精神医学52巻9号

2010年09月発行

展望

非定型うつ病―不安障害との併発をめぐって

著者： 貝谷久宣¹

所属機関： ¹医療法人和楽会パニック障害研究センター

ページ範囲：P.840 - P.852

はじめに

　パニック障害(PD)の臨床に従事していると，それに伴ううつ病を避けて通ることはできず，その治療には難渋する。PDに伴ううつ病に関する研究を探すと，その頻度については多くの文献が見つかったが³⁰⁾，臨床症状を詳しく記載した論文はそれほど多くなかった。数少ない中でVan Valkenburgら⁶⁵⁾は，PDに伴ううつ病は焦燥感が強く，心気症や離人症が多く慢性化の傾向が強い，さらに，治療反応が悪く社会的予後が悪いことを記していたが，治療に関する記載はなかった。その後，ロンドンの聖トーマス病院のWestとDally⁶⁷⁾による不安・恐怖症が前駆するうつ病の論文とめぐり会えた。この報告の貴重さは“まず治療ありき”である。この研究は，モノアミン酸化酵素阻害薬(MAOI)が奏効したうつ病群を取り出し，それが従来のうつ病と異なる臨床特徴を持つことを示し，現代の非定型うつ病(AD)概念の端緒を開いた。この論文は，半世紀経た今日，いまだ臨床的価値を失っていない。

　本稿ではAD概念成立の経緯をたどり，現代精神医学におけるADの臨床的意義を述べ，最後に筆者のAD成立機序の仮説を提出する。

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