歯科治療および対応に苦慮した統合失調症（精神分裂病）を疑った１例

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  • A case report of suspected schizophrenia with anxiety about dental treatment and correspondence

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Insight into the disease condition of schizophrenia patients remains poor, and we have often experienced difficulty with abnormal behavior during dental treatment. In this study, we report the case of a schizophrenia patient who harbored extreme doubts about a treatment and its correspondence. The patient was a 44 year old woman whose main complaint consisted of a request for caries treatment. The treatment was started at the Department of Operative Dentistry in April, 1997, but the patient would not cooperate at all with it. Even after being treated three times, the patient continued to complain strongly of toothache and demand a change of doctor on the grounds that she was not being treated well. The doctor in charge requested our assistauce with the doctor-patient relationship and treatment in June of the same year. The rapport between the doctor and patient was dearly not good, although the patient changed her tone completely when interviewed. Despite our perseverance, however, she still would not cooperate and continued to display both dissatisfaction and anger. The patient would say that we were treating the wrong tooth during treatment, but refused when offered to be shown the tooth by mirror to prove it was not so. She also complained of imagined dirt on my face guard, etc., and other complaints of persecutory delusion. Following negotiation with the chiefs of the hospital and department, the patient was told that it would be very difficult to continue her treatment in this hospital. The patient did not come back to the hospital after that. A psychiatric disorder was suspected from the first, and most of the time was spent in talking with a the patient. The opportunity of a hospital transfer to a psychiatri department was lost. Dentists cannot perform treatment if the patient does not want it, and this case dearly showed the difficulty of treatment by dentistry alone.

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