melancholia

• 抑欝、メランコリー、うつ病

関

depression、depressive disorder、depressive illness、depressive neurosis、depressive syndrome、endogenous depression、unipolar depression

関

Depression; Major depression

　 　

WordNet

1. extreme depression characterized by tearful sadness and irrational fears
2. a concavity in a surface produced by pressing; "he left the impression of his fingers in the soft mud" (同)impression, imprint
3. a long-term economic state characterized by unemployment and low prices and low levels of trade and investment (同)slump, economic crisis
4. a mental state characterized by a pessimistic sense of inadequacy and a despondent lack of activity
5. angular distance below the horizon (especially of a celestial object)
6. pushing down; "depression of the space bar on the typewriter"
7. sad feelings of gloom and inadequacy

PrepTutorEJDIC

1. 憂うつ病,うつ病
2. 〈C〉『くぼ地』,くぼみ / 〈U〉〈C〉『意気消沈』,憂うつ;うつ病 / 〈C〉『不景気』,不況 / 〈U〉押し下げること,降下,低下

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/01 06:15:18」(JST)

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This article is about the historical concept of melancholia as one of the "four temperaments". For other uses, see Melancholia (disambiguation).

Melencolia I by Albrecht Dürer, 1514

Black bile (Greek: µέλαινα χολή, melaina chole), also lugubriousness, from the Latin lugere, to mourn; moroseness, from the Latin morosus, self-willed, fastidious habit; wistfulness, from old English wist: intent, or saturnine, was a concept in ancient and pre-modern medicine. Melancholy was one of the four temperaments matching the four humours. In the 19th century, "melancholia" could be physical as well as mental, and melancholic conditions were classified as such by their common cause rather than by their properties.

History

Frontispiece for the 1638 edition of The Anatomy of Melancholy

The name "melancholia" comes from the old medical belief of the four humours: disease or ailment being caused by an imbalance in one or other of the four basic bodily liquids, or humours. Personality types were similarly determined by the dominant humor in a particular person. According to Hippocrates and subsequent tradition, melancholia was caused by an excess of black bile, hence the name, which means "black bile", from Ancient Greek μέλας (melas), "dark, black", and χολή (kholé), "bile"; a person whose constitution tended to have a preponderance of black bile had a melancholic disposition. In the complex elaboration of humorist theory, it was associated with the earth from the Four Elements, the season of autumn, the spleen as the originating organ and cold and dry as related qualities. In astrology it showed the influence of Saturn, hence the related adjective saturnine.

Melancholia was described as a distinct disease with particular mental and physical symptoms in the 5th and 4th centuries BC. Hippocrates, in his Aphorisms, characterized all "fears and despondencies, if they last a long time" as being symptomatic of melancholia. When a patient could not be cured of the disease it was thought that the melancholia was a result of demonic possession.

In his study of French and Burgundian courtly culture, Johan Huizinga noted that "at the close of the Middle Ages, a sombre melancholy weighs on people's souls." In chronicles, poems, sermons, even in legal documents, an immense sadness, a note of despair and a fashionable sense of suffering and deliquescence at the approaching end of times, suffuses court poets and chroniclers alike: Huizinga quotes instances in the ballads of Eustache Deschamps, "monotonous and gloomy variations of the same dismal theme", and in Georges Chastellain's prologue to his Burgundian chronicle, and in the late fifteenth-century poetry of Jean Meschinot. Ideas of reflection and the workings of imagination are blended in the term merencolie, embodying for contemporaries "a tendency", observes Huizinga, "to identify all serious occupation of the mind with sadness".

Painters were considered by Vasari and other writers to be especially prone to melancholy by the nature of their work, sometimes with good effects for their art in increased sensitivity and use of fantasy. Among those of his contemporaries so characterised by Vasari were Pontormo and Parmigianino, but he does not use the term of Michelangelo, who used it, perhaps not very seriously, of himself. A famous allegorical engraving by Albrecht Dürer is entitled Melencolia I. This engraving has been interpreted as portraying melancholia as the state of waiting for inspiration to strike, and not necessarily as a depressive affliction. Amongst other allegorical symbols, the picture includes a magic square and a truncated rhombohedron. The image in turn inspired a passage in The City of Dreadful Night by James Thomson (B.V.), and, a few years later, a sonnet by Edward Dowden.

The most extended treatment of melancholia comes from Robert Burton, whose The Anatomy of Melancholy (1621) treats the subject from both a literary and a medical perspective. Burton wrote in the 17th century that music and dance were critical in treating mental illness, especially melancholia.

