髄膜腫に伴う精神病性うつ病の1例

A Case of Psychotic Depression Associated with Meningioma

抄録

　原発性脳腫瘍は人口1万人につき年間1.5人程の低い発生頻度で，髄膜腫はその約3割を占める。特に髄膜腫は発育が緩徐で，脳実質外に局在するため，神経学的兆候に乏しく，精神症状のみで精神科を受診することが稀にみられ，配慮すべき鑑別疾患の一つとして挙げられる。大脳鎌天幕部髄膜腫に伴い精神病性うつ病を呈した66歳女性例の治療経験を報告する。一般に脳腫瘍の際，抗うつ薬治療の効果は乏しく，てんかんの惹起やせん妄を含めた意識障害の悪化などが危惧されるため使用を控える傾向にある。本症例はclomipramineの静脈投与とsulpirideを併用し，抗うつ薬治療が奏効した。脳腫瘍に合併する感情障害，うつ病の治療に関しては，未だ確立されているとは言い難く，報告や研究は本邦では少ない。脳腫瘍に伴う抑うつ症状の診断と治療の参考になると思われ，文献的考察を加えた。

　At approximately 1.5 per 10,000 population, the annual incidence of primary brain tumors is relatively low. N early 30% of such tumors are classified as meningioma. This disease is characterized by particularly slow growth and localization outside the brain parenchyma, and rarely involves clear neurological symptoms；thus, few patients with the disease undergo psychiatric consultation based on the presence of psychiatric symptoms alone. In short, psychiatrists need to be aware that meningioma is a physical illness that requires a careful differential diagnosis. Herein, we report the case of a 66-year-old female patient with psychotic depression associated with a falcotentorial meningioma. The use of antidepressants tends to be avoided in cases of brain tumors, as this treatment does not generally show sufficient therapeutic effects and can increase the risk of epileptic seizure and consciousness deterioration, including delirium. In the present case, antidepressant therapy through combined intravenous administration of clomipramine and oral sulpiride successfully treated psychiatric symptoms. Methods to treat affective disorders, especially depression, as a complication of brain tumors have yet to be established, and there are a limited number of reports and studies on this issue in Japan. Additionally, this paper reviews the literature to provide a basis for the diagnosis and treatment of the depressive symptoms associated with the occurrence of brain tumors.