੕ହ൨ாਙ௽૩पৌघॊৎ৑ে੟৾৓੘௜भిૢध଒ੀৈ௖࿚ ଝਮ叞ሺ௔প৾ୢ৾৖ಖઋઋ৽ఐ৾ઇ஼ᴫ᪥ࣜࢬ࣒㞀ᐖࡣ཮ᴟᛶ㞀ᐖࡢ⑓ែ࡜ᐦ᥋࡟㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠾ࡾࠊ㏆ᖺࠊ཮ᴟᛶ㞀ᐖࡢᴫ᪥ࣜࢬ࣒㞀ᐖ࡟↔Ⅼࢆᙜ࡚ࡓ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ᭷⏝ᛶࡀ♧ࡉࢀ࡚࠸ࡿࠋ㧗↷ᗘග⒪ἲࡸ᩿╀⒪ἲࡣ཮ᴟᛶ㞀ᐖࡢᢚ࠺ࡘ⑕≧ࡢᨵၿ࡟ࠊᬯ㜌⒪ἲࡣ཮ᴟᛶ㞀ᐖࡢ㌄⑕≧ࡢᨵၿ࡟᭷⏝ᛶࡀ♧ࡉࢀ࡚࠸ࡿࠋࡑࢀ࡟ຍ࠼࡚ࠊᚰ⌮♫఍⒪ἲࡸ࣓ࣛࢺࢽࣥ⣔⸆๣ࡢ᭷⏝ᛶࡶ♧၀ࡉࢀ࡚࠸ࡿࠋ୍᪉࡛ࠊࡇࢀࡽ᫬㛫⏕≀Ꮫⓗ἞⒪ࢆ
ᐇ⮫ᗋ࡟࠾࠸࡚ᐇ㊶ࡍࡿࡇ࡜ࡣࠊ἞⒪ᶵჾࡸ἞⒪⎔ቃࠊᝈ⪅ࡢ἞⒪࢔ࢻࣄ࢔ࣛࣥࢫࡢほⅬ࠿ࡽᚲࡎࡋࡶᐜ࡛᫆ࡣ࡞࠸ࠋ཮ᴟᛶ㞀ᐖࡢᐇ⮫ᗋ࡟࠾࠸࡚ࡣࠊࡇࢀࡽ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ࢚ࣅࢹࣥࢫ࡟ᇶ࡙࠸ࡓ╧╀⾨⏕
ᣦᑟ࡟ࡼࡾࠊ㉳ᗋᚋࡢእฟࡸග᭚㟢ࢆಁࡋࠊኪ㛫ࡢග᭚㟢ࡢไ㝈࡞࡝ࢆᣦᑟࡍࡿࡇ࡜࡟ࡼࡾ୍ᐃࡢຠᯝࡀᮇᚅ࡛ࡁࡿ࡜ឤࡌ࡚࠸ࡿࠋ௒ᚋࡣࡉࡽ࡞ࡿ◊✲⤖ᯝࡢ㞟✚࡟ࡼࡾ཮ᴟᛶ㞀ᐖ἞⒪࡟࠾ࡅࡿ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢᬑཬ࣭ᐇ⿦໬ࡀ㐍ࡳࠊ཮ᴟᛶ㞀ᐖᝈ⪅ࡢணᚋᨵၿ࡟⧅ࡀࡿࡇ࡜࡟ᮇᚅࡋࡓ࠸ࠋ ࡣࡌࡵ࡟㞀ᐖࡀ㛵୚ࡋ࡚࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠾ࡾࠊᴫ᪥ࣜࢬ╧╀࣭ぬ㓰ࣜࢬ࣒㞀ᐖࡣ཮ᴟᛶ㞀ᐖ࡟ᴟࡵ࡚㧗⋡࡟࣒㞀ᐖࡣ཮ᴟᛶ㞀ᐖࡢ⏕≀Ꮫⓗ࡞ᇶ┙ࡢ୍ࡘ࡛࠶ࡿ

ࡳࡽࢀࡿ⑕ೃ࡛࠶ࡾࠊ཮ᴟᛶ㞀ᐖࡢ࠺ࡘ⑕≧ࡸ㌄⑕≧ࡇ࡜ࡀ♧၀ࡉࢀ࡚࠸ࡿ 3ࠋ㏆ᖺࡣ୧⪅ࡢ㛵㐃ࢆ♧ࡍሗ࡞࡝ࡢẼศ⑕≧ࡢኚື࡟ඛ⾜ࡋ࡚ฟ⌧ࡍࡿࡇ࡜ࡀከ࿌ࡀቑ࠼࡚࠾ࡾࠊࡑࡢ⑓ែࡔࡅ࡛ࡣ࡞ࡃ཮ᴟᛶ㞀ᐖࡢࡃ 1ࠊ⸆≀⒪ἲ࡟ࡼࡿ἞⒪ᚋࡶṧ㑇ࡍࡿࡇ࡜ࡀከ࠸ࡇ⮫ᗋ⤒㐣࡟ࡶᴫ᪥ࣜࢬ࣒㞀ᐖࡀᙳ㡪ࢆ୚࠼࡚࠸ࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࡿ 2ࠋ཮ᴟᛶ㞀ᐖ࡟ࡳࡽࢀࡿ╧╀࣭ぬ࡜ࡀ♧၀ࡉࢀ࡚࠸ࡿ 4ࠋࡲࡓࠊࡑࢀࢆ⿬௜ࡅࡿࡼ࠺࡟ࠊ㓰ࣜࢬ࣒㞀ᐖࡣከᵝ࡛ࠊẼศ࢚ࣆࢯ࣮ࢻࡢኚ໬࡜┦஫╧╀㞀ᐖࡸᴫ᪥ࣜࢬ࣒㞀ᐖ࡟↔Ⅼࢆᙜ࡚ࡓ᫬㛫⏕≀࡟ᙳ㡪ࢆ୚࠼ྜ࠸࡞ࡀࡽ╧╀᫬㛫ࡸ╧╀࣭ぬ㓰ࣜࢬ࣒Ꮫⓗ࡞἞⒪ࡀ཮ᴟᛶ㞀ᐖࡢ࠺ࡘ⑕≧ࡸ㌄⑕≧ࠊ෌Ⓨணࡢኚ໬ࡀࡳࡽࢀࡿࠋ཮ᴟᛶ㞀ᐖ࡟࠾ࡅࡿ╧╀࣭ぬ㓰ࣜ㜵࡟᭷⏝࡛࠶ࡿࡇ࡜ࡀ♧ࡉࢀ࡚࠸ࡿ 5ࠋ㏆ᖺࡣᅜ㝿཮ࢬ࣒㞀ᐖࡸ཮ᴟᛶ㞀ᐖࡢ⑓ែࡑࡢࡶࡢ࡟ᴫ᪥ࣜࢬ࣒ᴟᛶ㞀ᐖᏛ఍ࢱࢫࢡࣇ࢛࣮ࢫࡼࡾ཮ᴟᛶ㞀ᐖ࡟ᑐࡍᅗ  ཮ᴟᛶ㞀ᐖᝈ⪅࡟࠾ࡅࡿෆⓗᴫ᪥ࣜࢬ࣒ࠊእⓗྠㄪᅉᏊࠊẼศㄪ⠇ࡢ㛵㐃཮ᴟᛶ㞀ᐖᝈ⪅࡟࠾࠸࡚ෆⓗ࡞ᴫ᪥ࣜࢬ࣒࡜እⓗ࡞ྠㄪᅉᏊࡀẼศㄪ⠇࡟ᙳ㡪ࡋ࡚࠾ࡾࠊ᫬㛫⏕≀Ꮫⓗ἞⒪᭷⏝ᛶࡀ♧၀ࡉࢀࠋ࡚࠸ࡿ㸦ᩥ⊩  ࡼࡾᨵゞᘬ⏝㸧‫ݩ‬takaesu@ks.kyorin-u.ac.jp᫬㛫⏕≀Ꮫ䚷㼂㼛㼘㻚㻌㻞㻢㻘㻌㻺㼛㻚㻌㻞㻌㻔㻞㻜㻞㻜㻕㻌㻝㻜㻥ࡿ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ᥎ዡࡀ࡞ࡉࢀ࡚࠾ࡾࠊ཮ᴟᛶ㞀3.