But to leave all declamatory speeches in praise of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against despair and melancholy, and will drive away the devil himself. Canus, a Rhodian fiddler, in Philostratus, when Apollonius was inquisitive to know what he could do with his pipe, told him, "That he would make a melancholy man merry, and him that was merry much merrier than before, a lover more enamoured, a religious man more devout." Ismenias the Theban, Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith Bodine, that are troubled with St. Vitus's Bedlam dance.

In the Encyclopédie of Diderot and d'Alembert, the causes of melancholia are stated to be similar to those that cause Mania: "grief, pains of the spirit, passions, as well as all the love and sexual appetites that go unsatisfied."

Cult

The young John Donne, the very picture of fashionable melancholy in the Jacobean era.

Melancholy, etching by Giovanni Benedetto Castiglione, 1640s

During the later 16th and early 17th centuries, a curious cultural and literary cult of melancholia arose in England. In an influential 1964 essay in Apollo, art historian Roy Strong traced the origins of this fashionable melancholy to the thought of the popular Neoplatonist and humanist Marsilio Ficino (1433–1499), who replaced the medieval notion of melancholia with something new:

Ficino transformed what had hitherto been regarded as the most calamitous of all the humours into the mark of genius. Small wonder that eventually the attitudes of melancholy soon became an indispensable adjunct to all those with artistic or intellectual pretentions.

The Anatomy of Melancholy (The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it... Philosophically, Medicinally, Historically, Opened and Cut Up) by Burton, was first published in 1621 and remains a defining literary monument to the fashion. Other major melancholic English authors whose works contain extensive meditations on death include Sir Thomas Browne, Hydriotaphia, Urn Burial (1658), and Jeremy Taylor with the conventionally religious Holy Living and Holy Dying (1650/51).

Night-Thoughts (The Complaint: or, Night-Thoughts on Life, Death, & Immortality), a long poem in blank verse by Edward Young was published in nine parts (or "nights") between 1742 and 1745, and hugely popular in several languages. It had a considerable influence on early Romantics in England, France and Germany. William Blake was commissioned to illustrate a later edition.

In the visual arts, this fashionable intellectual melancholy occurs frequently in portraiture of the era, with sitters posed in the form of "the lover, with his crossed arms and floppy hat over his eyes, and the scholar, sitting with his head resting on his hand"—descriptions drawn from the frontispiece to the 1638 edition of Burton's Anatomy, which shows just such by-then stock characters. These portraits were often set out of doors where Nature provides "the most suitable background for spiritual contemplation" or in a gloomy interior.

In music, the post-Elizabethan cult of melancholia is associated with John Dowland, whose motto was Semper Dowland, semper dolens. ("Always Dowland, always mourning.") The melancholy man, known to contemporaries as a "malcontent," is epitomized by Shakespeare's Prince Hamlet, the "Melancholy Dane."

A similar phenomenon, though not under the same name, occurred during the German Sturm und Drang movement, with such works as The Sorrows of Young Werther by Goethe or in Romanticism with works such as Ode on Melancholy by John Keats or in Symbolism with works such as Isle of the Dead by Arnold Böcklin. In the 20th century, much of the counterculture of modernism was fueled by comparable alienation and a sense of purposelessness called "anomie"; earlier artistic preoccupation with death has gone under the rubric of memento mori. The medieval condition of acedia (acedie in English) and the Romantic Weltschmerz were similar concepts, most likely to affect the intellectual.

Related concepts in Islam

The Arabic word found as ḥuzn and ḥazan in the Qur'an and hüzün and hazin in modern Turkish refers to the pain and sorrow over a loss, death of relatives in the case of the Qur'an. Two schools further interpreted this feeling. The first sees it as a sign that one is too attached to the material world, while Sufism took it to represent a feeling of personal insufficiency, that one was not getting close enough to God and did not or could not do enough for God in this world. The Turkish writer Orhan Pamuk, in the book Istanbul: Memories and the City, further elaborates on the added meaning hüzün has acquired in modern Turkish. It has come to denote a sense of failure in life, lack of initiative and tendency to retreat into oneself, symptoms quite similar to melancholia. According to Pamuk it was a defining character of cultural works from Istanbul after the fall of the Ottoman Empire. One may see similarities with how melancholic romantic paintings in the west sometimes used ruins from the age of the Roman Empire as a backdrop.

