内田 裕之 (ウチダ ヒロユキ)

Uchida, Hiroyuki

写真a

所属(所属キャンパス)

医学部 精神・神経科学教室 (信濃町)

職名

専任講師

 
 

著書 【 表示 / 非表示

  • Encyclopedia of Psychopharmacology

    内田 裕之, 2010年

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  • Circadian patterns of hallucinatory experiences in patients with schizophrenia: Potentials for chrono-pharmacology

    Koizumi T., Suzuki T., Pillai N., Bies R., Takeuchi H., Yoshimura K., Mimura M., Uchida H.

    Journal of Psychiatric Research (Journal of Psychiatric Research)  117   1 - 6 2019年10月

    ISSN  00223956

     概要を見る

    © 2019 Elsevier Ltd The objective of this study was to investigate possible circadian pattern of psychotic symptoms in patients with schizophrenia, which could be reflected on the dosing schedule/regimen, i.e. chrono-pharmacology. Patients with schizophrenia (ICD-10) who reported having auditory hallucination, receiving monotherapy with risperidone, olanzapine or paliperidone for at least two weeks were included. The subjects were provided a diary and asked to record the time and duration of auditory hallucinations during the eight time periods (i.e. 00:00–03:00, 03:00–06:00, 06:00–09:00, 09:00–12:00, 12:00–15:00, 15:00–18:00, 18:00–21:00, and 21:00–24:00). In the diary, times of medication doses and sleep were also recorded. Time and degree of peak and trough dopamine D2 receptor blockade with antipsychotics were estimated from 2 sparsely collected plasma drug concentrations. The prevalence and duration of auditory hallucinations were statistically examined among the eight time periods, respectively. Forty-nine patients participated in this study (mean ± SD age, 50.7 ± 14.8 years; 36 men (73.5%); 34 inpatients (69.4%)). Auditory hallucinations occurred most frequently and lasted for the longest duration in the period of 18:00–21:00 (75.5% (37/49) and 1.37 ± 1.67 h). This happened despite the fact that the difference in D2 receptor occupancy between the peak and trough was less than 2%, indicating a stable drug delivery. Since the dopamine D2 receptor blockade by antipsychotics was stable, the nocturnal circadian pattern found in this study may reflect intrinsic dopaminergic fluctuation or generally quieter environments at night. These circadian patterns may be considered to devise individualized treatment approach in the context of “chrono-pharmacology” for patients with schizophrenia.

  • Effectiveness and safety of long-term benzodiazepine use in anxiety disorders: a systematic review and meta-analysis

    Shinfuku M., Kishimoto T., Uchida H., Suzuki T., Mimura M., Kikuchi T.

    International clinical psychopharmacology (International clinical psychopharmacology)  34 ( 5 ) 211 - 221 2019年09月

     概要を見る

    Long-term benzodiazepines (BZDs) use is not endorsed in the treatment guidelines for anxiety disorders, but is prevalent in the real-world clinical settings. A systematic literature review was performed by using PubMed (last search: May 2019) to identify randomized controlled trials (RCTs) or maintenance studies following RCT that examined the effectiveness of BZDs in patients with anxiety disorders for a duration of 13 weeks or more. Meta-analyses were then conducted regarding changes in the Hamilton Anxiety Rating Scale (HAM-A) scores from baseline through endpoint, all-cause discontinuation, side effects, and the numbers of panic attacks at endpoint. Eight studies were identified (N = 1228). There were no significant differences in all outcomes between BZDs and antidepressants after the initial 8-week treatment. While no significant difference was noted in the HAM-A score changes between BZDs and placebo, BZDs resulted in a lower discontinuation rate and more frequent constipation and dry mouth than placebo. Our study indicates that for those who respond to an initial 8-week treatment, continuing BZDs is equivalent to antidepressants in efficacy and safety. However, the limited number of studies warranted further investigations of the long-term effectiveness and safety of BZDs.

