はじめに
こんにちは。精神科医として心の健康に関する情報を発信している、精神科医ブロガーのやっくん(@mirai_mental)です。
今回は、「注察妄想(ちゅうさつもうそう)」という用語について解説していきます。
注察妄想とは
「注察妄想」とは、精神科の用語の一つです。妄想(事実ではないことを思い込んでしまい修正できないこと)のうち、被害妄想と呼ばれるものの一種になります。
どのような妄想かというと、「注察」されること、つまり「誰かに見られている」「見張られている」と言った考えを持つタイプの妄想になります。
例えば実際によくあるケースでは、以下のような訴えが聞かれることがあります。
「隣の住人がカメラで私を監視している」
「電車に乗ると客が私のことを見てくる」
「注察妄想」がみられる病気の例
「注察妄想」が見られる病気のうち、最も有名なものは、「統合失調症」です。
統合失調症では幻覚や妄想と言った病的な体験(陽性症状)が起こることがあり、被害妄想や幻聴などがよく見られます。
統合失調症の患者さんでは、「家の外で人が見張っている」「カメラで監視されている」などと訴えて自宅から出られなくなったり、窓を塞いでしまうなどの行動をとることがあります。
精神科医は、こうした現象を「行動化」と言ったりします。妄想がある場合に、実際にそれに左右されて行動に移してしまうと悪い結果につながりかねません。
他にも、統合失調症と類似した病気に「妄想性障害」(妄想が主な症状となる病気)があります。
統合失調症は比較的若い世代に見られる病気ですが、認知症に伴う症状として、こうした妄想が出現することもあります。こうした場合は、認知症に伴う症状なのか、発症の遅い統合失調症なのか見分けが難しい時があります。
注察妄想に対する治療
先ほどお話ししたように、「注察妄想」は統合失調症や妄想性障害などの病気で起こることが多いです。
これらの病気に効果が期待できるのが、「抗精神病薬」というお薬です。抗精神病薬は妄想や幻聴などの統合失調症の症状に効果が見られ、日本でも保険で承認されている薬が何種類もあります。
薬物療法を行なっても妄想が完全に取りきれないこともあります。
このような場合も、実際に行動化に及び患者さんに不利益が起こってしまうことのないよう、距離が取れるように治療をおこなっていきます。
おわりに
「注察妄想」という用語について解説しました。以下が内容のまとめです。
- 「注察妄想」は被害妄想の一つで、他人から見られたり見張られたりする妄想のこと。
- 統合失調症や妄想性障害などの病気で見られることが多い
- 抗精神病薬が有効なことがある
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