論文 - 河西　千秋

Effectiveness of the 10 Essentials Workshop Program in Changing Attitudes Toward Suicide Among Mental Health Professionals.

Kenji Narita, Chiaki Kawanishi, Yusuke Tsuyama, Shizuka Kawamoto, Tomonori Kashiwagi, Ryutaro Ishibashi, Yoshinori Cho, Kotaro Otsuka

Cureus   17 ( 1 ) e77830  2025年01月  [国際誌]

　概要を見る

INTRODUCTION: Mental health professionals play an important role in helping patients at risk of suicide. Therefore, mental health professionals must acquire basic knowledge and skills in suicide prevention to support patients with suicidal behavior. However, not all mental health professionals have sufficient knowledge and skills, and educational programs for mental health professionals are rare. We previously developed a workshop covering 10 steps healthcare professionals must take to care for mentally ill patients (the 10 Essentials program), and we adapted it for suicide prevention. This study aimed to evaluate the 10 Essentials program's effectiveness in educating mental health professionals. METHODS: This was an intervention study (pre-post comparison test). The participants of the present study were the mental health professionals (psychiatrists, psychiatric nurses, mental health social workers, clinical psychologists, and occupational therapists) who took part in the 10 Essentials workshops we delivered to several communities in Japan. The Attitudes Toward Suicide Scale (ATTS) was administered to the participants pre- and post-training to assess changes in their attitudes toward suicide after participating in the program. RESULTS: We analyzed data from 264 participants who completed the questionnaires. Their ATTS scores at post-training were significantly higher (and therefore more favorable) in the following dimensions: "common occurrence" (p = 0.012), "unjustified behavior" (p < 0.0001), and "preventability/readiness to help" (p < 0.0001), compared with those at pretraining. The ATTS scores at post-training were significantly lower (and therefore more favorable) in "right to suicide" (p < 0.0001), "suicidal expression as a mere threat" (p < 0.0001), and "impulsiveness" (p < 0.0001) compared with pretraining scores. Attitudes toward suicide among the participants shifted in a favorable direction after the program. CONCLUSION:  In this study, the 10 Essentials program was effective in improving attitudes toward suicide among mental health professionals. Their attitudes became more favorable for helping patients with suicidal behavior. Further study will be needed to examine participants with different backgrounds and the long-term effects of the training.

DOI PubMed

入院中に自殺によって死亡したせん妄患者の特徴

井上 佳祐, 河西 千秋, 張 賢徳, 大塚 耕太郎

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  36 ( Suppl. ) S - 197  2024年11月

精神保健福祉士による自殺未遂者支援 救急患者精神科継続支援におけるソーシャルワーク支援

松村 里歩, 昌川 安希子, 石橋 竜太朗, 津山 雄亮, 成田 賢治, 佐野 智章, 河西 千秋

日本自殺予防学会総会・日本臨床死生学会総会合同大会プログラム・抄録集 ( 日本自殺予防学会・日本臨床死生学会 )  48回・29回   100 - 100  2024年08月

精神科病院における自殺未遂者に対するアサーティヴ・ケースマネジメント介入試験計画

石橋 竜太朗, 佐野 智章, 大塚 耕太郎, 杉山 直也, 張 賢徳, 河西 千秋

日本自殺予防学会総会・日本臨床死生学会総会合同大会プログラム・抄録集 ( 日本自殺予防学会・日本臨床死生学会 )  48回・29回   102 - 102  2024年08月

入院患者の自殺死亡の特徴 医療事故情報収集等事業における医療事故情報データの分析(第1報)

井上 佳祐, 河西 千秋, 張 賢徳, 大塚 耕太郎

日本自殺予防学会総会・日本臨床死生学会総会合同大会プログラム・抄録集 ( 日本自殺予防学会・日本臨床死生学会 )  48回・29回   72 - 72  2024年08月

集団心理教育による自殺事故後の医療者の悲嘆ケア その実践と効果検証

柏木 智則, 津山 雄亮, 人見 敬子, 河西 千秋

日本自殺予防学会総会・日本臨床死生学会総会合同大会プログラム・抄録集 ( 日本自殺予防学会・日本臨床死生学会 )  48回・29回   121 - 121  2024年08月

【統合失調症のさまざまな病態にどう対応するか】統合失調症における自殺と抗精神病薬 クロザピンを中心に

井上 佳祐, 河西 千秋

臨床精神薬理 ( (株)星和書店 )  27 ( 6 ) 589 - 596  2024年06月

　概要を見る

統合失調症患者は,一般人口と比較して自殺の危険性が高い。クロザピンは統合失調症患者の自殺を予防する効果があることが示されているが,クロザピン以外の抗精神病薬の自殺予防効果については明らかにされていない。統合失調症患者の自殺を予防するために薬物療法としてできることは,クロザピンを選択することだけでなく,副作用やアドヒアランスへの配慮が重要である。また,クロザピンの投与を中止する際は自殺の危険性が高まらないか注意を要する。(著者抄録)

