所謂 境界線 精神症 患者群에 關한 臨床的 考察

A Clinical Study on So-called Borderline Psychotic Group.

Facing the fact that many patients are labelled as borderline in the psychiatric practice, while there is no such category in the DSM- J and ICD-8, the author attempted to delineate the clinical-descriptive aspects of the ‘borderline group’, especially eying for possible diagnostic cue. The schizophrenias of pseudoneurotic, pseudopsychopathic and borderline types and the borderline patient presently included in the latent schizophrenia in the DSM-1 and ICD-8 were treated as the group of ‘borderline psychosis’ for the following reasons； A survey of literature led the author to conclude that there are enough resemblance in the symptomatology, the course and dynamics among the group, that all evidence a common resistant response to various modalities of treatment, that all are reported as genetically linked with schizophrenia, and that recent psychiatric orientation indicates such a trend of treating them as one group or disease entity. Thus the author reviewed the charts of 16 of such patients (schizophrenia, pseudoneurotic type 6, pseudopsychopathic type 4, and borderline type 4, and the borderline patient 2) admitted to Neuropsychiatric ward, Kyung Hee Univ. hospital, and obtained the following results. The patients showed neurotic, psychopathic, psychophysiologic and psychotic symptoms, in the order in frequency. The symptoms were many in number, varied in scope, vague in complaints and changeable in course. Among the more conspicuous symptoms were primitive undifferentiated affects as anxiety, phobia and loneliness, primary process thinking characterized by high tendency of fantasy, constant preoccupation with peculiar sexual fanta sies and/or promiscuous or perverse sexual life, and lack of genuine emotion. Nervertheless’ their superficial reality testing and social functioning were maintained on the as if level. Psychometry revealed that great majority of their ego strengths were weak. Interpersonal relationships were universally distorted and great majority of them were isolated by way of one or more of anthropophobia, infantile clinging attitude and aggressively impulsive disruptions. All of their early life experiences were pathogenetic in nature especially with parents; they were characterized by one or more of separation, indifference, rejection, overprotection with overexpectancy and contradictory attitudes between both parents. Their characterological make up was that of narcissism and characteristics of various psychosexual developemental stages were found in each of the patients. Some of them experienced transient psychotic episodes from which they soon recovered. Considering all of these manifestations, their nuclear psychopathology seems to be a “less differentiated state of personality functions . Various modalities of treatment including pharmacotherapy and psychorapy were given inconsistently with generally unsatisfactory results. Aside from the deep rooted psychopatho-logy and their extraor dinarily strong resistance to the formation of therapeutic alienee, the most appea-ling aspect of the reason of their therapeutic failure was frequent changes of the diagnostic impressions. During the hospitalization of 35 mean days, more than 3 diagn ostic impressions have been given to each patient, hence the inconsistent fluctuation of therapeutic approaches. The author concludes that the diagnostic approach in these patients should be made from the angle of their nuclear psychopathology, i. e. the less differentiated state of personality functons instead of focussing upon the notorious irregularities of their symptomatology