社交不安障害の併存症研究―気分障害を併存する症例の特徴について

Comorbidities in a Clinical Sample of Patients with Social Anxiety Disorder: Risk factors of subsequent mood disorders

抄録

　筆者が主治医として経験した社交不安障害(social anxiety disorder；SAD)123例について，発症年齢，初診時年齢，併存症，遺伝負因，その他の臨床的特徴について調べ，全般性と非全般性SADとの違い，大うつ病を伴う群および双極性障害を発症した9症例の特徴について後方視的に調査した。その結果，気分障害(初発の大うつ病エピソード)の平均発症年齢は非全般性(29.0歳)に比べ全般性(22.6歳)で有意に若かった。ロジスティック回帰分析の結果，SADの初発年齢のみが大うつ病の併存と有意に相関していた(オッズ比0.9)。同様に，OCDの並存(オッズ比14.28)，非定型症状(オッズ比16.09)，治療期間(オッズ比1.03)が双極性障害の併存と有意に関連していた。

　今回の研究結果から，SADを治療する際には発症年齢が若いほど気分障害の発症に注意する必要があること，またSADにOCDを並存している大うつ病エピソード，SADに伴う大うつ病エピソードに過眠や過食が認められる場合には，双極性障害を視野に入れた治療計画を立てる必要があるといえる。

　The current study examined differences in gender, the age of onset of social anxiety disorder(SAD), comorbidities, family histories, and other clinical characteristics among 123 outpatients with nongeneralized and generalized SAD. The associations between these variables and comorbid major depression or bipolar affective disorder were evaluated with logistic regression analyses.

　The ages of onset of affective disorder were significantly lower in depressed patients with generalized SAD(22.6 years old)than in those with nongeneralized SAD(29.0 years old). A logistic regression analysis revealed that comorbid depression was significantly associated with the age of onset of SAD(odds ratio, 0.9).

　Nine patients developed(hypo-)manic episodes during antidepressant treatment. Changes in diagnoses of comorbid depression to bipolar disorder were significantly associated with comorbid obsessive compulsive disorder(OCD；odds ratio, 14.28), atypical features of depressive episodes(odds ratio, 16.09), and the duration of treatment(odds ratio, 1.03).

　The present results indicated that the age of onset of SAD predicted subsequent depression, and comorbid OCD and atypical features(hypersomnia, overeating)predicted a switch from comorbid depression to bipolar disorder during antidepressant treatment.