著者

金澤 太茂 小長谷 敏浩 今村 祐志 金山 範明 松永 昌宏 大平 英樹 福山 誠介 篠田 淳 野村 理朗 野木森 剛 金子 宏 各務 伸一

出版者

愛知医科大学

雑誌

愛知医科大学医学会雑誌 (ISSN:03010902)

巻号頁・発行日

vol.35, no.2, pp.59-70, 2007-06

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Background: Brain activation areas in relation to bowel stimuli have been reported using brain imaging techniques in patients with irritable bowel syndrome(IBS). However, the results are controversial. The aim of this study is to clarify responsible brain site(s) when stimulated by the rectal balloon distension-induced abdominal symptom in IBS in terms of braingut interactions. Methods: Seven healthy volunteers and five patients with diarrhea-predominant IBS based on the Rome II criteria were recruited. All were right-handed men. Rectal sensitivity was examined with balloon distension using a barostat device. Studies are performed with or without rectal distension(RD). Each task took 4 minutes. The subjects were assigned to have each twice task at the individual pain threshold level with 11 minute intervals. The changes in brain blood flow were evaluated using H_2 ^<15>O-water positron emission tomography. Subjects were asked rectal pain and stress level with visual analogue scale(VAS) before and soon after the respective task. Blood pressure, heart rate, and several serum stress-related substances were also investigated. Results: The threshold of pressure for rectal pain was significantly lower in the IBS patients(IBS=14.4mmHg, volunteers=26.3mmHg on average). The IBS patients showed a significant increase in blood flow in especially insula, and in thalamus at RD as compared with that in volunteers. Analyzing changes in VAS score before and after task, an increase of score about physical stress was significantly larger in the IBS patients in RD although no differences was noted in pain perceived score among all subjects in RD. A tendency of correlation was observed between the RD-induced increment in blood flow in insula and that in VAS score of stress-feeling. Conclusions: The IBS patients had a significantly lower pain threshold against RD. Under RD stress at an individual pain threshold, a significant objective activation in insula, subjective physical stress, and correlation between them were obtained, indicating the brain activation magnitude-correlated stress in IBS.

著者

多羅尾 陽子 兼本 浩祐

出版者

愛知医科大学

雑誌

愛知医科大学医学会雑誌 (ISSN:03010902)

巻号頁・発行日

vol.35, no.1, pp.1-6, 2007-03-15

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In this retrospective study, we examined clinical settings and associated symptoms in patients with episodes of deliberate self-harm in order to investigate pertinent therapeutic approaches for subtypes of self-mutilators. A total of 55 patients with such episodes were randomly selected as a study sample from case records of outpatients treated directly by the authors from 2003 to 2005. The average observation period and age at examination were 2.1±3.1 and 24.9±11.3 years, respectively. Eighty nine percent of the study subjects were female, and more than 40% had experienced eating disorders, suicidal attempts by drug abuse, and doctor shopping. Fewer than 60% of the subjects were diagnosed with a DSM axis I mental disorder, of which 20% were mood disorders, while greater than 60% were categorized with personality disorders, including borderline personality disorders in 55%. Surprisingly, 38% of the subjects had an axis II diagnosis alone and not axis I. The average age of onset of self-mutilation was 22.7±11.0 years old and 65% of the subjects injured themselves without a definite precipitating event. Approximately one-third felt no pain during the self-mutilation, while amnesia to the episode and ecstasy accompanied self-injury in 13% and 29%, respectively. Factor analysis revealed late onset, marriage, and mood disorder as closely associated (first factor), which suggested the existence of a treatable subgroup of patients with mood disorders among the self-mutilators studied. In addition, analysis showed that high frequencies of self-injurious episodes, episodes of transient ecstatic feelings along with no pain following self-injury, and suicidal attempts associated with drug abuse were associated (second factor), which we speculated to be clinical hallmarks of addiction to self-mutilation. Based on our findings, we recommend that trials of medical treatment for treatable self-mutilators with hallmarks of the first factor be conducted and psychological support for patients with addiction to self-mutilation who demonstrate the second factor clinical constellation.

著者

角谷 昌昭 中山 明峰 佐藤 達明 稲福 繁

出版者

愛知医科大学

雑誌

愛知医科大学医学会雑誌 (ISSN:03010902)

巻号頁・発行日

vol.30, no.2, pp.145-151, 2002-06-15