Search

Psychogenic dysphagia is a rare swallowing condition in which no organic or structural dysfunction is detected by thorough investigation. Chief complaints cover from lump sensation to severe swallowing difficulties. Fear of swallowing, fear of choking, and difficulty in initiating deglutition of specific food, such as pills, are common symptoms. Psychogenic dysphagia is believed to be a multifactorial disorder. Interaction among genetic, biological, psychological, and sociocultural factors could lead to swallowing difficulties. Given that school-age children have profound psychosocial changes, children in elementary and junior high school are likely to suffer from psychogenic dysphagia. However, little is known about the incidence rate, features of symptoms, and outcome of this disease of each generation. Moreover, most school teachers lack guidelines and training opportunities in terms of how they cope with psychogenic dysphagia in the classroom. The aim of this study is to summarize published literature regarding psychogenic dysphagia in Japan and seek the clinical features of this disease in school-age children. This information would be helpful for school teachers in handling children with swallowing difficulties presumably due to psychosocial factors.

平成16年度～平成18年度科学研究費補助金(基盤研究(B))研究成果報告書, 研究概要：本研究は児童生徒の生体的ストレス反応(唾液中コルチゾール濃度)および自覚的ストレス反応と心理社会的学校環境との関連性を明らかにすることを目的とした。平成16年は沖縄県全域から選出した10公立中学校2年生1学級に在籍する生徒328名のうち保護者から承諾が得られた266名を対象に質問紙調査および唾液採取(10時と16時)を行った。平成17年は沖縄本島全域から選出した10公立小学校6年生1学級に在籍する児童348名のうち保護者から承諾が得られた274名を対象に質問紙調査および唾液採取(10時半と15時半)を行った。いずれも唾液中コルチゾール濃度はRIA法で測定した。さらに,平成16年は沖縄県全域から無作為抽出した23公立中学校の全学年1学級に在籍する生徒2425名を対象に,同様に平成17年は21公立小学校の5・6年生に在籍する児童2777名を対象に自覚的ストレス反応と心理社会的学校環境に関する質問紙調査を行った。本研究により得られた知見は以下の通りである。測定した唾液中コルチゾール濃度は午前の方が高く一般的な日内リズムに従っていた。心理社会的学校環境と唾液中コルチゾール濃度との関連を多変量解析で検討した結果,小学生の場合,女子の過剰な期待が日内変化量と有意な負の関連を示し,男子の親サポートが午前のコルチゾール濃度と,女子の教師サポートが午後のコルチゾール濃度および全体分泌量と有意な正の関連を示し,親や教師から過剰に期待されていると感じていたり,サポートされていないと感じていたりする者は日内リズムの平坦化が生じている可能性があることが示唆された。中学生の場合,いずれの変数もコルチゾール濃度とは関連がみられなかった。自覚的ストレス反応に関する調査結果から,学校ストレス,家族ストレス,家族構成などの心理社会的要因は自覚的ストレス反応に影響を及ぼす要因となることが示唆された。, 要約（欧文）:In order to determine relationships between biological stress responses and psychosocial school factors among Japanese school-aged children, we measured salivary cortisol concentrations and examined the effects of psychosocial school environment on the cortisol levels among elementary and junior high school students. Subjects were 348 sixth graders (ages 11-12) at 10 public elementary schools and 328 eighth graders (ages 13-14) at 10 public junior high school students in Okinawa, Japan. Among them, 268 children and 260 junior high students who obtained written consent from the guardians were conducted self-administered questionnaires and saliva sampling. Saliva samples were collected at 10:30-10:40 and 15:30-16:00 at each school by using Salivette. Cortisol concentrations were determined by Radioimmunoassay kits. We calculated "Area under the curve with respect to increase (AUC_I)" and "Area under the curve with respect to ground (AUC_G)" from two saliva samples to examine the daytime cortisol profile. The cortisol levels showed the expected diurnal rhythm with high morning and low evening levels among both elementary school children and junior high school students. Elementary school girls had significantly higher cortisol levels than boys. As for elementary school children, less support from parents were related to lower levels of morning cortisol for boys. For girls, less support from teachers were related to lower levels of evening cortisol and AUC_G. Additionally, girls' unrealistic expectations from teachers and parents were negatively associated with AUC_I levels. As for junior high school students, there were no differences in any cortisol levels according to other life style and health condition variables. Any psychosocial school environment factors were not significantly related to the-levels of cortisol concentrations. These findings show that salivary cortisol levels were associated with children's perceived support and unrealistic expectations from teachers and parents, suggesting the flattened diurnal cortisol curve., 未公開：P.8以降（別刷論文のため）