ある前頭葉損傷患者に対する強迫的行為の抑制の試み

Trial suppression of a frontal lobe-injured's obsessive behavior

要旨：唾を吐くという強迫的行為を示す前頭葉損傷患者に対し，その抑制方法の検討を行った．本症例は多彩かつ重度な高次脳機能障害を有し，強迫的行為においては右手でマスクを外してから唾を吐くという特徴があった．そこで抑制に有用と思われた3課題(輪移動，しりとり，立位保持)を施行し，その間にマスクを外そうとする右手をセラピストが抑制した回数を比較した．その結果，輪移動としりとりにおいて抑制回数が減少した．このことから，自発的に遂行可能な活動は強迫的行為から注意を逸す効果があるものと考えられた．行動観察に加え客観的数値による評価は，対応法の検討や家族やスタッフへの指導を行うのに有用であった．

　An examination was made of a possible suppressive approach to a frontal lobe-injured's obsessive behavior of spitting.

　The present case, which presents diversified and higher cerebral dysfunction, was characterized by spitting following taking off the mask with his right hand.

　Then, three tasks, regarded as useful for the suppression (ring shifting, capping verses keeping a standing position), were presented to him respectively, and frequencies of suppressing his right hand from taking off the mask were comparatively examined.

　As a result, ring shifting and capping, verses tasks which were spontaneously accomplishable for him, showed decreases in the frequency of suppression; this suggested that the patient's activity, which was more spontaneously accomplishable for him, enabled him to divert his attention from his obsessive behavior to behavior useful for daily living.

　An objective numerical evaluation, in addition to the behavior observation, proved to be useful in examining how to approach his obsessive behavior and how to guide his family members and the staff.