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> 臨床精神医学講座 S6巻外傷後ストレス障害 (PTSD)

臨床精神医学講座 S6巻外傷後ストレス障害 (PTSD)

出版社：	中山書店
著者：	中根允文(責任編集) 飛鳥井望(責任編集) 松下正明(総編集) 浅井昌弘(編集) 牛島定信(編集) 倉知正佳(編集) 小山司(編集) 中根允文(編集) 三好功峰(編集)
発行日：	2000-03-31
分野：	臨床医学：内科 > 精神医学
ISBN：	9784521492919
電子書籍版：	2000-03-31 （第2刷）

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PTSDは、災害によるトラウマを原因とするばかりでなく、暴力犯罪、性暴力、虐待、交通事故など、外傷的神経ショックを伴うあらゆる出来事を契機に起こりうる精神障害です。しかし、その研究の歴史は20年を超えておらず、関心の高さゆえの混乱も多いようです。本書は、研究先進国アメリカの執筆者をまじえ、PTSDとよばれる以前の歴史から今日までの研究成果を余すところなく収めた、わが国初の基準書です。

表紙
本巻の執筆者
目次
総論
I. 精神科診断学体系におけるPTSD概念の位置づけ
1. PTSDの歴史
a. トラウマ概念の歴史的変遷
b. 米国におけるPTSD研究の歴史
c. わが国におけるトラウマ関連研究の歴史
2. PTSDの診断基準
a. DSMシステムにおけるPTSD診断基準
b. ICDシステムにおけるPTSD診断基準
3. PTSD概念のもたらした意義と問題点
a. 災害精神医学への関心の喚起
b. 被害者の権利とニーズの認知の拡大
c. PTSD概念の革新性と混乱
d. bio-psycho-socialモデルとしてのPTSD
e. PTSDのcomorbidity
II. biopsychosocialモデルとしてのPTSD
1. PTSD概念の意義
2. 心的外傷 (トラウマ) とは
3. ストレッサー強度, 危険因子, 防御因子
a. 出来事のストレッサーとしての強度
b. 性
c. 遺伝的素因
d. 精神疾患の既往
e. 性格傾向
f. 過去の心的外傷歴
g. 養育環境と知的レベル
h. 心的外傷体験時の精神麻痺と解離体験
i. 防御因子
4. 神経生物学的要因
a. 自律神経系反応
b. 視床下部-下垂体-副腎皮質系機能の異常
c. 海馬の萎縮
d. 心的外傷イメージと記憶
e. PTSDの生物学的メカニズムとしての神経ネットワーク
f. 神経生物学的所見のもつ意味
5. 心理的要因
a. 情動処理過程 (Rachman)
b. ストレス反応症候群 (Horowitz)
c. 恐怖構造 (Foa)
d. ストレッサーに対する評定と対処行動
e. コントロール部位
f. 罪責感
6. 社会的要因
a. 社会による評価の影響
b. ソーシャル・サポート
c. ソーシャル・サポートとアタッチメント
7. PTSDと合併精神障害
a. 合併精神障害の割合
b. 災害後精神障害とPTSD
8. PTSDと身体健康
III. PTSDの疫学と診断測定スケール
1. PTSDの疫学
a. PTSDにおける疫学
b. PTSDの疫学において考慮される要因
c. PTSDの疫学研究から得られた有病率
2. PTSD診断アセスメントと症状の測定スケール
a. PTSDの診断 ― 構造化面接
b. 自記式症状スケール
c. その他の情報源
d. 測定スケールと方法論上の問題点
各論
I. 生物学的基礎
A. PTSDにおける脳機能変化
1. PTSDの動物モデル
2. ストレスとPTSDに関連する神経伝達物質と神経ペプチドシステム
3. PTSDの機能的神経解剖学
B. PTSDにおける神経内分泌機能
1. PTSDの原因 ― 障害の神経生物学的基礎の意味
2. PTSDにおける視床下部-下垂体-副腎皮質系の変化
a. CRF活性
b. コルチゾールレベル
c. リンパ球グルココルチコイド受容体
d. dexamethasoneに対するコルチゾール反応
e. 低量のDST研究
f. ネガティブフィードバック強調モデル
3. PTSDにおけるカテコールアミン変化
a. 安静時カテコールアミンレベル
b. 誘発刺激反応におけるカテコールアミンレベル
C. ストレスと記憶
1. ストレス, 記憶, PTSD
2. 正常記憶のメカニズム
a. 記憶の3過程
b. 記憶の分類
