女性の更年期障害に対する心身医学的対応(<特集>女性をめぐる心身医学)  [in Japanese] Psychosomatic Approach for Menopausal Women(<Special Issue>Clinical Management in Female Psychosomatic Disorders)  [in Japanese]

更年期障害に対する心身医学的対応としては一人の患者を,婦人科身体的診断,精神科的診断,心身医療的診断,東洋医学的診断の4方向から診るとより的確な診断ができる.当科で1995〜2008年までに診た2,166例を心身医学的立場から診断すると,身体病型(S型)1,001例(46.2%),うつ病型(D型)640例(29.5%),神経症型(N型)286例(13.2%),心身症型(P型)239例(11.0%)であった.また,同一対象者をDSM-IVによる分類で診ると,身体表現性障害が1,397例(64.5%),気分障害が596例(27.5%),パニック障害が54例(2.5%),不安障害が39例(2.2%),睡眠障害が20例(0.9%),統合失調症が9例,適応障害が9例,性障害が5例,パーソナリティ障害が4例,疼痛性障害が3例,摂食障害が2例,転換性障害が2例であった.東洋医学的診断としては,漢方薬の投薬が1,247例(57.6%)に用いられていた.身体的治療のホルモン補充療法は849例(39.2%)であった.面接主体はP型に多く,D,S型は少なかった.抗不安薬はN,D型に多く,抗うつ薬はD型に多かった.治療予後は,81.2%が良好でありS,P,D型はN型に比べよかった.夫婦関係の状態が病態や予後に大きな影響を与えることを証明した.更年期障害には心身医学的な対応が必須であることを証明している症例を提示した.

It is important to examine menopausal women from different angles. I usually diagnose them from psychosomatic medicine, mental diagnostic (DSM-IV), gynecological diagnostic and oriental (Kampo) medicine. We examined 2,166 cases of menopausal women who we treated in our clinic from 1995 to 2008. They can be sorted into four groups from a psychosomatic view, (1) somatic type (S-type, 1,001 patients, 46.2%), (2) depressive type (D-type, 640 patients, 29.5%), (3) neurotic type (N-type, 286 patients, 13.2%), (4) psychosomatic type (P-type, 239 patients, 11.0%). When they have been diagnosed by DSM-IV, there have been 1397 cases of somatoform disorders, 596 cases of mood disorders, 54 cases of panic disorders, 39 cases of anxiety disorders, 20 cases of sleep disorders, 9 cases of schizophrenia, 9 cases of adjustment disorders, 5 cases of sexual disorders, 4 cases of personality disorders, 3 cases of pain disorders, and 2 cases of eating disorders and 2 cases of conversion disorders. So we noticed that there were so many kind of levels of psychopathology. So we had to treat them individually. We had counseling to many patients who were sorted into P-type mainly, but to a few patients who were sorted into D and S-types. Many N and D-type patients were treated with tranquilizers and also D-type patients were treated with antidepressants. 1247 cases (57.6%) were treated by kampo therapy. 849 cases (39.2%) were treated by HRT. Prognoses were concerned with relationships to their husbands. We also show you a case of a menopausal woman who had a problem with her husband sexually. You can understand that she was D-type basically, and was S-type from her hormone state. Also, she was N-type from psychological tests and interviews. This case proves that menopausal disorder is one of the most typical psychosomatic disorder.