著者

Takaaki Ishikawa Takahiro Shinozaki Kazutaka Shimoda

出版者

日本臨床精神神経薬理学会

雑誌

Clinical Neuropsychopharmacology and Therapeutics (ISSN:18848826)

巻号頁・発行日

vol.5, pp.18-22, 2014-07-15 (Released:2014-07-15)

参考文献数

11

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The patient was a 67-year-old man. After the patient received a diagnosis of schizophrenia, various antipsychotics were prescribed but did not improve symptoms. However, 18 mg/day aripiprazole (APZ) was found to be highly effective and enabled the patient to continue treatment on an outpatient basis. Two weeks after prescribing clarithromycin for fever and cough, he was readmitted to our psychiatric ward because of anuresis and deterioration of bradykinesia and salivation. Biochemical analysis revealed elevated serum creatine phosphokinase (26060 U/I) and creatinine (2.2 mg/dL). On admission, the patient had a high blood concentration of APZ and its metabolite(s). APZ was therefore discontinued, but the concentration remained elevated until day 8. Hemodialysis was started on day 4 to treat persistent renal dysfunction. The patient's CYP2D6 genotype was CYP2D6*10/CYP2D6*10. The elevated APZ levels may have resulted from the inhibitory action of clarithromycin on CYP3A4 combined with the lower inherent CYP2D6 enzymatic activity of the CYP2D6*10/CYP2D6*10 genotype.

著者

渡邊 崇 古郡 規雄 下田 和孝 Takashi Watanabe Norio Furukori Kazutaka Shimoda

出版者

獨協医学会

雑誌

Dokkyo Journal of Medical Sciences (ISSN:03855023)

巻号頁・発行日

vol.47, no.2, pp.73-78, 2020-07-25

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父娘がともに注意欠如・多動症(attention-deficit/hyperactivity disorder;ADHD)を発症した2症例を経験した.ADHDは児童思春期に診察される場合が多いが,成人後にも症状が残遺することもあり,慢性的な疾患であると考えられる.この症例報告では,家族間であっても,有効な治療薬において差異が認められた.このような家族間での差異を多面発現性と多遺伝子モデルに基づいて考察した.

著者

Takashi Watanabe Yuki Hayashi Akiko Aoki Shin Ishiguro Mikito Ueda Kazufumi Akiyama Kazuko Kato Yoshimasa Inoue Shoko Tsuchimine Norio Yasui-Furukori Kazutaka Shimoda

出版者

日本臨床精神神経薬理学会

雑誌

Clinical Neuropsychopharmacology and Therapeutics (ISSN:18848826)

巻号頁・発行日

vol.6, pp.5-15, 2015 (Released:2015-03-13)

参考文献数

39

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Purpose: This study evaluated the impact of CYP2D6 polymorphism, and particularly CYP2D6*10 alleles, on the steady-state plasma concentrations of mirtazapine (MIR) and its metabolite N-desmethylmirtazapine (DMIR) in Japanese psychiatric patients.Patients and Methods: The subjects were 75 Japanese patients treated with racemic MIR. The steady-state plasma concentrations of MIR and DMIR were measured using liquid chromatography. The CYP2D6 genotypes were determined by polymerase chain reaction. Three subjects whose plasma levels of MIR and DMIR were below the limit of detection were regarded as non-adherent and excluded, and 4 subjects having the CYP2D6*5 allele (CYP2D6*1/CYP2D6*5 and CYP2D6*2/CYP2D6*5 (n = 3) and CYP2D6*5/CYP2D6*10 (n = 1)) were excluded from the analysis in order to eliminate the effect of the CYP2D6*5 allele. Accordingly, data from 68 subjects were subjected to analysis.Results: There were no significant differences in the plasma concentrations of MIR or DMIR (all corrected for dose and body weight) among different CYP2D6 genotypes. Multiple regression analysis also revealed that age affects MIR (corrected for dose and body weight) (p=0.079). Also, multiple regression analysis revealed that age correlated significantly to the plasma concentration of DMIR (corrected for dose and body weight) (p=0.026). Neither sex nor the number of CYP2D6*10 alleles were significant factors for either the plasma concentration of MIR (corrected for dose and body weight) or the plasma concentration of DMIR (corrected for dose and body weight).Conclusion: CYP2D6*10 polymorphism did not significantly affect the steady-state plasma levels of MIR and DMIR in Japanese patients, but age had a significant effect on the plasma levels of DMIR.

著者

一杉 正仁 菅谷 仁 平林 秀樹 妹尾 正 上田 秀一 下田 和孝 田所 望 古田 裕明 Masahito Hitotsugi Hitoshi Sugaya Hideki Hirabayashi Tadashi Seno Shuichi Ueda Kazutaka Shimoda Nozomu Tadokoro Hiroaki Furuta 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター 獨協医科大学国試教育センター Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine Medical Education Center for National Examination Dokkyo Medical University School of Medicine

雑誌

Dokkyo journal of medical sciences (ISSN:03855023)

巻号頁・発行日

vol.37, no.2, pp.77-81, 2010-07-25

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試験におけるヒューマンエラーの実態を明らかにし,予防教育の効果を検証するために,医師国家試験模擬試験を利用して受験生がおかすヒューマンエラーを包括的に調査解析した.医学部6年生が2回の医師国家試験模擬試験を受験し,自己採点結果と,マークシートによる機械的採点結果を対比した.2回の試験を通じて,受験生1人が1回の試験で平均1.4個のエラーをおかしていた.エラーの分類別頻度では,2肢選択すべきところを1肢しか選択しなかったエラーが49.1%,1肢選択すべきところを2肢以上選択したエラーが31.6%,選択したものと異なる記号をマークしたエラーが10.5%と続いた.全ての受験者(全受験者)と,2回の試験に参加した受験者(2回受験者)に大別してエラーの発生頻度,エラーの内容について比較した.2 回受験者は,1人当たりがおかすエラー数および2問以上のエラーをおかす人の割合ともに2回目の試験で有意に減少していた. これは,受験者自らがエラーの実態に気付き,そして適切な助言のもとに注意を払って試験に臨んだ結果と思われる.試験におけるヒューマンエラーの実態を明らかにし,それを最小限にくい止める対策は,単に医師国家試験における失点防止だけでなく,ミスをおかしてもそれに気付き,問題解決ができるようなerror tolerantの考え方を養う上でも重要と思われる.We analyzed inadvertent human errors made by 6thgrade medical students during two trial examinations madeup of 500 multiple-choice questions where either one or twocorrect answers were required. Forty and 39 students, respectively,took the two examinations. Students averaged1.4 errors each during the examinations. Most errors( 80.7%) involved selecting the wrong number among the answeroptions( i.e. when a two option selection was required,only one option was selected). The students who had takenboth examinations made significantly less errors in the latterexamination than the former. Furthermore, the prevalenceof students who had made more than one inadvertenterror was significantly lower among students who tookboth examinations. We showed the effectiveness of interventionregarding inadvertent errors during 500 multiplechoicequestion examinations and of educating the studentsabout preventive measures. These results might have auseful application to improved safety promotions based onerror-tolerant theories.