  • Alteration in AMPA receptor subunit expression and receptor binding among patients with addictive disorders: A systematic review of human postmortem studies

    Ueno F., Suzuki T., Nakajima S., Matsushita S., Mimura M., Miyazaki T., Takahashi T., Uchida H.

    Neuropsychopharmacology Reports (Neuropsychopharmacology Reports)  39 ( 3 ) 148 - 155 2019年09月

     概要を見る

    © 2019 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd. Background and Objectives: Altered trafficking of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors has been reported in postmortem studies and suggested the involvement of AMPA receptors in the pathophysiology underpinning addictive disorders. However, these findings seemed mixed. Methods: A systematic literature search was conducted, using PubMed and Embase (last search, August 2018), to identify human postmortem studies that examined the expression of proteins and mRNA of AMPA receptor subunits in patients with addictive disorders in comparison with healthy controls. Results: Twelve (18 studies) out of 954 articles were identified to be relevant. Eight studies included alcohol use disorders, and four studies included heroin/cocaine abusers. The most frequently investigated regions were the hippocampus (three studies), amygdala (three studies), and putamen (three studies). In summary, two out of the three studies showed an increase in the expression of AMPA receptors in the hippocampus, while the other study found no change. Two studies to examine the amygdala demonstrated either a decreased or no change in receptor expression or binding. Concerning putamen, two studies showed no significant change whereas an overexpression of receptors was observed in the other. Conclusions and Scientific Significance: The hippocampus and amygdala may be pertinent to addictive disorders through their functions on learning and memory, whereas findings in other regions were inconsistent across the studies. Human postmortem studies are prone to degenerative changes after death. Moreover, only qualitative assessment was conducted because of the limited, heterogenous data. These limitations emphasize the need to investigate AMPA receptors in the living human brains.

  • Model-guided antipsychotic dose reduction in schizophrenia: A pilot, single-blind randomized controlled trial

    Ozawa C., Bies R., Pillai N., Suzuki T., Mimura M., Uchida H.

    Journal of Clinical Psychopharmacology (Journal of Clinical Psychopharmacology)  39 ( 4 ) 329 - 335 2019年07月

    ISSN  02710749

     概要を見る

    © 2019 Wolters Kluwer Health, Inc. All rights reserved. Purpose/Background Patients with schizophrenia as well as their psychiatrists are hesitant to reduce the antipsychotic dose in fear of relapse. To overcome such dilemmas, we developed models to individually calculate an oral dose that corresponds to a given target dopamine D2 receptor occupancy. Methods/Procedures In this pilot, 52-week single-blind randomized controlled trial, 35 clinically stable patients with schizophrenia receiving either risperidone or olanzapine monotherapy were randomly assigned to dose reduction (n = 17) or dose maintenance group (n = 18). In the former group, baseline doses were reduced to the doses corresponding to 65% D2 occupancy (the lower end of therapeutic window) at trough that were calculated from randomly collected plasma concentrations using our models. Findings/Results In the dose reduction group, doses of risperidone and olanzapine were decreased from 4.2 ± 1.9 to 1.4 ± 0.4 and 12.8 ± 3.9 to 6.7 ± 1.8 mg/d, whereas the doses in the dose maintenance group were 4.3 ± 1.9 and 15.8 ± 4.6 mg/d, respectively. Twelve subjects (70.5%) and 13 subjects (72.2%) in the dose reduction and dose maintenance groups completed the study (P = 0.604), whereas 3 subjects (18.8%) and none dropped out because of clinical worsening in the dose reduction and dose maintenance groups, respectively. There were not significant differences in score changes in Positive and Negative Syndrome Scale between the 2 groups but in Positive subscale scores in the Clinical Global Impression-Schizophrenia (0.4 ± 0.7 in the dose reduction group vs -0.1 ± 0.7 in the dose maintenance group, P = 0.029). Implications/Conclusions Although our model-guided dose reduction strategy was found to be comparable with no-dose change in terms of dropout rates, safety issues have to be further examined.

