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Seishin Igaku Volume 34, Issue 1 （January 1992）

精神医学 34巻1号（1992年1月発行）

Japanese English

研究と報告

Rapid cycling affective disorder発症に関する諸因子と治療について The Contributing Factors and The Treatment for Rapid Cycling Affective Disorder 山口登 ¹ , 青葉安里 ¹ , 常泉智弘 ¹ , 高木博敬 ¹ , 千嶋達夫 ¹ , 酒井隆 ¹ , 根岸協一郎 ¹ , 廿楽通徳 ¹ , 諸川由実代 ¹ , 上村誠 ¹ , 竹下貴史 ¹ , 大田共夫 ¹ , 木代真樹 ¹ , 長谷川和夫 ¹ Noboru Yamaguchi ¹ , Anri Aoba ¹ , Tomohiro Tsuneizumi ¹ , Hiroyuki Takagi ¹ , Tatsuo Chishima ¹ , Takashi Sakai ¹ , Kyoichiro Negishi ¹ , Michinori Tsuzura ¹ , Yumiyo Morokawa ¹ , Makoto Kamimura ¹ , Takashi Takeshita ¹ , Tomoo Ohta ¹ , Masaki Kishiro ¹ , Kazuo Hasegawa 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： Bipolar affective disorder , Rapid cycling , Antidepressant , Mood stabilizer Keyword: Bipolar affective disorder , Rapid cycling , Antidepressant , Mood stabilizer pp.63-68

発行日 1992年1月15日 Published Date 1992/1/15

DOI https://doi.org/10.11477/mf.1405903180

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Abstract 文献概要
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　【抄録】　躁うつ病患者のrapid cycling現象（年に少なくとも4回かそれ以上の抑うつおよび躁または軽躁のエピソードを有する）の関連因子とその治療について主に精神薬理学的観点から検討した。双極型感情障害患者46名（男15名，女31名）を対象とし，それぞれの臨床経過をretrospectiveに調査したところ，rapidcycler（RCと略す）は12名（男4名，女8名），non-rapid cycler（non-RCと略す）は34名（男11名，女23名）であった。RC 12名の感情障害発病からrapid cyclingまでの期間は約7年であり，rapid cycling時には，すべての症例で躁または軽躁状態が認められた。RC発症に関与する因子として，遺伝負因を有することと自殺企図が比較的高頻度にみられることに加え，躁病相直前の抗うつ薬治療が重要な因子と考えられた。治療としては，大量の抗うつ薬投与を避けること，さらに，躁病相時には一時的にneurolepticsを用いることはあっても最終的には炭酸リチウム，カルバマゼピン，バルプロ酸ナトリウムの単独または併用が有効であった。

　We studied retrospectively the clinical courses of 46 patients with bipolar affective disorder. Twelve (4 males, 8 females) of the 46 subjects were rapid cyclers [RC] who experienced four or more affective episodes per year. The mean age at the first affective episode in RC was 29.8±8.2, and the mean age at the beginning of RC was 36.9±10.5, and rapid mood swings were observed just after manic or hypomanic episodes. In 34 non-rapid cyclers [non-RC] (11 males, 23 females) the mean age at the onset of affective disorder was 35.0±15.0, and then no significant difference was found in the mean age at the onset between RC and non-RC. Higher incidences of suicidal attempts and family histories of affective disorders were found in RC's than in non-RC's. The daily doses of antidepressants in the depressive phase, before the first manic episode became RC, were significantly higher than those before the manic phase in the non-RC's. These results suggest that rapid cyclings appeared to depend on both hereditary factors and high daily doses of antidepressants in the depressive phase. RC is often resistant to treatment, but it is better that the patients in the depressive phase should be given antidepressants as little as possible. The single administration or the combination of mood stabilizers such as lithium carbonate, carbamazepine and valproate is effective to prevent rapid cycling and to maintain a euthymic state in some affective disorders.