Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Insulin-like growth factor I (IGF-I) is a neurotrophic factor produced by the hypothalamic-pituitary-somatotropic axis and is considered a potential contributor to the pathology of major depressive disorder (MDD). Although it is known that the hypothalamic-pituitary-adrenal axis and cortisol are involved in the pathology of MDD, the association with dehydroepiandrosterone sulfate (DHEAS) remains unclear. The current study sought to clarify the relationship between these hormones and the pathology of MDD. METHODS: Subjects were 91 Japanese patients with a diagnosis of MDD. Serum IGF-I, cortisol, and DHEAS were measured. Samples were taken before breakfast after overnight fasting. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAM-D). RESULTS: Subjects included 59 men and 32 women with an average age of 44.1 ± 13.1 years (mean ± SD). The blood IGF-I level was 152.0 ± 50.0 ng/mL, the cortisol level was 10.1 ± 4.6, and the DHEAS level was 201.3 ± 112.7 μg/dL. The mean HAM-D score was 13.9 ± 9.0. Serum IGF-I levels were not correlated with cortisol. Higher IGF-I, cortisol, and cortisol/DHEAS ratios were associated with higher HAM-D scores (adjusted R = 0.240, P < 0.001), and higher IGF-I and cortisol were associated with higher melancholic or suicide subscores (adjusted R = 0.200, P < 0.001; adjusted R = 0.273, P < 0.001). CONCLUSIONS: Our findings suggest that hormonal dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-somatotropic axes may be related to the symptom severity of MDD, melancholia, and suicide-related factors.

DOI： 10.1097/JCP.0000000000001071

PubMed

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Plasma concentrations of the S-enantiomer of citalopram were different between extensive and poor CYP2C19 metabolizers in healthy subjects and depressed patients. However, most studies applied dose-corrected concentrations. Thus, we studied the effects of polymorphisms of the CYP2C19 gene on raw plasma drug concentrations in Japanese patients with depression. METHODS: Subjects in this study consisted of 412 depressed patients receiving 5, 10, 15, or 20 mg of escitalopram once a day. Plasma concentrations of escitalopram and desmethylescitalopram were quantified using HPLC. CYP2C19 genotypes were identified using polymerase chain reaction methods. RESULTS: There were no differences in the steady-state plasma concentrations of escitalopram or desmethylescitalopram in each dose group (5, 10, 15, or 20 mg of escitalopram) among CYP2C19 genotype groups. However, 1-way analysis of variance showed significant effects of CYP2C19 genotypes on the dose-adjusted plasma concentration of escitalopram but not in the dose-adjusted plasma concentration of desmethylescitalopram. Analysis of covariance including age, sex, and body weight showed significant effects of CYP2C19 genotypes on the dose-adjusted plasma concentration of escitalopram and the ratio of desmethylescitalopram to escitalopram. CONCLUSIONS: These findings suggest that the CYP2C19 variants are associated with steady-state plasma concentrations of escitalopram to some extent but are not associated with desmethylescitalopram.

DOI： 10.1097/FTD.0000000000000506

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

It has long been known that antipsychotic drugs (ATP) causes tachycardia, however details such as the differences between ATP are not well known. In recent years, the relationship between the rise in resting heart rate (RHR) and the increased risk of death in the general population has been garnering attention. In this study, we examined the difference in action on RHR between olanzapine (OLZ) and aripiprazole (ARP). The changes in the RHR on switching from OLZ to ARP and on increasing from the starting OLZ dose to the final one were evaluated in 19 outpatients (Study 1) and in 29 outpatients with schizophrenia (Study 2), respectively. To analyze the RHR, electrocardiographic measurements were obtained. At the same day, the Brief Psychiatric Rating Scale (BPRS) was evaluated, and fasting blood samples were drawn after an overnight fast of at least 8 h to examine electrolytes. Both Study 1 and 2 were conducted with the approval of the Gene Ethics Committee of Niigata University Graduate School of Medical and Dental Sciences, and the patients were treated at the outpatient psychiatric clinic at Niigata University Medical and Dental Hospital. All patients had been diagnosed with schizophrenia based on the DSM-IV-TR. In the Study 1, OLZ of 14.6 ± 9.2mg (mean ± standard deviation) was switched to ARP of 20.8 ± 8.1mg. Significant decreases were observed in the mean RHR after the switch to ARP (73.7 ± 9.7 vs 65.8 ± 10.9 beats/min, p = 0.008). In the Study 2, the starting OLZ dose was 7.2 ± 3.2mg and the increasing OLZ dose was 18.3 ± 7.4mg. Significant increases were observed in the mean RHR after increasing OLZ (69.7 ± 14.0 vs 75.6 ± 14.3 beats/min, p = 0.004). In this study, it was shown that OLZ has a stronger RHR enhancing effect compared to ARP and its effects are dose-dependent. If the increase in RHR increases the mortality rate of patients with schizophrenia, it may be necessary to further investigate the differences between ATP in terms of the effect on RHR of second-generation antipsychotics with a strong anticholinergic action or phenothiazine antipsychotics.

