Review ( J Tokyo Wom Med vjiUn 8 6 (artxE )1E10~E14 )6102( J
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Syndromes
Keiko KOJ0 1 and Kazumasa IW
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1 entmarepD t Pfoyrtaihcys lo， ohcS Mfoenicide ， Tkyoo Women's lacideM ytisrevinU 2 Kanagawa cirtaihcysP retneC ( A c c e p t e d J ylu 82)5， 102 On teh sisab tforieh suoivepr gnol 聞term snoitagitsevni ， eht sorhtua eavh dervseob tcefed seoshycps -drocca i n g tot eh lac“ipyt "cinerhpozihcs nilepearK mode .lriehT nigiro tnonca e abyletauqed edzlyana by teh-isopatxuj t i on pfoevitiso and evitagen symptoms and rieht .erutcurts Whether evitagen proevitiso symptoms era ryimapr i n mret-gnol snoissergorp slilits aisrevortnoc .lmpioiC sredisnoc cinorhc seshocysp sa a rtluse pfolaicosohcys s t r e s s retfa etuca .sedosipe However ， ninoitidda otgniredisnoc yticinorhc gnidrocca voyttilibarenlu and sserts m o d e l s tro to eh model bfocisa redrosid ， neo dluohs enco niaga nrutre tot eh lacigolotaomtpmys ewiv wsa.lle xiS ( 6 )scitsiretcarahc dluosh cbe derdeisno :ereh )1noituloser fo etuca citohcysp ytinu foevitceffa -lano， isuled h a l l u c i n a t o r
y and minus symptoms ， )2noitisopatxuj tfo eh lanoisuled ldrwo and eht laer ldwor ， )e3vitatilauq c h a n g e fonoisuled noitaloubatfnoc-evitanigami noisuled ， )4ecnetsixeoc fotnereffid sreyal fo oeg redrosid ， )5 m a n i f e s t a t i o n rrnooitatsefinam-e rfoevitcae and citoruen symptoms ， )6cidosipe eurposex afo 宜e'evitc ，i-mdoepr n a n t l y icmna coponentsm thiw esiwerhto permanent .setats On tehevelalcioglothapohcysp ，leht srohtua aveh o b s e r v e d eht xis )6(scitsiretcarahc denirmteed sasngis fnooitacifinorhc ni suoneegodn sesohcysp which era c l o s e l y detaler eot hac .rehto Key W o:sdr noitacifinorhc ni snuogeoden seshoycsp ， yogptomatolyms cfocissal tcefed cinerhpozihcs syndromes ， d o u b l e noitatneiro cnicinorh ainerhopzihcs ， outcome lacigolohtap， ohcysp seussi I n t r o d u c t i o n Based on trieh emrgt-lno sonitagitsevni ) -5) 1 and t h e i r sionatrvseob 6 )-8) ifolaudivdin stneitap with os ・ c a l l e d tceefd sisohycsp ， eht shoruta would ekil rot-e t u r n tot eh .snoitanduof Although siht reaa appears t o be yltneiciffus deifiralc with cissalc cionhrc s c h i z o p h r e n i c symptomatology ， they sizepothehy t h a t esiecrp symptomatology si lyno provided on r a r
e .snoisacco ceinS they have ot laed with eesth q u e s t i o n s niecitcarp ， they want ot zealyan lacipyt s c h i z o p h r e n i c tceefd psychoses on the symptoma 目 t o l o g i c a l level and on teh level psychopathology fo h e r e . D e f i n i t i o n of teh terms “n"oitaficinrohc and “inifynorhcg lacinilc es"turfea
