頻回の嘔吐のために入退院を繰り返した糖尿病1症例について(問題症例をめぐって第30回日本心身医学会総会)

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Vomiting is a common gastroenterologic symptom which is particularly pernicious in diabetics because of their precarious metabolic homeostasis. However, the severity of abnormal gastrointestinal motility is not necessarily caused by the diabetic state, but by psychosocial factors that we should address when dealing with diabetic patients whose symptoms include severe vomiting. In such cases, the psychosomatic approach is very important for treatment. We treated a 33-year old diabetic woman who had received hospital care about 50 times due to vomiting attacks before her admission to our hospital. She suffered from NIDDM when she was 17-years old. She vomited with motion sickness for the first time at the age of twenty. She married at 24,but was divorced at 27 after aborting artificially 3 times because of severe emesis. When she was 28-years old, she started working at an office and was admitted for treatment approximately once a month due to her vomiting. At the age of 31,she began to cohabit with a man and her vomiting attack slowly increased in frequency and severity despite several evaluations and courses of treatment. As vigorous medical management failed to control her vomiting, she was introduced to our hospital in September, 1987. On admission, her weight was 39 kg and her height 159.6cm. She was 22% under the standard weight and suffered from diabetic triopathy, especially severe nephropathy and gastropathy. On the 5th day after her admission, she requested to be released from the hospital, but we did not comply with her request. The next day, vomiting occurred throughout day and night, continuing for 5 days and subsiding on the 6th day. A similar attack occurred during a TRH test. In the intermittent period between the episodes, there was no vomiting and meals were taken normally, and she requested discharge repeatedly. It was difficult to persuade her to continue the therapy. On November 27th, she left the hospital without having been discharged. Ten days later, she was readmitted on an emergency basis due to vomiting and systemic edema. Once the attack subsided, she again left without formal discharge, but came back to the hospital within a few days due to a vomiting attack. In April, 1988,we contracted with her for a three-month admission. For the somatic aspect, we guided her through self control exercises to control her diabetes, and, for the psychological aspect, we dealt with her conflict with the man she cohabited with and the causes of her anxiety that resulted in vomiting attacks. The patient gradually improved on this regimen and was discharged after three months. After discharge, she did well for five months. By the sixth month, she had had no recurrence of vomiting, but her renal function had deteriorated, so she was started on dialysis.
日本心身医学会の論文
1990-06-01

頻回の嘔吐のために入退院を繰り返した糖尿病1症例について(問題症例をめぐって第30回日本心身医学会総会)

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