精神医学60巻6号

2018年06月発行

特集 医療・医学の課題としての身体合併症

精神疾患と身体疾患との関連が示唆される疫学的知見

著者： 宋龍平¹² 渡辺範雄¹

所属機関： ¹京都大学大学院医学研究科社会健康医学系専攻健康増進・行動学分野 ²岡山県精神科医療センター

ページ範囲：P.595 - P.601

はじめに
　精神疾患は2013年にがん，脳卒中，心筋梗塞，糖尿病と並んで，厚生労働省が定める5疾病に含まれた。精神疾患によって損なわれる健康は，精神面だけではなく，身体面にも及ぶ。精神疾患は健康的な生活を害する身体疾患の危険因子でもあるからだ。疾病によって失われる命と疾病により損なわれる健康・生活機能を統合したDALY(disability-adjusted life year)という指標がある。先進国においての身体疾患，精神疾患併せて333疾患のDALYを調べた研究では，うつ病が10位，自傷が13位，薬物使用障害が15位，不安障害が18位，アルコール使用障害が28位と上位10%に5つの精神疾患およびそれに関連する行動が含まれていた¹⁴⁾。つまり，精神疾患は日本人の健康的な生活を大きく損なっている。また精神疾患を持つ患者は，身体疾患の併存が多いのみならず，喫煙や過量飲酒など健康に好ましくない生活習慣を持つ者も多く，疾患予後にも影響を及ぼす。
　本稿では，重度精神疾患(severe mental illness：SMI)に含まれる統合失調症，うつ病，双極性障害の各種身体疾患の罹患リスク，生活習慣，予後についての疫学的知見を紹介する。

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