不定愁訴症候群(いわゆる自律神経失調症)の臨床像に関する検討 : 当科心身症外来患者における知見に基づいて

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Many patients complain of various physical symptoms without any related organic pathology. We often diagnose these cases as unidentified clinical syndrome or so-called vegetative syndrome, However, it is extraordinarily difacult for physicians to understand these disturbances because of the various conceptions of them and few clinical reports evaluating them from a multiple point of view including the whole profile of aspects of this disease. Therefore, appropriate treatment of this syndrome is usually difiicult to accomplish. In the present study, we examined 62 patients complaining of more than three physical symptoms without any related organic pathology, who were admitted to the psychosomatic medical clinic of the First Department of Internal Medicine, Kagoshima University Hospital. Their clinical features as well as the response to therapy were assessed as follows : All the patients had mental disorders which were diagnosed by DSM-III-R Classification. Depressive Disorders were most common at 48%, followed by Somatoform Disorders at 31%, Anxiety Disorder at 10% and Psychological Factors Affecting Physical Condition (so-called psychosomatic disease) at 8%. The groups which response best to therapy included patients who had been socially well adjusted before getting ill and those who were over 50 years old. Younger patients tend to have more severe disease, whereas patients over 50 years old were pathologically light, such as in Depressive Disorders whose type is categorized as having socalled "good prognosis". The main etiological factors contributing to this syndrome were social immaturity in 90% of the patients under 29 years old, problems in the work place in 56% of male patients over 30 years old, and family problems in 48% of female patients over 30 years old. Based on these findings, it may be concluded that the unidentified clinical syndrome (so.called vegitative syndrome) is a variety of pathological conditions. Thus, since this ambiguous and comprehensive diagnosis is of insufiicient help for medical treatment, it is necessary to treat the cases according to their respective pathological conditions. Diagnosing the patients from the psychological point of view, evaluating their previous social adaptability, and defining age and sex may bring us the proper understanding of the clinical features and the response to therapy of the patients. This may further lead us to better treatment of patients with this syndrome.
日本心身医学会の論文
1994-10-01

不定愁訴症候群(いわゆる自律神経失調症)の臨床像に関する検討 : 当科心身症外来患者における知見に基づいて

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