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Seishin Igaku Volume 55, Issue 7 （July 2013）

精神医学 55巻7号（2013年7月発行）

Japanese English

研究と報告

気分障害における自他覚症状の乖離と自覚症状評価の重要性―先進医療「光トポグラフィー検査を用いたうつ症状の鑑別診断補助」の経験から Discrepancies between the Subjective and Objective Severities of Depressive Symptoms: Characteristics of depressive patients who underwent advanced medical technology diagnostic procedures 辻井農亜 ¹ , 明石浩幸 ¹ , 三川和歌子 ¹ , 辻本江美 ^1,2 , 丹羽篤 ¹ , 安達融 ¹ , 髙屋雅彦 ¹ , 切目栄司 ¹ , 小野久江 ² , 白川治 ¹ Noa TSUJII ¹ , Hiroyuki AKASHI ¹ , Wakako MIKAWA ¹ , Emi TSUJIMOTO ^1,2 , Atsushi NIWA ¹ , Toru ADACHI ¹ , Masahiko TAKAYA ¹ , Eiji KIRIME ¹ , Hisae ONO ² , Osamu SHIRAKAWA ¹ ¹近畿大学医学部精神神経科学教室 ²関西学院大学大学院文学研究科総合心理科学専攻心理科学領域 ¹Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan ²Department of Psychological Science, Graduate School of Humanities, Kwansei Gakuin University キーワード： Advanced medical technology , Near-infrared spectroscopy , Outpatient Keyword: Advanced medical technology , Near-infrared spectroscopy , Outpatient pp.653-661

発行日 2013年7月15日 Published Date 2013/7/15

DOI https://doi.org/10.11477/mf.1405102502

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抄録

　近畿大学医学部附属病院において先進医療「光トポグラフィー検査を用いたうつ症状の鑑別診断補助」を受療した患者の背景因子について検討を行った。対象は261例であり72％が軽症以下のうつ症状と判断された。受療の主要な背景には，うつの自他覚症状の乖離が存在すると考えられた。そのうち気分障害171例では，乖離のみられる51例は，乖離のみられない120例よりも全般的精神機能やQOLは有意に低く，絶望感は有意に高く，それらは，うつ症状の軽重と関連が乏しいことが明らかとなった。うつ症状の評価にあたっては，他覚的評価だけではなく自覚症状を重視することが，回復や予後を考慮したより適切な診断，対応，治療に繋がると考えられた。

　The aim of this study was to investigate the current characteristics of depressive patients who underwent advanced medical technology diagnostic procedures with near-infrared spectroscopy to assist the determination of psychiatric diagnoses. A total of 261 outpatients of Kinki University Hospital were included in the study. Depressive symptoms were assessed with clinician-rated (Hamilton Rating Scale for Depression 17-item version, HAM-D₁₇) and self-rated (Beck's Depression Inventory-Ⅱ, BDI-Ⅱ) measures. In addition, the levels of social functioning, quality of life (QOL), and hopelessness were evaluated with the Global Assessment of Functioning (GAF), the Medical Outcomes Study Short-form 36, and the Beck Hopelessness Scale, respectively. In total, 72% of the patients exhibited a mild depressive state, and 34.5% of those with affective disorders showed a discrepancy between the subjective and objective severities of their depressive symptoms. Patients with these discrepancies had significantly lower GAF scores and QOL subscores and higher hopelessness scores than those without the discrepancy. While the hopelessness scores in patients without the discrepancy were positively correlated with both the HAM-D₁₇ total scores and the BDI-Ⅱ scores, the hopelessness scores in patients with the discrepancy were not correlated with either score. These results indicated that a clinician should assess both the subjective severity and objective severity of depressive symptoms.