いわゆる口腔心身症の入院治療についての臨床的研究　　治療技法の検討と病態仮説の構築について

DOI 被引用文献9件 参考文献70件
  • 豊福 明
    福岡大学医学部歯科口腔外科学教室

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タイトル別名
  • A clinical study on psychosomatic approaches in the treatment of serious oral psychosomatic disorders during hospitalization. Evaluation of "behavior restriction therapy" for oral psychosomatic disorders and consideration of its pathophysiology.
  • Evaluation of “behavior restriction therapy” for oral psychosomatic disorders and consideration of its pathophysiology
  • 治療技法の検討と病態仮説の構築について

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The author has been applying Fukamachi's “Behavior restriction therapy” which was developed for eating disorders, to severe oral psychosomatic disorders since 1993. In this paper, 29 cases treated for oral psychosomatic disorders on an in-patient basis at our institute were surveyed with regard to their clinical features, treatment methods applied, their effect, treatment outcome and long-term prognosis. The author is seeking to establish a hypothesis on the pathophysiology of oral psychosomatic disorders through the investigation of the clinical characteristics of these patients from the therapeutic viewpoint. The subjects consisted of 16 cases of occlusal disease, 8 of atypical facial pain, 2 of glossodynia, 1 of oral malaisis, 1 of delusional halitosis and 1 of odontophobia. All the patients were hospitalized and their repetition of “doctor-shopping” was restricted. All the subjects were prescribed several kinds of antidepressants and minor or major tranquilizers as pharmacological treatment with the aim of alleviating the pain or other symptoms. The use of “Descriptions of impressions” and therapeutic keywords such as “Bad myself” were introduced as psychotherapy. According to the state of remission of the symptoms, patients were allowed step by step to leave the hospital ward. After confirming their recovery, final dental treatment was carried out if necessary. Treatment outcomes were evaluated from the following four aspects; the strength of subjective symptoms, the degree of impairment of daily activity or role functioning and the degree of dependence on medical treatments. Evaluations of the treatment outcome at discharge consisted of 1 excellent, 23 good, 3 fair and 1 poor. One case was transferred to neurosurgery. About 80% of the patients left hospital with remission in 3 months. Neither severe side effects nor adverse reactions were observed during the treatment. The follow-up studies of 26 cases after 10 months classified their level of social adjustment as “good”, “adequate”, “fair”, or “poor”. The results were “good” in 10 cases (38.5%), “adequate” in 10 (38.5%), “fair” in 5 (19.2%), and “poor” in 1 (3.4%). Evaluation of the long-term outcome showed good courses in about 80% of the patients. From the above results it appears that, Fukamachi's “Behavior restriction therapy” is an effective treatment for severe oral psychosomatic disorders as well as eating disorders.<BR>On the basis of these findings, the author wishes to propose a hypothesis on the pathophysiology of oral psychosomatic disorders. From the clinical point of view, oral psychosomatic disorders may be due to several biochemical disorders involving neurotransmitters in the brain, poor connection between teeth (occlusion) and undefined complaints due to cognitive processes in the higher centers of the brain. Dental service often effects these patients iatrogenically for the worse. Increased attention should there fore, be focused on the role of centralis disorders as causative factors.

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