著明な前頭葉症状と失語症状を呈した機能性精神病の1例

A Case of Functional Psychosis with Marked Frontal Symptoms and Aphasia

抄録

　初老期に不安焦燥の強いうつ症状で発症し，緊張病症状に加え，模倣行動，利用行動，被影響性の亢進，考え不精などの前頭葉症状と失語症状を呈した機能性精神病の1例を経験した。脳血流SPECT検査で左優位の両側視床，基底核の血流低下を認めたが，頭部MRI検査，脳波，髄液，内分泌学的検査などでは異常を認めなかった。修正型電気けいれん療法により，前頭葉症状，失語症状は消失し，また抑うつ気分，意欲ともに改善した。本例では前頭側頭型認知症においてもみられる症候が特徴的であったが，自己の精神状態に対する心的葛藤を認めたことが異なっており，鑑別に有用と考えられた。

　We describe the case of a 57-year-old man diagnosed with functional psychosis. Initially, the patient suffered from depression and strong anxiety. A little later, a catatonic syndrome with alternating psychomotor excitement and akinesia occurred. In addition, frontal symptoms, such as imitation behavior, utilization behavior, stimulus-bound behavior, and "Denkfaulheit", which are often observed in patients with frontotemporal dementia (FTD) were observed in this patient, along with aphasia. The MRI showed no abnormalities, but ^99mTc-ECD SPECT revealed hypoperfusion in the thalamus, which was more prominent bilaterally in the left hemisphere and the basal ganglia. The administration of modified electroconvulsive therapy diminished the frontal symptoms and aphasia. There was also an improvement in the patient's depression levels and hypobulia. It is important to distinguish between functional psychosis and FTD, because functional psychosis is treatable；further, the presence of psychic conflict about the abnormal mental state was helpful for diagnosing functional psychosis.