c. 記憶の分子メカニズム
d. 記憶からみたPTSDの症状
3. 陳述記憶の解剖学とストレス
a. 海馬
b. ストレスと海馬
c. 扁桃体と記憶
4. 非陳述記憶の解剖学とストレス
a. 扁桃体と恐怖条件づけ
b. 恐怖条件づけの消去
5. ストレスと記憶の生化学・生理学
a. カテコールアミン
b. グルココルチコイド
c. その他の物質
6. 解離の神経基盤
D. ストレスと睡眠
1. 動物実験による研究
a. immobilization stress
b. foot shockおよびlearned helplessness
c. 慢性ストレス
d. 断眠
2. ヒトを対象とした研究
a. ストレスによるヒトの睡眠の変化
b. PTSDの睡眠
3. まとめと研究の展望
E. ストレスと免疫 ― そのメカニズムに対する考察
1. 末梢交感神経破壊による免疫系の変化
2. NPY
3. CGRP
4. VIP
5. SPその他
6. 中枢神経による免疫系の制御
7. ストレス・免疫・疾病
II. 臨床的側面
A. 災害前準備の原則と防災計画
1. 災害精神保健の射程
a. 災害の定義と分類
b. 災害の心理的影響への対策
c. とくにPTSDの予防について
2. 災害精神保健の前提と原則
a. 災害精神保健の特殊性と災害前準備の必要性
b. 災害援助の3モデル
c. 防災計画の意義
3. 災害前準備の実際
a. なにを準備すべきか
b. 災害精神保健活動のために必要なコンセンサス
c. 精神保健スタッフの役割
d. 外来救援者
4. あるべき防災計画・防災体制に向けて
B. 阪神淡路大震災後に行われた精神科救護所活動とPTSD
1. 阪神淡路大震災と精神科医療・精神保健
2. 精神科救護所活動のデータにみるPTSD
3. 災害後早期のPTSD症状
4. 災害後早期の精神保健活動のあり方
C. 津波災害
1. 北海道南西沖地震の津波災害
a. 津波災害とは
b. 北海道南西沖地震の被害
c. 仮設住宅の状況
d. 災害義援金の状況
2. 災害研究の経緯
a. 被災者の精神健康研究の流れ
b. 被災者の精神健康に関する研究の問題点
3. 北海道南西沖地震の長期化する被災者の精神健康問題
a. 調査の手続き
b. 長期化する精神健康の問題
4. 被災遺族のRorschachテストの事例
5. 今後の心理的支援
D. 犯罪被害者
1. 犯罪被害者援助とPTSD
a. 犯罪被害とトラウマとの関係
b. 訴訟とかかわる犯罪被害者のPTSD診断
2. 犯罪被害者のPTSD治療
a. 精神的援助の概観
b. 治療の実際
3. 犯罪被害者の精神科受診を困難にする要因
a. 被害者側の要因
b. 医療者側の要因
E. 地下鉄サリン事件
1. 症例から学ぶ
2. 考察
a. PTSDとしての普遍性
b. 地下鉄サリン事件によるPTSDの特殊性
F. 人質テロ事件
1. 人質テロ事件の心理的特徴
2. 心理的反応の段階説
3. 解放後の心理的変化
4. 人質の心理反応を悪化させる要因
5. 治療と支援
6. ストックホルム症候群
G. 航空機事故と心的外傷
1. 現代と航空機事故
2. 航空機事故とメンタルヘルス
a. 航空機事故の特徴
b. 対象者別にみた調査研究の概要
H. 交通事故
1. 交通事故と交通事故者
a. 定義
b. 交通事故の実態
c. 交通事故は外傷的出来事か
2. 交通事故とPTSD研究の歴史
a. 19世紀の研究
b. 現代の研究
3. 発病率
a. 追跡調査から
b. 疫学研究から
4. 量-反応関係
5. 予測・危険因子
6. 予後経過
a. 交通事故におけるPTSDの予後経過
b. 遅延性PTSDについて
7. 合併症 / comorbidity
I. 熱傷患者
1. 熱傷受傷後の経過
a. 急性期
b. 中間期
2. PTSDと他の精神症状の鑑別診断
3. 熱傷によるPTSDの治療
a. 心理的介入
b. 薬物治療
4. 考察
5. 症例
J. 児童虐待
1. 歴史
a. 児童虐待発見の歴史
b. 被虐待体験による精神症状への認識
2. 定義・概念・分類
a. 身体的虐待
b. ネグレクト
c. 性的虐待
d. 情緒的虐待
3. 疫学
4. 症状
a. 被虐待体験とトラウマ
5. 治療
a. 安全で安定した生活を与える
b. 環境療法
c. トラウマへの治療
d. 集団療法
e. 権利教育
f. 虐待者への治療
g. 虐待家族への治療
6. 予後
7. 結語
K. 子どものPTSD
1. 文献から
2. 子どものPTSDに関する診断と治療の基準
