Details of a Researcher - Uchida, Hiroyuki

Uchida, Hiroyuki

写真a

Affiliation: School of Medicine, Department of Neuropsychiatry （Shinanomachi）

Position: Associate Professor

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Books 【 Display / hide 】

Encyclopedia of Psychopharmacology

Uchida Hiroyuki, 2010

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Papers 【 Display / hide 】

Development of a risk stratification scoring system for deep vein thrombosis upon psychiatric admission

Ishida T., Shibahashi K., Sugai S., Abe D., Hamabe Y., Kashiyama T., Mimura M., Suzuki T., Uchida H.

Journal of Psychosomatic Research （Journal of Psychosomatic Research) 147 110540 2021.08

ISSN 00223999

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Aim: Psychiatric patients have increased risk of deep vein thrombosis (DVT). However, there is no systematic data on risk assessment of DVT among psychiatric inpatients. The aim of this study was to develop a risk stratification scoring system for DVT among psychiatic patients on admission. Methods: A systematic review of psychiatric patient's charts, who were admitted to the Tokyo Metropolitan Matsuzawa Hospital from June 2012 to February 2016 and underwent screening for DVT, was conducted. Patients were randomly divided into development (n = 2634) and validation (n = 2634) groups. Estimated risk values in the multiple logistic regression model for the development sample were rounded to the nearest integer, and used as points of associated factors in the risk stratification scoring system; the total scores were tested in the validation sample. The score's discriminatory ability was assessed with the area under the receiver operating characteristic curve (AUC). Results: Among the 5268 patients, 258 (4.9%) had DVT. Advancing age, female sex, active cancer, previous venous thromboembolism, transfer from a general hospital, catatonia, and major depressive episode were all significantly associated with the presence of DVT in the development sample. The total score showed good discriminatory ability in the validation sample (AUC: 0.816, 95% confidence interval: 0.781–0.851); scores of 0–1, 2–3, 4–5, and ≥ 6 were associated with very low risk (0.7%), low risk (4.6%), moderate risk (14.9%), and high risk (35%) for DVT, respectively. Conclusion: Our risk stratification scoring system showed good performance for detection of DVT among psychiatric patients on admission.
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Pre-existing psychiatric disorder is related to lower mortality from road traffic accident: A Japanese nationwide retrospective cohort study

Ishida T., Kuwahara Y., Shibahashi K., Okura Y., Sugiyama K., Yoshimura K., Hamabe Y., Mimura M., Suzuki T., Uchida H.

Injury （Injury) 52 （ 6 ） 1390 - 1395 2021.06

ISSN 00201383

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Background: Previous studies have reported inconsistent results on the mortality from trauma among psychiatric patients comparing to non-psychiatric population, which may be partly explained by the inclusion of both suicidal and accidental trauma. This study aimed to investigate the association of psychiatric diagnoses on admission with the outcomes of hospitalized patients for accidental trauma, namely road traffic injury. Methods: Detailed information of patients aged 15 years or older who were hospitalized for road traffic injury between 2004 and 2017 was extracted from the Japan Trauma Data Bank. The primary outcome was to compare in-hospital mortality between patients with and without a psychiatric disorder. We also conducted a subgroup analysis among patients with and without a serious head injury. Results: Altogether, 85,069 patients were included. Of these, 3,895 patients (4.6%) had a psychiatric diagnosis. The in-hospital mortality rate was significantly lower among patients with a psychiatric diagnosis than those without (5.4% vs. 8.3%; adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.47-0.70, p<0.001). In a subgroup analysis of patients with a serious head injury, in-hospital mortality was significantly lower in patients with a psychiatric diagnosis than in those without (10.5% vs. 17.3%; adjusted OR 0.48, 95% CI 0.37-0.62, p<0.001); in-hospital mortality of patients without a serious head injury showed no differences between patients with or without a psychiatric diagnosis (2.8% vs. 3.5%; adjusted OR 0.84, 95% CI 0.61-1.16, p=0.295). Conclusions: In-hospital mortality from road traffic injury was significantly lower among patients with a psychiatric diagnosis than those without, which was primarily evident in a subgroup of patients with a serious head injury. While further replication is necessary, results might be indicative of the neuroprotective effect of psychotropic medications.
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Effects of Discontinuation of Drugs Used for Augmentation Therapy on Treatment Outcomes in Depression: A Systematic Review and Meta-analysis

Kato H., Koizumi T., Takeuchi H., Tani H., Mimura M., Uchida H.

