著者

小林雅文

雑誌

日歯心身

巻号頁・発行日

vol.9, pp.84-91, 1994

被引用文献数

2

著者

小林 雅文

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.9, no.1, pp.84-91, 1994-06-25 (Released:2011-09-20)

参考文献数

11

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Cervico-omo-brachial syndrome consists of symptoms that include pain and paralysis extending from the neck, shoulders and arms to the fingers, muscle contracture or hypertonia of these parts and the inhibition of movement at the cervical vertebrae. Although the cause is complicated, it may be produced principally by compression and/or stimulation of the spinal cord and/or nerve root, plexis or periphery. Little literature describes psychogenic intervention in this syndrome. This study describes a case of the syndrome which exhibited psychosomatic influence.Patient: 40 years old housewife.First examination: August 8, 1993Chief complaint: Sensory disturbance of the neck, shoulders and arms together with pain in the mandibular joint produced by “close-bite malocclusion” of metal crowns set on the right and left mandibular molars several years previously.History of present illness: Patient complained of dry mouth, thoracic compression and cardiopalmus in addition to the above-described syndrome, although doctors told her that no abnormal state was found from clinical, physiological and biochemical examinations. Her sickness had changed from stiffness to paralysis after a miscarriage in the previous year, and the paralysis has extended to the arms. The syndrome was not improved during 30 days of taking (p. o.) of tizanidine hydrochloride prescribed by a plastic surgeon.Status praesens: The author advised her to stop taking tizanidine. Her complaint of maladaptation of metal crowns (765 567) was foud to have almost no physical basis when examined orally, including by x-ray. The result of CMI questioning was III.However, the author counseled the patient to accept and bear with her complaint on two occasions for one hour each and also devoted one hour to reassuring the patient that her sickness would heal, making a combined total of 3 hours during the 3 months' therapy. The author also adjusted the occlusion 65 567 65 567 and set the new metal crown at 7 after root canal treatment.Etizolam (0.5mg/tablet) was administered 3 times (1 tablet p. o. every time) per day for 5 days in the first month and 10 days in the second month, and then alprazolam (0.4mg/tablet) was administered twice (1 tablet p. o. every time) per day for 5 days during final week of the second month. Her sickness disappeared for the most part. Three weeks after stopping alprazolam, (0.5mg/tablet) was administered twice (1 tablet each time) per day for 5 days in the third month. Sleeplessness was also improved considerably.Her sickness has not recurred to date, i. e. 7 months since the final treatment.

著者

横田 雅実 桐野 靖子 小林 司 小林 雅文

出版者

日本歯科心身医学会

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.15, no.1, pp.85-89, 2000

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今回の症例は, 数か所の身体症状が病理学的に認められ, それにうつ状態がかさなっているものである.<BR>患者は, 1996年の初診時において78歳の女性である.彼女は20年以前から, 半身不随の夫の看病を続けており, 彼女自身も動脈硬化症, 高血圧, 狭心症, 脳梗塞等の身体症状に加えて, 不定愁訴, 悪夢, 不眠等で苦しんでいた.さらに娘の結婚による別居後, それらの症状に加えて, 自殺念慮, 発癌恐怖もおきてきた.かかりつけの内科医から, 末梢の治療薬に加えて, 抗不安薬も投与されて来たが, 充分な効果が得られないので投与量が増加されていた.<BR>彼女の下顎切歯 (21112) の金属冠は, 破損していたが, 近くの歯科医に不信感を持っているため, 7~8年放置したままで, 治療を受けようとしなかった.今般, 彼女の娘に連れられて筆者らを訪れた時にはdrowsinessのため歯科治療を行える状態ではなかった.筆者らはこのdrowsineSSは, 現在服用中のアルプラゾラムのためと考え, その服用を中止させ, その代わりに心身症性の臓器および循環障害に著効を示し, しかもアルプラゾラムよりも依存性の低いクロキサゾラムを処方した所, 小量投与にもかかわらず, 3週間の服用で身体症状を含めて精神症状に際だった改善が認められた.勿論この間に心身医学的療法として, 臨床心理学的アプローチによりカウンセリングを定期的に行った.約1か月経過時から口腔内治療を始めた.まず21112の破損金属冠を撤去し, 根管充填物を除去した.X線診査によれば, 21112の根尖端に病変はみられなかったので, ただちに根管充填を行い, その数日後にメタルコアーを合着し, 印象を採得した.翌月には金銀パラジウム裏装の硬質レジン前装冠を合着した.現在まで経過は良好である.<BR>クロキサゾラムの投与は1年間で中止した.それは患者が消化管障害の再発を訴えたためで, このため1997年10月から, 心身症性の消化管障害に著効を示し, 依存性の心配の少ないフルトプラゼパムの投与を開始し, 現在まで順調である.

著者

小林 雅文

出版者

Japanese Society of Psychosomatic Dentistry

雑誌

日本歯科心身医学会雑誌 (ISSN:09136681)

巻号頁・発行日

vol.12, no.1, pp.43-47, 1997-06-25 (Released:2011-09-20)

参考文献数

7

被引用文献数

1

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The study describes a case of ill-fitting dentures caused by long-term polypharmacy.Patient: 55 year old female office worker.First examination: March 26, 1996.Chief symptoms: Difficulty fitting lower denture.Therapeutic history: The patient gradually lost her lower teeth, except for a single canine, after breaking her leg in a fall. Several sets of dentures were made but the patient was unable to keep them correctly positioned.Present status: The patient walks with difficulty and has the characteristic moon-face induced by chronic steroid administration. The alveolar membrane was frail and inelastic. The remaining canine was very mobile and was removed with minimal damage. However, bleeding continued for longer than was expected and healing was delayed. She was advised to stop taking steroids, non-steroidal anti-inflammatory drugs, anti-allergic drugs (anti-histamines?) and anxiolytics which had been prescribed by different clinics over a period of several years. She also received counselling and was informed that the problems with ill-fitting dentures would be resolved. This was indeed the case. Her alveolar membrane and psychological well-being also improved.