チック様咳嗽に対する行動療法

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A rare case of female adolescent with coughing tics was reported with special reference to the behavioral therapeutic effects. Several psychosocial problems were observed to exist between the patient and her family members. These psychosocial factors frustrated her strongly because her personality was aggressive yet with a strong tendency of self-suppression. Some abnormal patterns of electroencephalogramm such as 6 & 14 c/sec positive spikes or spike & wave complexes (Gibbses-Shimoda) were frequently demonstrated but it seems unlikely that the patient should rightly belong to a diencephalic autonomic epilepsy ; this case who occasionally exhibited a variety of syndrome shifits represented by an attack of hyperventilation syndrome, might be put into a symptomatic category of one type of neuromuscular tics, because hystercal conversion mechanism was noticed in the course of the disease.On the other hand, from the viewpoint of learning theory, the symptoms appeard to be the consequence of automatically somatized movements ; in other words, it could be a sort of conditioned avoidance behavior reinforced by vaious types of social reward, because the symptoms of the patient seemed to be fixed steadily partly due to a relief from anxiety itself and, partly due to sympathetic attitudes around her. It was attempted to control the coughing tics which had previously been almost refractory to other psychosomatic therapies including negative practice and hypnotic desensitization. Two sessions of fasting indeed brought forth a dramatic effect in subduing tics but recurrences followed soon after discharge. Thus the method of reward learning was applied along with some external punishments, where she was intermittently reinforced either by giving her verbal rewards or what she wanted to have only when her symptoms were reduced, otherwise she was kept in an uncomfortable situation by neglecting her demends or by depriving her of her belongings.The results were satisfactory ; the abnormal tic was rapidly reduced and clearly extinguished in about one month. Inspite of some syndrome shifts observed at present, she has had no episode of coughing tics even in one and half years after her third discharge. Consequently, the favourable effects of operatnt conditioning was confirmed in such a complicated case with coughing tics.
日本心身医学会の論文
1974-06-01

チック様咳嗽に対する行動療法

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