As a parallel with physicians of classical Greece, ancient Arabic physicians and psychologists also categorized ḥuzn as a disease. Al-Kindi (c. 801–873 CE) links it with disease-like mental states like anger, passion, hatred and depression, while the Persian physician Avicenna (980–1037 CE) diagnosed ḥuzn in a lovesick man if his pulse increased drastically when the name of the girl he loved was spoken. Avicenna suggests, in remarkable similarity with Robert Burton, many causes for melancholy, including the fear of death, intrigues surrounding one's life, and lost love. As remedies, he recommends treatments addressing both the medical and philosophical sources of the melancholy, including rational thought, morale, discipline, fasting and coming to terms with the catastrophe.

The various uses of ḥuzn and hüzün thus describe melancholy from a certain vantage point, show similarities with female hysteria in the case of Avicenna's patient, and in a religious context are not unlike sloth, which by Dante was defined as "failure to love God with all one's heart, all one's mind and all one's soul". Thomas Aquinas described sloth as "an oppressive sorrow, which, to wit, so weighs upon man's mind, that he wants to do nothing."

See also

• Anomie
• Ennui
• Depression (mood)
• Dysthymia
• Major depressive disorder
• Melancholic depression
• Mono no aware
• Nostalgia
• Pessimism
• Saudade
• Vapours (disease)
• Weltschmerz

Notes

• Melancholia is a specific form of mental illness characterized by depressed mood, abnormal motor functions, and abnormal vegetative signs. It has been identified in medical writings from antiquity and was best characterized in the 19th Century. In the 20th Century, with the interest in psychoanalytic writing, "major depression" became the principal class in psychiatric classifications. [See Taylor MA, Fink M: Melancholia for details of history.]
• In 1996, Gordon Parker and Dusan Hadzi-Pavlovic described Melancholia as a specific disorder of movement and mood. [Melancholia" A Disorder of Movement and Mood, Cambridge UK: Cambridge University Press, 1996]. More recently, MA Taylor and M Fink crystallized the present image of melancholia as a systemic disorder that is identifiable by depressive mood rating scales, verified by the present of abnormal cortisol metabolism (abnormal dexamethasone suppression test), and validated by rapid and effective remission with ECT or tricyclic antidepressant agents. It has many forms, including retarded depression, psychotic depression and postpartum depression.

Citations

Further reading

• Blazer, Dan G.: The Age of Melancholy: "Major Depression" and its Social Origin. Routledge, 2005. ISBN 978-0-415-95188-3.
• Bowring, Jacky: A Field Guide to Melancholy. Oldcastle Books, 2009. ISBN 978-1-842-43292-1.
• Boym, Svetlana: The Future of Nostalgia. Basic Books, 2002. ISBN 978-0-465-00708-0.
• Jackson, Stanley W.: Melancholia and Depression: From Hippocratic Times to Modern Times. Yale University Press, 1986. ISBN 978-0-300-03700-5.
• Kristeva, Julia: Black Sun. Columbia University Press, 1992. ISBN 978-0-231-06707-2.
• Radden, Jennifer: The Nature of Melancholy: From Aristotle to Kristeva. Oxford University Press, 2002. ISBN 978-0-195-15165-7.
• Schwenger, Peter: The Tears of Things: Melancholy and Physical Objects. University of Minnesota Press, 2006. ISBN 978-0-816-64631-9.

External links

• Grunwald Center website: Durer's Melencolia and clinical depression, iconography and printmaking techniques
• "Dürer's Melancholia": sonnet by Edward Dowden
• Melancholy and abstraction, on the Berlin exhibition "Melancholy: Genius and Madness in Art"
• Diderot's historic writing on Melancholy
• A consideration of the Durer's work and the 2011 film 'Melancholia'

UpToDate Contents

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• 1. うつ病の臨床症状および診断 clinical manifestations and diagnosis of depression
• 2. 思春期のうつ病：疫学、臨床症状、および診断 depression in adolescents epidemiology clinical manifestations and diagnosis
• 3. 成人における治療抵抗性うつ病の治療 treatment of resistant depression in adults
• 4. 単極性うつ病における電撃療法（ECT）の適応およびその有効性 indications for electroconvulsive therapy ect in unipolar depression and its efficacy
• 5. 患者情報：思春期のうつ病（詳細） depression in adolescents beyond the basics

English Journal

• A Double-blind, randomized, placebo-controlled clinical trial of S-adenosyl-L-methionine (SAMe) versus escitalopram in major depressive disorder.

