在宅医療がきっかけで治療に結びついた超高齢発症の遅発パラフレニーの1例  [in Japanese] A case of late-onset paraphrenia in a very elderly patient receiving home medical care  [in Japanese]

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Author(s)

    • 野澤 宗央 Nozawa Motohiro
    • 医療法人松崎病院カームメディカルクリニック広尾 Matsuzaki Hospital Medical Corporation, Calm Medical Clinic Hiroo
    • 水上 勝義 Mizukami Katsuyoshi
    • 筑波大学大学院人間総合科学研究科スポーツ健康システム・マネジメント専攻 Graduate School of Comprehensive Human Science, Faculty of Health and Sports Sciences, University of Tsukuba

Abstract

<p>地域包括支援センターからの連絡で訪問診療を開始し治療に結びついた超高齢発症の遅発パラフレニーの症例を経験した.症例は94歳,女性.被害妄想や幻聴を呈した.近隣と騒音を巡ったトラブルや食思不振などがあり治療が必要だったが,外来受診の拒否が強く自力での通院が困難であったため,訪問診療が開始された.オランザピン2.5 mg/日を使用し改善を認めた.在宅医療では限られた資源と診療時間の中で,より精緻な鑑別診断と治療のアプローチが必要となる.高齢者に幻覚・妄想などの精神症状が出現することは臨床的にはよく知られているが,在宅医療現場では患者・家族やそれに関わる多職種にはよく知られておらず,見過ごされたまま対応に苦慮しているケースも少なくないと考えられる.今後更なる高齢化に伴い,在宅医療でも高齢者の精神疾患に対応しなければならない状況が増加すると推測される.超高齢社会の日本において,地域で高齢発症の遅発パラフレニーをいかに理解し継続支援していくのか,在宅医療・介護の推進にあたっての喫緊の検討課題であると考える.</p>

<p>A 94 year old woman with a late-onset paraphrenia was referred to our clinic from a community care center. The patient showed symptoms of paranoia and auditory hallucination. The patient was in conflict with her neighbors regarding noise-related problems and was experiencing loss of appetite. Because the patient had a strong aversion to outpatient treatment due to difficulty in commuting, home visits were commenced. Improvements were observed after administration of 2.5 mg per day of olanzapine.</p><p>In home medical care, precise definitive diagnosis and determination of treatment approach is necessary under limited time and resources. The fact that elderly people often exhibit psychological symptoms such as hallucinations is well known among clinical professions. However, this is not well known among home care patients, families and other professionals, and, therefore, is often overlooked. As the population ages further, it can be predicted that cases of elderly patients requiring treatment for psychological symptoms will increase in home medical care situations. In Japan, with a super-aging society, understanding and continuously supporting late-onset paraphrenia among elderly people is a pressing issue for all communities in advancing home medical care and nursing.</p>

Journal

  • Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics

    Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 55(4), 675-678, 2018

    The Japan Geriatrics Society

Codes

  • NII Article ID (NAID)
    130007529160
  • NII NACSIS-CAT ID (NCID)
    AN00199010
  • Text Lang
    JPN
  • ISSN
    0300-9173
  • NDL Article ID
    029381075
  • NDL Call No.
    Z19-25
  • Data Source
    NDL  J-STAGE 
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