DOI： 10.1371/journal.pone.0199922

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Users of antipsychotics (APs) have a risk of sudden cardiac death (SCD). Sudden cardiac death in such patients is thought to be largely due to drug-induced QT prolongation. It has been reported that many subjects with drug-induced torsades de pointes (TdP) have risk alleles associated with subclinical congenital long QT syndrome. METHODS: We investigated the effects of the risk alleles associated with long QT on the QT interval in patients receiving APs using 24-hour Holter electrocardiograms to take into account the circadian fluctuation of QT intervals. We investigated 8 single-nucleotide polymorphisms identified on a GWAS. RESULTS: We found that increased numbers of risk alleles at rs7188697 in NDRG4 and rs11970286 in PLN were the major predictors of an increased maximum QT interval over 24 hours in users of APs. CONCLUSIONS: It could be useful to perform a DNA-based analysis before the initiation of APs to reduce the risk of drug-induced torsades de pointes and SCD.

DOI： 10.1097/JCP.0000000000000724

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The effects of atomoxetine on QT in adults remain unclear. In this study, we examined whether the use of atomoxetine to treat attention-deficit hyperactivity disorder in adults is associated with QT prolongation. METHODS: Forty-one subjects with attention-deficit hyperactivity disorder were enrolled in this study. Participants were administered 40, 80, or 120 mg atomoxetine daily and were maintained on their respective dose for at least 2 weeks. We conducted electrocardiographic measurements and blood tests, measuring plasma atomoxetine concentrations after treatment. Electrocardiograms of 24 of the patients were also obtained before atomoxetine treatment. The QT interval was corrected using Bazett (QTcB) and Fridericia (QTcF) correction formulas. RESULTS: In these 24 patients, only the female patients had prolonged QTcB (P = 0.039) after atomoxetine treatment. There was no correlation between plasma atomoxetine concentrations and the corrected QT interval (QTc), or between atomoxetine dosage and the QTc. However, in female patients, there was a significant positive correlation between atomoxetine dosage and the QTcB (r = 0.631, P = 0.012), and there was a marginally significant positive correlation between atomoxetine dosage and the QTcF (r = 0.504, P = 0.055). In male patients, there was no correlation between atomoxetine dosage and the QTcB or QTcF intervals. There was no correlation between plasma atomoxetine concentrations and the QTc in either female or male patients. IMPLICATIONS: Clinicians should exhibit caution when prescribing atomoxetine, particularly for female patients.

DOI： 10.1097/JCP.0000000000000630

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Although several case reports suggested that donepezil hydrochloride can induce bradycardia or atrioventricular block, the details remain unclear. We implemented a study of the impact of donepezil hydrochloride administration on PR, RR, and QT intervals. METHODS: The subjects were 18 patients who were diagnosed with either dementia or cognitive disorder (DSM-IV-TR) and were hospitalized between January 2011 and December 2012. After hospitalization, they were treated with donepezil hydrochloride. Clinical parameters and electrocardiograms before and after the administration of donepezil hydrochloride were retrieved from the patients' medical records. RESULTS: After the administration of donepezil hydrochloride, the mean PR interval significantly increased from 177.3 ± 30.9 to 186.8 ± 38.4 ms (p<0.001). And the mean RR interval also significantly increased from 850.3 ± 112.5 to 886.7 ± 136.4 ms (p=0.014). The mean difference in the PR interval before and after the administration of donepezil hydrochloride was 9.5 ± 17.1 (range=-21.0-44.0) ms. The QT intervals were unaffected by the administration of donepezil hydrochloride. CONCLUSIONS: Care should be taken when administering donepezil to patients with atrioventricular block, or patients taking other drugs that can prolong the PR interval. Copyright © 2014 John Wiley & Sons, Ltd.

