Language：English   Publishing type：Research paper (scientific journal)   Publisher：Dove Medical Press Ltd.  

Many emotional disturbances such as post-stroke depression (PSD) and emotional incontinence (EI) commonly occur following cerebrovascular events. The efficacy of antidepressants for these conditions has been established but their comorbid treatment has not been well characterized. In the current study, the authors describe two cases of post-stroke emotional dysregulation
one case with EI
and the other with EI complicated by PSD. The authors describe their differential responses to treatment. Case 1 developed EI after an infarct due to occlusion of the penetrating branches of the left middle cerebral artery (MCA). Case 2 developed both PSD and EI after right MCA stem occlusion. Both patients were initially treated with the selective serotonin reuptake inhibitor (SSRI) paroxetine. Case 1 reacted promptly to SSRI treatment. However, Case 2 had only a partial response to paroxetine, even after many months of treatment. Adjunctive therapy with low-dose aripiprazole was eventually added, resulting in complete improvement of both EI and PSD after 2 additional months of treatment. Thus, Case 2 required a different treatment strategy than Case 1. These findings suggest that aripiprazole adjunctive therapy could be effective for some complex post-stroke emotional disorders. © 2014 Shimoda and Kimura.

DOI： 10.2147/NDT.S63290

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：DOVE MEDICAL PRESS LTD  

Many emotional disturbances such as post-stroke depression (PSD) and emotional incontinence (EI) commonly occur following cerebrovascular events. The efficacy of antidepressants for these conditions has been established but their comorbid treatment has not been well characterized. In the current study, the authors describe two cases of post-stroke emotional dysregulation; one case with EI; and the other with EI complicated by PSD. The authors describe their differential responses to treatment. Case 1 developed EI after an infarct due to occlusion of the penetrating branches of the left middle cerebral artery (MCA). Case 2 developed both PSD and EI after right MCA stem occlusion. Both patients were initially treated with the selective serotonin reuptake inhibitor (SSRI) paroxetine. Case 1 reacted promptly to SSRI treatment. However, Case 2 had only a partial response to paroxetine, even after many months of treatment. Adjunctive therapy with low-dose aripiprazole was eventually added, resulting in complete improvement of both EI and PSD after 2 additional months of treatment. Thus, Case 2 required a different treatment strategy than Case 1. These findings suggest that aripiprazole adjunctive therapy could be effective for some complex post-stroke emotional disorders.

DOI： 10.2147/NDT.S63290

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Language：Japanese   Publisher：Japanese Society of General Hospital Psychiatry  

To optimize the effectiveness of electroconvulsive therapy (ECT) for the treatment of mood disorder or psychosis, it is essential to induce adequate seizures at stimulus intensity above "therapeutic threshold," which means 50% to 150% above seizure threshold in bilateral electrode placement. When only inadequate seizures including missed or abortive ones are induced at a maximum intensity, augmentation of seizure induction is necessary. The authors report three patients with depression and bipolar disorder who received a course of acute ECT with bifrontal electrode placement. After only inadequate seizures were produced at their sessions, switching anesthetic (to thiamylal from propofol), using flumazenil as preanesthetic medication and administering oral sustained-released theophylline (200mg) the night before ECT, respectively, successfully augmented seizures as adequate. No adverse effects were observed in all cases. There have been only a few reports on augmentation of seizure induction in Japan, while a number of studies have been conducted mainly in America. No reports on theophylline augmentation from Japan can be found. According to APAs ECT Task Force Report, these augmentation methods remain controversial in their effectiveness. However, our cases suggest that the augmentation may be effective and safe. Moreover, not a few psychiatrists in Japan still tend to believe "The longer the seizure duration, the more effective the ECT." We emphasize that the aim of augmentation is not to induce motor seizures or prolong seizure duration, but to induce adequate seizures, which should be judged mainly by electroencephalogram during ECT.

