精神科領域におけるアレキシサイミアの意義と問題点(アレキシサイミアをめぐって)(第33回日本心身医学会総会)
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概要
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A1exithymia, which has been introduced to Japan by Ikemi in 1977,became popular in Japanese psychosomatic medicine, but not in psychiatry. Furthermore, the relationship between alexithymia and psychosomatic illnesses has been criticized by some psychiatrists. Since alexithymia is not so well recognized in psychiatry as in psychosomatic medicine, we investigated alexithymia in psychiatric disorders by MMPI alexithymia scale. Subjects are 106 patients (56 males, 50 females) whom the author presumed more or less alexithymic from the clinical point of view. We subsumed the subjects into the following three groups according to the scores of MMPI-A. Group A : A1exithymic group with the scores of 17 or more. Group B : Borderline group with the scores of 13〜16. Group C : Nonalexithymic group with the scores of 12 or less. There is a tendency for nonbipolar depressed patients and schizophrenics to belong to groups A and B, while bipolar depressed patients and neurotics to group C. To be more exact, 63.6% of schizophrenics end 55.8% of nonbipolar depressed patients belong to groups A and B. On the other hand, 75% of bipolar depressed patients and 62.2% of neurotics belong to group C. Thus we can find more alexithymia in schizophrenics and nonbipolar depressed patients, which implies that there is some relationship between alexithymia and melancholic type personality (Tellenbach) as well as schizoid personality. To our surprise, alexithymia in schizophrenia has not been referred in the literature within our knowledge. Although this had better be called as pseudo-alexithymia, it may give us some implications for the pathogenesis of alexithymia. Considering the discrepancy between clinical impression and MMPI-A scores in some cases, dissociative symptoms and histrionic personality may have anti-alexithymic factors in contrast to conversion symptoms, which are related to alexithymia with such somatoform symptoms as somatization and chronic pain. For psychotherapy of alexithymic depressed patients, some modifications are necessary for overcoming the communication barrier and preventing them from taking the chronic course. In liaison psychiatry, consultation work for cancer patients or patients under long standing hemodialysis cannot be carried out sufficiently without the knowledge of secondary alexithymia. Hence, it can be said that the concept of alexithymia is as important in psychiatry as in psychosomatic medicine.
- 日本心身医学会の論文
- 1993-01-08
著者
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