精神医学63巻3号

2021年03月発行

特集 サイコーシスとは何か—概念，病態生理，診断・治療における意義

高齢発症のサイコーシス

著者： 樫林哲雄¹ 赤松正規¹ 藤原維斗彦¹ 上村直人¹ 數井裕光¹

所属機関： ¹高知大学医学部神経精神科学講座

ページ範囲：P.363 - P.370

抄録　老年期に発症したサイコーシス(VLOS)と考えられる症例を提示し，VLOSで見られる臨床的な特徴について解説した。さらに，近年報告されているVLOSの病理学的背景についても概観した。VLOSでは被害妄想やpartition delusionと呼ばれる妄想が特徴的で，さまざまな幻覚や抑うつ，不安，緊張状態，混乱，興奮を伴うことが多い。その一方で思考過程の障害や陰性症状を呈する頻度は少なく，予後はよいとされる。治療についてはわが国で承認されている抗精神病薬での有用性は示されておらず，今後の課題である。病理学的背景としては，アルツハイマー病の可能性は低く，辺縁系に限局したargyrophilic grainsが関連していることが報告されている。

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