精神医学61巻1号

2019年01月発行

特集 高齢者のメンタルヘルス

高齢者の不安障害とメンタルヘルス

著者： 忽滑谷和孝¹

所属機関： ¹東京慈恵会医科大学附属柏病院精神神経科

ページ範囲：P.23 - P.30

はじめに
　うつ病は過去を振り返る喪失の病であり，不安は将来に対する懸念を持ち，その背景に死への恐怖，生への執着がある。高齢者は，振り返るには十分すぎる歴史を持ち，死を考える機会が多く，うつと不安が多い。一方，高齢者は長い間培った経験を持ち，うつや不安を乗り越えるか，やり過ごす術を知っている。ただ，知っているのと実際できることは異なる。このように青年期，成人期と性格を異にする高齢者の不安障害についてあらためて考えてみる。
　不安障害に関する研究報告は1990年代から2000年代に多く，高齢者に限定すると近年では少ない。そのため心的外傷後ストレス障害，強迫性障害，身体表現性障害なども混在した報告が目立つ。
　International Classification of Diseases, Tenth Revision(ICD-10)によると不安障害は，神経症性障害，ストレス関連障害および身体表現性障害の中に含まれ，恐怖症性不安障害とその他の不安障害に大別される。前者は，主に広場恐怖，社交恐怖，特定の恐怖症を含み，後者は，恐慌性障害(パニック障害)，全般性不安障害などがある。
　従来の神経症と言われていた強迫性障害，解離性障害，身体表現性障害などは，厳密には不安障害とは別の障害として分類されている。Diagnostic and Statistical Manual of Mental Disorders, Fifth edition(DSM-5)でも，不安症群/不安障害群には，限局性恐怖症，社交不安/社交不安障害，パニック障害，広場恐怖は含まれているが，強迫症(強迫障害)および関連障害，心的外傷およびストレス因関連障害群，解離性障害，身体症状症などはICD-10同様に不安障害とは分けて取り扱っている。
　本稿で概説する高齢者の不安障害も，それに準じて，強迫性障害，心的外傷後ストレス障害，解離性障害は除くが，身体表現性障害(身体症状症)は頻度も高いことより，触れることにする。

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