児童期より14年の経過を追った非定型精神病の1例—児童期の病像についての検討を中心に

A Case of Atypical Psychosis with Very Early Onset, Which Had Persisted for 14 Years

　【抄録】　児童期から約14年間追跡した非定型精神病の経過を報告する。本症例の最初のエピソードは9歳3カ月に始まり，強迫症状と抑うつ的な症状を主徴としていた。成人以後，双極性の気分変調が明らかとなり，これに随伴した精神運動性の増減に加えて，多彩な妄想と意識障害を伴う非定型な病相期を呈した。9歳3カ月のエピソードを成人以後の非定型病像と比較してみると，精神運動性の低下，不機嫌・不快気分の存在，強迫行為の出現など，後の病相期と共通の要素が認められ，内因性病相が小児期に未熟な病像をとって現れたと考えられた。本報告では，長期経過を追った上で各時期の病相を比較し，このような見方に基づく知見の蓄積が児童精神疾患の診断と，疾患の病態の理解に寄与する可能性について述べた。

　A 23-years-old female patient, who had firs visited the Psychiatric Outpatient Clinic, Tokyo University Hospital, at 9 years of age, displayed bipolar-like swings of mood and activity, dysphoria, and persecutory and grandiose delusions. Several weeks of slight consciousness-clouding was observed as well. Based upon these symptoms she was diagnosed as having “atypical psychosis”. When she first visited the Outpatient Clinic at 9 years of age, she demonstrated compulsive and depressive symptoms such as repeated handwashing, school refusal, and attempted suicide by taking a highdose of benzodiazepine. This episode was speculated to be the onset of her illness. This age at onset of the illness is the earliest ever reported in Japanese literature. It is discussed that a further accumulation of longitudinal follow-up studies are needed to establish more reliable diagnostic criteria for childhood and adolescent psychoses.