著者

和迩 健太 WANI Kenta

出版者

川崎医学会

雑誌

川崎医学会誌 = Kawasaki medical journal (ISSN:03865924)

巻号頁・発行日

vol.43, no.1, pp.43-55, 2017

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近年,職場ストレスにより抑うつ状態をはじめ心身の不調を来し休職したり,学校や社会に不適応を起こし不登校,ひきこもりになったりする適応障害患者が増えている.診断基準上,適応障害を引き起こす要因であるストレスの大きさは問われないが,一方でどのような人が適応障害になりやすいかという研究はこれまでない.本研究では,適応障害患者に対する成人用Wechsler 式知能検査第3版(Wechsler Adult Intelligence Scale Third Edition; WAIS-Ⅲ)の所見と臨床的特徴からそれらを検討した. 適応障害と診断されWAIS-Ⅲを施行された患者50名(14歳~48歳,男性29名,女性21名)を対象とした.IQ が70未満の精神遅滞と診断された者は除外した.臨床評価として,初診時年齢,発症年齢,精神主訴の有無,身体主訴の有無,初診時における社会参加の有無,初診時GAF(Global Assessment Scale)を用いた.WAIS-Ⅲは言語理解(Verbal Comprehension; VC),作動記憶(Working Memory; WM), 知覚統合(Perceptual Organization; PO), 処理速度(Processing Speed; PS)の4つの群指数に分類される.対象者を群指数パターンによってクラスタ分析を行った. その結果,3つのクラスタパターンに分類された.群指数に関しては,クラスタ1はWM がVCとPS よりも有意に低く,クラスタ2はPS がVC とWM よりも有意に低く,クラスタ3はPS がVC,WM,PO よりも有意に低かった.また,IQ に関しては,クラスタ3> クラスタ1>クラスタ2の順に高くそれぞれ有意差が認められた.クラスタ間の臨床的特徴を検討したところ,クラスタ3は身体主訴が有意に少なかったが,他の項目で有意差は認められなかった.さらに,対象者全体で見ると,GAF とWM において正の相関が認められた. 以上から,適応障害患者においてはWM とPS という認知機能低下が認められる可能性があり,特に社会適応の観点からWM に注目して診療を行うことが大切であると考えられた.Recently, there has been an increase in the number of patients with adjustment disorder (AD) who are absent from work or school. Such patients often withdraw from active social life because of a depressed mood and psychosomatic symptoms caused by workplace stress or maladjustment to their social environment. The diagnostic criteria for AD do not account for the level of stressful life events, and evidence regarding the association of cognitive features with the extent of maladjustment and clinical characteristics of AD is scarce. In this study, we examined the association between cognitive characteristics assessed with the Wechsler Adult Intelligence Scale-Third Edition (WAIS-Ⅲ) and clinical features in patients with AD.In this study, we included 50 patients with AD who completed the WAIS-Ⅲ (29 men and 21 women, age range: 14-48 years old). Patients with a diagnosis of mental retardation and an IQ less than 70 were excluded. At the initial visit, the following clinical features were measured: age at initial visit, age of onset, the presence of mental and/or somatic symptoms, social participation, and Global Assessment of Functioning (GAF) scale score. The WAIS-Ⅲ consists of four index scores: verbal comprehension (VC), working memory (WM), perceptual organization (PO), and processing speed (PS). Participants were classified into three groups by cluster analysis according to their WAIS-Ⅲ index score profiles.In Group 1, the WM index was significantly lower than both the VC index and PS index, whereas, in Group 2, the PS index was significantly lower than the VC and WM indices. Meanwhile, in Group 3, the PS index was significantly lower than the VC, WM, and PO indices. Group 3 had significantly higher full-scale intelligence quotient (FIQ) scores than did both Groups 1 and 2, while Group 1 had significantly higher FIQ scores than did Group 2. In addition, the proportion of patients who had somatic symptoms in Group 3 was significantly lower than that in Groups 1 and 2. In the analysis of all participants, we observed a positive correlation between GAF scores and the WM index.In conclusion, patients with AD are thought to have impairments in both WM and PS. We suggest that evaluation of AD from the perspective of WM might be useful to better understand a patient's social maladjustment.

著者

貝原 拓磨 浦上 淳 横田 ヒロミツ レオン 佐久間

出版者

川崎医学会

雑誌

川崎医学会誌. 一般教養篇 (ISSN:03865398)

巻号頁・発行日

no.42, pp.19-26, 2016

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解体新書は当時の日本において最先端の医学書であったが,改めて観察すると,現代医学との相違点がいくつか存在する。そこで解体新書の図譜を現代医学の視点から考察し,原図に沿って現代医学の要素をメディカルイラストレーションの手法を用いて加筆修正した。また江戸時代と現代において各臓器の見せ方の違いを考察した。本論文では解体新書の「肝臓篇」「膵臓,脾臓篇」の2章の中の,肝臓,胆嚢,膵臓の3臓器の図譜について現代医学の視点から考察して相違点を抽出した。それを基に,原図に沿って現代医学の要素を加筆修正した。加筆修正するポイントとして,臓器の構造や機能を,強調や省略を駆使して的確に表現した。また,臓器は生体的構図で描画し,関連する周囲組織も含めた構図を作成した。肝臓前面の図譜では,形状を整理し,間膜と肝円索を加筆した。肝門の図譜では,脈管を修正し,間膜と圧痕を加筆した。胆嚢の図譜では,形状と層の表現を修正し,胆嚢管の表現を修正した。膵臓の図譜では,前面と背面の2枚の図を作成した。また,肝門部を加筆,胆管と膵管を修正,胃と膵臓の前後関係を修正,脾臓の脈管を修正したうえで,腎臓を削除し,横行結腸を加筆した。Kaitai-Shinsho was one of the state-of-the-art medical books in Japan during the Edo period.However, on closer observation, there are several differences between the illustrations and modern medicine. Therefore, we nvestigated the illustrations in the Kaitai-Shinsho from a modern medical point of view, and retouched them using medical illustration techniques in accordance with the original figures. We also discussed the differences in how to show each organ in the Edo and modernperiods. Regarding the three organs of the liver, gallbladder, and pancreas, we extracted the differences and discussed from a modern medical point of view. The structures and functions of these organs that have been scientifically proven were adequately drawn through the use of emphasis and omission techniques. These organs were drawn with anatomical composition, which can be easily understood, including the relevant surrounding tissues. For the figure of "Liver: front", we 1) organized the shape of the entire liver, 2) retouched the surrounding membrane, and 3) retouched the round ligament. For the figure of "Liver: hilum", we 1) modified the vessels flowing into the liver, 2) retouched the surrounding membrane, and 3) retouched the impressions on the surface. For the figure of "Gallbladder", we 1) modified the layers of the wall, 2) retouched the shape, and 3) retouched the cystic duct. For the figure of "Pancreas", we drew two views of the pancreas front and pancreas back. In addition, we 1) retouched the hepatic hilum, 2) modified the bile duct and pancreatic duct, 3) modified the position of stomach and pancreas, 4) modified the vessels of the spleen, 5) removed the kidney, and 6) retouched the transverse colon.