双極性障害の早期診断と治療(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] Early Diagnosis and Management of Bipolar Disorder(Symposium/Depression-Its Diagnostic Issues and the Knack of Treatment)  [in Japanese]

単極性うつ病と双極性うつ病では治療アプローチが異なるため,「うつ病」診療においては早期診断が重要な鍵となる.抑うつ症状のみで鑑別することは困難であるが,双極性うつ病では非定型症状や躁成分の混入が診断の手掛かりとなることもある.双極性障害の診断には(軽)躁病エピソードの存在が必須であるが,患者の認識は乏しく,周囲からも注意深く(軽)躁症状の有無を聴取する必要がある.双極性障害のスクリーニングには自記式質問紙票も有用である.また,パーソナリティ障害や薬物依存などの併存も多く,複雑な病像を呈するため注意を要する.双極スペクトラムの観点から,双極性障害の家族歴や抗うつ薬による躁転などbipolarityについても確認することが望ましい.双極性障害の薬物治療としては,エピソードにかかわらず気分安定薬が第一選択であり,有効性や副作用(躁転や急速交代化)の面から,抗うつ薬の使用には慎重さが求められる.

Recent reports indicate that bipolar disorder is frequently misdiagnosed as unipolar depression, leading to inappropriate use of antidepressants. Early identification of bipolar disorder is one of the key points in managing depression in the primary care setting. Although it is difficult to differentiate bipolar and unipolar types of depression due only to depressive symptoms, atypical and manic features in the depressive episode may give some dues to the diagnosis of bipolar disorder. The clinician needs to check carefully evidence of past spontaneous (hypo) mania which is required to diagnose bipolar disorder, because of underreporting or lack of information on the (hypo) manic episodes. Alternatively, some self-reported questionnaires may be also useful in screening patients with bipolar disorder in a primary care practice. Moreover, bipolar disorder commonly has concomitant personality and substance abuse disorders, and is complicated by the presence of one or more comorbid disorders. It is preferable to estimate "bipolarity", especially a family history of bipolar disorder and antidepressant-induced (hypo) mania, from the viewpoint of bipolar spectrum. In the pharmacotherapy of bipolar disorder, mood stabilizer is recommended as a first-line treatment regardless of the types of mood episodes. Despite widespread antidepressant treatment for both unipolar and bipolar depression in a clinical practice, some recent reports suggest that antidepressants are not effective for the treatment of bipolar depression. Considering that antidepressants for bipolar depression may induce a manic switch or rapid cycling, the clinician would have to pay careful attention to the use of antidepressants in bipolar disorder.