精神医学65巻7号

2023年07月発行

特集 子どものうつ病に気づく

児童・思春期の抑うつ—躁転の危険因子と治療の戦略

著者： 庄司絵理¹² 加藤忠史³ 内田舞⁴⁵

所属機関： ¹ハーバード大学医学部附属マサチューセッツ総合病院精神科児童思春期 ²順天堂大学医学部附属精神医学教室 ³順天堂大学大学院医学研究科精神・行動科学 ⁴マサチューセッツ総合病院小児薬理学教室 ⁵ハーバード大学精神科

ページ範囲：P.1048 - P.1056

抄録
　うつ病の発症率は12歳以降では成人とほぼ同様であるとされている一方，子どもには独特の社会・心理学的な問題があり，臨床像が一般精神医学には当てはまらない場合も多い。特に双極性障害の臨床像は不安定で，若年発症の大うつ病性エピソードは，実は双極性障害であったという場合も少なくない。鑑別は困難をきわめる一方，その後の治療方針にかかわるため，リスクファクターや臨床像に注意しながら，診断と治療を行っていくことが重要である。現在知られている躁転の危険因子として気分障害（うつ病性障害，双極性障害）の家族歴，情動調節障害（emotional dysregulation），行動制御障害（behavioral dysregulation），閾値以下の躁症状，幻覚や妄想などの精神病症状の併発が挙げられる。さらには将来の躁転を踏まえた治療戦略，躁転してしまった場合のアプローチについて言及した。

参考文献

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