DOI： 10.11258/jjghp.22.153

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Other Link： http://search.jamas.or.jp/link/ui/2011113359

Language：Japanese   Publisher：The Medical Association of Nippon Medical School  

DOI： 10.1272/manms.4.210

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.47.1_53_3

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.47.4_292_3

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.47.4_294_2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：4  

Objective: As the prevalence of white matter hyperintensities detected on T 2 weighted MRI scans in patients with late-onset depression is higher than that in nondepressed patients, the concept of "vascular depression" (VDep) was introduced in 1997. However, the pathology of vascular depression has not been clarified. This study examined the differences in functional imaging between vascular and non-vascular depression (non-VDep). Methods: We utilized 123I-IMP single photon emission computed tomography (SPECT) to compare regional cerebral blood flows (rCBF) between 9 patients with VDep (Krishnan criteria) and 11 age- and sex-matched patients with non-VDep in both depressed and remitted states. Results: In both VDep and non-VDep patients, mean rCBF increased significantly as depression improved, partially aided by changes in left anterior temporal blood flow. In addition, compared to non-VDep patients, the left anterior frontal rCBF for VDep patients was significantly lower in both depressed and remitted states. Conclusions: Left anterior temporal rCBF therefore appears to represent a state marker that increases as symptoms associated with late-onset depression improve. regardless of vascular changes. Furthermore, in VDep patients, left anterior frontal rCBF was low in both states compared to non-VDep patients, and might not only represent a trait marker, but also correlated with the duration of disease and likelihood of recurrence and relapse.

DOI： 10.1272/jnms.70.321

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Language：Japanese   Publisher：Japanese Society of Psychosomatic Medicine  

Cenesthopathy is characterized by bizarre or strange sensations at various parts of the body, and it is not rare at the oral area (oral cenesthopathy). In such cases, the patients seek dentists for medical care, but will mostly fail to find any causes of the disease. It is also difficult for psychiatric treatments to reduce their sufferings from various symptoms. Although the relationships between cenesthopathy and some psychological factors have often been pointed out, there have not been the systematic researches in this field yet. In this study 13 cases of oral cenesthopathy (1 male, 12 females) were examined with the use of the Rorschach test, which is one of the well-known projective methods for exploring personality. The results were as follows. Eight of 13 cases were positive for the CDI (Coping Deficit Index), which indicates social immaturity or ineptness. They are limited in social skills and are vulnerable to problems in coping with the requirements of everyday living, and therefore more vulnerable to losing control of problems than others. Moreover, almost all of them are unable to express proper feelings, because of their poor emotional control. As to the cognitive activities, the limited information processing is likely to lead to their dysfunction in translating stimuli and it will be reflected into problems in reality testing. But no evidence was found to identify those problems in ideational clarity or bizarre thinking.

DOI： 10.15064/jjpm.43.9_599

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Other Link： http://search.jamas.or.jp/link/ui/2004019805

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO  

This study was undertaken to examine the prevalence of sexual dysfunction among 100 patients (75 men and 25 women) following stroke and its relationship to neuropsychiatric impairments or stroke characteristics. Forty-four men (58.6%) and 11 women (44.0%) reported dissatisfaction with their sexual functioning after stroke, as compared with only 16 men (21.3%) and five women (20.0%) before stroke. Twenty men (26.6%) end six women (24.0%) reported diminished libido after stroke as compared with eight men (10.6%) and seven women (28.0%) before stroke. Patients with sexual dysfunction had significantly more depressive symptoms among both males (P =.007) and females (P =.0005) and more impaired activities of daily living (ADL) in males (P =.0009). Based on logistic regression, the independent predictors of poststroke sexual dysfunction were Hamilton Rating Scale for Depression (HAM-D) score (odds ratio [OR] 1.55; 95% confidence interval [CI], 1.20 to 2.01), left hemisphere lesion (OR, 16.51; 95% CI, 2.34 to 116.25), and poststroke depression (OR, 8.09; 95% CI, 1.28 to 51.38), These data suggest that treatment of depression may have a significant beneficial effect on patients with sexual dysfunction, Our findings also suggest that left hemisphere lesions, for unknown reasons, play an important role in poststroke sexual dysfunction. Copyright (C) 2001 by W.B, Saunders Company.

DOI： 10.1053/comp.2001.23141

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.41.4_304_1

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.41.supplementII_144_2

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.41.supplementII_145_1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background: We have previously reported that during the acute poststroke period, poststroke major depression was significantly associated with left anterior lesions. Furthermore, we found that proximity of the lesion to the left frontal pole was correlated with severity of depression. Several investigators, however, have failed to replicate these findings when patients were studied beyond the acute stroke period.
Methods: We longitudinally examined the relationship between lesion size, lesion location, impairment variables, and the presence and severity of depression in 60 single lesion patients examined in-hospital and at short-term (3-6 months) and long-term (1-2 years)follow-up.
Results: Only in-hospital depression was significantly associated with left anterior hemisphere lesion location. At short-term follow-up, proximity of the lesion to the frontal pole, and lesion volume correlated with depression in both right and left hemisphere. At 1-2 years poststroke, depression was significantly associated with right-hemisphere lesion volume and proximity of the lesion to the occipital pole,
Conclusions: The anatomical correlates of poststroke depression change over time and may explain interstudy differences in the association of lesion location with poststroke depression. (C) 1999 Society of Biological Psychiatry.