DOI： 10.1002/hup.2398

PubMed

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: In Japan, the prevalence of overweight/obesity in the general population is considerably lower and the mean duration of hospitalization of patients with schizophrenia is much longer than those in Europe and North America. The aim of this study was to investigate whether these differences in ethnics or healthcare systems influence the nutritional status of patients with schizophrenia. METHODS: Body mass index (BMI) and blood biochemistry tests were determined at hospitalization and at discharge for 171 Japanese patients who were hospitalized for the treatment of acute phase schizophrenia. RESULTS: For 56 patients who were overweight/obese at hospitalization, BMI (p < 0.001), fasting plasma glucose (p = 0.039), and low-density lipoprotein (p = 0.027) were significantly lower at discharge than at hospitalization. BMI at hospitalization, duration of hospitalization, and age were associated with a decrease in BMI during hospitalization. Among the 115 patients who were not overweight/obese at hospitalization, there were no changes in BMI and blood biochemistry tests between hospitalization and discharge. CONCLUSIONS: Compared with inpatients, outpatients with schizophrenia may be more likely to be overweight/obese in Japan.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Major depressive disorder (MDD) is linked to an increased risk of diabetes; however, the underlying pathomechanism remains unknown. Although insulin-like growth factor 1 (IGF-1) is involved in the pathogenesis of both insulin resistance (IR) and MDD, no studies have investigated the relationship between IGF-1 and IR in patients with MDD. METHODS: We recruited 120 patients with MDD (84 non-remitting patients and 36 remitting patients) and 99 control participants. Blood samples were collected after overnight fasting to investigate associations between serum and clinical factors, such as serum IGF-1 levels and homeostasis model assessment-insulin resistance (HOMA-IR). RESULTS: Serum IGF-1 levels were higher in patients with non-remitting MDD than in control participants and patients with remitting MDD (P = 0.001 and P = 0.007, respectively). There were no significant differences in HOMA-IR between the three groups. HOMA-IR was positively correlated with serum IGF-1 levels in patients with non-remitting MDD (R = 0.355; P= 0.001) but not in control participants or patients with remitting MDD. A stepwise multiple regression analysis with various clinical factors revealed a positive association of serum IGF-1 levels and body mass index with HOMA-IR in patients with non-remitting MDD. LIMITATIONS: This is a cross-sectional study and therefore we cannot draw firm conclusions about causal associations. CONCLUSIONS: Serum IGF-1 levels may play a role in IR in patients with MDD who fail to achieve remission. Further studies, including longitudinal studies, are needed to determine the relationship between high serum IGF-1 levels and subsequent IR and diabetes risk.

DOI： 10.1016/j.jad.2023.10.009

PubMed

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Language：Japanese   Publisher：(一社)日本臨床薬理学会  

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Language：Japanese   Publisher：(一社)日本臨床薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(有)フジメディカル出版  

わが国は超高齢社会となり、高齢者のうつ病治療は重要性を増している。高齢のうつ病患者に対しても抗うつ薬は有効である。しかし、薬剤ごとに異なる副作用に留意しながら肝腎障害や心不全など、個々の身体合併症や常用しているほかの薬剤に合わせて抗うつ薬を選択し、低用量から慎重に漸増していく必要がある。高齢者ではとくにQT延長による不整脈などの重篤な副作用のリスクが高く、定期的な血液検査、心電図といったモニタリングが必要不可欠である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J05808&link_issn=&doc_id=20180508160003&doc_link_id=%2Fal1demud%2F2018%2F000802%2F004%2F0069-0074%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fal1demud%2F2018%2F000802%2F004%2F0069-0074%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)星和書店  

統合失調症患者は、平均寿命が健常群に比して20〜23年短いと言われている。統合失調症患者は、元来糖尿病などの生活習慣病のリスクが高く、加齢が与える影響は健常群に比して大きいと考えられる。さらに抗精神病薬の投与によって身体リスクが加算され、生活習慣病のみならず、ひいては脳血管、冠動脈疾患などによる死亡が増加する可能性が示唆される。薬物学的にも高齢者では薬剤用量などに配慮が必要なことは明らかであるが、高齢統合失調症患者に対して病状の悪化や再燃を恐れるがあまり、若年者と同様の抗精神病薬治療を漫然と続けていることも多く、高齢者に対する薬物療法を見直す時がきている。いまだ十分な知見がなく、高齢統合失調症患者に対する薬物療法には一致した見解は得られていない部分は大きいが、本稿では最新の知見をまとめつつ、推奨される投与方法やモニタリングについて考察していく。(著者抄録)

