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文献詳細

雑誌文献

精神医学60巻5号

2018年05月発行

展望

双極Ⅱ型障害の治療—薬物療法と気分ダイアリーの活用

著者: 吉村淳1 山田和男1 鈴木映二1

所属機関: 1東北医科薬科大学医学部精神科学教室

ページ範囲:P.533 - P.544

文献概要

はじめに
 双極Ⅱ型障害の病態は1976年にDunnerらにより初めて描写されて18),それから20年ほど経過した1994年にDSM(Diagnostic and Statistical Manual of Mental Disorders)-Ⅳで診断名として採用された。疾患として比較的長い歴史があるにもかかわらず,その病態への理解はいまだ乏しく,治療法は確立していない。発症してから適正な診断を受けるまでの期間は,単極性うつ病では3.3年,双極Ⅰ型障害では7年であったが,双極Ⅱ型障害では12年の歳月が費やされていた21)。米国では製薬会社の影響もあり,特に小児への過剰診断が問題になっている面も一部にあるが,全般的には双極Ⅱ型障害の過小診断や誤診の問題が大きい21,27)
 診断だけではなく,治療法に関しても,問題を抱えている。これまでに双極Ⅱ型障害の患者のみを対象として,薬物療法や精神療法で介入した,大規模な二重盲検ランダム化比較試験は実施されていない。ランダム化比較試験で特定の薬剤とプラセボでのコントロール群を比較した研究も限られている。多くの研究は対象者が双極Ⅰ型障害患者との合同であり,方法もオープンラベル試験や過去に別の目的で実施された研究の事後解析である。それゆえに,いまだ双極Ⅱ型障害の適切な治療への指針となるエビデンスが不十分である。

参考文献

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掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-126X

印刷版ISSN:0488-1281

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