Papers - Uchida, Hiroyuki

Treatment target in schizophrenia

Suzuki Takefumi, Uchida Hiroyuki, Watanabe Koichiro, Kashima Haruo

Psychopharmacology Bulletin 41 ( 4 ) 80 - 102 2008

ISSN  0048-5764

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<p>Patients with schizophrenia have many problems as well as symptoms, and various rating scales have been in use to address them. The authors review past representative rating scales and some pivotal studies to focus on treatment target in schizophrenia. Traditionally, positive symptoms have been the main target of treatment. However, other crucial domains such as negative and cognitive symptoms, and subjective perspectives are drawing due attention because of their clinical relevance. Given many domains to be addressed, there have eventually been too many assessment scales to be selected and widely utilized in real-world clinical settings, and there has been still no concrete consensus on which scales to utilize in a given situation, which is currently decided at the discretion of the investigators. Measurement is frequently difficult even with the existing assessments, especially as what constitutes an acceptable clinical status is hard to define, considering highly hetero generous nature of the illness. Many rating scales are met with limitations especially in time and in pragmatic comprehensiveness, which often hinder their routine application in time-limited busy settings. Still, problems and functioning of patients are the reasonable target to evaluate for measurement-based treatment. The authors suggest assessment of problems resulting from symptoms together with objective functioning, which clinical psychiatrists are actually doing in everyday practice, would serve as a minimum set of standardized assessment in schizophrenia, and the newly developed TIP-Sz and FACT-Sz would serve for that purpose. Other crucial viewpoints could be supplemented with (subjective) assessment scales as appropriate.</p>

陽性症状の神経化学的基盤に関する仮説 – Aberrant Salience仮説を中心に

Uchida Hiroyuki

Schizophrenia Frontier 8   252-256 2008

Research paper (scientific journal), Single Work

Salience仮説とドパミン

Uchida Hiroyuki

臨床精神薬理 11   1435-1440 2008

Research paper (scientific journal), Joint Work

A potentially aborted neuroleptic malignant syndrome following seclusion against uncontrollable water intoxication.

Suzuki Takefumi, Uchida Hiroyuki, Watanabe Koichiro, Kashima Haruo

Psychopharmacology Bulletin (Psychopharmacology bulletin)  41 ( 1 ) 164 - 170 2008

ISSN  0048-5764

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<p>Water intoxication in schizophrenia poses a great clinical challenge, and occasionally, behavioral restrictions are unavoidable. A patient with refractory schizophrenia comorbid with severe water intoxication had an apparent weight variation of ,7 kg/day to 65 kg. As he fell twice, when he had been treated with antipsychotic megadose therapy, he was secluded with restricted water access of 3 L/day. Two days later, consciousness level deteriorated significantly with autonomic instability; however, he was treated with intravenous hydration plus dantrolene and recovered completely on the following day. The sodium/chloride levels and serum osmolarity, which had been abnormally low, normalized abruptly. Only after seclusion was it found that his dry weight had been only 52 kg. The first description of such a case was indicative of a potentially aborted neuroleptic malignant syndrome. He is now treated with olanzapine, valproate, and lorazepam, with some success. Caution is required for secluding extreme cases of uncontrollable water intoxication.</p>

Treatment target in schizophrenia: a critical review and a clinical suggestion.

Suzuki T., Uchida H., Watanabe K., Kashima H.

Psychopharmacology bulletin (Psychopharmacology bulletin)  41 ( 4 ) 80 - 102 2008

ISSN  00485764

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Patients with schizophrenia have many problems as well as symptoms, and various rating scales have been in use to address them. The authors review past representative rating scales and some pivotal studies to focus on treatment target in schizophrenia. Traditionally, positive symptoms have been the main target of treatment. However, other crucial domains such as negative and cognitive symptoms, and subjective perspectives are drawing due attention because of their clinical relevance. Given many domains to be addressed, there have eventually been too many assessment scales to be selected and widely utilized in real-world clinical settings, and there has been still no concrete consensus on which scales to utilize in a given situation, which is currently decided at the discretion of the investigators. Measurement is frequently difficult even with the existing assessments, especially as what constitutes an acceptable clinical status is hard to define, considering highly hetero generous nature of the illness. Many rating scales are met with limitations especially in time and in pragmatic comprehensiveness, which often hinder their routine application in time-limited busy settings. Still, problems and functioning of patients are the reasonable target to evaluate for measurement-based treatment. The authors suggest assessment of problems resulting from symptoms together with objective functioning, which clinical psychiatrists are actually doing in everyday practice, would serve as a minimum set of standardized assessment in schizophrenia, and the newly developed TIP-Sz and FACT-Sz would serve for that purpose. Other crucial viewpoints could be supplemented with (subjective) assessment scales as appropriate.

