攻撃性が早期に出現する抑うつ症例について—産業精神医学の経験から

Depressive Patients expressing Aggression in the Early Stage: from the viewpoint of occupational mental health

　【抄録】今日，うつ病病像の現代的変容が注目されているが，我々は産業医としての臨床において，一群の特性を共有する抑うつ症例を見いだした。それは，若年成人の企業人で，内因性の症状を備えながらも，軽症にとどまり，出社の意志そのものは失われてはいないが，職場への忌避感や直属の上司への攻撃的感情が病相早期から出現し，他部署への異動を患者自身が強く望むというものである。4症例を呈示の上，両価的傾向の乏しい攻撃性が病相早期から出現する現象を最大の特徴ととらえ，疾病分類的に独自の位置を占める可能性を示唆し，基底的な病理構造として「しがみつきの希薄化」を抽出して，抑うつ病像が軽症にとどまるメカニズムの説明を試みた。

　Recently it is noted that the manifestations of depressive illness have been changing. In clinical practice at industrial corporations we have encountered a group of depressive patients who have the following features in common. 1) They are company employees in young adulthood, 2) Depressive symptoms have endogeneous characteristics, 3) However, the symptoms remain in a mild form, 4) They do not lose motivation to go to their companies, 5) But they express avoidant feelings toward the section where they work and aggressive feelings toward their superior in the early stage of depression, and 6) they ask for a job transfer.

　We presented 4 such cases and discussed their clinical features and the psychopathology. As our conclusion, 1) We regard the aggression which lacks ambivalence and is manifested in the early stage as the most distinctive feature, 2) We suggest that this form of depressive illness should be understood as a unique entity in the nosology of depression, 3)“weakenning of clinging tendency”is the basic psychopathology of this group, and we consider this explains why the symptoms remain in a mild form.