うつ病と不安発作(Panic Discover をめぐって)(第30回日本心身医学会総会)
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概要
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Since panic disorder was separated from generalized anxiety disorder in DSM-III (1980), panic disorder has become a current topic especially in American phychiatry. Along with such a trend, the relationship between panic attack and depression became a subject of investigation from various points of view. This subject, however, is historically rather old, because depressive cases with thoracic discomfort had been called "Pneumomelancholy" in the 19th century. The Great Debate in England is famous for a long controversy between unitarians and binary theorists. Unitarians like Lewis, A. assumed anxiety neurosis as a minor variant of manic-depressive illess and agitated depression as its major variant. Binary theorists like Roth, M. strictly distinguished anxiety state from depressive illness only by their clinical symptoms. In 1979 Hirose, T. proposed "panic attack-retardation" type of depression as some evidence of the unitary view, based on his clinical experiences of the cases with panic attacks followed by long intervals and subsequent retarded depression. Some bipolar courses may be seen among such cases, which imply endogenous origin excluding the possibility of secondary depression. Now it is known that several course patterns of depression with panic attacks other than the above-mentioned one can exist. Panic attacks may occur without interval just before or after and during a depressive episode. Hence, panic attack can be a prodromal symptom or a symptom of depression per se. It can also change to depression by syndrome shift. Panic disorder is distinctly different from generalized anxiety disorder and is more closely related to depression as regards drug response and hereditary characteristics. Tricyclics and MAO inhibitors are effective against both panic disorder and depression. Depression with panic attacks seems to be located nosologically in between panic disorder and depression without panic attack, according to some data of clinico-genetical investigations as well as several data of biological experiments such as lactate infusion provocation, polysomnography and dexamethasone suppression test. Thus, clinically, it is reasonable to treat a patient with panic attacks by tricyclics with or without alprazolam and we should take it into consideration that a depressive episode may come later. Theoretically, the endogeneous nature of panic attack, as indicated by Sheehan, D.V., et al., should be taken more account, since panic attack is closely related to depression as mentioned above.
- 日本心身医学会の論文
- 1990-08-01
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