精神医学52巻5号

2010年05月発行

特集 児童期における精神疾患の非定型性―成人期の精神疾患と対比して

児童期における摂食障害

著者： 木村記子¹ 岡田俊¹

所属機関： ¹京都大学大学院医学研究科精神医学分野

ページ範囲：P.467 - P.475

文献概要

はじめに

　摂食障害は思春期ないし若年成人の女性に多くみられ，かつてはやせ礼賛の社会風潮とともに，思春期女性の心性から理解されることが多かった。しかし，男性例や思春期以前の症例の存在が知られるようになって以降，摂食障害の病態理解が拡大しつつある。児童期における摂食障害では，体重減少や無月経の判断が困難であるほか，やせ願望・肥満恐怖・ボディイメージの障害・食行動異常が現れにくく，多様な身体症状を伴いやすい，神経性食欲不振症において男性例が多いなどの点で非定型的である。これは自己を表現する能力の未熟さや表現法の違いなど，発症年齢に由来した相違であると考えられる一方で，併存する精神疾患や発達障害との関連性なども示唆されるなど，病態の相違も関与している可能性がある。治療や予後については，思春期以降の症例に比べて限られたエビデンスしかないが，特に併存障害との関連は，転帰の相違や異なる介入の必要性を示す可能性もあり，今後の検討が求められる。

　本稿では，児童期における摂食障害の診断と臨床像，疫学的特徴，経過と転帰，併存症との関係について述べ，児童期における摂食障害の病態学的位置づけと診療上の留意点を明らかにしたい。

参考文献

1) Agras WS, Rossiter EM, Arnow B, et al：Pharmacologic and cognitive-behavioral treatment for bulimia nervosa：A controlled comparison. Am J Psychiatry 149：82-87, 1992

2) Andersen AE, Holman JE：Males with eating disorders：Challenges for treatment and research. Psychopharmacol Bull 33：391-397, 1997

3) Attia E, Haiman C, Walsh BT, et al：Does fluoxetine augment the inpatient treatment of anorexia nervosa?　Am J Psychiatry 155：548-551, 1998

4) Biederman J, Ball SW, Monuteaux MC, et al：Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr 28：302-307, 2007

5) Biederman J, Herzog DB, Rivinus TM, et al：Amitriptyline in the treatment of anorexia nervosa：A double-blind, placebo-controlled study. J Clin Psychopharmacol 5：10-16, 1985

6) Blinder BJ, Cumella EJ, Sanathara VA：Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med 68：454-462, 2006

7) Bryant-Waugh R：Overview of the eating disorders. In：Lask B, Bryant-Waugh R, eds. Anorexia Hervosa and Related Eating Disorders in Childhood and Adolescence. Psychology Press, Hove, pp27-40, 2000

8) Bryant-Waugh R, Knibbs J, Fosson A, et al：Long term follow up of patients with early onset anorexia nervosa. Arch Dis Child 63：5-9, 1988

9) Bryant-Waugh R, Lask B：Annotation：Eating disorders in children. Journal of Child and Adlescent Psychotherapy 36：191-202, 1994

10) Comings DE, Comings BG：A controlled family history study of Tourette's syndrome, II：Alcoholism, drug abuse, and obesity. J Clin Psychiatry 51：281-287, 1990

11) Dukarm CP：Bulimia nervosa and attention deficit hyperactivity disorder：A possible role for stimulant medication. J Womens Health 14：345-350, 2005

12) Fisher M, Golden NH, Katzman DK, et al：Eating disorders in adolescents：A background paper. J Adolesc Health 16：420-437, 1995

13) Fluoxetine Bulimia Nervosa Collaborative Study Group, No authors listed：Fluoxetine in the treatment of bulimia nervosa. A multicenter, placebo-controlled, double-blind trial. Arch Gen Psychiatry 49：139-147, 1992

14) Fosson A, Knibbs J, Bryant-Waugh R, et al：Early onset anorexia nervosa. Arch Dis Child 62：114-118, 1987

