脳血管性痴呆の自殺企図例の臨床的研究

A Study of Suicidal Cases of Vascular Dementia

【抄録】　脳血管性痴呆における自殺企図例の特徴を検討した。脳血管性痴呆241例のうち3.7％，9例（未遂5例，既遂4例）に自殺企図を認めた。自殺企図例はすべて痴呆初期に分類された。老年期痴呆例全体と比較して平均年齢は低く，痴呆罹患期間は短く，認知機能障害は軽度であった。自殺企図例全例で身体疾患を罹患しており，長期治療を強いられる心血管系疾患に運動器系疾患や感覚器系疾患の合併が自殺企図へのリスクをいっそう高めていると考えられた。自殺企図前に抑うつ状態と共に不安・心気状態を高率に認め，時に妄想状態も自殺企図と関連していた。特に自殺企図前の抑うつ状態と気分障害の既往歴は自殺企図と重要な関係にあると考えられた。また自殺例では，頭部CT所見において基底核領域の多発性梗塞が特徴として指摘された。そして，縊首，裂傷・切傷など患者にとって容易に施行できる自殺手段を選択する傾向がうかがわれ，多くが自殺の予兆なく突然に自殺を図った。

　We investigated the clinical manifestation for the cases of suicidal attempt in vascular dementia (VD) patients. In 241 cases of VD we found nine suicidal actions (3.7%) , five of them were attempted and four of them were completed. All the cases of suicidal attempts fell in the early stage of dementia. Among all dementia cases. VD has the following features : patients' shorter morbidity period, lower mean age, and milder cognitive disorder than other types of dementia. All cases of suicidal actions had physical problems.

　We suggested that cardiovascular disorders need a long-term treatment. Moreover, complications of motor and/or sensory function disturbance increase the risk of demented patients' committing suicide. Before suicidal attempts, most cases manifested particular psychiatric symptoms such as depression, anxiety and hypochondria while some manifested paranoia. Their psychiatric symptoms, especially depression and mood disorders in their medical history were also closely related to their suicide. CT scan views detected multiple cerebral infarctions in the basal nuclear area. We can find them characteristically in suicidal cases.