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

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
Shinji Sato Yoichi Kawanishi Masayuki Ide Noriko Sodeyama Hitoshi Takei
出版者
The Japanese Society of Clinical Neuropsychopharmacology
雑誌
Clinical Neuropsychopharmacology and Therapeutics (ISSN:18848826)
巻号頁・発行日
vol.10, pp.26-28, 2019-11-08 (Released:2019-11-08)
参考文献数
12

Autism spectrum disorder (ASD) includes disturbances in communication, imagination, and social interaction. In individuals with ASD, selective mutism is a common symptom of a communication disability. Selective serotonin reuptake inhibitors (SSRIs) have been recommended to treat selective mutism, especially after psychosocial interventions fail. However, the mechanism and efficacy of SSRIs in treating selective mutism remain unclear. Here we report the case of an adult male with ASD whose selective mutism was improved by aripiprazole but not SSRIs. To the best of our knowledge, this is the first such case report. We believe that our patient's case highlights the value of differentiating between psychopathology and psychopharmacology when examining ASD symptoms.
著者
Yumiko Akamine Kayoko China Tsukasa Uno
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.3, pp.8-14, 2012 (Released:2012-05-11)
参考文献数
53

At the Blood–Brain barrier (BBB), the superfamily of ATP-binding cassette (ABC) transporters includes the ABCB1 subfamily corresponding to P-glycoprotein (P-gp), the ABCC subfamilies of multidrug resistance-associated proteins (MRPs), and the ABCG2 subfamily corresponding to breast cancer resistance protein (BCRP). These efflux transporters are located mainly in the endothelial cells forming the BBB and prevent the entry of xenobiotics into the brain. Since psychotropics act on target sites of the central nervous system (CNS) in the brain, it is very important to know these transporters' roles at the BBB and to determine the brain drug concentrations at the targeted sites of the CNS. However, there is little information on human brain concentrations of psychotropics. Recent studies have demonstrated that brain concentrations of many psychotropics are significantly higher in P-gp-knockout mice than in wild-type mice. This result implies that P-gp may be a key player in the regulation of brain psychotropic pharmacokinetics and possibly causes the P-gp-mediated drug interaction at the BBB. In this review, we discuss the current findings concerning the role of drug transporters on the concentrations of psychotropics in the brain and summarize the available in vivo studies related to psychotropics.
著者
Kensuke Yoshimura Tasuku Hashimoto Yasunori Sato Aiko Sato Takashi Takeuchi Hiroyuki Watanabe Takeshi Terao Michiko Nakazato Masaomi Iyo
出版者
The Japanese Society of Clinical Neuropsychopharmacology
雑誌
Clinical Neuropsychopharmacology and Therapeutics (ISSN:18848826)
巻号頁・発行日
vol.9, pp.20-28, 2018-09-28 (Released:2018-09-28)
参考文献数
30
被引用文献数
2

Purpose: Pharmacological treatments with some anticonvulsants, including valproate, and lithium should be avoided where possible in childbearing-aged and pregnant women with epilepsy and bipolar disorder because they increase the risk of major congenital malformations. We surveilled real-world prescriptions of anticonvulsants and lithium in childbearing-aged female and male outpatients in Japan, using the first public National Insurance Claims Database of Japan.Methods: We performed a summary statistical analysis of the numbers of the most prescribed 11 anticonvulsants and lithium tablets in female and male outpatients aged 15-29 (younger childbearing age), 30-49 (older childbearing age), and >50 (non-childbearing age) years from April 2014 to March 2015. We determined the association between anticonvulsant or lithium use and sex at childbearing age, and the odds ratio (OR) and 95% confidence intervals (CIs) were estimated using logistic regression analysis.Results: Valproate (number of tablets = 273,135,937) was the most prescribed among the 12 investigated drugs, and 125,451,907 tablets were prescribed for women (younger, older, and non-childbearing ages, 19,296,528, 47,826,746, and 58,328,63, respectively), compared to 147,684,031 tablets for men (24,534,648, 57,229,981, and 65,919,402, respectively). Valproate prescription was only slightly lower in childbearing-aged women than in the same-aged men (i.e., 15-29 years of age, OR = 0.889 [95% CI, 0.888-0.890]; 30-49 years of age, OR = 0.944 [95% CI, 0.944-0.945]).Discussion: This study demonstrated valproate was highly prescribed for childbearing-aged women in Japan in 2014-2015. Physicians should prescribe valproate with considerable caution in girls and childbearing-aged women.
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

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.