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Language：Japanese   Publisher：日本うつ病学会・日本認知療法・認知行動療法学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00990&link_issn=&doc_id=20170707020012&doc_link_id=%2Fdg3nigta%2F2017%2Fs13102%2F006%2F0124-0125%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2017%2Fs13102%2F006%2F0124-0125%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟医学会  

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向精神薬の使用には身体的副作用のリスクが常に伴う。中でも体重増加、糖代謝異常、脂質代謝異常といったメタボリック症候群、QT延長症候群に代表される心電図異常、心臓突然死、顆粒球減少症、肝障害といった副作用は、患者の生命予後に関わる重大な問題である。身体的副作用を早期発見し、早期介入することで生命予後に関わるようなリスクを減らすことは可能であるが、それには定期的な身体モニタリングが欠かせない。いまだこれらの身体的副作用について一致した見解が得られていない部分は多くあるが、本稿では最近の知見を整理しながら、改めてモニタリングの重要性や具体的方法について考察する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本臨床薬理学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ELSEVIER SCIENCE BV  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ELSEVIER SCIENCE BV  

Web of Science

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Language：Japanese   Publisher：(株)メディカルレビュー社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01750&link_issn=&doc_id=20160915250005&doc_link_id=issn%3D0289-5803%26volume%3D34%26issue%3D9%26spage%3D25&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0289-5803%26volume%3D34%26issue%3D9%26spage%3D25&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(一社)日本臨床薬理学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：(株)日本医事新報社  

＜point＞▼統合失調症患者は心血管疾患による死亡率が一般人口の約2倍であり、背景にはメタボリック症候群(MetS)の高い有病率があると思われる▼向精神薬の中でも、特に抗精神病薬はMetSの発症に少なからず関与している▼抗精神病薬の中でも、第2世代抗精神病薬、特にクロザピンやオランザピンにおいて体重増加、糖脂質代謝異常のリスクが高い▼向精神薬による治療を行う場合、定期的なモニタリング(バイタルサイン測定、体重測定、血液検査、心電図)は必須である(著者抄録)

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Language：Japanese   Publisher：(株)先端医学社  

統合失調症患者の平均余命は、一般人口にくらべて12〜15年短いと報告されている。統合失調症患者の自然死による死亡率は一般人口の約2倍であり、なかでも心血管疾患による死亡率が高く、男性で一般人口の2.3倍、女性では2.1倍にのぼる。また、統合失調症患者は一般人口にくらべてメタボリック症候群(MetS)の有病率が高いことが知られており、このことが統合失調症患者で心血管疾患による死亡率が高い原因の一つになっているものと思われる。統合失調症治療が薬物療法の発展とともに近年大きな進歩を遂げたことは事実であるが、このような背景を踏まえたうえで、今後は統合失調症患者の身体的なリスクにもより一層配慮した治療選択が望まれる。本稿では統合失調症患者におけるMetSの有病率、関連因子、原因、薬物療法におけるリスク、管理などにつき、当施設での研究を交えながら最近の知見を振り返る。(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2015373799

Language：Japanese   Publisher：(公財)先進医薬研究振興財団  

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Language：Japanese   Publisher：(公財)先進医薬研究振興財団  

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Language：Japanese   Publisher：(株)星和書店  

うつ病寛解後の抗うつ薬による維持療法は再発予防のため重要であると考えられているが、一方で慢性化うつ病や治療抵抗性うつ病の増加が大きな問題となっている。近年、抗うつ薬の長期投与自体がうつ病の慢性化や治療抵抗性の増大を引き起こすのではないかという仮説が注目されている。1つは、初期の抗うつ薬治療では良好な効果を示していたにもかかわらず、繰り返し、また長期間抗うつ薬治療を続けることによって抗うつ効果が減弱したり失われたりすることを指すtachyphylaxis(タキフィラキシー)である。もう1つは抗うつ薬の慢性投与がセロトニン作動性の神経伝達を減弱させることによって、気分不快状態が出現するというtardive dysphoria(遅発性ディスフォリア)である。この2つの仮説にはまだまだ議論が必要であり、また、これらはうつ病再発予防における維持療法の重要性を否定するものでもない。我々は、日常臨床で難治化したうつ病の治療に手を焼いているが、難治例の治療を考える場合、これら仮説からヒントを得られるかもしれない。(著者抄録)

