{"id":1466,"date":"2017-12-05T12:30:36","date_gmt":"2017-12-05T03:30:36","guid":{"rendered":"http:\/\/chienowa.org\/?p=1466"},"modified":"2019-05-17T07:45:17","modified_gmt":"2019-05-16T22:45:17","slug":"%e3%83%91%e3%83%8b%e3%83%83%e3%82%af%e9%9a%9c%e5%ae%b3%e3%81%ab%e4%bd%bf%e3%81%86%e8%96%ac%e3%83%bc-%e3%83%91%e3%83%8b%e3%83%83%e3%82%af%e9%9a%9c%e5%ae%b3-3","status":"publish","type":"post","link":"https:\/\/chienowa.org\/?p=1466","title":{"rendered":"\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u4f7f\u3046\u85ac\u30fc \u30d1\u30cb\u30c3\u30af\u969c\u5bb3 3"},"content":{"rendered":"<p>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306e\u6cbb\u7642\u306b\u3064\u3044\u3066\u304a\u8a71\u3057\u3066\u884c\u304d\u307e\u3059\u3002<\/p>\n<div style=\"border: 2px solid #cccccc; padding: 10px;\"><strong>\u30af\u30ea\u30cb\u30c3\u30af\u3061\u3048\u306e\u308f\u306e\u63d0\u4f9b\u3059\u308b\u6cbb\u7642\u30fb\u652f\u63f4\u5168\u822c\u306b\u3064\u3044\u3066\u306f<a href=\"https:\/\/chienowa.org\/?p=610\">\u30af\u30ea\u30cb\u30c3\u30af\u3061\u3048\u306e\u308f\u304c\u3067\u304d\u308b\u3053\u3068<\/a>\u3092\u3054\u53c2\u7167\u4e0b\u3055\u3044\u3002<\/strong><\/div>\n<p>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306e\u6cbb\u7642\u306b\u306f\u85ac\u3092\u4f7f\u3046\u6cbb\u7642\uff08\u85ac\u7269\u7642\u6cd5\uff09\u3068\u4f7f\u308f\u306a\u3044\u6cbb\u7642\uff08\u5fc3\u7406\u7642\u6cd5\uff09\u304c\u3042\u308a\u307e\u3059\u3002<strong>\u30af\u30ea\u30cb\u30c3\u30af\u3061\u3048\u306e\u308f\u306e\u6cbb\u7642\u306e\u30e1\u30a4\u30f3\u306f\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306e\u5834\u5408\u3082\u5fc3\u7406\u7642\u6cd5\u3001\u7279\u306b\u8a8d\u77e5\u884c\u52d5\u7642\u6cd5\u3067\u3059\u3002<\/strong><\/p>\n<p><strong>\u305f\u3060\u3057\u3001\u85ac\u7269\u7642\u6cd5\u3082\u5fc3\u7406\u7642\u6cd5\u3068\u540c\u7b49\u306e\u52b9\u679c\u304c\u3042\u308b\u3068\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u305d\u3053\u3067\u307e\u305a\u85ac\u7269\u7642\u6cd5\u306b\u3064\u3044\u3066\u8aac\u660e\u3057\u3066\u304a\u304d\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/strong><\/p>\n<p>\u540c\u7b49\u306e\u52b9\u679c\u3068\u8a00\u3063\u3066\u3082\u305d\u308c\u305e\u308c\u306e\u6cbb\u7642\u306b\u306f\u9577\u6240\u3068\u77ed\u6240\u304c\u3042\u308a\u307e\u3059\u3002\u85ac\u7269\u7642\u6cd5\u306b\u3064\u3044\u3066\u306f<\/p>\n<ul>\n<li>\u9577\u6240\n<ul>\n<li>\u7c21\u5358