15) Gillberg C：Are autism and anorexia nervosa related?　Br J Psychiatry 142：428, 1983

16) Gillberg C, Rastam M：Do some cases of anorexia nervosa reflect underlying autistic-like conditions?　Behav Neurol 5：27-32, 1992

17) Godart NT, Flament MF, Curt F, et al：Anxiety disorders in subjects seeking treatment for eating disorders：A DSM-Ⅳ controlled study. Psychiatry Res 117：245-258, 2003

18) Gowers SG, Crisp AH, Joughin N, et al：Premenarcheal anorexia nervosa. J Child Psychol Psychiatry 32：515-524, 1991

19) Halmi KA, Eckert E, LaDu TJ, et al：Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline. Arch Gen Psychiatry 43：177-181, 1986

20) Hawley RM：The outcome of anorexia nervosa in younger subjects. Br J Psychiatry 146：657-660, 1985

21) Hebebrand J, Henninghausen K, Nau S, et al：Low body weight in male children and adolescents with schizoid personality disorder or Asperger's disorder. Acta Psychiatr Scand 96：64-67, 1997

22) Herpertz-Dahlmann B, Muller B, Herpertz S, et al：Prospective 10-year follow-up in adolescent anorexia nervosa-course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 42：603-612, 2001

23) Higgs JF, Goodyer IM, Birch J：Anorexia nervosa and food avoidance emotional disorder. Arch Dis Child 64：346-351, 1989

24) Hoek HW, van Hoeken D：Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34：383-396, 2003

25) Holtkampa K, Konrada K, Kaisera N, et al：A retrospective study of SSRI treatment in adolescent anorexia nervosa：Insufficient evidence for efficacy. J Psychiatr Res 39：303-310, 2005

26) Hsu LK：Epidemiology of the eating disorders. Psychiatr Clin North Am 19：681-700, 1996

27) Hudson JI, Hiripi E, Pope HG Jr, et al：The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61：348-358, 2007

28) Irwin M：Diagnosis of anorexia nervosa in children and the validity of DSM-Ⅲ. Am J Psychiatry 138：1382-1383, 1981

29) Jaffe AC, Singer LT：Atypical eating disorders in young children. Int J Eat Disord 8：575-582, 1989

30) Kaye WH, Bulik CM, Thornton L, et al：Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 161：2215-2221, 2004

31) Kaye WH, Nagata T, Weltzin TE, et al：Double-blind placebo-controlled administration of fluoxetine in restricting-and restricting-purging-type anorexia nervosa. Biological Psychiatry 49：644-652, 2001

32) Kotler LA, Walsh BT：Eating disorders in children and adolescents：Pharmacological therapies. Eur Child Adolesc Psychiatry 9(Suppl 1)：I108-116, 2000

33) Kreipe RE, Golden NH, Katzman DK, et al：Eating disorders in adolescents. A position paper of the Society for Adolescent Medicine. J Adolesc Health 16：476-479, 1995

34) Lacey JH, Crisp AH：Hunger, food intake and weight：The impact of clomipramine on a refeeding anorexia nervosa population. Postgrad Med J 56(Suppl 1)：79-85, 1980

35) Lucas AR, Beard CM, O'Fallon WM, et al：50-year trends in the incidence of anorexia nervosa in Rochester, Minn：A population-based study. Am J Psychiatry 148：917-922, 1991

36) Lucka I：Anxiety disorders in children suffering from anorexia nervosa. Psychiatr Pol 40：83-97, 2006

37) Matsumoto H, Takei N, Kawai M, et al：Differences of symptoms and standardized weight index between patients with early-onset and late-onset anorexia nervosa. Acta Psychiatr Scand 104：66-71, 2001

38) Messner E：Methylphenidate treatment of bulimia nervosa after surgery. Can J Psychiatry 34：824-826, 1989

39) Mitchell JE, Pyle RL, Eckert ED, et al：A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa. Arch Gen Psychiatry 47：149-157, 1990