When eth orsutha speak fonoitacifinorhc ， they a r e gnrirefer tot he change sfo etat taht si-craach t e r i s t i c tfo he rm-tenogl nosisregorp endogenous fo p s y c h o s e s . 九，henT speaking utoba “gniyfinorhc -inilc c a l "seruatef they ear gnirrefer ot endoform -idnoc t i o n s that show a cylusounitno netsisrep ，t and c h r o n i c niosesrgpor ， but not fi het lacinilc ertuaef remains eth same from eth rats ，t isa s eth easc rof example ni hebephrenic seurteaf ro iconhrc -arap n o i d seurtafe such tsa seho ni cionhrc iaanopar and c h r o n i c veitaterpretni .noisuled 図 :okieK KQJQ tentmarDpe Pfoyrtaihcys l， oohcS Mfoenicide ， oykoT Women's lacideM ytisrevinU ， 1-8 ho-caadawK ， S h i n j u k u -k u ， Tokyo 666， 8-261 J napa E -m a i l : [email protected]
Why do teh rshoaut esooprp speaking o f “ctenrru gnifyinorhc lacinilc ?"serutaef T h i s si utoab how eht etats yllanoitidart delebal a s lac“ipyt cinerhpozihcs tcefed "sisohcysp -leved o p s ， which eht srohtua would ekil otetangised a sa “inorhc f y i n g lacinilc "erutaef ， esuaceb ylno when t h e term sidootrsednu salacin“ilc "erutaef sedo eht term ton lympi elbisreverri stcefed rro.slaudise On t h e rehto hand ， laer slaudiser era derdeisnoc a tepy o f etats fo desareced mrotoochysp evird touhitw s c h i z o p h r e n i c .stiart edsscusiD era urep ycneicifed syndromes bre(uH G， 6691 9)， 4991 什r uo-retcarahcn i s t i c dynamic ycneiciffusni J(kirazna W ， 9591
サ.
There eratnereffid sehacorppa gnidrager eht -eneg s i s pfo reu tcefed syndromes ， utb eon may llew ays t h a t a felbarova noissergorp si more common thwi p u r e tcefed syndromes ni terms fo good laicos -da j u s t m e n ，t.sv hitw gniyfinorhc lacinilc .serutaef On teh rehto hand ciner， hpozihcs tcefed -ohycsp s e s gniyfinorhc( lacinilc )serutaef eriuqer mre-tgnol c l i n i c a l tentmeart seucaeb tistliuciffid ot have an a b r u p t cituepareht ctmpai sno huc .stneitap teipseD t h e taerg noitubirtnoc Hfos'rebu sisylana cfocinorh c l i n i c a l serutaef ， eht tcaf taht eht gniyfinorhc -inilc c a l erutaef snimare tnatsiser tot ypareh si a fsuco ni t h e tenmatret sfocinerhpozihc .stneitap Has nghiyterev yaderla been dias ggardinre “ginyifonhrc lacinilc ?"seurtaef C u r r e n t l y ereht era yerv few seiduts nisiht aera o n tehlevellcaiglootmaotpmys on tro eh -aopchyps t h o l o g i c a l l e v e l ， euscabe tisi eandehsilbats tcaf taht t h e aygolotmostpmy foeseht lacinilc serutaef nac a l r e a d y e ab yleatuqed detnseerper thwi eht symp-t o m a t o l o g y fociss“alc cinorhc "ainerhpozihcs ， isa n t h e esac rof dlo scinotatac ， permanent nicullah 仕 t i o n s ， and .scinerhparap As a rluse ，t eht tseretni ni p a t h o g e n e t i c sheacroppa skcal a pesicer symptoma-t o l o g y a lot egra nexte .t The lacioglotaomtpmys noitaziretcarahc tfoeseh c l i n i c a l serutaef seems hot vea elttil tecpsrop rof -eb i n g rehtruf udesrup ， ecnis eht yencendt tni eh -oson l o g i c a l chroaapp siot ees eht eritne noissergorp