統合失調症として処遇されてきたAsperger症候群の1例―緊張病様行動の発現機序に注目して

A Case of Asperger Syndrome Mistakenly was Treated as Schizophrenia: Pointing out the manifestation mechanism of catatonic-like behavior

抄録

　広汎性発達障害の患者が統合失調症様症状を示すことがあることは以前から知られているが，その場合，それを原疾患に由来する症状と考えるべきか，統合失調症の合併（comorbidity）と考えるべきかについては，必ずしも十分に議論がなされているとはいえない。我々は，妄想を伴う緊張病様行動によって精神科を受診し，その後8年間にわたって統合失調症として処遇されていたが，その異常行動を詳細に検討した結果，Asperger症候群への診断変更が望ましいと考えられた1症例に遭遇した。この症例の統合失調症様症状は，“格闘技ゲーム”への過剰没入に関係するものであり，Asperger症候群に伴う解離様症状として解釈すべきと考えられた。

　Asperger症候群が統合失調症と誤って診断される可能性は以前より指摘されている（Wing 1981）が，本稿のように統合失調症からAsperger症候群への診断変更が正面から議論された報告はまれであると思われる。青年期以降のAsperger症候群の診断には難渋するところが多いが，今後研究が進むにつれて，同様の症例の報告が増えていくものと思われる。

Summary

　It is known that patients with pervasive development disorder can also suffer schizophrenia-like symptoms. However, there has not been sufficient discussion about whether these symptoms are derived from the disorder itself or whether the schizophrenia arises independently as a case of comorbidity.

　We have encountered a case where after discussion of his abnormal behavior with a psychiatrist, the patients diagnosis was changed from schizophrenia to Asperger syndrome. His catatonic-like behavior with delusion had led to his being treated as a schizophrenic for eight years.

　However, his schizophrenia-like symptoms were related with over-absorption in “Combative video games” and should be regarded as the dissociative-like symptoms that accompany Asperger syndrome.

　It has been pointed out that, formerly, Asperger syndrome could be misdiagnosed as schizophrenia (Wing 1981). It seems to be rare that the change of diagnosis from schizophrenia to Asperger syndrome is discussed specifically as it is in this report. Case reports like this one are considered to be increasing as the study of Asperger syndrome develops, but although we have many difficulties with the diagnosis of Asperger syndrome during and after adolescence.