循環器心身症と不安(不安と心身症第22回日本心身医学会総会シンポジウム)

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The following investigation was undertaken in order to examine the possible role of anxiety in the development of psychosomatic circulatory diseases. Among such diseases, two groups of essential hypertension with both high and low anxiety levels and NCA were selected. Pressor responses and associated psychophysiological reactions via Mirror Drawing Test (MDT) of these groups were compared with controls. Secondly, beta-blocking agents were administered to determine whether or not these phenomena could be suppressed. In hypertensives, the pressor response tended to be significantly higher than in the controls, suggesting the presence of an organselective factor. Although the stress-induced elevation of blood pressure did not differ in the two age- and sex-matched groups of hypertensives with different anxiety levels, the high anxiety group showed a significant increase in heart rate and serum FFA. In some types of NCA, a significant correlation was seen in an increase in Katz's indices between MDT and an Isoproterenol loading test. This group of NCA, "somatic type"appeared to have a close interrelation between psyche and soma. Accordingly, the hyperdynamic beta-adrenergic circulatory state proposed by Frohlich was considered to be included in this group. However, the pressor response in NCA was lower than that in hypertension, whereas, the heart rate increase was much greater in NCA. On the other hand, resting plasma noradrenaline concentrations were quite similar in both groups. Under stressed situations via MDT however, increment of plasma noradrenaline was greater in hypertensives. Moreover, some hypertensives with higher anxiety levels even showed plasma adrenaline increase after MDT, although the mental stress failed to increase significantly the average adrenaline levels in all cases. A beta-adrenoreceptor blockade significantly suppressed the various psychophysiological responses after MDT in both hypertensives and patients with NCA. An attempt was, therefore, made to use combined treatment with an anxiolytic drug and a beta-blocking agent. The therapeutic effect was especially prominent in the somatic type of NCA. Analysis of the check list suggested a possible anxiolytic effect in the beta-blockers in comparison with the placebos. A vicious circle was thought to be established occasionally between anxiety (primary and secondary) and somatic symptoms. Consequently, psychosomatic approaches are required to break this vicious circle.
日本心身医学会の論文
1981-12-01

循環器心身症と不安(不安と心身症第22回日本心身医学会総会シンポジウム)

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