ni s c h i z o p h r e n i a thiw ssecorp ngidelmo sa a perma 同 n e n t noissegrorp and dotebircse eht suoirav lacinilc f e a t u r e s gnirrcuco tuhougroht eht noissegrorp on o n e elgnis evel ，l isaflla ehtsnoitatneserp were a d-i r e c t tluser tfo eh .esaesid tIstluiciffid rof them ot a c c e p t sihtlanoitidart citenegonagro gnidnif ， fieht a u t h o r s ， ton eh sisab tfo eh tnaveler erutaretil J(-na z a r i k W ， 8691 1ペ
gnidraH CM ， 7891ペ
Yuzawa Ch ， 1 9 9 8 41 )) and rieht own gnol 圃term pu-wollof seiduts
( I w a i K， 6991 3 )， oojK K e at ，l 8a991 4)， ojoK K， b8991 5)) c o n s i d e r taht eseht lacinilc serutaef nod to tluser ni a flani etats ， utb tluser ni a mredli ， vdepormi etats t h r o u g h a “ndecos evitisop ."knik On teh rehto hand la， cigoa sloico tniop vfo iew sah t o b te nkea otni unccoa ，t namely ， eht sencatsmurcic i n which eht stneitap .evil tIsielbissop taht redlim p r e s e n t a t i o n s era due fotsrotca gnitceffa eht gnivil c o n d i t i o n s pnicirtaihcys slatipsoh ipmoiC( L， 0891 51 )， 1 9 9 5 .)日) One dluoc kniht tfo eh seangch edvehica ni t h e slatipsoh by gvinorpmi ytilauq cenarsusa t h r o u g h which ehtlacinilc serutaef cfocissal tcefed p s y c h o s e s htmig have .degnahc One thgim pshaerp s a y taht some fo eht esanghc ni eht noitatneserp a r e detaicossa hitw eseht .srotcaf The gnisae and fo t h e ytiliba otecneulfni eht gniyfinorhc lacinilc -aef t u r e s dseauc them ot ceno niaga nrutre ot eht s y m p t o m a t o l o g i c a l .weiv How does noitacifinorhc ur?occ 1 . The onatindfou tfo eh 'srohtua method I n oredr iotetagitsevn how eon sevirra cta-inorh f i c a t i o n yllai， cepse ni eht ygloothpahoycsp fo-gnol term noissergorp ni suongeodne sesohcysp ， eno must ton ylno redisnoc eht alcigoltoamtopmys
meaning tfo eh snoitatneserp and what yrogetca ot s y m p t o m a t i c a l l y yfissalc them ni， tbu osla n which o p s y c h o p a t h o l o g i c a l sisab eseht lacinilc serutaef nca b e cdezirogeta ni semtr fo.noisnemid Hence eht a u t h o r s eedn yaglotomotpmys and -lohtapohcysp ogy sa a method rof gnvirsebo eht mret-gnlo -orp g r e s s i o n . For eht emit ngieb ， eht rsohtua want ot d i s c u s s eerh how ， edbas on eht gniwollof eerht s y m p t o m a t o l o g i c a l nsosinmeid ， eon sevirra ta c h r o n i f y i n g lacinilc serutaef and how eseht lacinilc f e a t u r e s may may ro ton :egnahc yltsrif ， n to eh edis o f nsotimoe and rotmoohcysp evird ， amicsdyn w i t h i n eht meaning fo
J
kirazna W (8891 勺，ylndoces ， f o r sredrosid fo oeg ssensuoicsnoc gnidulcni -agen t i v e and evitisop symptoms ro、