DOI： 10.1016/S0006-3223(98)00178-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Publishing Company  

Prior studies have identified that quality social functioning is strongly associated with both physical and cognitive recovery from stroke as well as with the existence of depression. This study was undertaken to identify the specific elements of social functioning that are related to depression and impaired recovery and to determine whether these elements are different between acute and chronic periods following stroke. There were 50 patients with acute stroke who were assessed in the hospital and at short- term (3- or 6-month) and long-term (12- or 24-month) follow-up. An impaired relationship with the patient's 'closest other' prior to the stroke and limited social activities were both associated with depression immediately after the stroke as well as with depression at long-term follow-up. An impaired relationship with the closest other prior to the stroke was also associated with impaired recovery in activities of daily living and cognitive recovery at long-term follow-up. Fears of economic stability and limited social activity were associated with depression at short-term follow-up whereas loss of job or job satisfaction was associated with depression at long-term follow-up. These findings suggest that during the first few weeks following stroke, social supports and contact are essential needs for patients, whereas during the chronic period, other factors such as financial security, adequacy of living arrangements, and loss of job satisfaction also become important. Future research should examine the effect of enhanced social support on poststroke depression and physical and cognitive recovery.

DOI： 10.1017/S1041610299005992

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DOI： 10.1176/jnp.10.1.34

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：2  

The EFFECT of social functioning and depression on recovery from stroke was examined in 142 patients with acute stroke who were followed over 2 years. Examinations included a semistructured mental status examination, the Social Functioning Examination (SFE) and diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom criteria for major and minor depressive disorders. At short-term follow-up (3 to 6 months), both impairment in social functioning and depression were related to impaired recovery in activities of daily living and cognitive functioning. On the other hand, at long-term follow-up (1 to 2 years), only depression influenced recovery from physical impairment. In addition, we found no significant interaction between depression and social impairment on activities of daily living or social functioning. These data suggest that both depression and impaired social function have independent negative effects on physical recovery from stroke. These data also suggest that treatment of depression as well as early psychosocial intervention may play an important role in the quality oflife after acute stroke. © 1998, Taylor &amp
Francis Group, LLC. All rights reserved.

DOI： 10.1521/00332747.1998.11024821

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Language：Japanese   Publisher：一般社団法人 日本心身医学会  

DOI： 10.15064/jjpm.34.8_691_3

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Total pages：48  

ASIN

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Language：Japanese   Publisher：(株)先端医学社  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J05863&link_issn=&doc_id=20210216190001&doc_link_id=%2Fae6depsd%2F2020%2F001004%2F001%2F0001-0003%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae6depsd%2F2020%2F001004%2F001%2F0001-0003%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)ワールドプランニング  

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＜Points＞▼脳血管障害に伴うせん妄では急性期、亜急性期、慢性期においてそれぞれ異なるアプローチを要するが、明確な指針は乏しい。▼急性期においては、原疾患の病状把握のためにも安易な鎮静は避けるべきであるが、せん妄による精神運動興奮がカテコラミンの放出を促し、病勢に深刻な悪影響を与える場合にはやむおえず鎮静を要する場合もある。▼急性期、亜急性期においてはせん妄治療のための薬剤の副作用による原疾患への悪影響に特に注意する。▼慢性期には後遺症としての人格変化や行動障害とせん妄との鑑別が重要である。低活動型のせん妄を脳卒中後のうつ状態やアパシーと区別することにも留意する。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01465&link_issn=&doc_id=20200610220014&doc_link_id=%2Fan1yakgl%2F2020%2F006208%2F017%2F1586-1590%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fan1yakgl%2F2020%2F006208%2F017%2F1586-1590%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(有)フジメディカル出版  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J05808&link_issn=&doc_id=20200526230006&doc_link_id=%2Fal1demud%2F2020%2F001002%2F007%2F0084-0086%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fal1demud%2F2020%2F001002%2F007%2F0084-0086%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05863&link_issn=&doc_id=20191202400005&doc_link_id=%2Fae6depsd%2F2019%2F000903%2F005%2F0013-0016%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae6depsd%2F2019%2F000903%2F005%2F0013-0016%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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DOI： 10.18936/islis.36.2_111

