Aripiprazoleが奏功した緘黙を伴う転換性障害の1例

A Case of Conversion Disorder with Mutism Treated Successfully with Aripiprazole

抄録

　25歳の福祉施設で働く男性が，緘黙状態に陥り，出勤不能になって来院した。患者には，緘黙に陥るに至った心理的に了解可能な状況が認められ，症状に対する無関心さがあることなどから，転換性障害と診断した。主剤として，sulpirideを10週間使用したが効果がなく，aripiprazoleに変更したところ，3日目に会話が可能となり，表情が生き生きとするとともに緘黙症状は著明に軽快した。緘黙は，dopamine系の失調と深い関係にあると考えられるが，aripiprazoleのdopamine受容体に対する部分アゴニストとしての特殊な働きが緘黙症状の軽快に寄与したと考えた。

　A 25-year-old male welfare-facility worker presented to the hospital with acute onset of mutism, which caused him to be unable to work. The patient had a psychologically comprehensible reason resulting in mutism. He was diagnosed with conversion disorder based on findings such as his apathy regarding the symptoms. Sulpiride was administered as the main drug for 10 weeks, but was ineffective. The drug was changed to aripiprazole. On the third day after beginning aripiprazole, the patient was able to converse, his facial expressions became animated, and mutism markedly improved. Mutism is thought to have a close association with ataxia because of dopaminergic-related dysfunction. It was speculated that aripiprazole improved the patient's mutism through its specific action, as a partial agonist against dopamine receptors.