心身医学の立場からみた神経内科の老年者(老年者の心身症)(第14回日本精神身体医学会総会)
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Among the elderly patients in neurologic clinics, organic neurologic diseases such as cerebrovascular accidents, cervical spondylosis and extrapyramidal disorders were very common.On the other hand, cases of anxiety neurosis and psychosomatic diseases in the strict sense were rate in the aged compared with patients in their thirties. The incidences of hypochondriasis, psychogenic reaction, hysteria and depression were similar in aged patients over 60 and patients in their thirties.Psychosomatic approaches are always necessary in the treatment of aged patients diagnosed as neurotic or depressed, because most of them have various complications such as hypertension, cerebral arteriosclerosis and cervical or lumbal spondylosis.Analysis of the clinical pictures of 112 elderly cases diagnosed as neurosis, depression and psychosomatic diseases in the neurologic clinics of Nagoya University Hospital and Gifu Prefectural Tajimi Hospital revealed that the most common symptoms were insomnia and headache. Anorexia, dysesthesia, pain other than in the head, loss of volition, depressive mood and irritability were other common symptoms.The most frequent complaints in the 32 cases with psychogenic reaction and hysteria were pain and dysesthesia in various parts of the body including the head.Insomnia, pain, dysesthesia, dizziness and abnormal sensation in the mouth were relatively frequent complaints in the 34 cases of hypochondriasis, phosia, sub-neurosis and anxiety neurosis.Nearly half of the 40 cases of depression in the aged were classified as a retarded type. Pseudoparkinsonian symptoms such as masked face, bradykinesia, mild regidity of limbs and fine tremor were observed in 9 cases among the patients with this type of depression. These symptoms were soon improved after treatment with tricyclic antidepressants. L-DOPA was also effective for this type of depression.Irritability, anxiety and insomnia were prominent symptoms in the 6 cases of agitated depression. In this type, excess of brain dopamine or decreased brain 5-HT was suspected.The incidence of headache among the aged outpatients in neurologic clinics was 28%.In these aged patients with headache, organic headaches due to cervical spondylosis or cerebrovascular accidents were more common than functional headaches. About 25% of the cases with headache were diagnosed as cases with depressive, hypochondriacal and psychogenic headaches. Psychosomatic headaches such as migraine and tension headaches which are more common in the young, could not be found in the aged group.
- 日本心身医学会の論文
- 1974-04-01
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