Behavior-genetic Study on a Group of Patients Characterized by Eating Disorders and Multiple Self-destructive Behaviors

近年、欧米諸国およびわが国においては、摂食障害が年々増加している。摂食障害を示す患者の症状、経過、転帰、そして治療に対する反応性などは、はなはだ多彩で単一な疾患とは考えられない。すでに多くの研究者が摂食障害の臨床遺伝学並びに、統計学的研究の結果、本症が異種性の疾患であると結論している。我々も長年にわたり、摂食障害患者ことに、摂食障害にアルコール症をはじめ薬物依存、性障害および性同一性障害、窃盗癖、性的逸脱、自殺、自傷行為など種々の問題行動を伴い、対応の困難な患者の治療に関わってきた。本研究においては、このような、摂食障害に各種の問題行動を伴うものの疾病学的な分類を目標に、行動遺伝学的な研究を行った。対象は1990年1月から1995年12月の6年間に入院・外来治療を行った65名の摂食障害患者で、その中から様々な自己破壊的行動を伴う亜型を類別し、EDMUL（Eating Disorders with Multiple self-destructive behaviors）とした。EDMULでは、アルコール症、薬物依存症、自傷行為、自殺、窃盗癖、性的逸脱行動その他の身体的生命および社会的生命にたいする破壊的行動が、同時に或いは互いに入れ替わって出現した。さらにEDMULの家族内にもアルコール症や問題行動の負因が多く認められ、その基盤として遺伝的背景に基づく強力な衝動性とそのコントロール障害が考えられた。Among a group of patients (n=65), the majority of whom had been introduced to us by eating-disorder specialists elsewhere because of difficulties in their treatment, we defined a subgroup disordered eating behavior, problematical behavior relating to the use of alcohol and other substances, shoplifting, promiscuity, and suicidal tendencies were seen in 74%, 36%, 33%, and 15% of the patients, respectively. Further, this subgroup showed an extremely worse outcome, when compared with the subgroup of patients with pure eating disorders (n=26). With regard to the intrafamilial traits examined among the first-and second-degree relatives, 49% of the patients had the trait for alcohol dependence, 28% had the trait for problematical behaviors. The physically or socially self-destructive types of behavior, which seemed to be attributable to vigorous and uncontrollable intrinsic impulses of the patients, tended to emerge in the respective patients in revolving or alternating manners. Therefore, enduring efforts should be taken to support the personality development of such patients rather than to struggle with respective problematical behaviors, which may be considered merely as facets of a single disorder.(n=39) characterized by eating disorders and multiple behavioral problems. In addition to th

Addiction to prescription medications of benzodiazepine-type drugs : Treatment in the mental clinic

1952年以来、精神科診療へのクロルプロマジンの導入に始まって、この60年間で薬物治療は大きな変遷を遂げた。またたくうちに、向精神病薬は精神科治療の中で欠くべからざるものとなり、色々な薬剤が開発されるにつれ、その量や種類も年々増加する傾向にあった。21世紀に入り、非定型抗精神病薬の開発によって副作用の少ない薬を単剤で使えるようになった。しかし一方、2000年～2012年にかけてPC、インターネットの進歩・普及に伴い、薬物問題は若年層に拡大し、“処方箋依存"もますます複雑化してきている。本稿では、最近の精神科外来で遭遇するベンゾジアゼピン系をはじめとする薬剤に関する具体的な問題と、それに対する取り組みについて報告し、考察を加えたい。Medical therapy has made great progress in the last sixty years since chlorpromazine, a sedative drug, was first introduced in psychiatric treatment in 1952. Since then, psychoactive drugs became an established therapy in no time, and the availability of such drugs increased both in number and in kind. At the turn of the 21st century, the appearance of atypical antipsychotics enabled single-agent treatment without strong side effects. Meanwhile, since 2000, drug-related problems have been spreading among young people, with the increasing popularity of personal computers and the internet. Addiction to prescription medications has become more prevalent, making drug therapy more complex. This paper discusses issues related to drugs, including benzodiazepine, which has been often prescribed for psychiatric outpatients in recent years, and discusses approaches to solve them by presenting specific examples

摂食障害と多発性自己破壊行動という特徴を有した症例における行動の遺伝学的研究について

Among a group of patients (n=65) , the majority of whom had been introduced to us by　eating-disorder specialists elsewhere because of difficulties in their treatment, we defined a　subgroup (n=39) characterized by eating disorders and multiple behavioral problems. In addition　to the disordered eating behavior, problematical behavior relating to the use of alcohol and other substances, shoplifting, promiscuity, and suicidal tendencies were seen in 74%, 36%, 33%, and 15% of the patients, respectively. Further, this subgroup showed an extremely worse outcome, when compared with the subgroup of patients with pure eating disorders (n =26). With regard to the intrafamilial traits examined among the first- and second-degree relatives, 49% of the patients had the trait for alcohol dependence, 28% had the trait for problematical behaviors. The physically or socially self-destructive types of behavior, which seemed to be attributable to vigorous and uncontrollable intrinsic impulses of the patients, tended to emerge in the respective patients in revolving or alternating manners. Therefore, enduring efforts should be taken to support the personality development of such patients rather than to struggle with respective problematical behaviors, which may be considered merely as facets of a single disorder. 多発性問題行動を有する摂食障害(EDMUL)39例を対象とし,標記検討を行った。これら症例は純粋な摂食障害に比べ予後不良であった。家族内形質としてはアルコール依存性を49%,問題行動を28%で認めた。EDMULにおける問題行動は身体的,社会的観点からの自己破壊行動であり,コントロールできない固有の衝動に基づいている可能性を示唆した。よってEDMULではそれぞれの問題行動に取り組むよりも,むしろ人間性の成長を支援する努力をすべきであると考えた