㧗↷ᗘග⒪ἲ

ᐖࡢ᪂ࡓ࡞἞⒪㑅ᢥ⫥࡜ࡋ࡚ᮇᚅࡉࢀ࡚࠸ࡿࠋᮏ✏࡛㧗↷ᗘග⒪ἲ࡜ࡣ 2,500㹼10,000 ࣝࢡࢫࡢⓑⰍගࡣ୺࡟཮ᴟᛶ㞀ᐖ࡟࠾ࡅࡿ╧╀࣭ぬ㓰ࣜࢬ࣒㞀ᐖ࡟↔

ࢆ㏻ᖖ᪩ᮅ࡟ 30 ศ㹼2 ᫬㛫↷ᑕࡍࡿ἞⒪ἲ࡛࠶ࡿࠋ

Ⅼࢆᙜ࡚ࡓ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢຠᯝ࡟ࡘ࠸࡚ᴫㄝࡋࠊ

㧗↷ᗘග⒪ἲࡢస⏝ᶵᗎࡣ⌧᫬Ⅼ࡛ࡣ᫂ࡽ࠿࡛ࡣ࡞ᐇ⮫ᗋ࡟࠾ࡅࡿࡇࢀࡽࡢ἞⒪ࡢ㐺ᛂ࡜㝈⏺Ⅼ࡟ࡘ࠸࠸ࡀࠊ࣓ࣛࢺࢽࣥศἪࠊ῝㒊య࡚ࡶ᳨ウࡋࡓ࠸ࠋࣝศἪࣜࢬ࣒࡞࡝ࡢ⏕≀᫬ィࡢ఩┦ࢆ๓㐍ࡉࡏࡿࡇࣜࢬ࣒ࠊࢥࣝࢳࢰ࣮࡜࡟ࡼࡾ╧╀࣭ぬ㓰ࣜࢬ࣒ࢆᩚ࠼ࠊᢚ࠺ࡘ⑕≧ࡢᨵၿ
2.

཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ᫬㛫⏕≀Ꮫⓗ἞⒪࡟ᐤ୚ࡋ࡚࠸ࡿ࡜᥎ᐹࡉࢀ࡚࠸ࡿ 7ࠋ㧗↷ᗘග⒪ἲࡢ཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ᫬㛫⏕≀Ꮫⓗ἞⒪ࡣᴫ᪥ࣜࢬ

స⏝ᶵᗎ࡟ࡘ࠸࡚ࡣࠊࡇࡢࡼ࠺࡞⏕≀᫬ィࡢ఩┦ኚ఩࣒ㄪᩚࢆ௓ࡋ࡚㛫᥋ⓗ࡟Ẽศ⑕≧ࡢᨵၿ࡟ᐤ୚ࡍࡿస⏝ࡢ࡯࠿ࠊᢠ࠺ࡘ⸆࡜ྠᵝ࡟ࢭࣟࢺࢽࣥ࡟ࡶస⏝ࡋࠊࡢ࡜ྠ᫬࡟ࠊ┤᥋ⓗ࡟Ẽศ⑕≧ࢆᨵၿࡍࡿຠᯝࡀ⪃࠼┤᥋ⓗ࡟ᢚ࠺ࡘ⑕≧ࡢᨵၿ࡟ᐤ୚ࡋ࡚࠸ࡿྍ⬟ᛶࡶࡽࢀ࡚࠸ࡿ㸦ᅗ 1㸧5ࠋ㏆ᖺࡣ཮ᴟᛶ㞀ᐖࡢᢚ࠺ࡘ⑕≧♧၀ࡉࢀ࡚࠸ࡿ 8ࠋ

ࡸ㌄⑕≧ࡢᨵၿຠᯝࠊ෌Ⓨண㜵ຠᯝ࡞࡝ࡀሗ࿌ࡉࢀ࡚

㧗↷ᗘග⒪ἲࡣࠊ⛅࠿ࡽ෤࡟࠿ࡅ࡚Ⓨ⑕ࡋ᫓࡟࡞ࡿ

࠸ࡿࠋᅜ㝿཮ᴟᛶ㞀ᐖᏛ఍࠿ࡽࡶ཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ࡜⮬↛ᐶゎࡍࡿᏘ⠇ᛶឤ᝟㞀ᐖࡢ἞⒪ἲ࡜ࡋ࡚⏝࠸᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ᥎ዡࡀ࡞ࡉࢀ࡚࠾ࡾࠊ௒ᚋࡢ཮ᴟ

