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、「嫉妬妄想」という症状について解説していきます。
嫉妬妄想とは
嫉妬妄想(しっともうそう)とは、「配偶者やパートナーが不貞をはたらいている」と誤って確信してしまう妄想のことを言います。
「浮気をしている」などと思い込み、それを周囲が修正しようとしても思い込みを変えることができなくなってしまいます。
エスカレートすると、配偶者に対して暴力行為に及んだり、逆に嫉妬された側が疲弊して関係が著しく悪化してしまうなど、夫婦関係に大きな亀裂をもたらしてしまいます。
嫉妬妄想がみられる病気
嫉妬妄想がみられる病気のうち、主なものをいくつか紹介します。
認知症
嫉妬妄想がみられることが多い病気の一つに、「認知症」があります。
認知症では、様々な妄想が出現することがあり、嫉妬妄想もその一つです。
「認知症患者の嫉妬妄想治療ガイドライン」によると、レビー小体型認知症の患者さんは特に嫉妬妄想のリスクが高いと記されています。
このガイドラインによると、こうした背景には、配偶者への劣等感が妄想の原因になっているのではないかと考察されています。
アルコール依存症
アルコール依存症の患者さんでは、長期間のアルコール依存によりアルコール精神病といわれる幻覚妄想状態になることがあります。
このアルコール精神病では、嫉妬妄想が生じやすいことが有名です。中にはアルコールによって抑制がはずれた状態となり、配偶者に暴行を及んでしまうケースもあります。
妄想性障害
妄想性障害は、妄想を主症状とする精神病の一つです。
妄想性障害には起こりやすい妄想によっていくつかのタイプがあり、その中に「嫉妬型」といって嫉妬妄想を認めることがあります。
統合失調症
統合失調症は、幻覚・妄想を主症状とする病気です。
妄想がメインの妄想性障害と異なり、妄想だけではなく幻聴やまとまりのない言動、陰性症状など、様々な症状が出現してきます。
こうした幻覚妄想症状のひとつとして、統合失調症で嫉妬妄想を認めることがあります。
嫉妬妄想の治療
薬物療法
嫉妬妄想は様々な病気で起こってくるため、その治療方針は病気によって異なります。
認知症の場合は、認知症のタイプに応じて抗認知症薬(認知症の進行を遅らせたり、認知症の症状を和らげる薬)が有効なことがあります。
また抗精神病薬といって、おもに統合失調症の治療に用いられる薬が効果を発揮することもあります。妄想性障害や統合失調症の場合は、こうした抗精神病薬を用いることが多いでしょう。
アルコール多飲の患者さんの場合は、飲酒量を減らしたりやめたりすることも大事な解決策になってきます。
非薬物療法
嫉妬妄想は、元をたどってみれば不安感や劣等感などがもとにあり、それが強まり確信に変わることで妄想という結果になってしまうことがあるといわれます。
そのため、元にある不安や劣等感にアプローチすることで妄想の改善に効果をもたらす可能性があります。つまり、本人が嫉妬や不安を覚えにくいよう工夫するということです。
「認知症患者の嫉妬妄想治療ガイドライン」では、例として、パートナーの単独での外出を減らす、患者本人に何らかの役割を与える、などの工夫が挙げられています。
おわりに
嫉妬妄想とは、配偶者が不貞をしていると思い込んでしまう妄想。
認知症やアルコール依存症、妄想性障害や統合失調症などでみられることがある。
治療は原疾患に応じて、薬物療法や非薬物療法を試みる。
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【精神科医が解説】嫉妬妄想とはどのような症状?どのような病気でみられる? – みらいメンタルクリニック
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