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公財)先進医薬研究振興財団  

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Language：Japanese   Publisher：(公財)先進医薬研究振興財団  

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Language：Japanese   Publisher：(株)星和書店  

うつ病治療において、抗うつ薬は大きな役割を占めるものの、SSRIなどの抗うつ薬使用で出現する嘔気や性機能障害などの副作用は、いまだに患者のアドヒアランスを低下させる大きな問題である。統合失調症治療において抗精神病薬を選択する場合、それぞれの抗精神病薬の副作用profileの違いを考慮して薬剤選択を行っているが、抗うつ薬の副作用profileについては抗精神病薬ほど明らかな薬剤間差は存在しないものの、副作用profileを考慮することは重要である。本稿では、抗うつ薬の副作用における薬剤間差や副作用を予測する遺伝的要因、非遺伝的要因についてこれまでの知見を概説する。また、最近では抗うつ薬によるQT延長が注目されているが、この副作用は患者が自覚症状としてとらえることはないが、場合によっては致死性不整脈を引き起こすことがあるため、治療者側が十分に注意を払うべきである。しかし、薬剤間差を含めて詳細は明らかでないため、当施設で行っている研究の一部を紹介しながら抗うつ薬によるQT延長について考えてみたい。(著者抄録)

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Language：Japanese   Publisher：(株)星和書店  

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00990&link_issn=&doc_id=20140303060011&doc_link_id=%2Fdg3nigta%2F2013%2Fs12709%2F004%2F0502-0502%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2013%2Fs12709%2F004%2F0502-0502%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00990&link_issn=&doc_id=20140303060014&doc_link_id=%2Fdg3nigta%2F2013%2Fs12709%2F007%2F0503-0504%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2013%2Fs12709%2F007%2F0503-0504%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)星和書店  

第二世代抗精神病薬(以下SGAs)は、統合失調症患者のインスリン分泌に影響を与え耐糖能異常を惹起すると指摘されている。近年、SGAsにより低血糖を引き起こす可能性も指摘され、我々はquetiapine投与中に糖負荷後低血糖を生じ、perospironeやblonanserinへの置換で改善した症例を報告してきた。耐糖能異常の発症頻度には薬剤間差があり、clozapineやolanzapineに比しaripiprazoleはリスクが低いと報告されている。今回我々は、quetiapine投与中に生じた糖負荷後低血糖がaripiprazoleへの置換後改善したが、インスリン抵抗性の増大が持続した1例を経験したので報告する。低血糖症状は統合失調症の精神症状と区別しにくい。またインスリン抵抗性の増大は薬剤中止後も持続する可能性があり注意が必要である。(著者抄録)

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Language：Japanese   Publisher：(株)星和書店  

急性期治療のため入院した統合失調症患者160名の内、入院時body mass index(BMI)が25kg/m2以上の患者53名(33.1%)について、入院時と退院時のBMIおよび血液・生化学検査値を調査した。平均在院日数は114.4±90.0日であった。入院時に比較し、退院時ではBMI(p<0.001)、空腹時血糖(p=0.039)が有意に減少した。53名中17名(32.1%)が退院時に標準体重となり、入院時と退院時で肥満、過体重、標準体重の割合が有意に異なっていた(p<0.001)。入院から退院までのBMI変化量と入院期間は、負の相関を示した(r=0.597、p<0.001)。本研究では、外来で過体重/肥満であった統合失調症患者が精神科病棟に入院することで、過体重/肥満が改善に向かうことが示された。これは、外来時の偏った食生活が入院によって是正されたことによると考えられる。外来治療中の統合失調症患者の方が入院患者に比べて過体重/肥満の割合が多い可能性が示唆され、外来では患者の食生活および身体的健康により配慮すべきかもしれない。(著者抄録)

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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Language：Japanese   Publisher：日本臨床精神神経薬理学会・日本神経精神薬理学会  

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