境界例の臨床症状と脳波異常

EEG Abnormalities in DSM-III Borderline Patients: Significance of EEG findings on the characteristics of clinical symptoms

　抄録　東大病院精神神経科に通院中の患者のうち，DSM-IIIの分裂病型人格障害または境界性人格障害の診断基準を満たす46名の脳波記録を検討し，対象を脳波正常群（22名），脳波境界群（10名），脳波異常群（14名）に分けた。脳波異常群の脳波異常は，陽性棘波7名，徐波群発3名，側頭部棘波2名，鋭波1名，非突発性異常1名であった。脳波正常群と脳波異常群の症状を，両人格障害の診断基準のA項およびPerryらの症状リストを用いて比較した。その結果，脳波異常群は脳波正常群と比べ，「不適切な激しい怒り」，「他者を利用する」，「多くの人と関わる」，「他者に真の敬意を示さない」という症状の出現頻度が有意に高かった。また，脳波異常群11名に抗てんかん薬を投与し，有効1名，やや有効5名，無効3名，悪化2名であった。以上の結果から，脳波異常と関連するような神経生理学的要因が，境界例の病態や症状を修飾している可能性が示された。

　Forty six out-patients, who met the diagnostic criteria of DSM- III for either schizotypal personality disorder or borderline personality disorder, were classified into three groups on the basis of EEG findings ; that is, normal EEG group (n=22), borderline EEG group (n=10), and abnormal EEG group (n=14 ; 14 & 6 Hz positive spikes, seven ; slow wave bursts, three ; temporal spikes, two; sharp waves, one ; non-paroxysmal abnormality, one). Clinical symptoms of abnormal EEG group patients were evaluated employing a check list specially devised for this study, and were compared to those of normal EEG group patients. Abnormal EEG group patients were characterized by 'inappropriate, intense anger or lack of control of anger' and 'affective instability' as defined in DSM-III. They were also distinguished by being 'exploitive,' being 'involved with many people', having, no real regard for others, even those whom they idealize,' laking adaptibility and behaving inappropriately during interview,' 'sexual deviation', and 'sadism others' as described by Perry (1978). Antiepileptic toward drugs were administered to eleven patients of the abnormal EEG group. Antiepileptics were found to be positively effective in one, slightly effective in five, and ineffective in three. These drugs worsened the symptoms in the remaining two patients. The results suggest that some neurophysiological factors correlating with abnormal EEG modify the clinical symptoms of borderline patients.