40) National Institute for Clinical Excellence (NICE)：Eating Disorders：Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders；a national clinical practice guideline. National Institute for Clinical Excellence, London, 2003

41) Nazar BP, Pinna CM, Coutinho G, et al：Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders. Rev Bras Psiquiatr 30：384-389, 2008

42) Nicholls D, Chater R, Lask B：Children into DSM don't go：A comparison of classification systems for eating disorders in childhood and early adolescence. Int J Eat Disord 28：317-324, 2000

43) North C, Gowers S：Anorexia nervosa, psychopathology, and outcome. Int J Eat Disord 26：386-391, 1999

44) Ong YL, Checkley SA, Russell GF：Suppression of bulimic symptoms with methylamphetamine. Br J Psychiatry 143：288-293, 1983

45) Pawluck DE, Gorey KM：Secular trends in the incidence of anorexia nervosa：Integrative review of population-based studies. Int J Eat Disord 23：347-352, 1998

46) Råstam M：Anorexia nervosa in 51 Swedish adolescents：Premorbid problems and comorbidity. J Am Acad Child Adolesc Psychiatry 31：819-829, 1992

47) Reinblatt SP, Redgrave GW, Guarda AS：Medication management of pediatric eating disorders. Int Rev Psychiatry 20：183-188, 2008

48) Rome ES, Ammerman S, Rosen DS, et al：Children and adolescents with eating disorders：The state of the art. Pediatrics 111：e98-108, 2003

49) Russell GF, Szmukler GI, Dare C, et al：An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry 44：1047-1056, 1987

50) Santonastaso P, Friederici S, Favaro A：Sertraline in the treatment of restricting anorexia nervosa：An open controlled trial. J Child Adolesc Psychopharmacol 11：143-150, 2001

51) Schmidt U, Tiller J, Hoades M, et al：Risk Factors for the Development of Early Onset Bulimia Nervosa. Berlin/New York, pp83-94, 1995

52) Sobanski E, Marcus A, Hennighausen K, et al：Further evidence for a low body weight in male children and adolescents with Asperger' s disorder. Eur Child Adolesc Psychiatry 8：312-314, 1999

53) Stein DM：The prevalence of bulimia：A review of the empirical research. J Nutr Educ 23：205-213, 1991

54) Steinhausen HC：Clinical guidelines for anorexia nervosa and bulimia nervosa. Eur Child Adolesc Psychiatry 6：121-128, 1997

55) Steinhausen HC：Eating disorders. Oxford University Press, Oxford, pp210-230, 1999

56) Stiver RL, Dobbins JP：Treatment of atypical anorexia nervosa in the public school：An autistic girl. J Autism Dev Disord 10：67-73, 1980

57) Strober M, Freeman R, DeAntonio M, et al：Does adjunctive fluoxetine influence the post-hospital course of restrictor-type anorexia nervosa?　A 24-month prospective, longitudinal followup and comparison with historical controls. Psychopharmacol Bull：33：425-431, 1997

58) Strober M, Freeman R, Morrell W：The long-term course of severe anorexia nervosa in adolescents：Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. Int J Eat Disord 22：339-360, 1997

59) Surman CB, Randall ET, Biederman J：Association between attention-deficit/hyperactivity disorder and bulimia nervosa：Analysis of 4 case-control studies. J Clin Psychiatry 67：351-354, 2006

60) Van Hoeken D, Seidell J, Hoek H：Handbook of Eating Disorders. Wiley, Chichester, pp11-34, 2003

61) Walford G, McCune N：Long-term outcome in early-onset anorexia nervosa. Br J Psychiatry 159：383-389, 1991

62) Welch SL, Doll HA, Fairburn CG：Life events and the onset of bulimia nervosa：A controlled study. Psychol Med 27：515-522, 1997

63) Whitaker AH：An epidemiological study of anorectic and bulimic symptoms in adolescent girls：Implications for pediatricians. Pediatr Ann 21：752-759, 1992