• Mischoulon D, Price LH, Carpenter LL, Tyrka AR, Papakostas GI, Baer L, Dording CM, Clain AJ, Durham K, Walker R, Ludington E, Fava M.Author information 1 Bowdoin Sq, 6th Floor, Massachusetts General Hospital, Boston, MA 02114 dmischoulon@partners.org.AbstractOBJECTIVE: To examine the comparative antidepressant efficacy of S-adenosyl-l-methionine (SAMe) and escitalopram in a placebo-controlled, randomized, double-blind clinical trial.
• The Journal of clinical psychiatry.J Clin Psychiatry.2014 Dec 24. [Epub ahead of print]
• OBJECTIVE: To examine the comparative antidepressant efficacy of S-adenosyl-l-methionine (SAMe) and escitalopram in a placebo-controlled, randomized, double-blind clinical trial.METHOD: One hundred eighty-nine outpatients (49.7% female, mean [SD] age = 45 [15] years) with DSM-IV-diagnosed major depr
• PMID 24500245

• GSK3β, CREB, and BDNF in peripheral blood of patients with Alzheimer's disease and depression.

• Pláteník J1, Fišar Z2, Buchal R1, Jirák R3, Kitzlerová E3, Zvěřová M3, Raboch J3.Author information 1Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Kateřinská 32, 121 08 Prague 2, Czech Republic.2Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Ke Karlovu 11, 120 00 Prague 2, Czech Republic. Electronic address: zfisar@lf1.cuni.cz.3Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Ke Karlovu 11, 120 00 Prague 2, Czech Republic.AbstractBACKGROUND: Glycogen synthase kinase-3β (GSK3β), cAMP-response element-binding protein (CREB) and brain-derived neurotrophic factor (BDNF) play critical roles in neuronal survival, synaptic plasticity and memory and participate in the pathophysiology of both depressive disorder and Alzheimer's disease (AD).
• Progress in neuro-psychopharmacology & biological psychiatry.Prog Neuropsychopharmacol Biol Psychiatry.2014 Apr 3;50:83-93. doi: 10.1016/j.pnpbp.2013.12.001. Epub 2013 Dec 12.
• BACKGROUND: Glycogen synthase kinase-3β (GSK3β), cAMP-response element-binding protein (CREB) and brain-derived neurotrophic factor (BDNF) play critical roles in neuronal survival, synaptic plasticity and memory and participate in the pathophysiology of both depressive disorder and Alzheimer's dis
• PMID 24334212

• Major depressive disorder in breast cancer: A critical systematic review of pharmacological and psychotherapeutic clinical trials.

• Carvalho AF1, Hyphantis T2, Sales PM3, Soeiro-de-Souza MG4, Macêdo DS5, Cha DS6, McIntyre RS7, Pavlidis N8.Author information 1Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil. Electronic address: andrefc7@terra.com.br.2Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.3Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.4Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.5Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.6Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.7Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.8Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece.AbstractBACKGROUND: While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related quality of life and treatment adherence. There are no systematic reviews that evaluate pharmacological and psychotherapeutic treatment trials for MDD among individuals with breast cancer.
• Cancer treatment reviews.Cancer Treat Rev.2014 Apr;40(3):349-55. doi: 10.1016/j.ctrv.2013.09.009. Epub 2013 Sep 14.
• BACKGROUND: While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related qual
• PMID 24084477

• The role of controlled attention on recall in major depression.

• Ellis AJ, Wells TT, Vanderlind WM, Beevers CG.Author information a Semel Institute of Neuroscience and Human Behaviour , University of California , Los Angeles , CA , USA.AbstractInformation processing biases are hallmark features of major depressive disorder (MDD). Depressed individuals display biased memory and attention for negative material. Given that memory is highly dependent on attention for initial encoding, understanding the interplay of these processes may provide important insight into mechanisms that produce memory biases in depression. In particular, attentional control-the ability to selectively attend to task-relevant information by both inhibiting the processing of irrelevant information and disengaging attention from irrelevant material-may be one area of impairment in MDD. In the current study, clinically depressed (MDD: n = 15) and never depressed (non-MDD: n = 22) participants' line of visual gaze was assessed while participants viewed positive and negative word pairs. For each word pair, participants were instructed to attend to one word (target) and ignore one word (distracter). Free recall of study stimuli was then assessed. Depressed individuals displayed greater recall of negatively valenced target words following the task. Although there were no group differences in attentional control in the context of negative words, attention to negative targets mediated the relationship between depression status and recall of negative words. Results suggest a stronger link between attention and memory for negative material in MDD.
• Cognition & emotion.Cogn Emot.2014 Apr;28(3):520-9. doi: 10.1080/02699931.2013.832153. Epub 2013 Sep 6.
• Information processing biases are hallmark features of major depressive disorder (MDD). Depressed individuals display biased memory and attention for negative material. Given that memory is highly dependent on attention for initial encoding, understanding the interplay of these processes may provide
• PMID 24006889

