心療内科における老年期デプレッション(生涯各期における心身症をめぐる諸問題 : 老年期)

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Depression in the old age has a greater frequency and is considered as an imoprtant disorder in the field of psychosomatic medicine. The authors studied senile depression with regard to epidemilogical, biological and psychological aspects.1) In an epidemiological survey, the authors made investigations using a self-rating questionnaire for depression (SRQ-D) in psychosomatic clinics, homes for the aged, clinics of general practitioners and old peoples homes (Total 1,063 caess).High SRQ-D scores were observed in 24% of the subjects in the psychosomatic clinics, moderate and high SRQ-D score groups occupying 54% of all. The differences of SRQ-D scores between the psychosomatic clinics and the homes for the aged, between psychosomatic clinics and the clinics of general practitioners, between psychosomatic clinics and the old peoples homes were statistically significant at p<0.01 level.High SRQ-D scores in the homes for the aged, the clinics of general practitioner and the old peopes homes revealed 7-11%, moderate and high score were found in 16-25%. All the differences were not statistically significant.2) The cortisol levels by dexamethasone supperession test (DST) were analysed in 10 senile depressive inpatients. As a result, DST showed 3 non-suppression and 7 suppression cases. The cortisol after dexamethesone administerd was over 10μg/dl in the cases of non-supression.3) With regard to psychological aspects, we reported 3 cases of object loss in the old. Case 1 is a 66-year-old male with senile depression. He retired due to the age ristriction, which made him recognize his life changed and feel sadnes. Case 2 is a 61-year-old female with depressive state. She felt sorrow of parting with her children because of their marriage and lost pleasure of eating as she had to diet herself for Diabetes Mellitus. Case 3 is a 70-year-old female with depressive pseudodementia. She lost her role of house work such as takign care of her grandichildren. These 3 cases indicated that their experiences of object loss in the old age induced depression and hopelessness.An epidemiological study suggested that latent depression was present in 10-20% of the old people who were staying home, et al. DST, when used for the old aged, appeared to induce a similar response as it was used for the younger and middle ages. It was suggested that DST was an important indicator to judge the severity of depression and responsiveness of antidepressants. Psychologically, the aged experience a lot of bio-psycho-social loss. Their mourning work for object loss requires a multi-dimensional approach. It is appropriate to treat the aged people at institutions where psychosomatic medicine is practiced.
日本心身医学会の論文
1985-04-01

心療内科における老年期デプレッション(生涯各期における心身症をめぐる諸問題 : 老年期)

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