\u3001\u98f2\u3080\u3060\u3051\u3067\u3088\u3044<\/li>\n<li>\u624b\u8efd\u3001\u3069\u306e\u30af\u30ea\u30cb\u30c3\u30af\u3067\u3082\u85ac\u306f\u51fa\u3057\u3066\u304f\u308c\u308b<\/li>\n<\/ul>\n<\/li>\n<li>\u77ed\u6240\n<ul>\n<li>\u85ac\u3092\u3084\u3081\u308b\u3068\u518d\u767a\u3057\u3084\u3059\u3044<\/li>\n<li>\u526f\u4f5c\u7528\u304c\u3042\u308b<\/li>\n<li>\u5e83\u5834\u6050\u6016\u3092\u4f34\u3046\u5834\u5408\u306f\u52b9\u679c\u304c\u52a3\u308b<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>\u3067\u3057\u3087\u3046\u304b\u3002<\/p>\n<p>\u8cbb\u7528\u9762\u3067\u306e\u6bd4\u8f03\u3067\u3059\u304c\u3001\u5fc3\u7406\u7642\u6cd5\u304c\u4fdd\u967a\u8a3a\u7642\u5185\u3067\u884c\u308f\u308c\u308b\u5834\u5408\u306b\u306f\u3001\u5fc3\u7406\u7642\u6cd5\u306e\u65b9\u304c\u5b89\u4e0a\u304c\u308a\u3067\u3059\u3002\u85ac\u306e\u8cbb\u7528\u304c\u304b\u304b\u3089\u306a\u3044\u306e\u3068\u6bd4\u8f03\u7684\u77ed\u671f\u9593\u3067\u6cbb\u7642\u304c\u7d42\u308f\u308b\u305f\u3081\u3067\u3059\u3002<\/p>\n<p>\u3055\u3066\u3001\u85ac\u7269\u7642\u6cd5\u3068\u5fc3\u7406\u7642\u6cd5\u306e\u3069\u3061\u3089\u304b\u3092\u60a3\u8005\u3055\u3093\u304c\u9078\u3079\u308b\u306e\u304c\u7406\u60f3\u3067\u3059\u304c\u3001\u5b9f\u969b\u306b\u306f\u3001\u85ac\u7269\u7642\u6cd5\u3057\u304b\u5229\u7528\u3067\u304d\u306a\u3044\u3053\u3068\u3082\u591a\u3044\u3068\u601d\u3044\u307e\u3059\u3002\u30af\u30ea\u30cb\u30c3\u30af\u3061\u3048\u306e\u308f\u3067\u3082\u3001\u5fc3\u7406\u7642\u6cd5\u3068\u306e\u4f75\u7528\u3067\u3059\u304c\u85ac\u3092\u4f7f\u3046\u3053\u3068\u3082\u3042\u308a\u307e\u3059\u3002\u3067\u3059\u306e\u3067\u3001\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306e\u85ac\u7269\u7642\u6cd5\u306b\u3064\u3044\u3066\u77e5\u3063\u3066\u304a\u304f\u3053\u3068\u306f\u610f\u5473\u304c\u3042\u308b\u3068\u601d\u3044\u307e\u3059\u3002<\/p>\n<h2>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u4f7f\u308f\u308c\u308b\u85ac<\/h2>\n<p>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u5bfe\u3057\u3066\u73fe\u5728\u4f7f\u308f\u308c\u3066\u3044\u308b\u306e\u306f\u6297\u4e0d\u5b89\u85ac\u3068\u6297\u3046\u3064\u85ac\u3067\u3059\u3002<\/p>\n<h3>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u6297\u4e0d\u5b89\u85ac\u306f\u4f7f\u308f\u306a\u3044\u65b9\u304c\u3088\u3044<\/h3>\n<p>\u65e5\u672c\u3067\u3082\u3063\u3068\u3082\u591a\u304f\u51e6\u65b9\u3055\u308c\u3066\u3044\u308b\u306e\u306f\u6297\u4