Psychosomatic Disorders of Adolescents and Psychosomatic Conceptions)  [in Japanese]

小児期に認められることが多い摂食障害として,異食症・異味症,哺育障害,神経性食欲不振症などについて概説する.次いで,札幌医科大学病院小児科で治療した16歳以下42例の神経性食欲不振症(辺縁群を含む)の精神医学的特徴と転帰について報告する.その転帰の概略は,ダイエット制限型の予後が良く,排出型ではドロップアウトや精神科転科例が多く予後不良のものが多かった.特に排出型で肥満恐怖が強い例は,入院治療において体重の増加に伴いさまざまな行動化が出現し,小児科での入院治療には限界があった.早めの精神科との連携が欠かせない.小児期における摂食障害の問題点として,やせの常態化による消化器系機能の減退・回復能力の低下,消化器系疾患の発症,身長の伸びの停止,長期月経停止,骨粗しょう症,甲状腺機能低下,血球減少,電解質異常など,脳精神機能への影響として食物への没頭,抑うつ・不安・焦燥感の増大,希死念慮・自殺未遂・既遂,学業不振,注意力散漫などがあり,これらに対する予防的な配慮が欠かせない.小児期摂食障害の治療においては,子どもの心身両面と家族に対する包括的な支援を行い,学校と積極的に連携を図ることが重要である.

As popular eating disorders seen during childhood, I give outlines of pica, feeding disorders of infancy and early childhood, anorexia nervosa etc. Subsequently I report psychosomatic characteristics of anorexia nervosa (including a borderline group) of 42 cases under 15 years of age whom I treated at the Pediatric Department of Sapporo Medical College Hospital. As to the outline of the implantation, an outcome of the diet limiting group was good, and there were many dropouts and cases needing to refer to the psychiatric department in the purging group. As for the cases who had an intense fear of obesity, various acting out developed with an increase of weight in inpatient care particularly among the purging group, and there was a limit for inpatient care at the pediatric department. Cooperation with the psychiatric department in the early stage of treatment is indispensable in those cases. Among problems of eating disorders in childhood are a physical decline or a fall of recovery ability of the alimentary system function, the onset of an alimentary system disorder, a halt of growth of body height, long term menolipsis, osteoporosis, hypothyroidism, cytopenia, electrolyte abnormality etc by being continually thin, and mental devotion to food, increased feelings of anxiety or irritation, death consideration, unsuccessful suicide, underachievement, poor concentration etc. Prophylactic consideration for these is indispensable. With regard to the treatment of childhood eating disorders, it is essential to see both sides of mind and body of child and family comprehensively, and it is important to promote cooperation with schools.