著者

永田 勝太郎 長谷川 拓也 喜山 克彦 青山 幸生 広門 靖正 大槻 千佳

出版者

一般社団法人 日本温泉気候物理医学会

雑誌

日本温泉気候物理医学会雑誌 (ISSN:00290343)

巻号頁・発行日

vol.70, no.4, pp.238-244, 2007 (Released:2010-04-30)

参考文献数

17

被引用文献数

1

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ObjectiveSeventeen patients with FMS were treated with balneo-Morita therapy, which combines the balneotherapy with Morita therapy. After one year of treatment, patients with favorable outcome were compared with those with poor outcome.Subjects and methodsThe mean treatment period was 4.3 weeks. The outcome after one year of treatment was assessed. Patients who were able to return to work without a relapse of FMS were classified into the responsive group (13 cases, 74.6% in all), and those who showed a relapse or were not able to return to work were classified into the unresponsive group (4 cases, 23.5%). The cases of these two groups were compared in terms of biological (physical), psychological, social and existential status induvidually.ResultsThere was no significant difference in sex or age distribution between the two groups. In terms of disease entity, FMS can be classified into psychosomatic type (hyperadaptation type) and neurotic type (possible presence of psychosocial-existential problems which are difficult to resolve such as great trauma, or the conditions ranging from neurosis to psychosis). Cases of neurotic type were prevailing in the unresponsive group. Patients were assessed to find out in which of the particular features of biological, psychological, social and existential aspects the notable problems proper to each patient lie.The number of patients having psychological problems was higher in the unresponsive group, with a significant difference. In one case of the unresponsive group, the condition changed into ME/CFS (myalgic encephalopathy/chronic fatigue syndrome).DiscussionIn the treatment of these patients, the somatic approaches or physical therapy such as pharmacological therapy or simple balneotherapy, should be given more importance for cases of the psychosomatic type. However, psychological therapy should be added to this treatment for cases of neurotic type. The efficacy of the balneo-Morita therapy was compared between the groups as classified by the type of the disease. The therapy was effective in 91.6% of the cases of psychosomatic type, while the efficacy rate was 40.0% for cases of neurotic type. During the period of the balneo-Morita therapy, a tendency of dependency on therapists may appear in patients. Although involution may be allowed transiently for the purpose of introducing catharsis, autonomy should be enhanced eventually. Yuatari (balneo-phenomenon, or balneo-intoxication) is a phenomenon, that develops in psychosomatic confusion resulting from sudden release from tension after the start of balneotherapy. This phenomenon is regarded as catharsis, from which patients are encouraged to establish a new self. Through this therapeutic experience, the therapists lead the patients from involution to autonomy without being so instructed, finally to cause a change in the way of living. In cases of psychosomatic type, this conversion was relatively easily achieved, but in cases of neurotic type such conversion was difficult. It is considered that difficulty in such conversion is attributable to psychological factors of patients (strength of self, severity of trauma, presence or absence of meaning, autonomy).

著者

青山 幸生 牧 裕一 山本 達夫 広門 靖正 永田 勝太郎

出版者

公益財団法人 国際全人医療研究所

雑誌

全人的医療 (ISSN:13417150)

巻号頁・発行日

vol.18, no.1, pp.22-28, 2020-01-25 (Released:2020-07-02)

参考文献数

13

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全人的医療では,身体・心理・社会・実存レベルにおいて患者を理解することが必要であり,具体的方法論として,パソジェネシスand/orサルトジェネシス的アプローチを的確に,しかもタイムリーに実践できることが求められる.さて,全人的医療の主柱のひとつである,「患者固有の資源を見出し,それを活性化していく」ことは,まさにサルトジェネシス(健康創成論)の考え方であり,「資源」は具体的な「患者力」そのものであると考えられる.さらに患者がコヒアレンス感(sense of coherence; SOC,人生への対処姿勢,人生には意味があると思える感覚)をどの程度有しているかにより,資源をうまく活用し患者力をさらに高めていけるかの決め手となる.患者力を意識しながら,治療者,患者が相互主体的関係の中でともに資源(患者力)に気づいてそれらを活性化していくところに従来のパソジェネシス(病因追究論)単独でのアプローチとの大きな違いがある.今回,45歳女性で,抗うつ薬離脱時,その副作用により約10年間にわたり心身ともに苦しめられ,その間もともとあった多くの資源をベースに,家族や友人などの暖かい傾聴,受容,支えにより自身の患者力をさらに伸ばすことができた結果,ゆっくりではあるが夢に向かっての一歩を踏み出せた症例を経験したので合わせて報告したい.

著者

永田 勝太郎 長谷川 拓也 岡野 寛 大槻 千住 広門 靖正 青山 幸生

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.44, no.7, pp.479-486, 2004

参考文献数

15

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専門医により予後不良と診断された末期がん患者28例に対し,補剤を投与し,実存分析的なアプローチを加え,全人的医療を試みた.その効果について,レトロスペクティブに検討した.評価は,主観的にはQOL調査票を用いてQOLを評価し,客観的には尿17-KS-S(以下,S),17-OHCS(以下,OH),S/OH比を用いた.補剤である十全大補湯,紅参末,コエンザイムQ10を用い,さらに実存分析を基盤とした心理療法を行った.その結果,延命効果(6カ月未満から平均18カ月へ)とQOLの改善(特に食欲と疼痛)が認められ,低下していたS,S/OH比が上昇した.さらに,6例が実存的転換を示した.転換群と非転換群の身体・心理・社会・実存的条件を比較した.トータルQOL,食欲,高S,至高体験,意味への気つきが転換群で優れていた.また,死の様態では転換群に尊厳死が多かった.