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Seishin Igaku Volume 44, Issue 10 （October 2002）

精神医学 44巻10号（2002年10月発行）

Japanese English

研究と報告

うつ病患者に対する電気けいれん療法の併発症（せん妄および逆向健忘）と臨床経過について Complications (Delirium/retrograde Amnesia) Following Electroconvulsive Therapy and Subsequent Clinical Courses in Patients with Major Depressive Episodes 山口登 ¹ , 宇田川至 ¹ , 杉山恒之 ¹ , 太田共夫 ¹ , 秋本多香子 ¹ , 渡部廣行 ¹ , 鈴木英伸 ¹ , 岡田良子 ¹ , 青葉安里 ¹ Noboru YAMAGUCHI ¹ , Itaru UTAGAWA ¹ , Tsuneyuki SUGIYAMA ¹ , Tomoo OHTA ¹ , Takako AKIMOTO ¹ , Hiroyuki WATANABE ¹ , Hidenobu SUZUKI ¹ , Nagako OKADA ¹ , Anri AOBA ¹ ¹聖マリアンナ医科大学神経精神科 ¹Department of Neuropsychiatry, St. Marianna University School of Medicine キーワード： Electroconvulsive therapy , Depression , Delirium , Amnesia , Relapse Keyword: Electroconvulsive therapy , Depression , Delirium , Amnesia , Relapse pp.1055-1060

発行日 2002年10月15日 Published Date 2002/10/15

DOI https://doi.org/10.11477/mf.1405902718

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Abstract 文献概要
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【抄録】　〈目的〉電気けいれん療法（electroconvulsive therapy：ECT）の併発症であるせん妄および逆向健忘と抗うつ効果および予後（再燃の有無）の関係を明らかにする。

　〈対象〉大うつ病エピソード（DSM-IV）のためECTが施行された55〜77歳の74（男15，女59）名である。

　〈方法〉本研究は診療録をもとに調査したretrospective studyである。Modified-ECTは，麻酔科医による身体管理下，サイン波治療器，100V，3〜5秒間，両側前頭部通電法にて施行され，平均施行回数は5.2，施行頻度は2回/週であった。

　〈結論〉①ECT後にせん妄を来す症例はうつ病症状の改善幅が小さく，さらに再燃の可能性が高い，②せん妄出現は年齢の影響を受け，またECT施行前のTCAの1日投与量の影響を受ける傾向がある，③ECT後の逆向健忘（非せん妄性）はうつ病症状改善の妨げにはならず，さらに予後に悪影響を及ぼす可能性も低いことが示唆された。

＜Purpose＞ To clarify the relationships between complications (delirium/retrograde amnesia) following electroconvulsive therapy (ECT) and both the antidepressant effects of ECT and relapses.

＜Subjects＞ Seventy-four (M/F : 15/59) subjects, age ranging from 55 to 77, suffering from major depressive episodes (DSM-IV) and receiving ECT.

＜Methods＞ Subjects were divided into two groups, designated as the delirium (N = 11) and the non-delirium (N = 63) groups respectively. In addition, the latter group was divided into the amnesia (N = 22) and the non-amnesia groups (N = 41) , and the groups were compared by age, by the number of ECT in a session, by the daily doses of tricyclic antidepressants (TCA) , by the score on the Hamilton rating scale for depression (Ham-D) before and after ECT, and according to the incidence of the relapses in the respective groups.

＜Results＞ ① The incidence of delirium was 15%, ②Older age, higher doses of TCA before ECT, smaller changes in the Ham-D scores and higher incidence of relapses were found in the delirium group than in the non-delirium group, ③ The incidence of retrograde amnesia was 35%, ④ There were no significant differences between the amnesia and the non-amnesia groups in age, doses of TCA, changes in the Ham-D scores, the number of ECT or incidence of relapses

＜Conclusions＞ These results suggested that ① Occurrence of delirium following ECT was related not only to a low grade of improvement of depressive symptoms but also to a higher incidence of relapses, ② Occurrence of delirium was affected by older age and higher dosage of TCA before ECT and ③ Occurence of retrograde amnesia following ECT neither interfered with the improvement nor with the increase in the incidence of relapses.