入院患者の外出・外泊中の自殺企図の特徴 医療事故情報収集等事業における医療事故情報データの分析

井上 佳祐, 河西 千秋, 張 賢徳, 大塚 耕太郎

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S403 - S403  2024年06月

わが国発信の自殺予防のための大規模臨床試験・ACTION-J研究の展開と社会実装 ACTION-J 2次解析と自殺未遂者介入の最新のエビデンス

米本 直裕, 河西 千秋, 川島 義高

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S367 - S367  2024年06月

高自殺率地域において自殺念慮を有する住民の心理社会的特徴

小熊 貴之, 津山 雄亮, 米本 直裕, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S404 - S404  2024年06月

高自殺率地域において自殺念慮を有する住民の心理社会的特徴

小熊 貴之, 津山 雄亮, 米本 直裕, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S404 - S404  2024年06月

わが国発信の自殺予防のための大規模臨床試験・ACTION-J研究の展開と社会実装 ACTION-J 2次解析と自殺未遂者介入の最新のエビデンス

米本 直裕, 河西 千秋, 川島 義高

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S367 - S367  2024年06月

精神障害の労災認定基準改正を機に医師の働き方改革や職域の自殺予防、そして現場でできる介入を考える 職場のメンタルヘルス支援 アジェンダと求められるタスクとの「ギャップ」という実状

河西 千秋, 津山 雄亮

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S286 - S286  2024年06月

若者のメンタルヘルス問題の現実と対応:大学キャンパスを拠点に 保健管理センターによる大学生のメンタルヘルス支援の実際

津山 雄亮, 松浦 久美子, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S366 - S366  2024年06月

医療従事者のメンタルケアに向けたさまざまな取り組み 保健管理センターを拠点とした医療者のメンタルヘルス支援

津山 雄亮, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S449 - S449  2024年06月

医療従事者のメンタルケアに向けたさまざまな取り組み 自殺事故後のスタッフ・ケア

柏木 智則, 津山 雄亮, 人見 敬子, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2024特別号 ) S450 - S450  2024年06月

自殺未遂者へのアサーティヴ・ケースマネジメントの実装 多施設共同コホート研究

石井 貴男, 米本 直裕, 大高 靖史, 岡村 和哉, 辻井 農亜, 大塚 耕太郎, 吉村 玲児, 木下 利彦, 藤澤 大介, 太刀川 弘和, 山田 光彦, 津山 雄亮, 橋本 聡, 河西 千秋

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  35 ( Suppl. ) S - 166  2023年11月

自殺ハイリスク者に対する第1介入者のAttitude

柏木 智則, 津山 雄亮, 菅原 夏海, 橋本 恵理, 成田 賢治, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2023特別号 ) S394 - S394  2023年06月

【高齢者の社会的孤立・孤独とメンタルヘルス】高齢者の社会的孤立・孤独と自殺

大塚 耕太郎, 河西 千秋

老年精神医学雑誌 ( (株)ワールドプランニング )  34 ( 2 ) 147 - 153  2023年02月

　概要を見る

高齢者の自殺は従来から自殺対策における重要課題である.高齢者のうつや自殺の背景には,身体的不調,喪失体験,個人的な悩み,心理的孤独,心理的支援の乏しさ等の状況がある.個人的苦悩体験にさらされ,身体的衰えや身体疾患を抱え,またうつ病への罹患もあり,周囲に家族がいるものの心理的孤立の状況に陥っているため,実際には高齢者の自殺の背景に防御因子が乏しい状況が存在する.老年人口割合の増加,経済的困窮,老人医療費の負担増大,そして医療資源の乏しさなど高齢者を取り巻く問題は深刻さを増している.地域においては,自殺対策として啓発活動やスクリーニング等医療モデルのみならず,ソーシャルサポート等の援助体制,地域のこころの健康づくり,そして地域の関連機関のネットワーク等包括的な予防体制が重要である.そして,新型コロナウイルス感染症の問題が拡大して以降,孤立・孤独の問題は改めて顕在化している.2022年10月に閣議決定された自殺総合対策大綱(「自殺総合対策大綱～誰も自殺に追い込まれることのない社会の実現を目指して～」)では,孤立・孤独対策など関連施策との連携が重要な課題として掲げられている.自殺対策をさまざまな領域がかかわるように包括的な地域づくりとして進め,差し迫った自殺問題への対処であるだけでなく,今後地域が抱えていくであろう健康保健問題への対処にもつなげていく必要があると考えられる.(著者抄録)

病院内の自殺事故予防と事後対応 教育プログラムの効果

菅原 夏海, 津山 雄亮, 成田 賢治, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  124 ( 12 ) 895 - 895  2022年12月