ࡽࢀ࡚࠸ࡓࡀ 9ࠊ㏆ᖺ཮ᴟᛶ㞀ᐖࡢ࠺ࡘ≧ែࡢᨵၿຠ

ᛶ㞀ᐖࡢ἞⒪㑅ᢥ⫥࡜ࡋ࡚ὀ┠ࡉࢀ࡚࠸ࡿࠋᗈ⩏ࡢ᫬ᯝࡀᮇᚅࡉࢀ࡚࠾ࡾࠊ」ᩘࡢ↓సⅭ໬ẚ㍑ヨ㦂࡟࠾࠸㛫⏕≀Ꮫⓗ἞⒪ࡣ୺࡟ 5 ࡘࡢ࢝ࢸࢦ࣮ࣜ࡟ศ࠿ࢀ࡚

࡚ᮏ἞⒪ࡢ᭷ຠᛶࡀ♧ࡉࢀ࡚࠸ࡿ 10 11ࠋᅜ㝿཮ᴟᛶ㞀࠾ࡾࠊ㧗↷ᗘග⒪ἲࠊ᩿╀⒪ἲࠊᬯ㜌⒪ἲࠊ࣓ࣛࢺࢽ

ᐖᏛ఍ࡢࢱࢫࢡࣇ࢛࣮ࢫ࠿ࡽࡶ཮ᴟᛶ㞀ᐖࡢᢚ࠺ࡘࣥ࠾ࡼࡧ࣓ࣛࢺࢽࣥཷᐜయసື⸆࡟ࡼࡿ⸆≀⒪ἲࠊᑐ

࢚ࣆࢯ࣮ࢻ࡟ᑐࡋ࡚᥎ዡࡀ࡞ࡉࢀ࡚࠸ࡿࠋᡃࠎࡣ཮ᴟ

ே㛵ಀ♫఍ࣜࢬ࣒⒪ἲ㸦Interpersonal social rhythmᛶ㞀ᐖ࡟ᑐࡍࡿ㧗↷ᗘග⒪ἲࡢᢚ࠺ࡘ⑕≧ᨵၿຠᯝ

therapy: IPSRT㸧ࡸ཮ᴟᛶ㞀ᐖࡢ୙╀⑕≧࡟ᑐࡍࡿࢆ᳨ウࡋࡓ↓సⅭ໬ẚ㍑ヨ㦂ࡢ⣔⤫ⓗࣞࣅ࣮ࣗ࡜࣓ㄆ ▱ ⾜ ື ⒪ ἲ 㸦 Cognitive behavioral therapy forࢱゎᯒࢆᐇ᪋ࡋࡓࠋࡋ࠿ࡋ࡞ࡀࡽࠊ㸳ࡘࡢ↓సⅭ໬ẚ

insomnia adapted to bipolar disorder: CBTI-BP㸧࡞㍑ヨ㦂ࢆ࣓ࢱゎᯒࡋࡓ⤖ᯝࠊ㧗↷ᗘග⒪ἲࡢᢚ࠺ࡘ⑕

࡝ࡢᚰ⌮♫఍ⓗ἞⒪࡞࡝ࡀᣲࡆࡽࢀࡿࠋᅜ㝿཮ᴟᛶ㞀≧ᨵၿຠᯝࡣࢩ࣒ࣕ἞⒪ჾ࡜ẚ㍑ࡋ࡚᭷ព࡞ᢠ࠺ࡘ

ᐖᏛ఍ࢱࢫࢡࣇ࢛࣮ࢫ࠿ࡽࡢ཮ᴟᛶ㞀ᐖࡢྛ⑓┦࡟ຠᯝࡢᕪࢆㄆࡵ࡞࠿ࡗࡓ 12ࠋࡇࡢ⤖ᯝࡢゎ㔘ࡣ㞴ࡋࡃࠊᑐࡍࡿ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ᥎ዡࢆ♧ࡍ 6㸦⾲ 1㸧ࠋ⮫ᗋヨ㦂ࡢࢹࢨ࢖ࣥࡢ㠀ᆒ୍ᛶࡸ◊✲ࡢつᶍࡸヨ㦂ᮇ㛫ࡀ༑ศ࡛࡞࠸ࡇ࡜ࡀᙳ㡪ࡋࡓ࡜⪃࠼ࡽࢀࡿࡀࠊ◊᫬㛫⏕≀Ꮫ㻌㼂㼛㼘㻚㻌㻞㻢㻘㻌㻺㼛㻚㻌㻞㻌㻔㻞㻜㻞㻜㻕㻌㻝㻝㻜✲ẖࡢಙ㢗༊㛫ࡢᖜࡀ኱ࡁ࠸ࡇ࡜ࡀ୍ࡘࡢせᅉ࡜⪃ၿࡀගࢆ㐽᩿ࡋࡓࡇ࡜࡟ࡼࡿຠᯝ࡞ࡢ࠿ࠊᬯᐊ࡛Ᏻ㟼࠼ࡽࢀࡿࠋࡇࢀࡣ㧗↷ᗘග⒪ἲࡢຠᯝࡀᝈ⪅ࡈ࡜࡟ࡤࢆಖࡗࡓࡇ࡜࡟ࡼࡿຠᯝ࡞ࡢ࠿ࡣ᫂☜࡛ࡣ࡞࠿ࡗࡓࡽࡘࡁࡀከࡃࠊຠᯝࢆㄆࡵࡓᝈ⪅࡜ࠊࡑ࠺࡛࡞࠿ࡗࡓ16ࠋᝈ⪅ࡢᕪࡀ኱ࡁ࠿ࡗࡓࡓࡵࡔ࡜⪃࠼ࡽࢀࡿࠋࡍ࡞ࢃࡕࠊ㏆ᖺࠊ཮ᴟᛶ㞀ᐖࡢ㌄≧ែ࡟ᑐࡋ࡚ࠊ⏕యࣜࢬ࣒࡬㧗↷ᗘග⒪ἲࡣ୍㒊ࡢ཮ᴟᛶ㞀ᐖࡢᝈ⪅ࡢᢚ࠺ࡘ⑕ࡢస⏝ࡀ᭱ࡶ኱ࡁ࠸㟷ⰍἼ㛗ගࢆ㐽᩿ࡍࡿࢧࣥࢢࣛ≧࡟ຠᯝࡀ࠶ࡿࡀࠊ඲࡚ࡢᝈ⪅࡟ᑐࡋ࡚➼ࡋࡃຠᯝࢆࢫ࡟ࡼࡿຠᯝࢆ᳨ウࡋࡓ↓సⅭ໬ẚ㍑ヨ㦂ࡀᐇ᪋ࡉㄆࡵࡿࢃࡅ࡛ࡣ࡞࠸ࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿ࡜⪃࠼ࡽࢀ

ࢀࡓ 17ࠋࡑࡢ⤖ᯝࠊࣈ࣮ࣝࣛ࢖ࢺ࢝ࢵࢺࢧࣥࢢࣛࢫࢆࡿࠋᏘ⠇ኚືࡸ╧╀࣭ぬ㓰ࣜࢬ࣒㞀ᐖࡀᏑᅾࡍࡿ཮ᴟ⿦╔ࡋࡓ཮ᴟᛶ㞀ᐖࡢᝈ⪅⩌࡛ࡣࠊࢡࣜ࢔ࣞࣥࢬࢢࣛᛶ㞀ᐖᝈ⪅࡛ࡣࠊࡇࢀࡽࡢ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢೃ⿵࡜ࢫࢆ⿦╔ࡋࡓᝈ⪅⩌࡜ẚ㍑ࡋ࡚㌄⑕≧ࡢᨵၿຠᯝࡀ࡞ࡾ࠺ࡿ࡜⪃࠼ࡽࢀࡿࡀࠊࡇࡢⅬ࡟ࡘ࠸࡚ࡣࡉࡽ࡞ࡿ᭷ព࡟㧗࠿ࡗࡓࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ᳨ウࡀᚲせ࡛࠶ࡿࠋ ࣓ࣛࢺࢽࣥ ᩿╀⒪ἲ࣓ࣛࢺࢽࣥࡣ⏕యෆ࡛୺࡟ኪ㛫࡟ᯇᯝయ࡛ศἪࡉ᩿╀⒪ἲࡣࠊኪ㛫ࡢ╧╀᫬㛫ᖏࡢ඲࡚࡞࠸ࡋ୍㒊ࢆࢀࠊࡑࡢศἪࡣど஺ཫୖ᰾࠿ࡽࡢ஺ឤ⚄⤒ࢆ௓ࡋࡓ⚄ぬ㓰ࡋ࡚㐣ࡈࡍࡇ࡜࡟ࡼࡾᢚ࠺ࡘ⑕≧ࡢᨵၿࢆᅗࡿ⤒άື࡛ㄪ⠇ࡉࢀ࡚࠾ࡾࠊࡑࡢศἪࡣ᪥୰࡟ᑡ࡞ࡃࠊ

