著明なてんかん性要因を示し,挿間性昏迷状態をくりかえした非定型精神病の1例
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A 16-year old girl. It is said that there was a psychotic case in the relatives on the paternal side of the patient. Her hereditary history remains obscure, but her own history is uneventful. A review was made of this case who had episodes of stuporous state six times, and episodes of delutional-hallucinatory state twice since the age of 13. Clinical and EEG observations were carried out from Nov. 1965 to Aug. 1966, and from March 1967 to July 1967 when she was admitted to our clinic. The results are breifly summarized as follows. The stuporous state which presented mutism and akinesia as the principal symptom was difficult to differentiate from the stupor observable in schizophrenia, and it developed in a day or two at the onset, which lasted for about two weeks and then was alleviated. During this period of episodes she showed no noteworthy symptom of disturbed consciousness and she could recall what had happened to her precisely. Her EEG revealed that paroxysmal abnormal waves characterized by spike wave were inhibited during the stuporous state, but in the stage of remission paroxysmal abnormal waves appeared spontaneously and were activated easily by hyperventilation. This stuporous state could be alleviated transiently by the administration of amytal sodium, and also with a large dose of valium it was improved. On the contrary, anti-epileptic agents had no effect at all on the stuporous state. From the characteristic features of the psychotic state, this case could be construed as a type of atypical psychosis, but paroxysmal abnomality on EEG was similar to that of epilepsy, and so this was the case that had clearly shown to stand on the boundary line between atypical psychosis and epilepsy. Therefore, it seemed that epileptic factors of atypical psychosis should be dicided only after long, continuous observations of the case. Some discussion was made on physiological mechanism inducing a stuporous state. Namely, the mechanism that induced a stuporous state seemed to have a close relation to the excitation of system which tried to inhibit the abnormal EEG, and this system was provably the reticular formation system of the midbrain.症例は13才女子.患者の7親等にあたる父系に精神病者があつたというが遺伝歴の詳細は不明.既往歴に特記すべきものはない.本症例に招来した前後7回の昏迷状態と,その他幻覚妄想の表面化した,昏迷状態と異なる状態像をあわせ観察し,発病より入院に至る経過,及び前後2回の入院の経過を詳述した.昏迷状態はつよい無動無言を主兆とする分裂病性昏迷と区別のつかないもので,始まりは急で1日を境にして訪れ,2週間前後続き寛解をみる.この間認むべき意識障害はなく,患者は些細な出来事迄すべてを想起できる.前後18回の脳波による継時的観察を行なつた結果,昏迷状態下では,棘波を中心とする発作性異常波は抑制され,寛解期にはこれが出現しやすい傾向を認めた.昏迷状態はAmytal sodiumで,一時的ではあるが劇的に改善され, Valiumの大量内服でも臨床像を改善できた.しかし抗てんかん剤は,むしろ昏迷状態には奏効しなかつた.本症は精神病像からは非定型精神病群の1型としてみられるが,発作波の消長からは,てんかんにみられる所見と同一の傾向を有し,両者を結ぶ1点を鮮やかに示した1例であつた.非定型精神病のてんかん性要因はかかる症例の継時的観察から決定されるべきものであると考えた.その他昏迷状態の出現と,発作波の消長に関し,若干の生理学的推論を試み,考察を加えた.
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