e0d\u5b89\u85ac\u3067\u3057\u3087\u3046\u3002\u901a\u79f0\u300c\u5b89\u5b9a\u5264\u300d\u3067\u5fc3\u7642\u5185\u79d1\u30fb\u7cbe\u795e\u79d1\u4ee5\u5916\u3067\u3082\u3088\u304f\u4f7f\u308f\u308c\u3066\u3044\u308b\u3068\u601d\u3044\u307e\u3059\u3002\u300c\u8efd\u3044\u85ac\u300d\u3068\u304b\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306e\u5834\u5408\u306b\u306f\u300c\u767a\u4f5c\u306e\u304a\u5b88\u308a\u7528\u306b\u300d\u3068\u304b\u8aac\u660e\u3055\u308c\u305f\u3001\u3068\u60a3\u8005\u3055\u3093\u306f\u8a00\u308f\u308c\u307e\u3059\u3002<\/p>\n<p>\u4ee3\u8868\u7684\u306a\u85ac\u306f\u3001<\/p>\n<p>\u30b8\u30a2\u30bc\u30d1\u30e0\u3001\u30a2\u30eb\u30d7\u30e9\u30be\u30e9\u30e0\u3001\u30a8\u30c1\u30be\u30e9\u30e0\u3001\u30ed\u30e9\u30bc\u30d1\u30e0\u3001\u30af\u30ed\u30c1\u30a2\u30bc\u30d1\u30e0\u3001\u30af\u30ed\u30ad\u30b5\u30be\u30e9\u30e0\u3001\u30d6\u30ed\u30de\u30bc\u30d1\u30e0\u3001\u306a\u3069\u306a\u3069(<a href=\"#note1\">\u6ce81<\/a>)<\/p>\n<p>\u30af\u30ea\u30cb\u30c3\u30af\u3061\u3048\u306e\u308f\u306e\u60a3\u8005\u3055\u3093\u304c\u4ee5\u524d\u306b\u51e6\u65b9\u3055\u308c\u3066\u3044\u305f\u3068\u3044\u3046\u85ac\u3092\u6319\u3052\u3066\u307f\u307e\u3057\u305f\u3002\u305f\u304f\u3055\u3093\u306e\u9298\u67c4\u304c\u3042\u308a\u307e\u3059\u304c\u3001\u3059\u3079\u3066<strong>\u30d9\u30f3\u30be\u30b8\u30a2\u30bc\u30d4\u30f3<\/strong>\u3068\u3044\u3046\u7a2e\u985e\u306e\u6297\u4e0d\u5b89\u85ac\u3067\u5927\u304d\u306a\u9055\u3044\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<p>\u3057\u304b\u3057\u3001<strong>\u6297\u4e0d\u5b89\u85ac\u306f\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u306f\u304a\u52e7\u3081\u3057\u307e\u305b\u3093<\/strong>\u3002<\/p>\n<p><a href=\"https:\/\/www.nice.org.uk\/guidance\/cg113\/chapter\/1-Guidance#stepped-care-for-people-with-panic-disorder\">NICE\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3<\/a>\u306b\u306f<\/p>\n<blockquote><p>Benzodiazepines are associated with a less good outcome in the long term and should not be prescribed for the treatment of individuals with panic disorder.