Pharmacopsychiatry （Pharmacopsychiatry) 54 （ 3 ） 106 - 116 2021.05

ISSN 01763679

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Introduction There has been no consensus on whether and how long add-on drugs for augmentation therapy should be continued in the treatment of depression. Methods Double-blind randomized controlled trials that examined the effects of discontinuation of drugs used for augmentation on treatment outcomes in patients with depression were identified. Meta-analyses were performed to compare rates of study withdrawal due to any reason, study-defined relapse, and adverse events between patients who continued augmentation therapy and those who discontinued it. Results Seven studies were included (n=841 for continuing augmentation therapy; n=831 for discontinuing augmentation therapy). The rate of study withdrawal due to any reason was not significantly different between the 2 groups (risk ratio [RR]=0.86, 95% confidence interval [CI]=0.69-1.08, p=0.20). Study withdrawal due to relapse was less frequent in the continuation group than in the discontinuation group (RR=0.61, 95% CI=0.40-0.92, p=0.02); however, this statistical significance disappeared when one study using esketamine as augmentation was excluded. Analysis of the data from 5 studies that included a stabilization period before randomization found less frequent relapse in the continuation group than in the discontinuation group (RR=0.47, 95% CI=0.36-0.60, p<0.01). This finding was repeated when the esketamine study was excluded. Discussion No firm conclusions could be drawn in light of the small number of studies included. Currently available evidence suggests that add-on drugs, other than esketamine, used for augmentation therapy for depression may be discontinued. This may not be the case for patients who are maintained with augmentation therapy after remission.
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Continuous versus extended antipsychotic dosing in schizophrenia: Less is more

Servonnet A., Uchida H., Samaha A.N.

Behavioural Brain Research （Behavioural Brain Research) 401 113076 2021.03

ISSN 01664328

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Antipsychotic drugs temper psychotic symptoms by interacting with dopamine D2 receptors to reduce dopamine neurotransmission. Currently, the standard of care involves antipsychotic treatment protocols that achieve steady-state levels of medication. Maintaining patients on continuous treatment is thought to be necessary to keep them stabilised. However, continuous antipsychotic exposure increases the risk of adverse effects over time. These effects include metabolic and cardiovascular disorders, extrapyramidal complications, and dopamine receptor supersensitivity, the latter of which could potentially promote both treatment tolerance and psychosis relapse. In the present review, we describe evidence showing that continuous exposure to antipsychotic drugs can not only worsen long-term outcome, but—past acute phase treatment—it is also unnecessary to effectively manage schizophrenia symptoms. We also describe evidence that regular but extended dosing, allowing predictable periods of lower antipsychotic levels/D2 occupancy, is both safe and effective in patients, and it greatly reduces drug exposure overall. Studies in laboratory animals show that compared to continuous antipsychotic exposure, regular but extended dosing actually has superior antipsychotic-like efficacy, and it also substantially reduces the likelihood of both motor side effects and dopamine receptor supersensitivity. We propose that regular, but extended dosing should be considered in the long-term treatment of people with schizophrenia, because the available evidence suggests it can be just as effective as continuous treatment, while decreasing overall drug exposure and potentially reducing harmful side effects.
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Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus

Sakurai H., Yasui-Furukori N., Suzuki T., Uchida H., Baba H., Watanabe K., Inada K., Kikuchi Y.S., Kikuchi T., Katsuki A., Kishida I., Kato M.

Pharmacopsychiatry （Pharmacopsychiatry) 54 （ 2 ） 60 - 67 2021.03

ISSN 01763679

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Introduction Conventional treatment guidelines of schizophrenia do not necessarily provide solutions on clinically important issues. Methods A total of 141 certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology evaluated treatment options regarding 19 clinically relevant situations in the treatment of schizophrenia with a 9-point scale (1=disagree and 9=agree). Results First-line antipsychotics varied depending on predominant symptoms: risperidone (mean±standard deviation score, 7.9±1.4), olanzapine (7.5±1.6), and aripiprazole (6.9±1.9) were more likely selected for positive symptoms; aripiprazole (7.6±1.6) for negative symptoms; aripiprazole (7.3±1.9), olanzapine (7.2±1.9), and quetiapine (6.9±1.9) for depression and anxiety; and olanzapine (7.9±1.5) and risperidone (7.5±1.5) for excitement and aggression. While only aripiprazole was categorized as a first-line treatment for relapse prevention (7.6±1.0) in patients without noticeable symptoms, aripiprazole (8.0±1.6) and brexpiprazole (6.9±2.3) were categorized as such for social integration. First-line treatments in patients who are vulnerable to extrapyramidal symptoms include quetiapine (7.5±2.0) and aripiprazole (6.9±2.1). Discussion These clinical recommendations represent the expert consensus on the use of a particular antipsychotic medication for a particular situation, filling a current gap in the literature.
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Papers, etc., Registered in KOARA 【 Display / hide 】

Glutamatergic dysfunction in patients with treatment-resistant schizophrenia : a cross-sectional 1H-MRS study