἞⒪ἲ࡛࠶ࡿࠋࡇࡢ἞⒪ࡣຠᯝⓎ⌧ࡀ᪩ࡃࠊ᭷ຠ⋡ࡶኪ㛫࡟ከ࠸࡜࠸࠺᫂☜࡞ᴫ᪥ࣜࢬ࣒ࢆ♧ࡋ࡚࠸ࡿ 18ࠋ㧗࠸ࡢࡀ≉ᚩ࡛࠶ࡿ 13ࠋ୍᪉࡛᩿╀⒪ἲ༢⊂࡛ࡣຠᯝ࣓ࣛࢺࢽࣥࢆእⓗ࡟ᢞ୚ࡍࡿࡇ࡜࡟ࡼࡾᴫ᪥ࣜࢬ࣒ࡀᣢ⥆ࡋ࡟ࡃ࠸࡜࠸ࡗࡓḞⅬࡶᣲࡆࡽࢀࡿࠋࡲࡓࠊᙉ࡟ᚑࡗࡓ╧╀࣭ぬ㓰ࣜࢬ࣒ࡢ఩┦ࢆኚ఩ࡉࡏࡿࡇ࡜ࡀ

ຊ࡞ᢠ࠺ࡘຠᯝ࡟ࡼࡾ㌄㌿ࡢ༴㝤ᛶࡶᣦ᦬ࡉࢀ࡚࠸▱ࡽࢀ࡚࠸ࡿࠋ࣓ࣛࢺࢽࣥཷᐜయసື⸆ࡢࣟࢮ࣒ࣞࡶࡿࡀࠊẼศᏳᐃ⸆ࢆే⏝ࡋࡓ㝿ࡢ㌄㌿ࡢࣜࢫࢡࡣపࡃࠊ

ྠᵝ࡟ᴫ᪥ࣜࢬ࣒ㄪ⠇స⏝ࡀ࠶ࡿ࡜⪃࠼ࡽࢀ࡚࠸ࡿᢠ࠺ࡘ⸆ࡢే⏝ࡼࡾࡶ㌄㌿ࡢ༴㝤ᛶࡣప࠸࡜⪃࠼ࡽ

19ࠋࢀ࡚࠸ࡿ 14ࠋࡑࡢࡓࡵࠊ᩿╀⒪ἲࡣ༢⊂࡛⾜ࢃࢀࡿࡇࡑࡢࡓࡵࠊ࣓ࣛࢺࢽࣥࡸ࣓ࣛࣝࢸ࢜ࣥᢞ୚࡟ࡼࡿ╧࡜ࡣᑡ࡞ࡃࠊẼศᏳᐃ⸆ࡸ㧗↷ᗘග⒪ἲ࡜ࡢే⏝࡛⾜╀ࡸᴫ᪥ࣜࢬ࣒ࡢㄪ⠇స⏝ࢆ௓ࡋࡓ཮ᴟᛶ㞀ᐖࡢ⑕ࢃࢀࡿࡇ࡜ࡀ࡯࡜ࢇ࡝࡛࠶ࡿࠋ≧ᨵၿࡸ෌Ⓨண㜵ຠᯝࡀ᳨ウࡉࢀ࡚ࡁࡓࠋ཮ᴟᛶ㞀ᐖ㧗↷ᗘග⒪ἲ࡟᩿╀⒪ἲࢆ⤌ࡳྜࢃࡏࡓ᫬㛫⏕≀ࡢᢚ࠺ࡘ⑕≧ᨵၿຠᯝࡸ㌄⑕≧ᨵၿຠᯝ࡟ࡘ࠸࡚ࡣ

Ꮫⓗ἞⒪ࡣࠊ཮ᴟᛶ㞀ᐖ࡟ᑐࡋ࡚ࡣẚ㍑ⓗ୍㈏ࡋࡓຠ

ሗ࿌ẖ࡟㐪࠸ࡣ࠶ࡿࡶࡢࡢࠊ᫂☜࡞ຠᯝࡣ♧ࡉࢀ࡚࠸ᯝࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋBenedetti ࡽࡣࠊ」ᩘᅇࡢ඲᩿

࡞࠸ 20,21ࠋ୍᪉࡛෌Ⓨண㜵ຠᯝ࡟㛵ࡋ࡚ࡣࠊ2013 ᖺ╀࡟ࡼࡿぬ㓰⒪ἲ࡟ຍ࠼࡚ࠊ10000 ࣝࢡࢫࡢ㧗↷ᗘග࡟୙╀ࢆక࠺཮ᴟᛶ㞀ᐖᝈ⪅࡬ࡢ࣓ࣛࣝࢸ࢜ࣥࡢే↷ᑕࢆే⏝ࡍࡿࣉࣟࢺࢥ࣮࡛ࣝࠊ཮ᴟᛶ㞀ᐖࡢ࠺ࡘ≧⏝⒪ἲࡢ෌Ⓨண㜵ຠᯝࢆ᳨ウࡋࡓ↓సⅭ໬ẚ㍑ヨ㦂ែ࡟ᑐࡍࡿຠᯝࡢ᳨ウࢆ⾜ࡗࡓࠋࡑࡢ⤖ᯝࠊ㏻ᖖࡢ⸆

ࡀሗ࿌ࡉࢀࡓ 22ࠋᮏ◊✲࡛ࡣ 83 ౛ࡢᐶゎᮇ཮ᴟᛶ㞀≀⒪ἲ⩌࡜ẚ㍑ࡋ࡚ࠊ᫬㛫⏕≀Ꮫⓗ἞⒪ࢆే⏝ࡋࡓ⩌ᐖᝈ⪅ࢆ㏻ᖖࡢ཮ᴟᛶ㞀ᐖ἞⒪⸆࡟㏣ຍࡋ࡚࣓ࣛࣝ

࡛ࡣ᭷ព࡟㧗࠸࠺ࡘ⑓⑕≧ࡢᨵၿࢆㄆࡵࠊ⣙ 7 ๭ࡢᝈࢸ࢜ࣥෆ᭹⩌࡜ࣉࣛࢭ࣎⩌࡟↓సⅭ࡟๭ࡾ௜ࡅ࡚ 24⪅ࡀ἞⒪㛤ጞᚋ 1 㐌㛫࡛ HAM-D ࢫࢥ࢔ࡢ 50㸣௨ୖ㐌㛫ホ౯ࡋࡓ⤖ᯝࠊ࣓ࣛࣝࢸ࢜ࣥෆ᭹⩌࡛᭷ព࡟⑕≧ࡢᨵၿࢆㄆࡵࡓࠋࡲࡓࠊࡇࡢࣉࣟࢺࢥ࣮ࣝࡣ཮ᴟᛶ㞀

