結核を合併した精神障害者の経過中にみられた特異な精神—神経症状について—臨床および病理学的考察

SOME CHARACTERISTIC PSYCHIATRIC AND NEURO-LOGICAL SYMPTOMS THAT WERE OBSERVED IN PATIENTS WITH CHRONIC TUBERCULOSIS AND CHRONIC MENTAL DISORDERS:CLINICO-PATHOLOGICAL STUDY

Ｉ．はじめに

　抗結核剤のあるものが，既存の精神症状の増悪を促進したり，内因性精神病とまつたく同じような症状を引き起す可能性があることは，今までにも報告がある^{4）5）6）13）14）15）}。

　我々は結核を合併した精神障害者が，その治療の経過中に，特異な精神—神経症状を現わし，数週間から6ヵ月間の経過で死亡した症例を8例集めることができた。そのうち4例は剖検する機会を得た。さらにそのうちの3例については，神経病理学的に詳しく検討することができたので，臨床経過の特徴と病理所見について報告する。なおこれらの症例は，結核病棟を有する数ヵ所以上の精神病院からの症例で，そのほとんどが死亡後病床日誌の記載を手がかりに集めたものである。したがつて，生前の臨床データが不充分な点はまぬがれず，以下述べることは，主として統計的観察に終始するきらいはあるが，今後かかる症例について充分な検討を促す目的で報告する。

Nine cases with chronic pulmonary tuberculosisand chronic mental disorders, who were administer-ed continually with antituberculous drugs and most-ly with psychotropic drugs were investigated. Of these, eight died and four of them were autopsied, and three were neuropathologically examined. In their clinical courses in which they had been given both antituberculous drugs and psychotropic drugs, they mainly developed such symptoms as insomnia, agitation, anorexia, delusion, hallucination and stuporous state that suggested the clouding of cons-ciousness. These symptoms persisted for several weeks to months and were followed by general emaciation. Then, they showed characteristic clini-cal features such as general rigidity, involuntary movements including tremor and myoclonus, high fever, sleep disturbance and delirious state. These psychiatric and neurological symptoms lasted, and eight patients died within several weeks to six months. Only one (case 9) recovered from such severe conditions after withdrowal of antituberculous drugs.

Neuropathologically, subacute and chronic changes of nerve cells were observed in all the three cases that were examined. Two of them showed diffuse degenerative change of nerve cells termed "primare Reizung" in Betz's cells and pontine nuclei with neuronophagia.

From these neuropathological findings, we could not make any diagnosis of central nervous system. We think that these cases were of toxic encephalo-pathy probably due to antituberculous drugs, psy-chotropic drugs and systemic exhaustion.