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Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1405205615

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：国際生命情報科学会 ISLIS本部  

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Language：Japanese   Publisher：(株)ワールドプランニング  

超高齢社会のなかでうつ病や脳血管障害による心理的および社会経済学的損失は重要な問題である。このような背景から、うつ病と血管性認知症は予防的側面が重視され、両者は脳血管障害を基盤とする疾患と広義に解釈される方向にあるが、課題も多い。血管性認知症は頻度が高く、さまざまな精神症状を呈するため、適切な認識と治療が重要であるが、脳卒中後の臨床研究からの引用が多く、今後、独自の研究報告の発展が必要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(有)フジメディカル出版  

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Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(株)全日本病院出版会  

睡眠障害は国民病とまでいわれ、生活習慣病の悪化などの健康上の問題や社会経済学的損失を招くため、その対策が急務となっている。脳卒中と睡眠障害は双方向性に密接な関連があり、睡眠障害は発症や予後にかかわる重要な因子である。睡眠障害は不眠症だけでなく、下位分類では様々な種類のものが存在するが、本稿では脳卒中後に出現する睡眠障害について、不眠症そして不眠症に伴むうつ病やせん妄の問題、過眠症、睡眠関連呼吸障害を取り上げ、臨床上診断のポイントとなる点をまとめた。さらに、脳卒中危険因子としての睡眠障害として、睡眠時の無呼吸(apnea)や低呼吸(hypopnea)によって特徴付けられる閉塞性睡眠時無呼吸(obstructive sleep apnea;OSA)に注目した。脳卒中治療にかかわるスタッフは、患者の睡眠にも注目すべきであり、そのためには睡眠障害に関する幅広い知識と適切な観察および評価すべきポイントの把握が望まれる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

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Language：Japanese   Publisher：(株)星和書店  

血管性うつ病にアパシーが合併した72歳女性の症例を報告した。3年前に夫が脳梗塞で倒れ、介護のための環境の変化や妹の他界など予想しないことが重なり、易疲労感や無力感を感じるようになった。2年前に近医精神科クリニックを受診し、ストレスによるうつ状態と診断された。通院し、sulpiride 150mgなどの内服を続けていくうちに症状の改善が見られたが、薬剤性のパーキンソン症候群が疑われる症状が出現した。かねてよりうつ病ではなく認知症ではないかと懸念していた長女に連れられA総合病院の精神科を受診した。治療方針を決定する前に、脳血管障害という器質的脆弱性が背景の影響の強い血管性うつ病では器質因による他の病態の合併も考えられたため、やる気スコアでアパシーを評価した。血管性うつ病に加えてアパシーを併発していると考えられる状況であり、A総合病院受診時には、アパシーが優勢な病状であった。ドパミンagonistであるpramipexoleを用いて加療したところで改善が見られた。

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抗うつ薬治療に抵抗性を示していた65歳の女性の老年期うつ病患者に対して電気けいれん療法(ECT)後の増強療法が効果的であった症例を報告した。2年前に夫が認知症となり、夫の介護疲れから抑うつ気分、不眠、食欲不振、不安焦燥感、自責感を認めるようになり、近医メンタルクリニックを受診した。うつ病の診断で処方をされたが改善を認めず、日本医科大学千葉北総病院メンタルヘルス科に初診となった。夫の介護を契機として発症した難治性内因性うつ病であり、選択的セロトニン再取り込み阻害薬(SSRI)、セロトニン、ノルアドレナリンなどを使用しても寛解せず、三環系抗うつ薬(TCA)に変更した。しかし、TCAは副作用により減薬となった。そこで修正型電気けいれん療法(mECT)を10回まで施行したが、効果は限定的で、最終的には増強療法としてTCAであるamoxapineに抗精神薬であるaripiprazole 3mgを加え、6mgまで増量したところ、寛解に至った。

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Language：Japanese   Publisher：(株)星和書店  

ディスチミア親和型うつ病の35歳男性の症例を報告した。29歳頃から介護職の職場の対人関係に悩み、抑うつ気分、不安焦燥感、意欲低下などを自覚し、近医メンタルクリニックを受診し、うつ病の診断で休職し、投薬を受けた。2ヵ月の休職と通院により症状が軽快したが、復職リハビリテーション開始後、1度の出勤で就労困難となり、30歳時に介護職を退職した。症状の改善を認めず、31歳時に紹介で転院した。入院を希望したため入院となり、DSM-IV-TRの大うつ病性障害の診断基準を満たさず適応診断と診断した。薬物調整により、軽快し、2週間で退院となった。しかし、33歳、34歳と入院を繰り返す状態となった。本症例は人間関係の悩みを契機として発症した二重うつ病と呼ばれる気分変調症に大うつ病性障害が重なっており、薬物療法への反応が限定的で、本人にも「内服と環境の調整で半分ずつ治療していきましょう」と説明した。退院はしたが、就労はできず引きこもりがちの生活を続けることとなった。

