気管支喘息の発症機序・病態に応じた心身医学的治療の展開(心身症の発症機序・病態に応じた新たな治療技法の展開)

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We have been using the stepwise psychosomatic treatment (SPST) on asthmatic patients according to the evaluation of their medical examination and psychosocial factors that influenced the onset and clinical course of their asthma. The SPST consists of pharmacotherapy and stepwise psychotherapy in the following stages : 1) introduction to psychosomatic treatment and establishment of rapport between doctor and patient. 2) reduction of inner tension induced by a stressful situation and release from asthmatic attack. 3) making a patient aware of the relationship between asthmatic attack and psychosomatic factors. 4) helping the patients to modify their maladaptive behaviors and to develop an adaptive coping behavior. 5)termination of psychosomatic treatment. In this study, we investigated the effectiveness and problems in the practice of this therapy in 3 different medical care systems. The results are summarized as follows. 1. The modified SPST was applied to 17 patients (1 severe, 6 moderate and 10 mild cases), at A medical office, which is a clinic and has a small medical staff Most of the patients were young office workers, 14 of them had atopic disposition and 14 had psychosocial problems mainly at work. Fifteen patients showed a marked or fair improvement by this treatment. 2. Thirty-six patients (8 severe, 23 moderate and 5 mild cases) were treated with the modified SPST at B hospital which is a general hospital with respiratory division and has a sufficient medical staff. Seventeen patients had an atopic disposition and 26 patients had psychosocial problems at work or at home. Twenty-six patients showed a marked or fair improvement after personal or group education programs for asthma management and brief psychotherapy with pharmacotherapy. 3. The SPST was applied to 65 patients (31 severe and 34 moderate cases) at hospitals with an established psychosomatic care unit. All of them had psychosocial problems and 43 patients had an atopic disposition. Fifty-two patients showed a marked improvement or complete remission. The significant increase of Berle Index (BI) , which is the indicator of the ability for stress coping and social adaptation, was observed after the treatment for 2.4±1.1 years. The effectiveness of this treatment was seen to be best in life stress related types, better in neurotic types, and worst in personality related types. These results suggest that SPST may be applicable to all patients according to their pathophysiology and psychosocial situations at any hospital. SPSt's main aim, that is, the self-control of asthma, is consistent with the aim of the International Consensus Report on Diagnosis and Management of Asthma, which is the control of asthma and the reduction of the side effect of medication and promotion of the Quality of Life.
日本心身医学会の論文
1995-01-01

気管支喘息の発症機序・病態に応じた心身医学的治療の展開(心身症の発症機序・病態に応じた新たな治療技法の展開)

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