治療的働きかけへの反応の仕方にもとづく精神分裂病圏患者の臨床的類型化の試み—「自己啓発型精神分裂病患者群」と「役割啓発的接近法」の提唱（第1報）

A New Classification of Schizophrenics on the Basis of the Pattern of Response to Therapeutic Approaches: Liberal therapeutic approach toward heuristic type of schizophrenics (1)

　抄録　本論では治療的働きかけへの反応の仕方により精神分裂病圏患者を2大別できることを述べた。すなわち，具体的で断定的な働きかけが奏効する群（「他者依存型精神分裂病患者群」）と混乱をひきおこす群（「自己啓発型精神分裂病患者群」）とに分けた。両者は働きかけへの反応の仕方のみでなく，いくつかの重要な臨床的所見において対照的な特徴を有していた。第1に，社会生活上必要な判断能力の体得の仕方にそれぞれ特徴があった。第2に，陽性症状，現実逃避的・誇大的空想，身体的愁訴，気分変動，「問題行動」，対人的態度などの臨床症状において差異が認められた。第3に，「自己啓発型精神分裂病患者群」は単純に模式化できる病態を示した。これらの特徴から両者は治療の早期に判別できることを述べた。本類型化が精神分裂病圏患者群の治療にいかに有益かは続報で述べる。

　We have found out that schizophrenic patients could be classified into two groups on the basisof their response to didactic therapeutic approach ;"The Dependent Type of Schizophrenics" responded favorably, and "The Heuristic Type of Schizophrenics" responded with confusion. In this paper we describe the characteristics of the Heuristic Type of Schizophrenics and present our therapeutic approach to them.

　Compared to the Dependent Type of Schizophrenics, the Heuristic Type of Schizophrenics had more somatic complaints and less positive symptoms. Grandiose fantasies as if to escape from uninteresting reality were often found in the Heuristic Type of Schizophrenics. "Troublesome Acts" such as attempted suicides, violences to parents, sexual deviation, shoplifting and so on were initiated more often by the Heuristic Type of Schizophrenics than by the Dependent Type. The Heuristic patients inclined to have an ambivalent attitude towards therapists, while the Dependent patients were liable to be dependent on therapists.