著者

斎藤 清二 北 啓一朗 桜井 孝規

出版者

一般社団法人日本心身医学会

雑誌

心身医学 (ISSN:03850307)

巻号頁・発行日

vol.31, no.7, pp.587-590, 1991-10-01

被引用文献数

1

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A long-term course of physical and psychological treatment on a patient with laxative abuse was described in this report. A 52-year-old woman was referred to our hospital because of chronic diarrhes, hypokaremia, and general weakness with unexplained cause. Laboratory data showed hypokaremia and high value of plasma renin, angiotensin and aldosterone, which indicated pseudo-Bartter syndrome. Multiple diagnostic procedures on digestive organs including endoscopy and barium study revealed no organic abnormalities. A room search showed a package of laxative tablets (containing bisacody1), and the diagnosis of surreptitious laxative abuse was confirmed. Guide lines of management for this patient were introduced as follows; (1) The target of treatment should not be diarrhea but constipation and abdominal distention. (2) Confrontation regarding laxative use should be avoided until good physician-patient relationship would develope. (3) Psychotherapy would be introduced in a regular shedule. The patient could stop laxative use during the first admission. After laxative withdrawal, severe constipation and idiopathic edema developed. Supportive treatment fron both physical and psychological aspect was continued throughout several admissions and at the outpatient clinic. The patient has been free of laxative and diuretics ato the time 5 years after initial admission. Diagnosis and treatment of laxative abuse are usually difficult because patients often deny their laxative use. Another difficulty is to manage water retention and constipation after withdrawal of laxative. Long-term energetic support from both somatic and mental aspect seem to be essential help the patient give up laxative abuse.