Uchida, Hiroyuki

科学研究費補助金研究成果報告書 2018
Timing of optimal antipsychotic dosing: chronopharmacology

Uchida, Hiroyuki

科学研究費補助金研究成果報告書 2017
Development of app to determine antipsychotic dose in the treatment of schizophrenia

Uchida, Hiroyuki

学事振興資金研究成果実績報告書（慶應義塾大学) 2017
Resilinece and its biologocal correlates in schizophrenia

Uchida, Hiroyuki

科学研究費補助金研究成果報告書 2014
Predicting plasma concentration of risperidone associated with dosage change: a population pharmacokinetic study

Uchida, Hiroyuki

科学研究費補助金研究成果報告書 2011

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Reviews, Commentaries, etc. 【 Display / hide 】

【向精神薬の保険適用と規制】向精神薬の名称と適応の不一致を克服する新しい国際的分類法(NbN)

内田裕之

臨床精神薬理 ((株)星和書店) 24 ( 5 ) 455 - 461 2021.05

ISSN 1343-3474

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現在使用されている向精神薬の命名法(nomenclature)は、適応疾患に基づき命名するため、最新の科学的知見を必ずしも反映しているわけではない。そこで、欧州神経精神薬理学会(ECNP)が中心となり、現在の科学的知見を反映させた新しい多軸命名法"Neuroscience-based Nomenclature(NbN)"を提唱することになった。NbNは明瞭なシステムであり、新たな薬物、標的、作用機序は、容易にこのシステムに追加することができ、正確な最新の科学的情報を提供可能である。より簡便に使用できるように無料のアプリが制作されている。疾患の病態生理や薬剤の作用機序が不明瞭なことの多い精神科領域で、この命名法が定着するためには時間を要すると考えられる。また、言語という文化を変えることは容易ではない。しかし、現在の命名法がもはや妥当とは言えない以上、この挑戦は非常に有意義であるといえよう。(著者抄録)
Prescription patterns in patients with schizophrenia who discontinued long-acting injectable antipsychotics: A chart-review

Asano K., Suzuki T., Mimura M., Uchida H.

Psychiatry and Clinical Neurosciences (Psychiatry and Clinical Neurosciences) 75 ( 5 ) 184 - 185 2021.05

ISSN 13231316
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【精神科医が知っておくべき皮膚科疾患】天疱瘡・類天疱瘡に関連した精神・神経症状

小林優佳, 赤尾綾香, 竹内啓善, 内田裕之, 山上淳

精神科 ((有)科学評論社) 38 ( 2 ) 179 - 184 2021.02

ISSN 1347-4790
Quality of life changes in response to yoga therapy in patients with schizophrenia: Reanalysis of Three randomized controlled trials

Ikai-Tani S., Tani H., Kamiyama S., Mimura M., Uchida H.

Asian Journal of Psychiatry (Asian Journal of Psychiatry) 54 102250 2020.12

ISSN 18762018
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COVID-19こころのケアチーム活動報告

木村範子, 河野佐代子, 滝上紘之, 山市大輔, 片山奈理子, 竹内啓善, 菊地俊暁, 佐渡充洋, 内田裕之, 田中謙二, 三村將

総合病院精神医学 ((一社)日本総合病院精神医学会) 32 ( Suppl. ) S - 193 2020.11

ISSN 0915-5872

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Presentations 【 Display / hide 】

処方変更後のリスペリドン血中濃度を予測する試み: Population Pharmacokineticsを用いて

Uchida Hiroyuki

第20回日本臨床精神薬理学会 (仙台) ,

2010
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Poster presentation
Effects of discontinuing benzodiazepine-derivative hypnotics on cognitive and motor functions in the elderly.

Uchida Hiroyuki

American Association for Geriatric Psychiatry (Savannah) ,

2010
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Poster presentation
Clozapine and global cognition in schizophrenia.

Tarek RajjiUchida Hiroyuki

American Association for Geriatric Psychiatry (Savannah) ,

2010
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Poster presentation
Low dose versus standard dose of antipsychotics for relapse prevention in schizophrenia: a meta-analysis

Uchida Hiroyuki

2nd International Schizophrenia Research Society (Florence) ,

2010
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Poster presentation
抗うつ薬の変更はどのタイミングで行うべきか？無作為割り付け前向き試験

Uchida Hiroyuki

第20回日本臨床精神薬理学会 (仙台) ,

2010
,
Poster presentation

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Research Projects of Competitive Funds, etc. 【 Display / hide 】

Elucidating mechanisms of antidepressant effects of ketamine for treatment-resistant depression: an AMPA PET study

2022.04

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2025.03

MEXT,JSPS, Grant-in-Aid for Scientific Research, 基盤研究(B), Principal investigator
Development of pre-morbid diagnostic marker of schizophrenia: AMPA PET study