ࡢ෌Ⓨ⋡ࡀప࠿ࡗࡓࡇ࡜ࡀ♧ࡉࢀࡓࠋࡋ࠿ࡋ࡞ࡀࡽࠊ

ᐖࡢ἞⒪᢬ᢠᛶ࠺ࡘ≧ែࡢᝈ⪅ࡢᢚ࠺ࡘ⑕≧ࢆᨵၿ

2017 ᖺ࡟ᐇ᪋ࡉࢀࡓ࣓ࣛࣝࢸ࢜ࣥ⯉ୗ㘄ᢞ୚㸦ࣉࣛࡍࡿࡢ࡜ྠ᫬࡟ࠊᕼṚᛕ៖ࡢ㍍ῶຠᯝࡶ♧ࡉࢀ࡚࠸ࡿ

ࢭ࣎㸸0.1 ਺㸸0.4 ਺㸸0.8 ਺ࡢ 4 ⩌࡛ẚ㍑㸧࡟ࡼࡿ15ࠋ

642 ౛ࡢᐶゎᮇ཮ᴟᛶ㞀ᐖᝈ⪅ࢆᑐ㇟࡜ࡋࡓ 12 ࠿᭶㛫ࡢ෌Ⓨண㜵ຠᯝࢆ᳨ウࡋࡓ኱つᶍ࡞↓సⅭ໬ẚ㍑

 ᬯ㜌⒪ἲ

ヨ㦂࡛ࡣࠊ࠸ࡎࢀࡢ⏝㔞⩌࡛ࡶࣉࣛࢭ࣎࡜ẚ㍑ࡋ࡚෌

㧗↷ᗘග⒪ἲࡀ཮ᴟᛶ㞀ᐖࡢᢚ࠺ࡘ⑕≧࡟ຠᯝࢆⓎ⋡࡟᭷ព࡞ᕪࡣㄆࡵ࡞࠿ࡗࡓ 23ࠋୖ㏙ࡢ஧ࡘࡢ࣓ࣛ♧ࡍࡇ࡜࡞࡝࠿ࡽ╔᝿ࢆᚓ࡚ࠊኪ㛫ࡢග᭚㟢ࢆไ㝈ࡍࣝࢸ࢜ࣥࡢ཮ᴟᛶ㞀ᐖࡢ෌Ⓨண㜵ຠᯝࢆ᳨ウࡋࡓ◊ࡿࡇ࡜࡟ࡼࡾ㌄⑕≧ࡢᨵၿຠᯝࡀᮇᚅ࡛ࡁࡿ࡜⪃࠼ࠊ✲࡛␗࡞ࡿ⤖ᯝ࡜࡞ࡗࡓ⌮⏤࡜ࡋ࡚ࡣࠊᚋ⪅ࡢ◊✲࡛ጞࡵࡽࢀࡓࡢࡀᬯ㜌⒪ἲ࡛࠶ࡿࠋ཮ᴟᛶ㞀ᐖࡢ㌄≧ែࡣ୙╀⑕≧ࢆㄆࡵ࡞࠸ᝈ⪅ࡶ⤌ࡳධࢀࡓࡇ࡜ࡸࠊᴟࡵ

ࡢᝈ⪅ࢆ㸱᪥㛫㐃⥆࡛ 18 ᫬࠿ࡽ⩣᪥ࡢᮅ 8 ᫬ࡲ࡛ 14࡚ప࠸⏝㔞タᐃ࡟ၥ㢟ࡀ࠶ࡗࡓྍ⬟ᛶࡀᣦ᦬ࡉࢀ࡚᫬㛫ࠊᬯᐊ࡛㐣ࡈࡉࡏࡓ࡜ࡇࢁ㌄⑕≧ࡀ᪩ᮇ࡟ᨵၿࡋ࠸ࡿࠋ࠸ࡎࢀ࡟ࡏࡼࠊ⌧᫬Ⅼ࡛ࡣ࣓ࣛࣝࢸ࢜ࣥࡢ཮ᴟ

ࡓࡇ࡜ࡀሗ࿌ࡉࢀࡓࠋࡋ࠿ࡋ࡞ࡀࡽࠊࡇࡢ㌄⑕≧ࡢᨵᛶ㞀ᐖࡢ෌Ⓨண㜵┠ⓗࡢᢞ୚ࡣ᥎ዡ࡟ࡣ⮳ࡗ࡚࠸࡞᫬㛫⏕≀Ꮫ䚷㼂㼛㼘㻚㻌㻞㻢㻘㻌㻺㼛㻚㻌㻞㻌㻔㻞㻜㻞㻜㻕㻌㻝㻝㻝࠸ࠋ௒ᚋࠊ࣓ࣛࢺࢽࣥࡸ࣓ࣛࣝࢸ࢜ࣥࡢ⏝㔞タᐃࡸᢞ⫱ࡸ⸆≀⒪ἲࡢࡳ࡛ࡣ༑ศ࡞⑕ೃᏛⓗ࡞ᐶゎࡸ෌Ⓨ୚ࢱ࢖࣑ࣥࢢࠊ⤌ࡳධࢀᝈ⪅ࢆ෌ᗘ᳨ウࡋ࡚ࡑࡢຠᯝண㜵ຠᯝࢆᚓࡿࡇ࡜ࡀ㞴ࡋ࠸཮ᴟᛶ㞀ᐖᝈ⪅ࡢ἞⒪ࢆ᳨ドࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࡔࢁ࠺ࠋ࡟᪂ࡓ࡞㑅ᢥ⫥ࢆ୚࠼࠺ࡿࡶࡢ࡛࠶ࡿࠋࡋ࠿ࡋ࡞ࡀࡽࠊ⌧᫬Ⅼ࡟࠾࠸࡚ࡣ࠸ࡎࢀࡢ἞⒪ࡶ࢚ࣅࢹࣥࢫࡀ༑ศ ᚰ⌮♫఍⒪ἲ࡛࠶ࡿ࡜ࡣゝ࠸㞴࠸ࡔࢁ࠺ࠋ཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ᫬㛫཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿᴫ᪥ࣜࢬ࣒ㄪ⠇స⏝ࢆྵࢇࡔ⏕≀Ꮫⓗ἞⒪ࢆ࢞࢖ࢻࣛ࢖ࣥ➼࡛඲࡚ࡢ཮ᴟᛶ㞀ᐖᚰ⌮♫఍⒪ἲ࡜ࡋ࡚ࠊIPSRT ࡜ CBTI-BP ࡀᣲࡆࡽࢀᝈ⪅࡟ᑐࡋ୍࡚⯡໬ࡋ࡚ࡑࡢ౑⏝ࢆ᥎ዡࡍࡿࡢࡣៅ

