著者

黒川 順夫 河合 雅代

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.32, no.5, pp.399-405, 1992

被引用文献数

7

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Of the patients with anorexia nervosa (A. N.), those with body weight less than 20 percent of the standard body weight and particularly those whose body weight decreased below 40 kg may see their weight loss rapidly accelerate to 35 kg, 30 kg or less and fall into a dangerous mental and physical condition, which might lead to death. The treatment of A.N. is very difficult and not much about it has been grasped although various characteristics have been mentioned. According to studies, these A. N. patients with a marked body weight loss were found to have a strong feeling of rejecting hospitalization as follows : ・They have an image of the hospital where patients are made put on weight like a broiler. ・Why should I be hospitalized when 1'm getting along very well ? ・I don't want to be alone, ・I don't want to part with my family members, ・My daily life will be restrained. ・I doubt if the attending physician will understand me when I'm hospitalized. ・I am worried that the weight gain might not stop. ・Worrying about the hospital life. We therefore fixed an out-patient body weight limit (body weight requiring hospitalization) by which to take the hospitalization measure in accordance with patient's mental/physical conditions in case of their body weight decreasing below that limit. We also had them make efforts not to break below the level of the body weight in hospital by the period promised and had them gradually increase their body weight on their own. By this method, eighty percent of 18 cases of A. N. who met the diagnostic criteria of DSM-III-R were able to escape from the critical body weight zone and to receive treatment at the out-patient clinic. The merit of this therapy lies in that even intractable A. N. can receive treatment only at the out-patient clinic and escape from the critical loss and that extreme thinness can be prevented by setting up the body weight requiring hospitalization, if A. N. is discovered early. From the standpoint of medical economy which has recently been taken up actively for debate, this therapy can be said to have the cost merit since the whole cost of hospitalization is saved. It is therefore concluded that this is an excellent therapy for A. N.