[A psychopathological study of hypochondriacal symptoms in manic-depressive psychosis]

Depressive patients often have some hypochondriacal symptoms, but their various patterns are prone to be overlooked. The author presents statistical characteristics of 24 depressive patients (based on DSM-III-R, major depression, melancholic type), who have some hypochondriacal symptoms. Taking into consideration these statistical characteristics and a detailed analysis of representative cases, the author proposes a psychopathological perspective and classification of patients, who have hypochondriacal symptoms during manic-depressive psychosis. The author presents five characteristics, namely, (1) age during depression, (2) personality trait, (3) anxiety-agitation, (4) dependency, and (5) guilt feelings, as factors that raise the hypochondriacal symptoms in depressive patients. Based on such characteristics, depressive patients with hypochondriacal symptoms can be classified into 3 subgroups; the anxiety-agitation group, the dependency group and the guilt feeling group. Among the anxiety-agitation group hypochondriacal depression is considered as a mixed state of manic-depressive psychosis with the grandiosity of hypochondriacal idea and agitation as manic expressions. In personal relations, patients in the anxiety-agitation group are ego-centric ("eigenwelt-bezogen"). On the contrary, patients in the dependency group are often conscious of others, and their hypochondriacal symptoms mean an escape from reality and also the intention of a new personal relationship. In the guilt feeling group, hypochondriacal symptoms arise due to guilt obsessiveness. A difference in the 3 groups also appears in the discourse characteristics of the hypochondriacal symptoms. The discourse of patients in the anxiety-agitation group can be called a "Circle type" or "Go-round type", since their complaints are various, but have a common structure. Discourse in guilt feeling group can be characterized as a "Tied-up type" or "Standstill type", since they repeat only a fixed complaint in a depressive state. Discourse in dependency group does not have a regular linguistic structure, and the patients make a great deal of importance in complaining to others. In addition to such considerations, the author suggests an affinity between hypochondriacal symptoms and manic elements on the grounds that some patients have hypochondriacal symptoms in their manic state, and that depressive patients with hypochondriacal symptoms, especially in the anxiety-agitation group, as well as manic patients, are strongly concerned with the present. Treatment for hypochondriacal depression requires the therapist to recognize the individuality of the disease, to safeguard against suicide and other ramifications.