࡚࠸ࡿࠋIPSRT ࡣᚰ⌮⒪ἲ࡜ࡋ࡚ᑐே㛵ಀ࡟↔Ⅼࢆ㔜࡞᳨ウࡀᚲせ࡛࠶ࡿ࡜ឤࡌࡿࠋࡲࡓࠊ⮫ᗋヨ㦂࡛࢚ᙜ࡚ࡓᑐே㛵ಀ⒪ἲ㸦Interpersonal therapy㸧࡜╧ࣅࢹࣥࢫࢆㄆࡵࡓ࡜ࡋ࡚ࡶࠊࢃࡀᅜࡢ⮫ᗋ⌧ሙ࡟࠾࠸╀࣭ぬ㓰ࣜࢬ࣒㸦♫఍ࣜࢬ࣒㸧ࡢㄪᩚ࡟↔Ⅼࢆᙜ࡚ࡓ࡚ࡇࢀࡽࡢ἞⒪ࡢᐇ᪋ࡍࡿࡇ࡜ࡣᚲࡎࡋࡶᐜ࡛᫆ࡣ

♫఍ࣜࢬ࣒⒪ἲ㸦Social rhythm therapy㸧ࢆ⤌ࡳྜ࡞࠸࡜⪃࠼ࡿࠋ౛࠼ࡤࠊ཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ㧗↷ᗘගࢃࡏ࡚࠸ࡿⅬࡀ≉ᚩⓗ࡞἞⒪ἲ࡛࠶ࡿࠋIPSRT ࡣ཮⒪ἲࡣࠊẖᮅ 30 ศ㹼2 ᫬㛫⛬ᗘ἞⒪ჾࢆ౑⏝ࡍࡿᚲᴟᛶ㞀ᐖࡢᛴᛶᮇࡢᢚ࠺ࡘ⑕≧ࡢᨵၿຠᯝ࡟ຍ࠼࡚

せࡀ࠶ࡿࡀࠊᢚ࠺ࡘ⑕≧ࡀ㔜ᗘ࡛㉳ᗋᅔ㞴ࢆక࠺ࡼ࠺

24ࠊ෌Ⓨண㜵ຠᯝࡶ♧ࡉࢀ࡚࠾ࡾ 25ࠊᛴᛶᮇࠊ⥔ᣢᮇ࡞཮ᴟᛶ㞀ᐖᝈ⪅ࡀࠊࣉࣟࢺࢥ࣮ࣝ㏻ࡾ࡟㧗↷ᗘග⒪࠸ࡎࢀ࡟࠾࠸࡚ࡶ᥎ዡࡉࢀ࡚࠸ࡿࡀࠊ◊✲ࡢ෌⌧ᛶࡀἲࢆᐇ᪋ࡍࡿࡇ࡜ࡣእ᮶⎔ቃ࡛ࡣ⌧ᐇⓗ࡛ࡣ࡞࠸ࠋࡇஈࡋ࠸࡜࠸࠺ၥ㢟Ⅼࡶᣦ᦬ࡉࢀ࡚࠸ࡿࡓࡵ௒ᚋࡉࡽࡢࡼ࠺࡞㔜⑕౛࡛ࡣධ㝔ຍ⒪࡟ࡼࡾࠊ㧗↷ᗘග⒪ἲࡸ

࡞ࡿ᳨ウࡀᚲせࡔࢁ࠺ࠋࡲࡓࠊIPSRT ࡣᡃࡀᅜ࡟࠾⸆≀⒪ἲ࡜᩿╀⒪ἲࢆ⤌ࡳྜࢃࡏࡓ἞⒪ἲࡢ᭷ຠᛶ

࠸࡚ᐇ᪋ྍ⬟࡞་⒪ᶵ㛵ࡀ㝈ࡽࢀ࡚࠸ࡿⅬࡶၥ㢟࡛ࡣ♧ࡉࢀ࡚࠸ࡿࡶࡢࡢࠊ᩿╀⒪ἲᐇ᪋࡟ࡣᑓ㛛ⓗ࡞▱࠶ࡿࡓࡵࠊ௒ᚋࡣᡃࡀᅜ࡛ࡶ IPSRT ࡢᬑཬࡀ㐍ࡴࡇ㆑࡟ຍ࠼࡚ࠊኪ㛫ࡢ᩿╀⒪ἲ࡟ᚲせ࡞┳ㆤᖌ࡞࡝ࡢே࡜ࡀᮃࡲࢀࡿࠋဨࡸ⑓Ჷࡢࣁ࣮ࢻ㠃ࡢၥ㢟࡞࡝ࡀ࠶ࡾࠊᡃࡀᅜ࡟࠾࠸

㏆ᖺࠊ୙╀⑕ࡢ἞⒪࡜ࡋ࡚ὀ┠ࡉࢀ࡚࠸ࡿᚰ⌮♫఍࡚ࡣᴟࡵ࡚㝈ࡽࢀࡓ᪋タ࡛ࡋ࠿ᐇ᪋࡛ࡁ࡞࠸≧ἣ࡛⒪ἲ࡜ࡋ࡚୙╀⑕࡟ᑐࡍࡿㄆ▱⾜ື⒪ἲ㸦Cognitive࠶ࡿࠋ㌄⑕≧ᨵၿ࡟ᮇᚅࡉࢀ࡚࠸ࡿࣈ࣮ࣝࣛ࢖ࢺ࢝ࢵ

behavioral therapy for insomnia: CBT-I㸧ࡀᣲࡆࡽࢺࢧࣥࢢࣛࢫࢆ⏝࠸ࡓᬯ㜌⒪ἲ࡟㛵ࡋ࡚ࡣࠊẼศࡀ㧗ࢀࡿࠋCBT-I ࡣ୙╀⑕࡟ᑐࡋ࡚㇏ᐩ࡞࢚ࣅࢹࣥࢫࡀ࠶ᥭࡋ࡚࠸ࡿ㌄≧ែࡢᝈ⪅࡟ࣉࣟࢺࢥ࣮ࣝ㏻ࡾࡢ౑⏝ࡿࡓࡵࠊḢ⡿ࡢ࢞࢖ࢻࣛ࢖࡛ࣥࡣ୙╀⑕἞⒪ࡢ➨୍἞ࢆồࡵࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡿࠋࡲࡓࠊIPSRT ࡸ CBTI-⒪㑅ᢥ⫥࡜ࡋ࡚᥎ዡࡉࢀ࡚࠸ࡿ 26ࠋࡲࡓࠊCBT-I ࡣ࠺BP ࡢࡼ࠺࡞ᚰ⌮♫఍⒪ἲ࡟࠾࠸࡚ࡶࠊࢃࡀᅜ࡛ࡣᐇ

ࡘ⑓࡟ᑐࡋ࡚ࠊ୙╀⑕≧ࡢᨵၿࡢࡳ࡞ࡽࡎࠊᢚ࠺ࡘ⑕

᪋ྍ⬟࡞་⒪ᶵ㛵ࡀ㠀ᖖ࡟ᑡ࡞࠸࡜࠸࠺ၥ㢟Ⅼࡶᣲ≧ࡢᨵၿຠᯝࡶሗ࿌ࡉࢀ࡚࠸ࡿ 27ࠋ
Harvey ࡽࡣ CBT-ࡆࡽࢀࡿࠋI ࢆ཮ᴟᛶ㞀ᐖ⏝࡟ಟṇࡋ࡚ࠊ୺࡟╧╀࣭ぬ㓰ࣜࢬ࣒ࡇࡢࡼ࠺࡞⌧≧ࢆ⪃࠼ࡿ࡜ࠊࢃࡀᅜࡢ⮫ᗋ⌧ሙ࡛᫬ࡢ⥔ᣢ࡟↔Ⅼࢆᙜ࡚ࡓ CBTI-BP ࢆ㛤Ⓨࡋࠊࡑࡢຠᯝ㛫⏕≀Ꮫⓗ἞⒪ࢆ⮫ᗋ◊✲ࡢࣉࣟࢺࢥ࣮ࣝ㏻ࡾ࡟ᐇ