2020.07

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2024.03

MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Challenging Research (Pioneering), Principal investigator

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統合失調症は早期発見・早期治療により、より良い予後が達成できる。精神病発症危険状態（At Risk Mental State [ARMS]）という、発病前ではあるものの今後の発病リスクの高い一群がある。ARMSのうち約30％が精神病（主に統合失調症）に移行するが、“移行者”を早期診断する方法はないため治療の遅れにつながっている。本研究では、統合失調症と関連の深いAMPA受容体をPET検査により測定し、統合失調症に移行するARMS症例、移行しないARMS症例の両者を比較し、今後の診断に役立てる。
AMPA受容体に注目した統合失調症の病態解明：世界初AMPA受容体PET研究

2019.04

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2022.03

MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Scientific Research (B), Principal investigator

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統合失調症の原因解明は停滞しており、斬新な視点による研究が緊急課題である。グルタミン神経系のAMPA受容体は、動物研究により統合失調症の発病への関与が明らかになっているが、ヒトのデータはなかった。そこで本研究では、統合失調症患者の脳内のAMPA受容体密度を、陽電子放射断層撮影（PET)検査により測定し、AMPA受容体が統合失調症の発病にいかに関連しているか解明する。
唾液メタボロームマッピング解析を用いた精神疾患の病態解明および臨床応用法の開発

2019.04

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2022.03

Kanagawa Dental College, Grant-in-Aid for Scientific Research (C), No Setting

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近年、複雑な社会環境により精神疾患に罹患した歯科受診患者が急増している。しかしながら、精神疾患の病態は複雑で、未だ原因が解明されていないのが現状である。また精神疾患の診断法は、問診や臨床症状を基にした主観的な診断が主体であるが、病態が複雑であることから診断の客観的評価法の確立が必須である。さらに再発が多いことから、予防、早期発見および予後管理を行うことが喫緊の課題である。本研究は、唾液の代謝産物から精神疾患の病態を解明し、さらに精神疾患の予防、早期発見、診断として利用できるように簡易検出系の開発を行い、ヒトで臨床応用することを最終目標とする。
電気けいれん療法の急性期作用期機序解明に関するマルチモーダルでの縦断的観察研

2017.04

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2021.03

Keio University, Grant-in-Aid for Scientific Research (C), No Setting

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2019年4月19日現在、15症例が登録されている。本年度は１年間で7症例の登録を行った。研究遂行にあたって有意な有害事象は認められていない。
電気けいれん療法(ECT:Electroconvulsive therapy)施行前後でMontgomery Asberg Depression Rating Scale(MADRS)総得点にて計測されうるうつ病の重症度は改善を示した。予備的な解析を行いfunctional MRI（fMRI）にて計測される安静時機能的結合性がECT施行前後で変化する傾向が確認された。また、MRIの構造画像解析では海馬を中心として灰白質の容積がECT施行前後で増加する傾向、白質が変化する傾向が確認された。
本課題と関連した研究としてECT施行前後での安静時脳波の変化を計測することにより、うつ病で重要と考えられているデフォルトモードネットワークの主要な結節点の電気的活動をECTが修飾する事を明らかとした。この結果は過去のfMRIやPETの知見と矛盾しない。また、ECT後のせん妄リスクに関して文献的検討も行った。その結果、ECT後のせん妄に関して緊張病症状、脳血管障害、パーキンソン病、認知症、両側電極配置、高刺激、痙攣時間は危険因子となること、デクスメデトミジンの事前投与と超短矩形波は予防的因子になることを明らかとした。
本年度は画像解析の講習会に積極的に参加し、本研究にて行う画像解析技法並びに機械学習を用いた解析技法を習得した。現在ECT前後での脳波変化をmicrostate 解析を用いて解析中であり、ECT施行前の脳波を用いた効果予測のための予備的解析も行っている。
2018年4月19日現在、2年間で15症例が登録されている。本年度は１年間で7症例の登録を行った。当初は1年間に10症例の登録を目指していたため概ね順調に進行していると判断される。また、研究遂行にあたって有害事象は認められていない。また、先端バイオイメージング支援プラットフォームのMRI画像講習会への参加、世界的に標準的な画像解析ソフトとされるSPMの講習会に参加して最先端の脳画像解析技術を習得した。また、ECT施行前の脳波を用いた効果予測のための予備的解析を行っている。
概ね順当に遂行されている。4年計画の2年目であり、有意な結果を得るまで症例数が至っていない。このため次年度も引き続き症例登録を遂行していく。また、症例登録が円滑に行われるために広く対象症例を募っていく。また、脳波、MRI、NIRSに関して得られたデータをもとに解析を開始する。解析においては、機械学習の手法も取り入れ、高度な解析を行っていく。