ライフステージからみたうつ病 : その診断と治療(シンポジウム:うつ病の診断・治療上の問題点とコツ,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Depression from the Viewpoint of Life Stage : Diagnosis and Treatment(Symposium/Depression-Its Diagnostic Issues and the Knack of Treatment)  [in Japanese]

うつ病の発症,症状形成には,病前性格や環境,ライフステージが関与している.うつ病者の人格は,伏在する気分変動性と対象希求性をベースに発展する.重要人物への依存性を断念して社会規範に同一化すれぼ,壮年期以降に観察されるメランコリー親和型や執着性格に発展するし,依存性がそのまま満たされれば青年期後期から出現する逃避型抑うつ者や未熟型うつ病者となる.うつ病像もこうした病前性格を反映するため,それに見合った精神療法も必要となる.10代後半から20代前半にかけてのうつ病症例では,生来の気分変動のブレが大きく,その上に形成される人格の統合水準もより低いため,人格と気分変動の境目がはっきりしないことがある.その中には軽躁的因子を備え行動化しやすいBPD様双極II型(阿部)や,躁的要素や行動化に乏しく回避的な傾向の強いディスチミァ親和型(樽味)が含まれる.前者では気分安定薬の処方,後者では患者の生き方を再構築する援助がポイントとなる.

Premorbid personality, environment and life stage contribute to the pathogenesis and development of depression. Depressive patients develop their personality based on concealed mood fluctuation and aspiration for objects. If they give up dependency on their important persons and identify themselves with social norms to form a higher integrated level of personality structure, they develop a melancholic-type personality or an immodithymic personality observed after middle age, manifested with classical-type depression with feelings of guilt. If dependence is oversatisfied, escape-type depression (Hirose) or immature-type depression (Abe et al.) develops with narcissistic tendencies appearing after the second half of the 20s. Whether mood fluctuation is situated within personality traits or one of the symptoms in the case of depressive patients from their late 10s to the first half of their 20s who had a lower integrated level of personality structure and exposed mood fluctuation is unclear. Two of the typical depressive pictures at this life stage are BPD-like bipolar II (Abe) with hypomanic elements that act out easily and dysthymia-type depression (Tarumi) with a marked tendency to avoidance. In summary, the clinical picture of depression varies depending on the integrated level of personality structure, quantity of manic element and life stage.