ࢆ᳨ドࡋࡓࠋ58 ౛ࡢ୙╀⑕≧ࢆ᭷ࡍࡿᐶゎᮇ཮ᴟᛶ㊶ࡋ࡚ࡃࡇ࡜ࡣᴟࡵ࡚㞴ࡋ࠸ࡀࠊࡇࢀࡽ⮫ᗋ◊✲࡛ᚓ㞀ᐖࢆᑐ㇟࡟ CBTI-BP ࡜ᚰ⌮ᩍ⫱ࢆᐇ᪋ࡋࡓ⩌ࡢ 2ࡽࢀࡓ▱ぢࢆ⮫ᗋ⌧ሙ࡛ᛂ⏝ࡍࡿࡇ࡜ࡣྍ⬟࡛࠶ࡿ⩌࡟↓సⅭ࡟๭ࡾ௜ࡅࠊ6 ࠿᭶㛫ࡢ⑕≧෌⇞ࡢẚ㍑ࢆ

࡜⪃࠼ࡿࠋලయⓗ࡟ࡣࠊ╧╀࣭ぬ㓰ࣜࢬ࣒⾲ࢆ⏝࠸࡚ࠊ⾜ࡗࡓ⤖ᯝࠊCBTI-BP ⩌࡛ࡣ᭷ព࡟㌄⑕≧ࡢ෌Ⓨ⋡཮ᴟᛶ㞀ᐖᝈ⪅࡟⮬ࡽࡢ╧╀࣭ぬ㓰ࣜࢬ࣒ࢆグ㍕ࡋ࡚

ࡀప࠿ࡗࡓࡇ࡜ࡀ♧ࡉࢀࡓ 28ࠋ୍᪉࡛ࠊᢚ࠺ࡘ⑕≧ࡢࡶࡽ࠺ࡇ࡜࡟ࡼࡾࠊᝈ⪅⮬㌟ࡢ⑕≧ᢕᥱࡸࢭࣝࣇࢣ࢔෌Ⓨ⋡ࡣ᭷ព࡞ᕪࢆㄆࡵ࡞࠿ࡗࡓࡓࡵࠊᅜ㝿཮ᴟᛶ㞀ព㆑ࢆ㧗ࡵࡿࡇ࡜࡟⧅ࡀࡾᚰ⌮♫఍ⓗ࡞௓ධຠᯝࡀ

ᐖᏛ఍ࡢ᥎ዡࡣ㌄⑕≧ࡢண㜵ຠᯝࡢࡳ࡜࡞ࡗ࡚࠸ࡿࠋᮇᚅ࡛ࡁࡿࠋࡑࢀࢆ⏝࠸࡞ࡀࡽࠊ㧗↷ᗘග⒪ἲࢆᐇ᪋

ࡲࡓࠊCBTI-BP ࡢຠᯝࡣᑠつᶍ࡞↓సⅭ໬ヨ㦂୍ࡘࡍࡿ௦ࢃࡾ࡟༗๓୰ࢆ୰ᚰ࡟እฟࢆࡍࡿࡇ࡜ࢆಁࡋࠊࡢࡳ࡛ࡋ࠿♧ࡉࢀ࡚࠸࡞࠸ࡓࡵࠊ௒ᚋ⤖ᯝࡢ෌⌧ࡢࡓᬯ㜌⒪ἲࢆᐇ᪋ࡍࡿ௦ࢃࡾ࡟ኪ㛫ࡢࢫ࣐࣮ࢺࣇ࢛ࣥࡵࠊ኱つᶍ࡞㞟ᅋ࡛ほᐹᮇ㛫ࢆᘏ㛗ࡋࡓࡉࡽ࡞ࡿ᭷ຠࡸ PCࠊ⺯ගⅉ࡞࡝ࡢᙉ࠸ගࢆᴟຊ㑊ࡅࡿࡼ࠺࡟ᣦᑟᛶࡢ᳨ドࡀᮇᚅࡉࢀࡿࠋࡍࡿࡇ࡜࡟ࡼࡾ╧╀࣭ぬ㓰ࣜࢬ࣒ࡢ஘ࢀࢆ᫝ṇࡍࡿࡇ࡜ࡀᢚ࠺ࡘ⑕≧ࡢᨵၿࠊ㌄⑕≧ࡢᨵၿࠊ෌Ⓨண㜵࡟୍ ཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ㐺ᛂ࡜ᐃࡢຠᯝ♧ࡍࡇ࡜ࢆᐇឤࡋ࡚࠸ࡿࠋ㝈⏺
཮ᴟᛶ㞀ᐖ࡟ᑐࡍࡿ᫬㛫⏕≀Ꮫⓗ἞⒪ࡢ࢚ࣅࢹࣥ
ࢫ࡟ࡘ࠸࡚ᴫㄝࡋࡓࠋࡇࢀࡽࡢ἞⒪ࡣ୍⯡ⓗ࡞ᚰ⌮ᩍ ࠾ࢃࡾ࡟཮ᴟᛶ㞀ᐖࡢ╧╀࣭ぬ㓰ࣜࢬ࣒㞀ᐖ࡟╔┠ࡋࡓ᫬㛫᫬㛫⏕≀Ꮫ䚷㼂㼛㼘㻚㻌㻞㻢㻘㻌㻺㼛㻚㻌㻞㻌㻔㻞㻜㻞㻜㻕㻌㻝㻝㻞⏕≀Ꮫⓗ἞⒪ࡢ᭷⏝ᛶ࡟ࡘ࠸࡚ᴫㄝࡋࡓࠋ཮ᴟᛶ㞀ᐖ

serotonin transporter binding in the anterior

ࡣ㏻ᖖࡢᚰ⌮ᩍ⫱࡜⸆≀⒪ἲࡢࡳ࡛ࡣ෌Ⓨࢆ㜵ࡄࡇcingulate࡜ࡀᅔ㞴࡛࠶ࡿࡓࡵࠊࡇࡢࡼ࠺࡞᪂ࡓ࡞἞⒪㑅ᢥ⫥ࡀ

psychiatrica Scandinavica 132, 379-388 (2015).

ቑ࠼࡚࠸ࡃࡇ࡜ࡣᮃࡲࡋ࠸ࡇ࡜ࡔࢁ࠺ࠋ୍᪉࡛ࠊከࡃ

9.

andprefrontalActa

cortex.

Golden, R. N. et al. The efficacy of light therapyࡢ᫬㛫⏕≀Ꮫⓗ἞⒪ࡣ⌧᫬Ⅼ࡛ࡣ⮫ᗋᛂ⏝ࡍࡿࡇ࡜in the treatment of mood disorders: a reviewࡣᐜ࡛᫆ࡣ࡞࠸ࠋ௒ᚋࠊࡇࢀࡽࡢ἞⒪ࡢ⡆౽ᛶ࡞࡝᭦

and meta-analysis of the evidence. Am. J.

