背景:

【目的】

本研究の目的は統合失調症患者における

【方法】

診療報酬請求データベースを用いてコホート研究を行った。研究対象は2015年5月1日から2019年11月30日の間に外来で

【結果・考察】

健康関連QOLをプライマリエンドポイントとしたランダム化比較試験（以下、RCT）において、

【結論】

精神科病棟への入院及びLAI治療の中止のリスクに関して、

目的：精神遅滞を伴うてんかん患者の衝動性，易怒性に対する，

方法：40代女性．中等度神発達遅滞，症候性全般てんかんがあり，施設入所中であった．衝動性や易怒性を認め，入所施設職員に対する暴力行為があった．また，高用量の抗てんかん薬，抗精神病薬が処方されており，倦怠感および日中傾眠傾向を認め，就労が困難な状態にあった．

結果：精神症状の改善が得られ，昼夜の覚醒リズムも改善した．そのため，日常生活も安定し，作業所通所による就労も再開できた．著明な副作用は認められなかった．

結論：精神遅滞を伴うてんかん患者の衝動性，易怒性に対して，

統合失調症の病態発現において，酸化ストレスの関与が示されている。これまでに非定型抗精神薬は抗酸化作用を有することが報告されているが，様々な臨床症状を持つ統合失調症の病態発現機序および抗精神病薬の神経細胞に対する作用は未解明な部分が多い。本研究では，非定型抗精神病薬である

A sustained-release injectable formulation with polylactic acid-glycolic acid (PLGA) copolymer particles was developed. The suspension of the formulation dispersed in injection fluid provided excellent gliding performance when extruded from the syringe. The PLGA microparticles (MRPs) with aripiprazole (ARP), as a model drug in this study, were prepared by a spray-dryer. The resultant MRPs were entrapped in a granular matrix composed of water-soluble additives and a surfactant through a drop freeze-drying process to design the granulated microparticles (G-MRPs). In this study MRPs and G-MRPs were evaluated for their physicochemical and pharmaceutical properties. It was found that the MRPs, which were spherical particles approximately 1-20 μm in size, were strongly aggregated in the aqueous phase. The clogging of a needle hole was frequently observed while discharging MRP suspension from the syringe, resulting in increased gliding force up to around 5 kgf, which was detected by extrusion force. On the other hand, the G-MRPs were spherical granules 200-400 μm in size, and had a microparticles-in-granule structure in which the MRPs were embedded in the porous matrix inside the granule. Unlike the MRPs, the G-MRPs had excellent needle passagability with tolerant gliding force, which was attributed to the nearly mono-dispersibility of the MRP particles in the injection fluid. ARP release behavior from G-MRPs could be controlled by changing PLGA:ARP ratio, which indicated a potential for development of a depot-type injectable formulation. In addition, the G-MRPs had excellent powder properties, suggesting that the current granulated MRP solid dosage form would contribute to automatic filling into a pre-filled syringe.

ブレクスピプラゾール（レキサルティ^®）は，大塚製薬が

患者は33歳の女性で，閉口障害を主訴に当院救急診療部を受診し，右側顎関節前方脱臼の診断で脱臼の整復処置が行われた。再度脱臼が自然発生したため，当科へ対診となった。初診時，仮面様顔貌が認められ，下顎が左側に偏位し，さらに小刻みに振戦していた。最大開口量の測定は困難であった。パノラマ顎関節4分割モード撮影を行ったところ，右側の下顎頭は関節結節の前方にわずかな逸脱を認めた。一方，左側の下顎頭は下顎窩の中央部に位置していた。既往歴に関しては，統合失調症，不眠症，パーキンソン症候群および悪性症候群があり，服用薬は非典型抗精神病薬および睡眠薬であった。顎口腔ジストニア（下顎偏位型）と診断した。外側翼突筋下頭の持続的な過緊張を一時的に緩和させる目的で，Gow-Gates下顎神経伝達麻酔を施行した。続いて，下顎偏位および再脱臼の防止策として，顎間および顎外固定を施行した。翌日，固定は解除され，その後，患者の通院している診療内科で内服調整が行われた。6か月を経過した現在まで下顎偏位および再脱臼は認められない。Gow-Gates下顎神経伝達麻酔は下顎の偏位抑制に有効であった。顎間および顎外固定は下顎偏位および脱臼の再発防止に役立った。

Delayed sleep phase disorder (DSPD) comprises a persistent or recurrent pattern of sleep disturbances, sleep disruption that leads to insomnia and/or excessive daytime sleepiness, and impaired functioning in social, occupational, or other spheres. Three techniques are typically used to treat DSPD : chronotherapy, phototherapy, and exogenous melatonin administration. Antipsychotics have not been reported in the treatment of DSPD, aripiprazole (APZ), which is a second generation antipsychotic, manifests a novel mechanism of action by serving as a partial agonist of D2 receptors. Depression is reported to be the most common psychopathology associated with DSPD, and APZ is reported to be effective in major depressive disorder as adjunctive therapy. Therefore, we speculated that APZ might be effective to treat DSPD, and we observed how APZ works for the treatment of DSPD.

Methods : 18 subjects (including 7 women) who are 14–48–year–old (the average is 31.6) were included. The patients were prescribed 0.75–4.5mg APZ at once a day.

Results : We prescribed 1.5–3.0mg/day of APZ, all subject reduced total sleep time (9.6 +/− 2.3h → 7.8 +/− 2.0h, p＝0.03), many cases got up earlier (9.1 +/− 1.9h → 6.7 +/− 1.4h, p＝0.005) in the morning and advanced their sleep phase within one week. The sleep onset was not significantly changed (23.5 +/− 2.0h → 22.9 +/− 1.9h, n.s.).

Conclusion : Low dose of APZ would reduce nocturnal sleep time in the subjects who had prolonged sleep time and DSPD symptoms. The mechanism of action would be dopaminergic up regulation due to dopamine D3 agonistic activity. Since it is difficult for physicians to treat prolonged sleep time and DSPD symptoms, this medication would become a new therapeutic tool for these patients.