Japanese Journal

• 非定型うつ病 : パーソナリティ特性・障害に関連したうつ病の診療覚書 (特集 うつ病の亜型分類への展望(その1))

• 黒木 俊秀
• 臨床精神医学 42(7), 841-847, 2013-07
• NAID 40019730391

• 内因性うつ病 : 概念史と現代的意義 (特集 うつ病の亜型分類への展望(その1))

• 大前 晋
• 臨床精神医学 42(7), 825-839, 2013-07
• NAID 40019730353

• 軽症うつ病:病態と治療の考え方 : うつ病治療の古くからある,そして忘れられつつあるストラテジー

• 大前 晋
• Depression strategy : うつ病治療の新たなストラテジー 3(2), 1-3, 2013-06
• NAID 40019748761

• 高齢透析患者の療養生活における体験の意味づけ

• 田中 紀子,原田 小夜,太田 節子
• 聖泉看護学研究 2, 69-81, 2013-04
• 背景 近年,透析治療の進歩による生存寿命の長期化と導入の高齢化により,高齢透析患者が年々増加している.透析治療の受容には,認知機能が影響することから,年齢が高くなるほど透析治療の受容は悪いことが指摘されている.しかし,高齢透析患者の多くは,透析治療を休むことや放棄することなく治療を継続しており,そこには透析の受容とは異なる療養生活における体験の意味づけがあると考えられる.目的 本研究は,高齢透析患 …
• NAID 110009585898

Related Links

• Melancholia (2011) - IMDb

Directed by Lars von Trier. With Kirsten Dunst, Charlotte Gainsbourg, Kiefer Sutherland, Alexander Skarsgård. Two sisters find their already strained relationship challenged as a mysterious new planet threatens to collide with Earth.

• 毎日の趣味と健康日記

全て一つになっている化粧品を使うと、スキンケアまでできて、手間はかからないし、便利な物です。 私は、いつもは、化粧水から始まって、クリームまで、順番につけて行きます。 ある日知人が、あなた、今日は体調が悪いの ...

• Melancholia - by Lars von Trier

Melancholia - A beautiful movie about the end of the world - by Lars von Trier ... Well, it's hard to smuggle in a bit of ugliness. So I think the film is slightly on the edge of plastic. Here and there. Would you please write that?

Related Pictures

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★リンクテーブル★

リンク元	「うつ病」「抑欝」「depressive disorder」「depressive syndrome」「endogenous depression」

「うつ病」

　　[★] 鬱病

英

depression

関

抗うつ薬、抑うつ症、メランコリー melancholia

[show details]

鬱病 : 約 5,160,000 件
うつ病 : 約 23,500,000 件

分類

• 一次

• 大うつ病性障害(単極性障害)
• 双極性障害
• 気分変調性障害
• 気分循環性障害
• 特別な気分障害

• 産後うつ病
• 季節性気分障害

• 二次

• 薬物の使用による

疫学

• 世界的に有病率が高い(十ヵ国を対象とした研究では生涯有病率は平均8-12%、日本では3%、米国では17%であった(参考2))　　097G008(うつ病は世界的に主要な健康問題になっている。)

病因

• 脳のノルエピネフリン神経、セロトニン神経の働きに異常
• レセルピンと鬱病の関係
• レセルピン

• 血圧低下作用が臨床応用されていた
• 1931年に鎮静作用を示すことが明らかにされていた。
• ノルエピネフリン神経におけるシナプス小胞への取り込みを阻害することによって

血圧↓→脳内モノアミン枯渇→うつ病発症→使われなくなる

評価

• ベックうつ病自己評価尺度 Beck Depression Inventory BDI
• ハミルトンうつ病評価尺度 Hamilton Rating Scale for Depression HRSD
• 自己評価抑うつ尺度 SDS：自記式で、重症度の評価が可能