A case report of Asperger\u27s syndrome with severe eating disorder

Only a few cases of Asperger\u27s syndrome with a concomitant eating disorder have been reported in Japan and abroad. We encountered a case that manifested the comorbidity of severe eating disorder and Asperger\u27s syndrome. The patient first manifested symptoms while in Germany as a student. Despite visiting different health care providers and receiving psychological counseling for about 10 years, the patient was in critical condition with low body weight of only 22.8kg when she first consulted us. During hospitalization she was prohibited her from taking laxatives and compressing her abdomen with a belt. We established a target weight for the patient to allow her to stay out overnight or be discharged. The patient was discharged on the 52nd day of hospitalization. The case met the diagnostic criteria of DSM-IV-TR (American Psychiatric Association, 1994). Simple directive inpatient behavior therapy appeared to be effective in this case

性的逸脱行為を繰り返す摂食障害の1例

我々は摂食障害患者の中から,様々な自己破壊的行動をともなう症例をとりあげ,eating disorders with multiple self-destructive behaviors:EDMULとして類別し,1例を報告するが,このようなEDMULでは,摂食障害の他に,アルコール乱用,薬物乱用,自傷,自殺,窃盗癖,性的逸脱行動その他の,身体的生命および社会的生命にたいする破壊的行動が,同時に,あるいは互いに入れ替わって出現し,その家族内にも,アルコール症や問題行動の負因が多く認められた。このような問題行動の基礎として,遺伝的背景に基づく衝動性とそのコントロール障害が考えられた。Our clinical team has long been involved in the treatment of patients with eating disorders. They were introduced to us by specialists of eating disorders because of the difficulties in treating the patients due to their problematical behaviors. Alcoholism and/or other substance-related disorders, promiscuity, sexual and gender identity disorders, kleptomania, self-harmful behaviors, suicidal tendency and so forth were often discovered in these patients in addition to eating disorders. We defined a subtype among eating disorders displaying a variety of problematical behaviors, and designated the subtype as eating disorders with multiple self-destructive behaviors (EDMUL). In this study, we report an example of EDMUL, a woman of eating disorders displaying a variety of problematical behaviors, including sexual behavior

A case report of a patient characterized by abnormal eating and multiple self-destructive behaviors

摂食障害患者が増加するに従い,その初発年令,食行動,随伴する問題行動,性に対する態度,結婚,出産など本症者の示す臨床像も複雑多彩となり,今日では,本症を単一のものとして規定するのは難しい状況である。今回我々は,万引きした食品(主に豆腐)を自室にため込み,それらが,腐敗し,かびが生えているにもかかわらず,過食・嘔吐する摂食障害の1例を経験したので,ここに報告する。このような特異な症例は,断面的には神経性無食欲症,神経性大食症,特定不能の摂食障害(DSM-IV),と診断されるが経時的な症状の変化のため診断も治療も困難である。またこのような症例をRussell (1979)のいう過食症の1群と考えるか,新しい疾患単位-例えば,著者らの既に報告したEDMUL (Eating Disorders with MULtiple self-destructive behaviors)としてとらえるかは今後の課題である。In our previous paper, we defined a subtype of eating disorder displaying a variety of problematical behaviors and referred to it as EDMUL (Eating Disorders with MULtiple self-destructive behaviors). In the present study we report a case of a female who for a 6-year period, shoplifted every day, stored a large amount of rotten tofu (soybean curd), konnyaku (paste made from konnyaku-mannan), and bread in her room, ate them and vomited

重度の摂食障害を合併したアスペルガー障害の一例

摂食障害とアスペルガー障害の合併した症例の報告は,僅かしか見られない。今回我々は,重度の摂食障害とアスペルガー障害の合併(comorbidity)した症例を経験した。患者はドイツ留学を契機に摂食障害を発症し,10年余り処々の医療機関や心理カウンセリングを受けていたにもかかわらず,来院時体重は,わずか22.8kgの低体重で,生命の危機的状況にあった。入院時使用していた下剤や,腹部を締め付けていたベルトの使用を禁止し,外泊・退院のための目標体重を設定し,それを努力目標とした。その結果,入院52日目に退院できた。なお,アスペルガー障害については,DSM-IV-TRの診断基準を満たしていた。単純な指示的な入院行動療法が,効を奏したものと考えられた。Only a few cases of Asperger\u27s disorder with a concomitant eating disorder have been reported in Japan and abroad. We encountered a case that manifested the comorbidity of severe eating disorder and Asperger\u27s disorder. The patient first manifested symptoms while staying in Germany as a student. Despite visiting different health care providers and receiving psychological counseling for about 10 years, the patient was in critical condition with low body weight of only 22.8 kilograms when she first consulted us. We prohibited her from taking laxatives and compressing her abdomen with a belt while hospitalized. We established a target weight for the patient to attempt to achieve in order to stay out overnight or be discharged. Consequently, the patient was discharged on the 52nd day of hospitalization. The case met the diagnostic criteria of DSM-IV-TR. Simple directive inpatient behavior therapy appeared to be effective in this case

Ego states of nursing students assessed by egograms : with special reference to the level of anxiety during a nursing practice course

The present study analyzes the egograms of nursing college students with special reference to their level of anxiety during nursing practice. We analyzed the responses of 149 nursing college students to two questionnaires, i.e. the STAI (State-Trait Anxiety Scale) and TEG (Tokyo University Egogram). The TEG results indicated that the high anxiety group had significantly lower in the A (Adult) scores and FC (Free Child) scores but higher AC (Adapted Child) scores than the low anxiety group. We concluded that nursing students with a low FC score and a high AC score should be encouraged toward more logical thinking as a nurse, and to receive training in coping with stressful situations, in addition to the academic component of their education