larutcurt -otnevniT a b l e 1 6 scitsiretcarahC sasngiS noitfaocifinorhC i nusoengdonE sesohcysP 1 )tuloseR i o n foetucacitohcysp ytinu foeavi旺tce -noisu，led a l -h a l l u c i n a t o r y dna sunim .smotpmys 2 )isopaJ txu t i o n foelhatnoisuled dlrow dna ehtlaer.dlrow 3 )tilauQ a t i v e egnahc fnoiosuled-otalubafnoc-evoitatnigami r y dnoisule . 4 )tsixeoC e n c e foidt旺nere sreyal foog.eredrosid 5 )sefinaM t a t i o n noitatserfionam-er efviotcaer dnacitoruen s y m p t o m s . 6 )idosipE c erusopxe foeavi旺tce yltnanimo，derp cinam -moc p o n e n t s htiwesiwrehto tnenamrep .setats r i e s " ngdiorcca ot
J
kiarzna ， and yldriht ， rof ego -er a c t i o n s tot eh environment tro he dhares .dlrow 2 . scistiertcarahC on the symptomatological l e v e l I n the 'srohtua tenecr mret-gnol pu-wollof seiduts and osla tnirieh sniotarvesob inilaudividn stneitap ， t h e r e era xis )6( symptomatic scitsiretcarahc taht have been ederidnsoc ssa een Tni able .1 The tsrif citsiretcarahc si eht noituloser fo eht a c u t e icthocysp ytinu detsisnoc 3 symptoms fo -etac gory ， such saevitceffa yrotanicull， ah-lanoisuled ，and minus symptoms. hisT means -lanoisuled h a l l u c i n a t o r
y and minus symptoms ploeevd and
c o n t i n u e ndependenti foevitceffa symptoms. On t h e rheto hand ， ni eht txentoc fo etuca ictochysp symptoms ， eshet 3 symptoms yrogetac plovede ni c o n n e c t i o n ithw each .srehto The second citsiretcarahc si eht noitisopatxuj fo t h
e lanoisuled world and eht laer world ， namely .， i.e
d o u b l
e bookkeeping reluelB( E， 5981 勺and sudden
s w i t c h i n g (Rumke HC ， 6391 91 ) ) between eht -ysp c h o t i
c world and eht laer world ， and shut eht -otser r a t i o n rfoytilae ni eht form "fo leboud "noitatneiro
U
serpas K， 7319 2勺 The driht citsiretcarahc si a flmaor and -atilauq t i v e change tfo he noisuled and noitanicullah sot -du den d氏ule 路S剖oi∞
na悶l iasaed yrotlaubfano-c， eviatnigami -ed l u s i o n ， votsecio from ssehlceeps stcejbo drosllo sa if one were ni eht world fo animism ， otlanoitcnuf h a l l u c i n a t i o n s and acousma ， yltnanimoderp with good encont .t The htrouf citsiretcarahc sieht ecntesixeoc dfo-fi f e r e n t sreyal fo ego redrosid ， such sa eht -sixeoc t e n c e dfonoisule rfo.ecnerefe .i.eecneerfer oot -en s e l f and yrtoidua .snoitanicullah The htfif citsiretcarahc sieht noitatsefinam rro-e m a n i f e s t a t i o n foevitcaer and citoruen symptoms ， whereby laciretsyh snoitcaer rrosnoitcae cottcilfno up to eht level foenilredrob sredrosid urcco sa p s y c h o -r e a c t i v e gnitcil， fnoc .sesnopser The htxis citsiretcarahc si eht cidosipe ureexpos o f aevitceff ， yltnaminoderp manic components hwit an oeisrwhet permanent .etats 3 . lacihologtacsyPhop snoitcelfer on rnotiale 圃 s h i p s between het xis )6( symptomatological r-ahc a c t e r i s t i c s The xis rdevesbo scitsiretcarahc era ylesolc -er l a t e
d one ot .rehtona The sorhtua would ekil cot-no s i d e r siht on tehLevellacioglhoatpohcysp F i r s ，t het ecnauintnoc fosredrosid fo ego -noc s c i o u s n e s s sidredeinsoc be cot gniyifnorh ， stlymo ni t h e form hfo ginare seciov retfa eutca esgats ， and a l s o tnitah eht autonomous emergence dfosredrosi o f
