入院時大うつ病症例における気質と転帰の関連

Relationship between Affective Temperaments and Clinical Features of Patients Hospitalized for Major Depression

抄録

　Akiskalらは気質を定量化する目的で自記式質問紙であるTEMPS-A（Temperament Evaluation of Memphis, Pisa，Paris and San Diego-autoquestionnaire version）を作成した。我々はTEMPS-A短縮版で測定される気質と入院大うつ病性障害症例（MDD）の転帰との関連を検討した。2007年4月から2008年3月に当科入院し入院時にMDDと診断された症例のうち，2009年7月時点で診断が気分障害圏である23例を対象とし，診療録を用いた後方視的研究を行い，TEMPS-A短縮版の記載を依頼した。平均観察期間1年10か月で22％が双極性障害（BP）に診断が変更され，BP群は循環気質の点数がMDD群と比して有意に高かった。循環気質の高得点群では，寛解率が低く，抗うつ薬内服中の躁転が多く，抗うつ薬のwear-offが少なかった。気分障害診療における気質の把握の有用性および，TEMPS-A短縮版で検出される循環気質が双極性障害の予測因子となる可能性が示唆される。

　The aim of this study is to investigate the clinical relevance of affective temperaments measured by TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, and Sandiego-autoquestionnaire version) short version to the outcomes of patients with major depression. The subjects were 23 patients who had been for major depression hospitalized for major depression between April 2007 and March 2008. A diagnostic change from major depression to bipolar disorder had occurred in 22% of the patients at the time of investigation (July 2009) and the others were still followed as major depression. Affective temperaments were evaluated by TEMPS-A short version. The average score of cyclothymic temperament in the patients who had undergone diagnostic change to bipolar patients was higher than that of the patients who were still diagnosed as major depression. Furthermore, the high cyclothymic temperament score group showed lower remission rate, more antidepressant-induced mania or hypomania and less antidepressant “wear-off” than the low score group. The present findings suggest the importance of affective temperaments for the clinical diagnosis and outcome in major depressive disorder. TEMPS-A short version is easy to use in the clinical setting, and cyclothymic temperaments evaluated by TEMPS-A short version may be related to bipolarity.