気管支喘息と心身症

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Is has been known from ancient times that emotion induces an asthmatic attack. This fact may show that asthma is a psychosomatic desease. Namely, in a wide sense, psychological factors may promote an antigen-antibody reaction, snd in a narrow sense, an asthmatic attack may occur only by psychological factors and not by antigen-antibody reaction. In the latter, emotion is said to act as a stressor to the diencephalon through the brain cortex or limbic system, then to influence the hypothelamus, the pituitary anterior lobe and the adrenal cortex system and/or the hypothalamus and the automic nervous system and to accerelate the broncho-pulmonary reaction. For diagnosis of asthma as a psychosomatic disease, psychological examination is necessary besides physical examination. Psychological diagnosis is performed by interview and various pasychological tests snd also by CAI (comprehensive asthma inventory). Results obtained were as followes : 1.Psychological examination 1) CMI : III and and IV fields were 60.7% 2) YG : B and E types were 28.5%. 3) MAS : Score more than 20 were 44%. 4) SDS : Score more than 50 were 8.3%. 5) PF study : GCR under 46% was 49.5% and overadaptation was 72.7%. These reactions were analyzed. 6) Large Rorschach test : Superficial adaptation was found in 68.5% of the patients. 7) CAI : In severe asthmatics, dependence, frudtration, negative attitudes toward prognosis and decreased motivation toward therapy were high in incidence. All these results were remarkable in severe cases. 2. Clinical examination. 1) Provocation test : Under suggestion of a severe asthmatic attack during hypnosis , ild and moderate attacks occurred in 8 of 24 cases. In these 8 cases eosinophile leukocytes tend to increase in blood and sputa. Plasma levels of histamine and cortisol showed no definte changes. 2) MDT (mirrow drawing test) : By MDT an asthmatic attack did not occur In asthmatics MDT types showed some difference as compared with those of healthy subjects and speed was sle and accurecy was inferior. 3) MV (microvibration) : As compared with healthy subjects asthmatics had high incidence in parasympathicotony. Parasympathicotony was seen frequently in the patients who had low threshold titer in acetylcholine and histamine inhalation tests. From the above-mentioned results, it is assumed that if the first asthmatic attack occurred without prrof of antigen, infection or any relationship with chemical mediators and also if a subsequent attack occurred similarly, then an expression "psychosomatic facror" may still be usable. LAmpen supposed an allergic center in the diencephalon. Is it permitted to think that whatever subjects which are seen, head and thought of go through the diencephalon and reach the allergic center and then an asthmatic attack is constructed? From the results of psychological and clinical examinations, psychological factors are considered to relate frequently to severe asthma. An asthmatic attack provocated under suggestion during hypnosis was thought to be induced by psychological factors. However, in these patients, histamine and cortisol did not show a definite change. Did the parasympathetic tension rize from suggestion centrally? As these patients had an asthmatic attack very often, they were thought to be in the condition prepared for an asthmatic attack (pre-asthmatic condition). In the patients who are under these conditions, an asthmatic symptom may occur easily. In 2 to 6 percent of the patients whose attack was reported to occur only by psychological factors, these conditions had already exsisted and by psychological factors an asthmatic attack might be induced. Along with the progress of examination technique, these hidden condetions preparing for an asthmatic attack will gradually be alarfied.
日本心身医学会の論文
1980-12-01

気管支喘息と心身症

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