࡞ࡿᨵⰋ࡜ࡑࡢຠᯝࡢ᳨ドࡀᚲせࡔ࡜ឤࡌ࡚࠸ࡿࠋࡇ

Psychiatry 162, 656-662 (2005).

ࢀࡽࡢ᫬㛫⏕≀Ꮫⓗ἞⒪ἲࡀࡉࡽ࡟ᨵⰋࡉࢀࠊᬑཬࡋ

10. Sit, D. K. et al. Adjunctive bright light therapy࡚࠸ࡃࡇ࡜ࡀ཮ᴟᛶ㞀ᐖᝈ⪅ࡢணᚋᨵၿ࡟⧅ࡀࡿࡇ

for bipolar depression: A randomized double-࡜ࢆᮇᚅࡋࡓ࠸ࠋ

blind

placebo-controlledAm.

trial.

J.

Psychiatry 175, 131-139 (2018).
11. Zhou, T. H. et al. Clinical efficacy, onset timeཧ⪃ᩥ⊩and safety of bright light therapy in acute

1.

Jackson, A., Cavanagh, J. & Scott, J. A

bipolar depression as an adjunctive therapy: A

systematic review of manic and depressive

randomized controlled trial. J. Affect. Disord.

prodromes. J. Affect. Disord. 74, 209-217

227, 90-96 (2018).
12. Takeshima, M. et al. Efficacy and safety of(2003).
2.

3.

4.

5.

6.Gruber, J. et al. Sleep functioning in relationbright light therapy for manic and depressive

to mood, function, and quality of life at entry

symptoms in patients with bipolar disorder: A

to the Systematic Treatment Enhancement

systematic

Program for Bipolar Disorder (STEP-BD). J.

Psychiatry and clinical neurosciences 74, 247-

Affect. Disord. 114, 41-49 (2009).

256 (2020).

meta-analysis.

13. Wirz-Justice, A. & Van den Hoofdakker, R. H.

bipolar disorder: seeking synchrony, harmony,

Sleep deprivation in depression: what do weand regulation. Am. J. Psychiatry 165, 820-829

know, where do we go? Biol Psychiatry 46, 445-(2008).

453 (1999).

Takaesu, Y. et al. Circadian rhythm sleep-

14. Suzuki, M. et al. Does early response predict

wake disorders predict shorter time to relapse

subsequent remission in bipolar depressionof mood episodes in euthymic patients withtreatedbipolar disorder: A prospective 48-week study.

combined with light therapy and lithium? J.

J. Clin. Psychiatry 79, 17m11565 (2018).

Affect. Disord. 229, 371-376 (2018).

Takaesu, Y. Circadian rhythm in bipolar

withrepeatedsleep

deprivation

15. Benedetti, F. et al. Rapid treatment response

disorder: A review of the literature. Psychiatryofand clinical neurosciences 72, 673-682 (2018).

deprivation,

Gottlieb, J. F. et al. The chronotherapeutic(chronotherapeutics) in drug-resistant bipolar

treatment of bipolar disorders: A systematicdepression. J. Clin. Psychiatry 75, 133-140

review and practice recommendations from the(2014).

task

force

on

chronotherapy

andchronobiology. Bipolar Disord. 21, 741-773

suicidal

symptomsandtolithium,lightsleep

therapy

16. Barbini, B. et al. Dark therapy for mania: apilot study. Bipolar Disord. 7, 98-101 (2005).
17. Henriksen, T. E. et al. Blue-blocking glasses as(2019).

al. Winter Depression:

additive treatment for mania: a randomized

Integrating mood, circadian rhythms, and theplacebo-controlled trial. Bipolar Disord. 18,

sleep/wake and light/dark cycles into a bio-

221-232 (2016).

Lewy,

A.

J.

et

psycho-social-environmental
8.

andHarvey, A. G. Sleep and circadian rhythms inISBD

7.

reviewmodel.

Sleep

18. Macchi, M. M. & Bruce, J. N. Human pineal

medicine clinics 4, 285-299 (2009).

physiology and functional significance ofHarrison, S. J. et al. Light therapy andmelatonin. Front. Neuroendocrinol. 25, 177-᫬㛫⏕≀Ꮫ䚷㼂㼛㼘㻚㻌㻞㻢㻘㻌㻺㼛㻚㻌㻞㻌㻔㻞㻜㻞㻜㻕㻌㻝㻝㻟phase 3, randomized controlled trial. J. Affect.

195 (2004).
19. Hirai,K.

etal.

Ramelteon(TAK-375)

Disord. 221, 275-282 (2017).

accelerates reentrainment of circadian rhythm

24. Miklowitz, D. J. et al. Psychosocial treatments

after a phase advance of the light-dark cycle infor bipolar depression: a 1-year randomized

rats. J. Biol. Rhythms 20, 27-37 (2005).

trial

20. Romo-Nava, F. et al. Melatonin attenuates
antipsychotic metabolic effects: an eight-week

from

the

Systematic

Treatment

Enhancement Program. Arch. Gen. Psychiatry64, 419-426 (2007).

parallel-group,

25. Frank, E. et al. Two-year outcomes forplacebo-controlled clinical trial. Bipolar Disord.

interpersonal and social rhythm therapy in

16, 410-421 (2014).

individuals with bipolar I disorder. Arch. Gen.

randomized,

double-blind,

21. McElroy, S. L. et al. A randomized, placebo-Psychiatry 62, 996-1004 (2005).

controlled study of adjunctive ramelteon in26. Qaseem, A. et al. Management of chronic

ambulatory bipolar I disorder with manic

insomnia disorder in adults: A clinical practice

symptoms and sleep disturbance. Int. Clin.

guideline from the American College ofPsychopharmacol. 26, 48-53 (2011).

Physicians. Ann. Intern. Med. 165, 125-133

22. Norris, E. R. et al. A double-blind, randomized,(2016).

adjunctive27. Watanabe, N. et al. Brief behavioral therapy

ramelteon for the treatment of insomnia andfor refractory insomnia in residual depression:mood stability in patients with euthymic

an assessor-blind, randomized controlled trial.

placebo-controlled

trial

of

bipolar disorder. J. Affect. Disord. 144, 141-147
23. Mahableshwarkar, A. R. et al. Efficacy andsafety

J. Clin. Psychiatry 72, 1651-1658 (2011).
28. Harvey, A. G. et al. Treating insomnia(2013).
ofadjunctive

anbipolar disorder: a pilot randomized controlled

maintenancetrial. J. Consult. Clin. Psychol. 83, 564-577

sublingual

ramelteon

therapytheinimproves mood state, sleep, and functioning inastreatment of bipolar I disorder in adults: A(2015).

᫬㛫⏕≀Ꮫ䚷㼂㼛㼘㻚㻌㻞㻢㻘㻌㻺㼛㻚㻌㻞㻌㻔㻞㻜㻞㻜㻕㻌㻝㻝㻠