3. 子どものPTSDに関する若干の問題
III. 治療的側面
A. PTSDの薬物療法 ― 次世紀に向けて
1. 臨床試験で蓄積された現段階での知識はどのようなものか
a. 歴史的ならびに臨床的状況
b. 文献学的検討
2. 実証的報告から一般化された重要課題はどのようなものか
3. PTSDの精神生物学に関しては現段階でどのようなことがわかっているか
4. 明らかになってきたPTSDの理論的な理解をどのようにして現在の臨床に反映させたらよいのか
5. 明らかになってきたPTSDの理論的な理解を精神薬理学研究の将来の発展にどのように反映させたらよいのか
B. 認知行動療法
1. 認知行動療法とは
2. PTSDに対する認知行動療法
3. おもな認知行動療法
a. 系統的脱感作療法
b. フラッディング
c. 刺激被曝療法
d. 眼球運動による脱感作と再処理法
e. ストレス免疫法
f. cognitive processing therapy
g. デブリーフィング
4. PTSDへの臨床適用例
a. 系統的脱感作療法の適用例
b. 刺激被曝療法の適用例
c. フラッディングの適用例
d. 眼球運動による脱感作と再処理法の適用例
e. 認知的療法の適用例
C. 力動的精神療法
1. PTSDにおける心的外傷をどのように理解するか
2. PTSDの力動的な治療に関する基本的な認識
3. 個人精神療法
a. 力動的精神療法
b. 認知行動療法
4. 身代わりの外傷体験について
D. 児童期の虐待によるPTSDの治療
1. アダルト・サバイバーの特徴
2. 回復の3段階
a. 第1段階 ― 安全と自己管理
b. 第2段階 ― 外傷体験の統合
c. 第3段階 ― 人間関係の再構築
3. 回復基準ないし反発力領域
4. 記憶と精神療法
a. 外傷体験を語ることの意味
b. 回復とは記憶の再編
c. 過誤記憶
5. 症状軽減のための薬物と短期精神療法
a. 薬物療法
b. 短期精神療法技法
E. EMDR (眼球運動による脱感作と再処理法)
1. EMDRの歴史
2. EMDRの手続きと実際
3. 作用機序
4. まとめ
F. 地域精神保健対策とPTSD
1. 災害の定義
2. 災害の時間的経過と精神医学的問題
a. 衝撃期
b. 反動期
c. 幻滅期
d. 再適応期
3. 被災時の地域精神保健対策の原則
a. 長期的な地域精神保健対策の基本姿勢
b. 精神保健の具体的対策
c. 精神保健の連続性
4. 被災住民の心理的苦悩度の推移と支援ニーズ変容の過程
G. 災害救助業務に関連した心的外傷への治療的介入 (警察官および消防士など)
1. 職務に関連した心的外傷の特徴
2. 急性反応
3. 長期的な反応
4. 急性介入
5. 治療的介入
a. 治療をはじめるにあたって
b. 心理教育
c. イメージ・ガイダンス
d. 書く作業と出来事に関連した物の利用
e. 意味の領域
f. 別れの儀式
IV. 社会文化的側面
A. アジア社会とPTSD
1. アジア社会における精神医学上の問題
a. somatization
b. 精神障害の有病率
2. アジア社会に関連したPTSD研究
a. インドシナ難民
b. アジア社会におけるPTSD診断の問題
3. わが国のPTSDに触れて
B. 日本社会における災害トラウマ
1. わが国の災害対策における災害トラウマの位置づけ
2. アメリカ合衆国の防災における災害トラウマの位置づけ
3. 阪神・淡路大震災を契機とした災害ストレス問題への関心の高まり
4. 阪神・淡路大震災後の災害ストレスとそのケア対策の位置づけ
5. 防災の観点からみた災害ストレスとそのケア
6. 災害ストレスの重層性
C. PTSDと補償 ― とくに産業精神医学の領域
1. PTSDと災害神経症の歴史的概念
2. 労災, 自賠責保険とPTSD
a. 労災, 自賠責保険
b. 心因性精神障害とPTSDの業務上外認定
c. PTSDの後遺障害認定
d. PTSDと損害賠償
3. 症例呈示
a. 航空機墜落事故のPTSD事例
b. 近年の新聞などで報道された補償にかかわるPTSD
4. 米国における労災認定の現状と日本のPTSDの補償
索引
和文索引
欧文索引
奥付

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本参考文献は電子書籍掲載内容を元にしております。

総論

P.14 掲載の参考文献

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