How effective is it to sequentially switch among Olanzapine, Quetiapine and Risperidone? - A randomized, open-label study of algorithm-based antipsychotic treatment to patients with symptomatic schizophrenia in the real-world clinical setting

Suzuki Takefumi, Uchida Hiroyuki, Watanabe Koichiro, Nomura Kensuke, Takeuchi Hiroyoshi, Tomita Masayuki, Tsunoda Kenichi, Nio Shintaro, Den Ryoske, Manki Hiroshi, Tanabe Akira, Yagi Gohei, Kashima Haruo

Psychopharmacology (Psychopharmacology)  195 ( 2 ) 285 - 295 2007.12

ISSN  0033-3158

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<p>Rationale: Evidence on sequential trial with atypical antipsychotics has been scarce. Objectives: We conducted an algorithm-based antipsychotic pharmacotherapy. Materials and methods: In this open-label study, patients with schizophrenia (DSM-IV) were treated with antipsychotic monotherapy, step-by-step, with each trial lasting up to 8 weeks. At baseline, they were highly symptomatic to score more than 54 in the total Brief Psychiatric Rating Scale (BPRS_1-7) score. When the posttreatment BPRS score was above 70% of the baseline, they were subsequently treated with another and up to three atypicals. Basically, anticholinergics were prohibited, and only adjunctive allowed was lorazepam. The secondary endpoint was a clinical status good enough to be discharged for 66 inpatients and a successful continuation therapy with the same antipsychotic agent for more than 6 months for 12 outpatients. Results: Three groups of 26 patients each were randomized to Olanzapine, Quetiapine, or Risperidone. Thirty-nine (50%) responded to the first agent (Olanzapine16, Quetiapine9, Risperidone14), and 14 responded to the second. Only two showed response to the third, and 16 failed to respond to all three antipsychotics, with only 7 dropouts. Overall, there were 22 Olanzapine, 14 Quetiapine, and 19 Risperidone responders. Based on the secondary outcome, 20 Olanzapine-treated (average maximum dose, 15.4 mg), 10 Quetiapine-treated (418 mg), and 20 Risperidone-treated (4.10 mg) patients responded. The difference in response as the first choice was significant (p&lt;0.05). Relative doses of those failing to respond were comparable (Olanzapine 18.3 mg, Quetiapine 564 mg, Risperidone5.47 mg). Extrapyramidal symptoms did not change significantly. Conclusions: When the first atypical antipsychotic is inadequate, switching to the second is worth trying, although some remain treatment-refractory. Quetiapine may be inferior to Olanzapine and Risperidone in symptomatic patients.</p>

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Identification of novel suppressors for Mog1 implies its involvement in RNA metabolism, lipid metabolism and signal transduction.

Oki M, Ma L, Wang Y, Hatanaka A, Miyazato C, Tatebayashi K, Nishitani H, Uchida H, Nishimoto T

Gene 400 ( 1-2 ) 114 - 21 2007.10

ISSN  0378-1119

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Use of atypical antipsychotic medications in later life

Rajji Tarek, Mulsant Benoit H., Uchida Hiroyuki, Mamo David

Geriatrics and Aging (Geriatrics and Aging)  10 ( 9 ) 578 - 587 2007.10

ISSN  1488-8408

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<p>Antipsychotics are increasingly being prescribed to older patients for the management of a variety of neuropsychiatric conditions. Available evidence supports the use of second-generation antipsychotics (SGAs) when treating these conditions. However, given their modest clinical effect for certain conditions (e.g., behavioural and psychological symptoms of dementia), their adverse effects, and their safety profile, a careful analysis of their risks and benefits is needed before initiating treatment with an SGA for an older patient. Among SGAs, choice of medication should be guided by their respective clinical indications and adverse effect profile, with use of lower initial and target doses (compared to younger adults) and periodic reviews of whether or not their continued use is warranted.</p>

Minimizing antipsychotic medication obviated the need for enema against severe constipation leading to paralytic ileus

Suzuki T., Uchida H., Watanabe K., Kashima H.

Journal of Clinical Pharmacy and Therapeutics 32 ( 5 ) 525 - 527 2007.10

ISSN  0269-4727

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<p>Objective: To report the usefulness of antipsychotic dose-reduction for avoiding paralytic ileus in a patient with chronic schizophrenia and comorbid dementia. Case summary: A 65-year-old in-patient developed severe paralytic ileus warranting a transfer to the general hospital. Constipation was very troublesome and he often needed enema to prevent intestinal obstruction. He had originally been treated with 24 mg of bromperidol, which was reduced to 4 mg, and other psychotropic treatments were simultaneously simplified. As a result, bowel habits improved and enema is now only rarely necessary. Constipation is a frequent adverse effect of antipsychotics and adjunctive psychotropics, which can be severe and may lead to life-threatening paralytic ileus. Dose-reduction obviated a necessity of enema against persistent constipation, while the patient's mental status remained under control. Assessment using the Naranjo probability scale revealed a definite causal relationship. Discussion: With an increasing number of elderly patients with schizophrenia, more cases of severe gastrointestinal motility problems from antipsychotic medication are to be expected. In this patient population dose-reduction of antipsychotics and simplification of concomitant psychotropics should be seriously considered.</p>

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Minimizing antipsychotic medication obviated the need for enema against severe constipation leading to paralytic ileus: A case report

Suzuki T., Uchida H., Watanabe K., Kashima H.

