破瓜型分裂病様症状を呈した児童期発症の双極性感情障害の2例—児童期における診断の困難さと親へのインフォームド・コンセントに関する検討

Two Cases of Early Onset Bipolar Affectivc Disorder showed Symptoms Similar to those of Hebephrenic Schizophrenia in the First Episode

【抄録】　小学校高学年の児童期に，意欲の低下と引きこもり，奇異な行動などの症状を呈し破瓜型分裂病と診断され，神経遮断薬の投与により病状が悪化した双極性感情障害の2児童例を経験した。児童期に発症する双極性障害は，うつ病相から始まることが多く，言語能力の稚拙さや奇異な行動が目立つなどの理由で超早期発症分裂病や分裂病の前駆症状と誤診されやすい。そのため，神経遮断薬の投与により長期にわたって鎮静化され病状の遷延化を招くことはまれではない。今回の経験から，児童期発症の精神障害の診断や治療，家族へのインフォームド・コンセントには成人とは異なる配慮が必要であることが示唆された。

　We observed two patients with early onset bipolar affective disorder. They showed poor spontaneity, withdrawal. and strange behavior during their upper grades in the elementary school. Both patients were diagnosed as having hebephrenic schizophrenia, and given typical neuroleptics, which worsened their symptoms.

　One of the characteristics of the early stage of early onset bipolar disorder is “depressive state”. These patients are likely to be diagnosed as having early-onset schizophrenia or being in a prodromal stage of schizophrenia, because they reveal their condition artlessly and show conspicuously strange behavior. Because of this, psychiatrists tend to prescribe a lot of neuroleptics and oversedate the patients for a long term. Psychiatrists for children and adolescents need both directives concerning medication and informed consent from the parents of their juvenile patients.