  • Etiology of out-of-hospital cardiac arrest in psychiatric patients: Chart review

    Ishida T., Miyazaki K., Yukawa T., Yamagishi T., Sugiyama K., Tanabe T., Hamabe Y., Mimura M., Suzuki T., Uchida H.

    Psychiatry and Clinical Neurosciences (Psychiatry and Clinical Neurosciences)  73 ( 5 ) 243 - 247 2019年05月

    ISSN  13231316

     概要を見る

    © 2018 The Authors. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology Aim: Although sudden cardiac deaths are more common in psychiatric patients than the general population, data on their causes are very limited. The aim of this study was to investigate initial rhythms and causes of out-of-hospital cardiac arrest (OHCA) in patients with psychiatric disorders. Methods: We conducted a systematic chart review of patients resuscitated after OHCA and hospitalized in the Tertiary Emergency Medical Center of Tokyo Metropolitan Bokutoh Hospital in Japan between January 2010 and December 2017. The initial rhythms and causes of OHCA were compared between psychiatric patients and non-psychiatric patients. Parameters of interest were compared using chi-squared test, Fisher's exact test, or the Mann–Whitney U-test, as appropriate. Results: A total of 49 psychiatric and 600 non-psychiatric patients were eligible for this study. Fatal but shockable arrhythmias (i.e. ventricular fibrillation and ventricular tachycardia) were less frequently observed as initial rhythms in patients with psychiatric disorders than the others (22.4% vs 49.7%, P < 0.001). Cardiac origin was less common as the cause of OHCA (26.5% vs 58.5%, P < 0.01), while airway obstruction and pulmonary embolism were more frequent in psychiatric versus non-psychiatric patients (24.5% vs 6.5%, P < 0.01; and 12.2% vs 1.5%, P < 0.01, respectively). The results were similar when psychiatric patients were compared with sex- and age-matched controls selected from the non-psychiatric patient group. Conclusion: Although fatal arrhythmias may be less common, non-cardiac causes such as pulmonary embolism and airway obstruction need to be treated with high clinical suspicion in an event of sudden cardiac arrest in psychiatric patients.

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総説・解説等 【 表示 / 非表示

研究発表 【 表示 / 非表示

  • 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

    内田 裕之

    第20回日本臨床精神薬理学会 (仙台) , 2010年, ポスター(一般)

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

    内田 裕之

    American Association for Geriatric Psychiatry (Savannah) , 2010年, ポスター(一般)

  • Clozapine and global cognition in schizophrenia.

    内田 裕之

    American Association for Geriatric Psychiatry (Savannah) , 2010年, ポスター(一般)

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

    内田 裕之

    2nd International Schizophrenia Research Society (Florence) , 2010年, ポスター(一般)

  • 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

    内田 裕之

    第20回日本臨床精神薬理学会 (仙台) , 2010年, ポスター(一般)

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競争的資金等の研究課題 【 表示 / 非表示

  • 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年04月
    -
    2022年03月

    文部科学省・日本学術振興会, 科学研究費助成事業, 内田 裕之, 基盤研究(B), 補助金,  代表

  • 抗精神病薬の効果を最大化する投与タイミング:時間薬理学の導入

    2015年04月
    -
    2018年03月

    文部科学省・日本学術振興会, 科学研究費助成事業, 内田 裕之, 基盤研究(C), 補助金,  代表

受賞 【 表示 / 非表示

  • 日本精神神経学会国際発表賞

    2018年06月

  • 日本臨床精神神経薬理学会 ポールヤンセン賞

    2016年11月

  • 日本統合失調症学会 台湾統合失調症学会Travel Award

    2016年08月

  • 日本神経精神薬理学会 第5回学術奨励賞

    2016年07月

  • 日本臨床精神神経薬理学会 学会奨励賞

    2015年10月

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担当授業科目 【 表示 / 非表示

  • 精神医学講義

    2019年度

  • 精神科治療技法

    2019年度