著者

和迩 健太 WANI Kenta

出版者

川崎医学会

雑誌

川崎医学会誌 = Kawasaki medical journal (ISSN:03865924)

巻号頁・発行日

vol.43, no.1, pp.43-55, 2017

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近年,職場ストレスにより抑うつ状態をはじめ心身の不調を来し休職したり,学校や社会に不適応を起こし不登校,ひきこもりになったりする適応障害患者が増えている.診断基準上,適応障害を引き起こす要因であるストレスの大きさは問われないが,一方でどのような人が適応障害になりやすいかという研究はこれまでない.本研究では,適応障害患者に対する成人用Wechsler 式知能検査第3版(Wechsler Adult Intelligence Scale Third Edition; WAIS-Ⅲ)の所見と臨床的特徴からそれらを検討した. 適応障害と診断されWAIS-Ⅲを施行された患者50名(14歳~48歳,男性29名,女性21名)を対象とした.IQ が70未満の精神遅滞と診断された者は除外した.臨床評価として,初診時年齢,発症年齢,精神主訴の有無,身体主訴の有無,初診時における社会参加の有無,初診時GAF(Global Assessment Scale)を用いた.WAIS-Ⅲは言語理解(Verbal Comprehension; VC),作動記憶(Working Memory; WM), 知覚統合(Perceptual Organization; PO), 処理速度(Processing Speed; PS)の4つの群指数に分類される.対象者を群指数パターンによってクラスタ分析を行った. その結果,3つのクラスタパターンに分類された.群指数に関しては,クラスタ1はWM がVCとPS よりも有意に低く,クラスタ2はPS がVC とWM よりも有意に低く,クラスタ3はPS がVC,WM,PO よりも有意に低かった.また,IQ に関しては,クラスタ3> クラスタ1>クラスタ2の順に高くそれぞれ有意差が認められた.クラスタ間の臨床的特徴を検討したところ,クラスタ3は身体主訴が有意に少なかったが,他の項目で有意差は認められなかった.さらに,対象者全体で見ると,GAF とWM において正の相関が認められた. 以上から,適応障害患者においてはWM とPS という認知機能低下が認められる可能性があり,特に社会適応の観点からWM に注目して診療を行うことが大切であると考えられた.Recently, there has been an increase in the number of patients with adjustment disorder (AD) who are absent from work or school. Such patients often withdraw from active social life because of a depressed mood and psychosomatic symptoms caused by workplace stress or maladjustment to their social environment. The diagnostic criteria for AD do not account for the level of stressful life events, and evidence regarding the association of cognitive features with the extent of maladjustment and clinical characteristics of AD is scarce. In this study, we examined the association between cognitive characteristics assessed with the Wechsler Adult Intelligence Scale-Third Edition (WAIS-Ⅲ) and clinical features in patients with AD.In this study, we included 50 patients with AD who completed the WAIS-Ⅲ (29 men and 21 women, age range: 14-48 years old). Patients with a diagnosis of mental retardation and an IQ less than 70 were excluded. At the initial visit, the following clinical features were measured: age at initial visit, age of onset, the presence of mental and/or somatic symptoms, social participation, and Global Assessment of Functioning (GAF) scale score. The WAIS-Ⅲ consists of four index scores: verbal comprehension (VC), working memory (WM), perceptual organization (PO), and processing speed (PS). Participants were classified into three groups by cluster analysis according to their WAIS-Ⅲ index score profiles.In Group 1, the WM index was significantly lower than both the VC index and PS index, whereas, in Group 2, the PS index was significantly lower than the VC and WM indices. Meanwhile, in Group 3, the PS index was significantly lower than the VC, WM, and PO indices. Group 3 had significantly higher full-scale intelligence quotient (FIQ) scores than did both Groups 1 and 2, while Group 1 had significantly higher FIQ scores than did Group 2. In addition, the proportion of patients who had somatic symptoms in Group 3 was significantly lower than that in Groups 1 and 2. In the analysis of all participants, we observed a positive correlation between GAF scores and the WM index.In conclusion, patients with AD are thought to have impairments in both WM and PS. We suggest that evaluation of AD from the perspective of WM might be useful to better understand a patient's social maladjustment.