抄録
Hypertension is demonstrated to be the most commonly associated medical diagnosis in panic disorder, though the nature of the observed association is not clear. The case reported here is the clinical course of a patient with panic disorder and hypertension whose diastolic blood pressure was ultimately normalized as his QOL (quality of life) improved.Miled hypertension was observed during a six year course of psychiatric therapy for panic disorder with agoraphobia in this 32 year old unoccupied male with a family history of essential hypertension. When he first visited our hospital complaining of tachycardia and chest disomfort, his blood pressure was 170/100mmHg. He had been evaluated as hypertensive for three years. though he hadn't taken the prescribed antihypertensive drugs. Laboratory findings excluded possible secondary forms of hypertension. Retinal change was Scheie H_<1>S_<2> stage, and no left ventricular hepertrophy was demonstrated in the echo cardiogram. Laboratory findings showed mild liver dysfunction and elevation of uric acid, both of which came in normal range within 6 months. Obesity (+23%) and increased alcohol intake for selftreatment was observed. General antihypertensive education such as reduction of sodium intake, exercise and control of obesity, as well as pharmacological therapy withβ-blocking agents, a diuretic, benzodiazepiness and a tricyclic antidepressant were administered. The patient was also given in vivo desensitization for agoraphobia. After the agoraphobia was controled and anxiety was reduced, however, diastolic blood pressure did not decrease sufficiently to reduce the dose of antihypertensive drugs. In this situation, the patient was not impaired in evryday life, but he was dissatisfied with his inability to perform social roles, and especially inability to find an appropriate job. His problem was having unrealistically high achievement motives which had led him to constant dissatisfaction and low self esteem. After brief psychotherapy, he becaom more realistic, and interparsonal relationships also improved. He applied for an appropriate job and was employed. As he proved to be capable on the job, his self esteem heightened, satisfaction with life increased, and his QOL improved remarkably. This led to his high psychological well-being, and eventually diastolic blood pressure settled in the normal range and no more antihypertensive medication was needed. This case suggests that it is better not to view a patient as having either a medical or a psychiatric illness but to see him as a whole including physical, phychological and social characteristics. Aiming at improving his characterictic QOL will in itself have a therapeutic effect which leads to favorable outcome. QOL improvement is recommended for inclusion in the therapeutic plan to heighten the efficacy of treatment.