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Language：Japanese   Publisher：(一社)日本総合病院精神医学会  

日本総合病院精神医学学会(JSGHP)会員の認知症治療の実態と課題を明らかにする目的で2012年3月に認知症診療に関するアンケート調査を実施した。87施設(総合病院42施設、大学病院24施設、精神科病院8施設、精神科診療所13施設)から回答を得た。認知症の主たる診療科は精神科86.2%、神経内科44.8%、脳神経外科5.7%、内科5.7%が担っており、認知症診療を行っていないとした施設は4施設であった。回答のあった87施設中認知症疾患医療センターの機能を有するのは10施設であった。「認知症診療を行う上での問題点と課題」について自由記載によるアンケート結果を整理したところ、専門医療機関の負担、BPSDへの対応、連携・教育の必要性、その他重度認知症への対応などについて意見があげられた。回答を得た大学病院・総合病院の65歳以上の入院における他科からのコンサルテーションにおいて、いずれも40%以上が認知症であった。

DOI： 10.11258/jjghp.25.171

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Language：Japanese   Publisher：長寿科学振興財団  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2013246469

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：フジメディカル出版  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2011252647

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：BLACKWELL PUBLISHING  

Web of Science

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2007325235

Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2005097937

Language：Japanese   Publisher：ワールドプランニング  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2005048463

Language：English   Publisher：(一社)日本総合病院精神医学会  

35例の対象は初めてECTを受け,全例が緩解した(完全緩解92%,部分緩解8%).ECT後の1年間の経過観察中に12例(34%)が再発した.再発の殆どがECT治療後数ヵ月間で起こり,再発した症例のうち25%は2ヵ月以内に,75%は4ヵ月以内に,92%は6ヵ月以内に再発した.平均再発期間は4ヵ月であった.再発群は非再発群と比較して,女性であること,高齢であること,高齢発症であることに有意差があった.再発群12例についてその後1年ごとに経過観察したところ,平均再発期間3ヵ月で全例が再発(2回目のエピソード)し,ECTを受けた.ECT後のHRSDの平均得点は初めのエピソードと比較して有意に高く,緩解率は低下した.更にこれに引き続き経過観察のできた8例は再び再発(3回目のエピソード)しECTを受けたが,ECT後のHRSD平均得点は初回,2回目のエピソードより高くなり,緩解率は更に低下した

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2002219581

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口腔内異常感覚を訴える狭義のセネストパチー(CP)8例(A群)と,大鬱病を伴なう広義のCP5例(B群),大鬱病9例(C群)を対象に検討した.C群と比べA群では左右視床と右前部帯状回で有意に高い局所脳血流量(rCBF)を示し,B群では左視床で高いrCBFを示した.A,B群間にはrCBFの有意差を認める部位はなく,左右視床と右前部帯状回の機能変化がCP症状の出現に関与している可能性が示唆された.狭義及び広義のCPに認められた視床領域,特に左視床の所見はCP症状と密接に関連していると考えられたが,今後,正常対照群との検討が必要である

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高齢者虐待4例を報告した.被害者はADLは自立していたが家族に依存せざるを得ない生活状況にあった.虐待加害者の言動と態度により緊張感,恐怖感,うつ症状,身体症状の悪化を認めたが理解者の死去や不在のため相談できず,また,責任感の強い性格傾向と抑圧された感情から虐待を報告できなかった.加害者は同居の主介護者で身体的虐待2例の加害者は精神的脆弱性を有していた.弱者・依存者となった高齢者に対し,過去から蓄積された緊密関係,老親子間の未解決の葛藤と歪んだ相関関係から,蔑視意識,嫌悪感,差別意識が強まり,家族内において高齢者の存在は空虚化・希薄化した.このため加害者の虐待認識の欠如と家族成員の虐待に対する問題意識の欠如から,家庭内に加害者は拡大していき,結果として虐待の発見が困難になったと考えられた.以上より,虐待の原因として介護ストレス以外の要因が考えられた

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