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Seishin Igaku Volume 28, Issue 11 （November 1986）

精神医学 28巻11号（1986年11月発行）

Japanese English

研究と報告

精神分裂病の陰性症状と社会適応経過 Negative Symptoms and the Course of Social Adjustment in Schizophrenia 染矢俊幸 ^1,2 , 安西信雄 ¹ , 池淵恵美 ¹ , 小沢道雄 ¹ , 原田誠一 ¹ , 上田哲 ¹ , 金生由紀子 ¹ , 中込和幸 ¹ , 岩波明 ¹ , 熊谷直樹 ¹ , 宮内勝 ¹ Toshiyuki Someya ^1,2 , Nobuo Anzai ¹ , Emi Ikebuchi ¹ , Michio Ozawa ¹ , Sciichi Harada ¹ , Satoshi Ueda ¹ , Yukiko Kano ¹ , Kazuyuki Nakagome ¹ , Akira Iwanami ¹ , Naoki Kumagai ¹ , Masaru Miyauchi ¹ ¹東京大学医学部精神医学教室 ²現所属，滋賀医科大学精神医学教室 ¹Department of Neuropsychiatry, Faculty of Medicine, University of Tokyo ²Department of Psychiatry, Shiga University of Medical Science キーワード： Schizophrenia , Negative symptoms , SANS , Social adjustment , Day hospital Keyword: Schizophrenia , Negative symptoms , SANS , Social adjustment , Day hospital pp.1229-1236

発行日 1986年11月15日 Published Date 1986/11/15

DOI https://doi.org/10.11477/mf.1405204240

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Abstract 文献概要
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　抄録　東大病院精神神経科デイホスピタル（DH）を終了した41名の精神分裂病患者を対象に，陰性症状を中心とする臨床症状の変化，およびそれらと社会適応経過との関連を検討した。陽性症状・陰性症状の評価は，DH開始時，DH終了時およびDH終了後5年目の3時点について，陰性症状評価尺度（SANS），症状群チェックリスト（SCL）を用いて行った。社会適応経過の評価は，DH終了後5年までについて就労期間率，入院期間率，再発の3項目を用いて行った。

　その結果，陰性症状は，集団療法を中心とするDHでの治療により改善し，その効果はDH終了後5年間持続することが示された。またDH終了時の症状と社会適応経過との関連では，SANSの情動の平板化・情動純麻，意欲・発動性欠如，SCLの中核症状群，残余の症状群，幻聴，関係妄想が認められたものほど，経過が不良であった。

　The purpose of this study was to investigate the longitudinal course of clinical symptoms of schizophrenia, especially of negative symptoms, and their relationship with the course of social adjustment. We studied fortyone young schizophrenic patients, who had been treated in the Day Hospital, Department of Neuropsychiatry, University of Tokyo. The patients were followed up for more than five years after the termination of the Day Hospital treatment.

　Negative and positive symptoms were retrospectively assessed, using the Scale for the Assessment of Negative Symptoms (SANS) and the Syndrome Check List (SCL) on the following three occasions, 1) at the time of the admission to the Day Hospital treatment, 2) at the time of the termination of the Day Hospital treatment and 3) five years after the termination of the Day Hospital treatment. Social adjustment was reassessed every year during the five years following the termination of the Day Hospital treatment. The following three items were checked, viz. "relapse", the "rate of employment duration" and the "rate of hospitalization duration".

　The result of statistical analysis revealed that negative symptoms were improved by the Day Hospital treatment, especially by group therapy, and the effect of this therapy remained fairly stable throughout the five years after the termination of the Day Hospital treatment. Negative symptoms, specifically "affective flattening or blunting" and "avolition and apathy", which were assessed by SANS at the termination of the Day Hospital treatment, were found to be effective prognostic signs in schizophrenic patients for predicting later poor social adjustment in terms of "relapse" and the "rate of employment duration". Contrary to the present hypothesis that positive symptoms seem to be invalid in predicting long-term outcomes, positive symptoms, specifically "nuclear syndrome", "residual syndrome", "auditory hallucinations" and "delusions of reference", which were assessed by SCL at the termination of the Day Hospital treatment, were found to be of value for predicting later poor social adjustment in terms of the "relapse" and "rate of employment duration". This finding suggests that long-lasting positive symptoms during the post acute-phase of schizophrenia were also important for assessing the prognosis.