<\/p><\/blockquote>\n<p>\u9577\u671f\u7684\u306b\u306f\u52a3\u308b\u306e\u3067\u4f7f\u3046\u3079\u304d\u3067\u306f\u306a\u3044\u3001\u3068\u3042\u308a\u307e\u3059\u3002<\/p>\n<p><strong>\u767a\u4f5c\u304c\u8d77\u3053\u3063\u305f\u3068\u304d\u306e\u9813\u670d\u85ac\u3068\u3057\u3066\u4f7f\u3046\u3053\u3068\u306f\u7279\u306b\u304a\u52e7\u3081\u3067\u304d\u307e\u305b\u3093<\/strong>\u3002\u6297\u4e0d\u5b89\u85ac\u306b\u306f\u8010\u6027\uff08\u7e70\u308a\u8fd4\u3057\u4f7f\u3063\u3066\u3044\u308b\u3068\u52b9\u679c\u304c\u306a\u304f\u306a\u3063\u3066\u304f\u308b\uff09\u3068\u96e2\u8131\u75c7\u72b6\uff08\u85ac\u304c\u5207\u308c\u308b\u3068\u304b\u3048\u3063\u3066\u4e0d\u5b89\u304c\u9ad8\u307e\u308b\uff09\u3068\u3044\u3046\u554f\u984c\u304c\u3042\u308b\u306e\u3067\u9577\u671f\u7684\u306b\u306f\u3080\u3057\u308d\u30de\u30a4\u30ca\u30b9\u306b\u306a\u308a\u5f97\u307e\u3059\u3002<\/p>\n<p>\u5fc3\u7406\u7684\u306a\u554f\u984c\u3082\u3042\u308a\u307e\u3059\u3002\u9813\u670d\u85ac\u3092\u98f2\u3080\u3068\u3044\u3046\u3053\u3068\u81ea\u4f53\u304c<strong>\u5b89\u5168\u884c\u52d5<\/strong>\u306b\u306a\u308b\u304b\u3089\u3067\u3059\u3002\u4eee\u306b\u98f2\u307e\u305a\u306b\u300c\u304a\u5b88\u308a\u300d\u3068\u3057\u3066\u6301\u3063\u3066\u3044\u308b\u3060\u3051\u3067\u3082\u300c\u304a\u5b88\u308a\u304c\u3042\u308b\u304b\u3089\u5927\u4e08\u592b\u300d\u3068\u8a00\u3044\u805e\u304b\u305b\u308b\u306a\u3089\u305d\u308c\u306f\u5b89\u5168\u884c\u52d5\u3067\u3059\u3002\u305d\u308c\u3082\u9577\u671f\u7684\u306b\u306f\u30de\u30a4\u30ca\u30b9\u3067\u3059\u3002<\/p>\n<p>\u4e00\u65b9\u3001<a href=\"http:\/\/www.uptodate.com\/contents\/approach-to-treating-panic-disorder-with-or-without-agoraphobia-in-adults?source=search_result&amp;search=panic+disorder&amp;selectedTitle=3~150\">UpToDate<\/a>\uff08\u6709\u6599\u30b3\u30f3\u30c6\u30f3\u30c4\u306a\u306e\u3067\u4e00\u90e8\u3057\u304b\u3054\u89a7\u306b\u306a\u308c\u307e\u305b\u3093\u3001\u3059\u307f\u307e\u305b\u3093\uff09\u3067\u306f\u4ed6\u306e\u6cbb\u7642\u306e\u52b9\u679c\u304c\u5341\u5206\u306b\u4e0a\u304c\u3089\u306a\u3044\u3068\u304d\u3001\u60a3\u8005\u3055\u3093\u306b\u85ac\u7269\u4f9d\u5b58\u50be\u5411\u304c\u306a\u3044\u3053\u3068\u3092\u78ba\u304b\u3081\u305f\u4e0a\u3067\u4f7f\u3063\u3066\u3082\u3088\u3044\u3001\u3068\u306a\u3063\u3066\u3044\u307e\u3059\u3002\u65e5\u672c\u3067\u3088\u304f\u884c\u308f\u308c\u3066\u3044\u308b\u3088\u3046\u306a\u6700\u521d\u306e\u624b\u6bb5\u3067\u306f\u306a\u304f\u3001<strong>\u6700\u5f8c\u306e\u624b\u6bb5<\/strong>\u306a\u306e\u3067\u3059\u3002<\/p>\n<p><strong>\u6297\u4e0d\u5b89\u85ac\u306f\u526f\u4f5c\u7528\u3092\u8003\u3048\u308b\u3068\u6c7a\u3057\u3066\u300c\u8efd\u3044\u85ac\u300d\u3067\u306f\u306a\u304f\u3001\u3080\u3057\u308d\u4f7f\u3044\u65b9\u304