ego sesnusocisnoc stems from a changed o-chsyp motor evird citsiretcarahc( .)1 Such sgnidnif show t h a t sredrosid efo go ssensuiocsnoc a dfo erepe level may osla be bdesa on ttneisnar psychomotor evird c h a n g e s . rerefoehT ， eht rshotau assume taht eht tendency toward sredrosid efo og ssnesouiscnco si s t r u c t u r a l l y d.earprep As a rtluse ， eshet lacinilc -aef t u r e s era dereidsnoc an uelbarovafn .noissergorp S e c o n d l y ， eht dnoces citsiretcarahc siylesolc -er l a t e d tot eh 4th ， th5 and .ht6 tnI eh epyt dfo eblou bookkeeping taht het srohtua have shown csa -rah a c t e r i s t i c number 2， eerht sraeppa be a rot citsilae a d j u s t m e n
t tot eh environment and communication
w i t h het redsha ldrow siosla elbissop ， ghhoulta siht i syleritne edusac by an ego ssenusocisnoc .redrosid One may view taht a psa laitra improvement tfo eh e g o .noitcnuf As a rluse ，t het tendency towards -fles i n v o l v e m e n t ginrdcoac otcitsiretcarahc number f o u r )4( ， manic stiart gndirocca otcitsiretcarahc
number xis )6( ， and evitcaer nrocitorue symptoms a c c o r d i n g otcitsiretcarahc number evif )5( may -co c u
r on teh sisab such fo an improved ego .noitcnuf I
n
teh sudden ginchtiws between het laer world and eht lanoisuled world ， ginunt tuo fo eht laer world promotes eht noitargetnisid fo het renni w o r l d . glyordinAcc ， yllausu a hginare vfosecio otn
r e l a t e d ot eth environment ro an -evitnaiagmi c o n f a b u l a t o r y onislued urscco citsiretcarahc( .)3 The tneitap stcaer yllacitsilaer rafosni s s/he a si-iro e n t e
d towards het laer .dlrow But fi s/he sidetcreid t
o het renni world ， s/he siylgnisearcni -anicullah t
o r
y orlanoisuled with evatiegn symptoms. How-ever ， siht ldhuos tno be tnaek sa an ueablvornfa p r o g r e s s i o n ， because het tneitap stcnenoc with het r e a l world when es/h sdnif siht enctas dfo lua -neiro t a t i o n when .gnhictisw A syllarutcurt prepared autonomous emergence fo srderosid fo ego -noc s c i o u s n e s s may be credsideon laitnesse rof -yfinorch i n g lacinilc .serutaef The gnitlsuer noitatimil ， but a l s o eht recovrye rfo ecenrefe otytilaer scause eth a u t h o r s cot rdeisno eth gnhicwtis between eth laer world and eth ernin world tsa eh latovip ntiop tfo eh symptomatology cfogniyifnorh lacinilc .serutaef
Conclusion
The shoraut may summarize rieht sgnidnif n-oc c e r n i n g dellac-os tcfeed soesshcyp fsa:swollo On teh oevellcigalotamotpmys ，l het rsuthoa have found xis )6(scitsiretcarahc sa sngis fo-acifinorhc t i o n atht rea ylesolc dtealer each ot .rehto On teh laicoglothpahocysp level ， siht stluser rof example ni a cnoitcenno dgnirrage het autonomous emergence on eth edis fo sredorsid fo ego -noc s c i o u s n e s