鬱の診断基準

also see DSM-IV

• 1. 抑うつ気分

• 気分の落ち込みや何をしても癒されない気分や空虚感など

• 2. 興味、喜びの喪失

• 感情が麻痺した状態

鑑別診断

KPS.973　←　あまり整理されていない印象

• 抑うつ気分を伴う適応障害
• 気分変調性障害
• 失調感情障害
• 統合失調症
• 大うつ病性障害
• 双極I型障害
• 境界性人格障害
• 低カリウム血症
• 短期精神病性障害
• 気分循環性障害
• 抗高血圧性毒性
• ステロイド精神病性障害
• 甲状腺機能低下症
• 脳腫瘍
• 全身不全麻痺
• アンフェタミン使用障害
• コカイン使用障害
• 膵癌
• 肝炎
• ウイルス感染後症候群
• アルツハイマー型認知症
• 血管性認知症
• 晩発性アルツハイマー型認知症
• 早発性アルツハイマー型認知症
• 肝硬変
• 動脈硬化症
• 伝染性単核球症
• 甲状腺機能亢進症
• 潜在性悪性腫瘍
• エイズ
• シゾイド人格障害/統合失調質人格障害
• 失調型人格障害/統合失調型人格障害

IMD.1077 PSY.284

• 統合失調症：病初期にうつ状態。疎通性障害、幻覚・妄想の出現で鑑別される。
• 神経症

• 薬物性：糖質コルチコイド、降圧薬(レセルピン)、インターフェロン、レボドパ、抗精神病薬：服用歴で鑑別。

• 二次性：

• 内分泌疾患(クッシング症候群、シーハン症候群、甲状腺機能異常(甲状腺機能低下症(橋本病など))、糖尿病)、悪性腫瘍、膠原病：ホルモン検査、免疫学的検査、生化学検査にて鑑別を行う。

• 脳器質性疾患

• 脳血管障害：脳梗塞、脳出血など：CT、MRI、神経学的所見などから鑑別する
• 脳変性疾患：パーキンソン病、アルツハイマー病：CT、MRI、神経学的所見などから鑑別する

症状

昏迷、不安焦燥、精神活動抑制、微小思考

• 気分の憂うつだったり、寂しくなったりという抑うつ気分
• 将来に希望を持てなくて悲観的になり、考ええばかりおそってくる抑うつ気分
• 意欲、興味、関心の低下をきたす
• 朝に抑うつ気分がひどい
• 症状がひどいと自殺を試みる

治療

方針

• 1. うつ病であることを説明
• 2. 休息
• 3. 治癒の見通しを明らかにする
• 4. 重要決定は延期させる
• 5. 自殺しない約束

modality

• 薬物療法

効果の発現は服用開開始から1-2週間後で即効性はない。鬱症状が改善した後も4ヶ月継続すべき。(PSY.288)

軽症～中等症：SSRI, SNRI

重症：三環系抗うつ薬

• 精神療法

• 支持的精神療法
• 認知療法
• 力動的精神療法：再発防止、慢性期の治療

• 身体療法

• 電気痙攣療法 electroconvulsive therapy ECT：薬物療法に反応しない薬物治療抵抗性うつ病が適応。自殺の危険が迫っている例、身体疾患もしくは副作用により薬物療法に耐えられない例も適応。修正型電気痙攣療法もある。
• 高照度光療法：季節性感情障害 SADが適応。

薬物療法

• MAOとうつ病
• MAO inhibitorは脳モノアミン神経伝達物質の量を増やす
• MAO inhibitor

• モノアミン神経伝達物質が蓄積される
• パーキンソン病やうつ病の病状をよくする

参考

• 1. [charged] うつ病の疫学、病因、および神経生物学 - uptodate [1]

「抑欝」

　　[★]

英

depression、melancholia

関

うつ病、低下、抑圧、抑制、うつ、うつ状態、鬱、鬱病、メランコリー、抑うつ、抑うつ状態

-melancholia

「depressive disorder」

　　[★]

• うつ病性障害

関

depressive illness、depressive neurosis、depressive syndrome、endogenous depression、melancholia、unipolar depression

「depressive syndrome」

　　[★]

• 抑うつ症候群

関

depressive disorder、depressive neurosis、endogenous depression、melancholia、unipolar depression

「endogenous depression」

　　[★]

• 内因性うつ病

関

depressive disorder、depressive neurosis、depressive syndrome、melancholia、unipolar depression