c\u96e3\u3057\u3044\u85ac\u3067\u3059\u3002<\/strong>\u306b\u3082\u95a2\u308f\u3089\u305a\u6c17\u5b89\u304f\u51e6\u65b9\u3055\u308c\u3066\u3044\u308b\u73fe\u72b6\u306b\u306f\u6279\u5224\u3082\u51fa\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\u3055\u3066\u3001\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306e\u6cbb\u7642\u85ac\u3068\u3057\u3066\u52b9\u679c\u304c\u8a8d\u3081\u3089\u308c\u3066\u3044\u308b\u306e\u306f\u6297\u3046\u3064\u85ac\u3067\u3059\u3002<\/p>\n<h3>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u4f7f\u3046\u3068\u3057\u305f\u3089\u6297\u3046\u3064\u85ac<\/h3>\n<p>\u6297\u3046\u3064\u85ac\u306b\u306f\u5fc3\u7406\u7642\u6cd5\u3068\u540c\u7b49\u306e\u52b9\u679c\u304c\u8a8d\u3081\u3089\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\u73fe\u5728\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u4f7f\u308f\u308c\u308b\u4e3b\u306a\u6297\u3046\u3064\u85ac\u306fSSRI\u3068\u3044\u3046\u7a2e\u985e\u306e\u85ac\u3067\u3001\u30bb\u30eb\u30c8\u30e9\u30ea\u30f3\u3001\u30a8\u30b9\u30b9\u30bf\u30ed\u30d7\u30e9\u30e0\u3001\u30d1\u30ed\u30ad\u30bb\u30c1\u30f3\u306a\u3069\u304c\u3042\u308a\u307e\u3059(<a href=\"#note2\">\u6ce82<\/a>)\u3002<\/p>\n<p>\u306a\u305c\u3046\u3064\u306e\u85ac\u304c\u52b9\u304f\u306e\uff1f\u3068\u7591\u554f\u306b\u601d\u308f\u308c\u308b\u65b9\u3082\u304a\u3089\u308c\u308b\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u7d50\u8ad6\u304b\u3089\u8a00\u3046\u3068\u3001\u306a\u305c\u52b9\u304f\u306e\u304b\u306f\u5206\u304b\u308a\u307e\u305b\u3093\u3002\u305d\u3082\u305d\u3082\u3001SSRI\u304c\u3046\u3064\u306b\u52b9\u304f\u7406\u7531\u3082\u3088\u304f\u5206\u304b\u3063\u3066\u3044\u306a\u3044\u306e\u3067\u3059\u3002\u8133\u5185\u4f1d\u9054\u7269\u8cea\u306e\u30bb\u30ed\u30c8\u30cb\u30f3\u304c\u3069\u3046\u3068\u304b\u8aac\u660e\u3055\u308c\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059\u304c\u3001\u305d\u306e\u7a2e\u306e\u8133\u79d1\u5b66\u7684\u30fb\u751f\u7269\u5b66\u7684\u8aac\u660e\u306f\u3088\u304f\u8a00\u3063\u30661\u3064\u306e\u4eee\u8aac\u3001\u60aa\u304f\u8a00\u3048\u3070\u7591\u4f3c\u79d1\u5b66\u7684\u306a\u304a\u8a71\u306b\u904e\u304e\u307e\u305b\u3093\u3002<\/p>\n<p>\u3053\u306e\u3088\u3046\u306b\u7406\u7531\u306f\u4e0d\u660e\u3067\u3059\u304c\u3001SSRI\u306f\u3046\u3064\u306b\u3082\u4e0d\u5b89\u306b\u3082\u4e00\u5b9a\u306e\u52b9\u679c\u304c\u3042\u308b\u3053\u3068\u306f\u81e8\u5e8a\u7814\u7a76\u306b\u3088