心療内科受診患者における心身症と身体表現性障害(心身症と身体表現性障害)(第27回日本心身医学会総会)

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Statistical studies on psychosomatic diseases and somatoform disorders in outpatients in a psychosomatic clinic of Tokyo University Hospital were performed. Subjects were 179 outpatients who visited Dr. Sogo from 1982 to 1984. Table I shows the classification of patients who were diagnosed with DSM-III criteria. As a typical psychosomatic disease, patients with " psychological factors affecting physical condition " numbered 69. As somatoform dlsorders patlents of "somatlzatron disorder " numbered 12 (7%), " conversron drsorder" 6 (3%), " psychosomatic pain" 8 (5%), " hypochondrlasls" 14 (9%), and " atypical somatoform disorder" 3 (2%). The total number of somatoform disorders patients numbered 43 (24%), about 1/4 of the 179 outpatients studied. Differences were found between the DSM-III diagnosis and the diagnosis of the psychosomatic clinic. For example, patients with "somatoform disorders " were diagnosed as " vegetative labile syndrome, " "climacteric disorder, " or " irritable bowel syndrome." Patients with " conversion disorder " were diagnosed as " headache " or "left abdominal pain." Patients with " hypochondnasrs " were dlagnosed " cardrac neurosls" or " chronlc gastntis." These differences were due to the fact that the axis I-diagnosis of DSM-III is based on psychiatric symptomatology while the diagnosis in the psychosomatic clinic, which resembled the axis nl diagnosis of DSMm, is based on somatic symptomatology. Several of these cases are reported. One patient, a 23-year old female, diagnosed as " vegetative labile syndrome " in the psychosomatic clinic, complained of 16 symptoms including abdominal pain, diarrhea, back pain, palpitation and dizziness. Using the DSM-III criteria, she was diagnosed as " somatoform disorders." A 66-year old female, diagnosed as " neck pam " In the psychosomatlc climc was dragnosed as " psychogenrc paln " vath DSM-III cntena as she had no organic damage, and the psychological cause of the pain was clear. As the egogram of patients with psychogenic pain resembled that of hysterical patients, psychogenic pain may be related in some way with hysteria. A 59-year old male visited our clinic for over 17 years complaining of a fear of heart attack. His diagnosis in the psychosomatic clinic was " cardiac neurosis, " but according to DSM=III criteria, because his fear was too strong and without any physical abnormality, he was rediagnosed as " hypochondriasis." Table 2 shows the comparison of patients between the psychiatric clinic and the psychosomatic clinic. In the psychiatric clinic, many patients were observed with "affective disorders " or " schizophrenic disorder." In the psychosomatic clinic, patients with " psychological factors affecting physical condition " were in the majority. In the psychiatric clinic, 100% of patients were found to have " somatoform disorders " in comparison to 24% in the psychosomatic clinic. DSM=III is very useful in understanding patients from a wholistic standpoint.
日本心身医学会の論文
1987-02-01

心療内科受診患者における心身症と身体表現性障害(心身症と身体表現性障害)(第27回日本心身医学会総会)

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