10年以上家を出られなかったパニック障害の1症例

A Case of Panic Disorder Who had been Unable to Go Out for More Than Ten Years Because of Agoraphobia

【抄録】　10年以上家を出られなかったパニック障害の症例を報告し，治療過程や症状長期化の要因について考察した。患者は44歳時にパニック障害を発症し，広場恐怖と心臓病恐怖が強く，ついには寝たきりの状態となり，排泄もベッド上で行うありさまとなった。

　55歳時入院治療を開始した。薬物療法で発作は消失し，入院当初はADLの向上も順調に進んだ。しかし途中から不安階層表を用いた行動拡大訓練はなかなか進まなくなった。背後に夫婦関係の問題があると考え，定期的な三者面接を行い，患者の感情の言語化を促し夫に受け入れるよう求めた。その結果，約1年後に退院し家庭生活に移行することができた。家族力動の変化が改善の一因と考えられた。

　Investigating the factors of the longevity of symptoms and the therapeutic process, we reported a case of panic disorder who had been unable to go out for more than ten years because of agoraphobia. Her first panic attack occurred when she was 44 years old, followed by agoraphobia and cardiophobia. Her phobias were so severe that she finally became bedridden and could not take a bath or even go to toilet. She managed her excretions in the bed and asked a housekeeper to clean her up.

　After ten years of being in such a situation, she was admitted to hospital at the age of 55. Her panic attacks were well controlled by 75 mg of imipramine, 2.4 mg of alprazolam and 30 mg of propranolol, and the activities of her daily life began to improve soon after the admission.

　However, the behavioral therapy with an anxiety hierarchy broke down half-way through. It was suspected that her marital problems had been related to her long-term symptoms and resistance against the therapy. For this reason, marital counselling was conducted regularly with the therapist helping the patient to verbalize her emotions and asking her husband to accept them. Her activities expanded again through this process. This enabled her to finish the inpatient treatment in one year and to return home. It is speculated that her improvement was obtained by psychotherapy as well as because of the change of family dynamics resulting from her husband's retirement and her son's engagement.