小児期の"心因性"視聴覚障害についての心身医学的考察

We had studied "psychogenic" hearing loss in childhood from a point of psychosomatic medicine (Shinshin-Igaku 25 : 429-436,1985.). This study was performed to compare "psychogenic" auditory disorders with visual disorders psychosomatically because the number of patients with both disorder is on the increase. The purpose of this study was, first, to investigate the points of similarity and/or differences between "psychogenic" auditory disorders and visual disorders with regard to psychological tests, clinical psychiatric view points, and secondly, to examine whether the classification which we had attempted to apply to "psychogenic" auditory disorders could be applied to "psychogenic" visual disorder patients. The subjects were 30 cases, who were devided into 3 groups. That is, 10 cases (Group I) had been diagnosed only as "psychogenic" auditory disorder at the outpatient clinic of otology. Another 10 cases (group II) only as "psychogenic" visual disorder at the outpatient clinic of opththalmology. And 10 cases (group III) as "psychogenic" auditory and visual disorders. The age of subjects ranged from 6Y5M and l2Y5M, the mean being 9Y5M (Male 6,Female 24). We analyzed the subjects to learn the relationship between psychological tests (Rorschach test, WISC-R, P-F study, Taken-shiki parent-child relationship test, etc.) and clinical observation (results of auditory and visual tests, psychosomatic symptom, prognoses etc.). The following results were obtained : (l) No significant difference was observed between group I and group III with auditory tests, and between group II and group III with visual tests. (2) No significant difference was observed among 3 groups about age of onset, sex, subjective symptoms, but cases who complained of psychosomatic symptoms were twice as many in group III as in group I and group II. (3) With prognoses, 9 cases of group I improved within a year. In group II, 4 cases improved within a year and 4 cases dropped out. But in group III, 5 cases improved and 3 cases relapsed. (4) As to psychological tests, they showed somewhat similar characters ; high passivity, high level of aspiration and suppression of their aggression. (5) According to the last report, the sufjects of Group I were classified into 3 types, that is, : over-adaptation type; 4 cases, mal-adaptation type; 5 cases and pre-adaptation type; l case. Group II : over-adaptation type ; 3 cases, mal-adaptation type ; 6 cases and pre-adaptation type ; l case. Group III : mal-adaptation type ; 9 cases and pre-adaptation type ; l case. As a result of the present investigation, it was concluded that there were many similarities and few differences between "psychogenic" audititory disorders and visual disorders with regard to psychological viewpoint and to clinical observation. Then, we proposed that both groups should be regarded as "psychogenic" sensory disorders and it would be advisable to apply a therapeutic approach based on our psychological classification. It is suggested that cases of the complexed group should be approached psychotherapeutically.