Journal of Clinical Pharmacy and Therapeutics (Journal of Clinical Pharmacy and Therapeutics)  32 ( 5 ) 525 - 527 2007.10

ISSN  02694727

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Objective: To report the usefulness of antipsychotic dose-reduction for avoiding paralytic ileus in a patient with chronic schizophrenia and comorbid dementia. Case summary: A 65-year-old in-patient developed severe paralytic ileus warranting a transfer to the general hospital. Constipation was very troublesome and he often needed enema to prevent intestinal obstruction. He had originally been treated with 24 mg of bromperidol, which was reduced to 4 mg, and other psychotropic treatments were simultaneously simplified. As a result, bowel habits improved and enema is now only rarely necessary. Constipation is a frequent adverse effect of antipsychotics and adjunctive psychotropics, which can be severe and may lead to life-threatening paralytic ileus. Dose-reduction obviated a necessity of enema against persistent constipation, while the patient's mental status remained under control. Assessment using the Naranjo probability scale revealed a definite causal relationship. Discussion: With an increasing number of elderly patients with schizophrenia, more cases of severe gastrointestinal motility problems from antipsychotic medication are to be expected. In this patient population dose-reduction of antipsychotics and simplification of concomitant psychotropics should be seriously considered. © 2007 The Authors.

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Multi-detector-row CT angiography as a preoperative evaluation for spinal arteriovenous fistulae.

Yamaguchi S, Eguchi K, Kiura Y, Takeda M, Nagayama T, Uchida H, Ito Y, Hotta T, Arita K, Kurisu K

Neurosurgical review 30 ( 4 ) 321 - 6; discussion 327 2007.10

ISSN  0344-5607

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Dietary nitrite inhibits early glomerular injury in streptozotocin-induced diabetic nephropathy in rats.

Ohtake K, Ishiyama Y, Uchida H, Muraki E, Kobayashi J

Nitric oxide : biology and chemistry 17 ( 2 ) 75 - 81 2007.09

ISSN  1089-8603

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An open-label trial of discontinuing benzodiazepines in patients with chronic schizophrenia [6]

Nakajima Shinichiro, Uchida Hiroyuki, Suzuki Takefumi, Tomita Masayuki, Tsunoda Kenichi, Kitta Masaya, Takeuchi Hiroyoshi, Nomura Kensuke, Watanabe Koichiro, Kashima Haruo

Journal of Clinical Psychopharmacology 27 ( 4 ) 401 - 403 2007.08

ISSN  0271-0749

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Treating a schizophrenic patient with severe tardive dystonia without antipsychotics

Suzuki Takefumi, Uchida Hiroyuki, Watanabe Koichiro, Kashima Haruo

Progress in Neuro-Psychopharmacology and Biological Psychiatry 31 ( 5 ) 1141 - 1142 2007.06

ISSN  0278-5846

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Reply to comments by Dr Magalhães [15]

Uchida Hiroyuki, Takeuchi Hiroyoshi, Suzuki Takefumi, Nomura Kensuke, Watanabe Koichiro, Kashima Haruo

Journal of Clinical Psychopharmacology 27 ( 3 ) 318 - 319 2007.06

ISSN  0271-0749

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Oxygen reduction activity of carbon-supported Pt-M (M = V, Ni, Cr, Co, and Fe) alloys prepared by nanocapsule method.

Yano H, Kataoka M, Yamashita H, Uchida H, Watanabe M

Langmuir : the ACS journal of surfaces and colloids 23 ( 11 ) 6438 - 45 2007.05

ISSN  0743-7463

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知覚変容

Uchida Hiroyuki

臨床精神医学 別冊    87-91 2007

Research paper (scientific journal), Single Work

Enhanced proton conduction in polymer electrolyte membranes with acid-functionalized polysilsesquioxane.

Miyatake K, Tombe T, Chikashige Y, Uchida H, Watanabe M

Angewandte Chemie (International ed. in English) 46 ( 35 ) 6646 - 9 2007

ISSN  1433-7851

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Expression of Aspergillus oryzae phytase gene in Aspergillus oryzae RIB40 niaD(-).

Uchida H, Arakida S, Sakamoto T, Kawasaki H

Journal of bioscience and bioengineering 102 ( 6 ) 564 - 7 2006.12

ISSN  1389-1723

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Antipsychotics-induced hypersensitivity of visual perception

Uchida Hiroyuki, Suzuki Takefumi, Watanabe Koichiro, Kashima Haruo

European Psychiatry (European Psychiatry)  21 ( 5 ) 343 - 344 2006.07

ISSN  0924-9338

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