身体疾患と気分障害(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] Mood Disorder in Medically III(Symposium/Depression-Its Diagnostic Issues and the Knack of Treatment)  [in Japanese]

身体疾患患者は,健常者に比し気分障害を高率に併存する.一般診療科を受診する気分障害患者は,身体症状を訴えるが,精神症状については訴えることが少ないことから,診断が困難な場合がある.さらに基礎疾患の症状とうつ症状が類似していることも多く,ていねいな医療面接を行い注意深く観察することが必要である.また気分障害を併存する場合,基礎疾患に伴う症状以外に多くの症状を有する.基礎疾患と乖離する身体症状を認めた場合には,他の疾患の合併を疑い検索すると同時に,うつ症状を適切に認知し慎重に判断する必要がある.基礎疾患の示す検査所見とうつ症状の程度が関連することもあり,身体管理には検査成績の変化とともにうつ症状についても注意を要する.適切な身体医学的な治療にもかかわらず,改善の乏しい場合,治療困難を感ずる場合,またQOL障害の低下が予想以上である場合には気分障害の併存について検討を要し,状況の応じて専門医と連携を図り,包括的診療を行う.

Patients with medical illness have a markedly higher rate of comorbid mood disorder than healthy people. However, diagnosis can be difficult as patients with mood disorders will report physical symptoms when examined at regular medical institutions, but rarely mention psychological symptoms. In many cases, the symptoms of the primary illness and those of depression are similar, and thorough medical interviews and careful observation are required. Furthermore, in cases of comorbid mood disorder, many symptoms aside from those of the primary illness are present. If physical symptoms unrelated to the primary illness are observed, it is necessary to be sufficiently aware of the possibility of depression and to make a careful evaluation while also considering and searching for other comorbidities. There may be a relationship between laboratory findings indicating the primary illness and the degree of depression; therefore, for physical management, attention must be paid to depression as well as changes in examination findings. If improvement is poor, patients experience difficulty in treatment. Furthermore, if QOL decreases more than expected despite appropriate medical physical therapy, it is necessary to consider comorbid mood disorder, and depending on the situation, coordinate with medical specialists and perform comprehensive diagnosis and treatment.