\u3063\u3066\u8a8d\u3081\u3089\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4>SSRI\u306e\u6b20\u70b9<\/h4>\n<p>SSRI\u306b\u306f\u6b20\u70b9\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n<p>\u307e\u305a<strong>\u52b9\u679c\u304c\u73fe\u308c\u308b\u306e\u306b\u6642\u9593\u304c\u304b\u304b\u308b<\/strong>\u3053\u3068\u3067\u3059\u30022,3\u9031\u9593\u304b\u304b\u308b\u3068\u8003\u3048\u305f\u65b9\u304c\u3088\u3044\u3067\u3057\u3087\u3046\u3002\u4e00\u65b9<strong>\u526f\u4f5c\u7528\uff08\b\u6ce8\uff09\u306f\u98f2\u307f\u59cb\u3081\u305f\u76f4\u5f8c\u304b\u3089<\/strong>\u51fa\u307e\u3059\u3002\u3088\u304f\u3042\u308b\u306e\u306f\u6d88\u5316\u5668\u7cfb\u306e\u75c7\u72b6\u3001\u80c3\u304c\u30e0\u30ab\u30e0\u30ab\u3059\u308b\u3001\u5410\u304d\u6c17\u304c\u3059\u308b\u3001\u4fbf\u79d8\u30fb\u4e0b\u75e2\u306a\u3069\u3067\u3059\u3002<\/p>\n<p>\u3053\u306e\u6b20\u70b9\u3092\u88dc\u3046\u305f\u3081\u306b\u306f<\/p>\n<ul>\n<li>\u3053\u306e\u3088\u3046\u306a\u85ac\u306e\u6027\u8cea\u3092\u8aac\u660e\u3057\u3066\u304a\u304f<\/li>\n<li>\u5c11\u91cf\u304b\u3089\u958b\u59cb\u3057\u3066\u526f\u4f5c\u7528\u3092\u898b\u306a\u304c\u3089\u5341\u5206\u306a\u91cf\u306b\u5897\u3084\u3057\u3066\u3044\u304f<\/li>\n<li>\u526f\u4f5c\u7528\u5bfe\u7b56\u3092\u884c\u3046\uff08\u5410\u6c17\u304c\u8d77\u304d\u3084\u3059\u3044\u4eba\u3001\u5410\u6c17\u304c\u4e0d\u5b89\u306a\u4eba\u306b\u306f\u3042\u3089\u304b\u3058\u3081\u5410\u6c17\u6b62\u3081\u3092\u51fa\u3057\u3066\u304a\u304f\u3001\u306a\u3069\uff09<\/li>\n<\/ul>\n<p>\u306a\u3069\u304c\u5fc5\u8981\u3067\u3059\u3002<\/p>\n<p>\u305f\u3060\u3001\u3053\u308c\u3089\u3092\u884c\u3063\u3066\u3082\u6b8b\u308b\u554f\u984c\u304c\u3042\u308a\u307e\u3059\u3002<strong>\u85ac\u306e\u52b9\u679c\u304c\u73fe\u308c\u308b\u307e\u3067\u306f\u3069\u3046\u3059\u308c\u3070\u3088\u3044\u306e\u3067\u3057\u3087\u3046\u3002\u305f\u3060\u3072\u305f\u3059\u3089\u5f85\u3064\u3001\u3068\u3044\u3046\u306e\u306f\u3064\u3089\u3044\u306e\u3067\u306f\u306a\u3044\u3067\u3057\u3087\u3046\u304b\u3002<\/strong><\/p>\n<p>\u306a\u306e\u3067\u79c1\u306f\u3001\u6297\u3046\u3064\u85ac\u3092\u51fa\u3057\u305f\u5834\u5408\u306f\u3001<strong>\u30d1\u30cb\u30c3\u30af\u969c\u5bb3\u306b\u3064\u3044\u3066\u306e\u8aac\u660e\uff08\u524d\u56de\u3001\u524d\u3005\u56de\u3067\u3057\u305f\u3088\u3046\u306a\uff09\u3092\u3057\u305f\u4e0a\u3067\u3001<a 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