s because psychomotor fo eivrd changes ， u s u a l l y tni eh form cfo usnuotino yroitdua -anicullah t i o n
s retfa tecua .segats On teh one hand ， one can assume taht temporary psychomotor eivrd changes a
l s
o adel ot serdorsid fo ego ssnseouscinoc ta eth deeper level such atht eht tendency towards -rosid d
e r
s ego fo ssensiousccno siyllarutcurts d.areeppr This lliw determine whether eseht lacinilc esrtuafe must be regarded usa leboravafn noiessogrpr aro s a sgni c.fnooitacifinorh
On teh herot hand ， one may redsinoc ti a plaitra improvement tfo eh ego noitcnuf fi， through a du-o b
l
e noitatneiro ， ca ritsilae adjustment ot het -ivne ronment ， eth tendency otnemevlonvi-fles ，t manic t
r a i t
s and eivtcaer ro cioturen symptoms become m a n i f e s ，t even fitisinetfo eth seca taht eth etnisid 田 g r a t i o n ni eht rneni world si encouraged by tingun o u t tfo eh laer d.lorw This ningtu out cursoc mostly i n form afo yoritud snoitanicullah which rea tno -er l a t e d ot eth environment ro through evatiinagmi 聞 c o n f a b u l a t o r y .noisuled The srohtua eveilbe taht t h e s e lacinilc seurtafe udlosh not be dtdegnaise sa u n f a v o r a b l e nioessgrrop ， but a rsa noitarotse rfo -e a l i t y ， because stneitpa ear elba ot nnectco with het r e a l world by fgnindi siht ceants dfo lau .noitatneiro I n any seac ， sehet lacinilc seruatef do not nteserepr any elbisreverri stcefed rro.slaudise The summarl) tfosih elcitra sidehsilbup ni DGPPN (German noitaicossA rof yrtiahcysP ， yraphtecohsyP and N e)ygoloru ssegrnoC 0002 hnec(aA ， 02 す90.3 .)0，002 Acknowledgments The srohuta ankth iasumKt Y oausmihs ， M.D. ， .D.hP and ihcinihS sawaariH ..D.M .D.hP rof rieht elbaulav -da v i c e gindarger eht oyglodhteom lfomret-gno wollof up s t u d i e s ginrud siht .yduts The rsohtua have cnostcilfno ifostseretn do.tesolcsi R e f e r e n c e s 1 ) ojoK K ， Yamazaki T ， Kamo T e at:l-aredisnoC t i o n dnoevisserpe seomrdnys niehtlanidutignol c o u r s e s f.aoinerhpozihcs uykneK-ukagI-nihsieS ( P s y c h i a t r )seR :6711-601 ， 6891 2 ) arahihsI :S The mret-gnol esruoc fousongeodne p s y c h o s e s : A sydut dno lau laixa noitaulave desab o nevitceffa dnacinerhpozihcs .smordnys o-ykoT J ihso -I k a d a i g a k u ihss同aZ J( yookT Wom Med )11oC 6 3 : 7 2 6 -7 4 2 ，3991 3 ) aiwI K eiD kimanydsfualreV renegdone P s y c h o s e n -E r g e b n i s s e onv-nuhcusretnusfualreV g e n rehcssuiatohcyspstiehnie hciS .tnI 051 J erha P s y c h i a t r i e : Das krewJ smualibu red DGPN niiewz B a n d e n und menei dnabgnuznagrE sreteP( UH ， S c h i f f e r d e c k e r M， lharK A e)sd ， lpp lO501- ini， traM ， K凸n (l)6991 4 ) joKo K ， rasawaHi S， Kamo T e at:l evitingoC d i s o d e r s SABS)(B deiduts tyb ehlanidutignol -sa p e c t s . saifnerohpozihc uykneK-ukagI-nihsieS -ysP( c h i a t r )seR :11581-271 ， a8991 cartsbA[ :tnpJ J P-ys c h i a t 14roueN :161-061 ，1]7891 5 ) ojoK : SKlarutcurt sisylana foainamotore nieht s t a g e cfocinorh cinerhpozihcs :esuoc The noitaler b e t w e e n evitagen serutcurts evndiatceffa-oedi -ed l u s i o n a l woriruoyB-nihs.ikeS-ohsniR J( J Ppn -ohcys p a t h o l ) :91261-751 ， b8991 6 ) ojoK E:Kscitenegodn nignikaep-snamreG -irtnuoc e s '.ygolohtapohcysp ukagI-nihsieS-uohsniR J(pn J C l i n )taihcysP :040201-3101 ，1102 7 ) ojoK U:Kyratin .sisohcysp ainerhpozihcS reitnorF 1 2 : 22-512 ，12102 8 ) joKo K， iwaI : WK ie theihcseg ?gnureizifinorhC
N e r v e n a r z t (17:)1lppuS 961 ，0002 9 ) Huber R:G eine yemorndstkefeD und neidatssisaB e n d o g e n e r .enshocsyP rhsctroF loureN rtahicysP 3 4 : 4 0 9 -4 2 6 ，6691 1 0 ) Huber G: :eirtaihcysP rehcstimaetsyS texrtehL f u r tendenStu und .etzrA 5 A.lfu erutathacS S t u t t g a r t -N e w York )4991( 1 1 ) kJanzari W: Dynamische noitallestnokdnurG ni-ne d o g e n e n nhosePsyc ， rgeinrpS -negn， ittoG-nilreB H e i d e l b e r g )9591( 1 2 ) kJanzari W: Senerphzoihc efualreV ， rengiprS ， B e r l i n -H e i d e l b e r g -N e w York )8691( 1 3 ) Harding CM: yticinorhC ni:ainerhpozihcs ctFa ， p a r t i a l caf，t Aro?tcafitr latipsoH and Community P s y c h i a t r y :83 867-447 ，7819 1 4 ) Yuzawa :hC On teh ptceonc dfoebluo noitatneiro i n cinorhc anierhpoizhcs - 1nnoitaler otveitgane symptoms-. iruoyB-nihsieS-ohsniR J(pn J Po-hycs p a t h o l ) :91 65-1491 ， 8991 1 5 ) Ciompi 1:Lts eid echsinorhc einerhpozihcS nie -Ar t e f a k t ? rhscrtoF olurNe taihcysP :84 8247-32 ，8091 1 6 ) Ciompi D:L ie βluifniEzooshcsyp 1 ea Fr nrektoa ni d e r .einerhpozihcS ehcsiteroehT und -hcsitkarp t h e r a p e u t i s c h e n.nzeequenoKs zeiSwhc Arch -Neu r o l rtaichysP :641 14-2072 ，5991 1 7 ) J ariknza W: Sehcsimanydrutkurt neagdlrnuG red P s y c h i a t r i e . Enke tra， gttutS )8891( 1 8 ) rleuleB E: Lehrbuch rde.eirtaihcysP 51 lfuA ， S p r i n g e r weN-gerbldeiHe， -nilreB York )5891( 1 9
) Rumke HC: Uber etla .enerhpozihcS Arch f Nolure N e u r o c h i r g u Ptaichys 91: 01-2022 ，3619 2 0 ) rspeasJ K: Aeinemegll .eigolohtapochysP 9 Alfu ， S p r i n g e r n， ilreB 幽weN-grbeledieH York )3791( どのようにして慢性化は生じるかー古典的欠陥統合失調症症候群の精神病理学のためにー l東京女子医科大学医学部精神医学講座 2神奈川県立精神医療センター コジョウ ケ イ コ イ ワ イ カズマサ 古 城 慶 子1 ・ 岩 井 一 正2 本稿では筆者らのこれまで、行ってきた長期経過研究を基礎にして， Kpelinrae モデルによる「典型的欠陥統合失 調症」を検討した.その成立については陽性と陰性症状との区別によっては十分には構造分析することはできな い.長期経過においては陰性あるいは陽性症状のいずれが一次的であるか，そのことについてはいまだなお議論 の余地がある. Ciompi は慢性精神病を急性エピソード後の精神社会的ストレスの結果とみなした.しかし易損性 モデルやストレスモデル，あるいは基底障害モデルによる慢性性の考察のほかに，今一度症状学的観点に戻って， この問題を取り上げる必要があるであろう.その際，症状学的水準では以下の 6 つの指標が顧慮された①感情 性，妄想幻覚性そして欠損性の諸症状の急性精神病性統一性が弛緩すること，②妄想世界と現実世界との二重見 当識的態度，③空想作話'1主妄想への妄想、の質的変化，④段階の異なる自我意識障害の複層化，⑤反応性ないしは 神経症性症状の顕現あるいは再顕現，そして⑥それ以外は持続状態にありながらも感情病性，特に操病性要素の 出現である.内因性精神病における慢性化の徴候として取り上げられたこの 6 つの諸特徴相互の意味連関を精神 病理学的水準で、考察した.
