被害関係妄想と自生体験を主症状とした統合失調症患者への認知行動療法的介入

Cognitive behavior therapy intervention for a schizophrenic paranoid autochthonous patient

要旨：近年，薬物抵抗性の統合失調症患者に対する心理社会的アプローチが展開され，精神症状の安定化や症状対処技能の獲得に向けた援助が行われている．しかし，まだ具体的な改善を示す報告数は僅かでありその手段は確立されているとは言い難い．筆者はデイケアにおいて，被害的妄想知覚や自生体験に苦痛を募らせる自閉的な症例に対して認知行動療法を試みた．面接の中で症状を振り返り，病的な対人スキーマと自動思考により生じた認知的歪みに対して，症例の認知機能水準に配慮した介入により認知的修正体験を図った．同時に，SSTやデイケアにおいて安全感を保障した関わりによる集団適応の促進は，症例の自己価値観の再構築に繋がるものであった．

　In recent years, psychosocial approaches have been developed for schizophrenic patients who resist medication and have provided support to stabilize and cope with the psychotic symptoms. However, few studies show measurable improvements, and a specific approach has not been established. The authors attempted to use cognitive behavior therapy in a day-care center for a withdrawn autochthonous subject suffering from paranoid perception. Through guidance from the authors, the subject talked and thought about the symptoms during individual therapy. Also, the authors approached the abnormal personal scheme and cognitive distortion caused by automatic thought using a cognitive modification method while considering the subject's cognitive level. At the same time, SST and the safe and secure environment at the day-care center led to a re-structuring of the subject's self-esteem.