九州神経精神医学
Online ISSN : 2187-5200
Print ISSN : 0023-6144
ISSN-L : 0023-6144
66 巻 , 2 号
九州神経精神医学_66_2
選択された号の論文の4件中1~4を表示しています
巻頭言
総説
研究と報告
  • 木下 聰, 神野 哲平, 川原 一洋, 田中 響, 朴 秀賢, 竹林 実
    原稿種別: 研究と報告
    2020 年 66 巻 2 号 p. 49-53
    発行日: 2020/08/15
    公開日: 2021/10/14
    ジャーナル フリー

    The cerebellum is involved not only in the motor function but also in cognition and emotion. Therefore, impairment of the cerebellum is associated with cognitive deficits and affective symptoms in addition to motor deficits, which is known as cerebellar cognitive affective syndrome (CAAS). We herein report a case of psychomotor excitation caused by CAAS in which a multifaceted approach was effective.

    The patient was a 20-year-old woman. She had received surgery for cerebellar astrocytoma in her childhood. She experienced a problem with walking at 18 years of age following emergency surgery for obstructive hydrocephaly, an aftereffect of the surgery for astrocytoma. Since then, her walking problem worsened every time she received surgery for obstructive hydrocephaly, which seriously afflicted her. At 20 years of age, she had severe psychomotor excitation and self-harmed with suicidal ideation during hospitalization in the neurosurgery unit of Kumamoto University Hospital. She was moved to the neuropsychiatry unit and diagnosed with CAAS. Although her psychomotor excitation was ifficult to treat with medication alone, the combination of medication, psychological treatment and environmental coordination was effective. She was then able to move to a rehabilitation hospital.

    In addition to CAAS, psychological and environmental factors were involved in her psychomotor excitation. Therefore, it is considered that medication alone was not effective and that the combination of medication, psychological treatment and environmental coordination, known as the bio-psycho-social approach, was effective for improving the psychomotor excitation caused by CAAS.

  • 宇都宮 和則
    原稿種別: 研究と報告
    2020 年 66 巻 2 号 p. 54-57
    発行日: 2020/08/15
    公開日: 2021/10/14
    ジャーナル フリー

    患者はかかりつけ内科よりうつ状態の治療のために紹介されて来院した。いわゆる空の巣症候群から大うつ病に進展したケースであった。抗うつ薬,精神療法,認知行動療法を中心とした治療で寛解したものの,季節性の増悪,再燃を繰り返したため長期の治療継続が必要になった。経過中に全身倦怠感や易疲労感が出現したが筆者はこれをうつ病に基づく症状ではないと判断した。身体疾患はかかりつけ内科に任せていたが患者はこれらの症状を内科医には全く伝えてなかった。約5ヶ月後には息切れや足のしびれも加わってきた。この時点で患者に内科での精査を指示した。血液検査でビタミンB12欠乏による高度の巨赤芽球性貧血と診断された。ビタミン補充療法が開始され順調に回復し後遺症も残さなかった。かかりつけ内科の診療と重複しないようにと配慮しすぎたために,患者に長期の苦しみを与えてしまった。より柔軟で機能性のある病診連携の構築の必要性を痛感した。

feedback
Top