がん患者の自殺予防を目的としたケース・マネジメント介入 フィジビリティ研究

石井 貴男, 岩木 敦子, 津山 雄亮, 菅原 夏海, 成田 賢治, 大江 開, 佐野 智章, 河西 千秋

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  34 ( Suppl. ) S - 186  2022年10月

「新型コロナウイルス感染症の現場事例に学ぶ～今後求められる危機管理～」 新型コロナウイルス感染症と医療従事者のメンタルヘルス

津山 雄亮, 松浦 久美子, 田所 重紀, 河西 千秋

北海道公衆衛生学雑誌 ( 北海道公衆衛生学会 )  36 ( 1特別付録 ) 23 - 23  2022年10月

消防・救急隊員と医師・看護師における自殺企図行動に対するAttitudeの比較・検討

柏木 智則, 津山 雄亮, 菅原 夏海, 成田 賢治, 河西 千秋

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  34 ( Suppl. ) S - 162  2022年10月

札幌医科大学附属病院高度救命救急センターに搬送された自殺企図事例の実態調査

石橋 竜太朗, 佐野 智章, 大江 開, 津山 雄亮, 岩木 敦子, 昌川 安希子, 柏木 智則, 古俣 皓涼, 石井 貴男, 河西 千秋

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  34 ( Suppl. ) S - 163  2022年10月

公立・私立大学を対象とした死亡学生実態調査について

安宅 勝弘, 太刀川 弘和, 布施 泰子, 丸谷 俊之, 高橋 あすみ, 河西 千秋, 石井 映美, 小田原 俊成

全国大学保健管理研究集会プログラム・抄録集 ( (公社)全国大学保健管理協会 )  60回   77 - 77  2022年10月

札幌医科大学附属病院高度救命救急センターに搬送された自殺企図事例の実態

古俣 皓涼, 石橋 竜太朗, 佐野 智章, 大江 開, 津山 雄亮, 岩木 敦子, 昌川 安希子, 柏木 智則, 石井 貴男, 河西 千秋

日本精神科救急学会学術総会プログラム・抄録集 ( (一社)日本精神科救急学会 )  30回   161 - 161  2022年09月

「自殺未遂者の自殺再企図防止のための救急患者精神科継続支援」を受けた自殺企図患者の心理社会的特徴

菅原 夏海, 岩木 敦子, 昌川 安希子, 津山 雄亮, 柏木 智則, 石橋 竜太朗, 石井 貴男, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  124 ( 7 ) 504 - 504  2022年07月

ケース・マネジメント介入を実施した自殺企図患者の精神医学的特徴と予後

石橋 竜太朗, 津山 雄亮, 岩木 敦子, 昌川 安希子, 石井 貴男, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  124 ( 5 ) 360 - 360  2022年05月

大学保健管理センターのメンタルヘルス相談者にみるCOVID-19感染拡大の影響

津山 雄亮, 松浦 久美子, 高橋 聡, 田所 重紀, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  124 ( 5 ) 361 - 361  2022年05月

【統合失調症患者の身体的脆弱性:精神科薬物治療と寿命の短縮】統合失調症の自殺および向精神薬との関係

井上 佳祐, 河西 千秋

臨床精神薬理 ( (株)星和書店 )  25 ( 4 ) 371 - 376  2022年04月

　概要を見る

統合失調症患者は、一般人口と比較して自殺の危険性が高い。統合失調症患者の自殺の危険因子には、自殺未遂歴や自殺の家族歴といった一般的なものの他、陽性症状や病識の獲得などといった特異的なものがある。また、精神病症状だけでなく抑うつ症状も自殺に関係すると言われる。Clozapineは、統合失調症患者の自殺を予防する効果があることが示されているが、他の抗精神病薬における統合失調症患者の自殺予防効果は十分に明らかにされていない。統合失調症患者の自殺を予防するためには、まず危険因子を把握し、患者の心理・精神病理を理解することが大切である。薬物療法においては、抗精神病薬の選択以上に、副作用やアドヒアランスに注意することが重要である。(著者抄録)

Assertive case management介入を実施した自殺企図患者の心理社会的特徴

佐野 智章, 石橋 竜太朗, 岩木 敦子, 昌川 安希子, 柏木 智則, 石井 貴男, 津山 雄亮, 河西 千秋

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  33 ( Suppl. ) S - 206  2021年11月

【自殺の予防と危機・救急対応-新たな局面を迎えた日本の自殺対策にどう対応するか】危機・救急対応の標準化 精神科救急医療ガイドライン 自殺未遂者対応

大塚 耕太郎, 杉山 直也, 河西 千秋

医学のあゆみ ( 医歯薬出版(株) )  279 ( 1 ) 36 - 42  2021年10月

　概要を見る

自殺未遂者ケアでは、精神科救急医療機関受療後に家族や地域の関係機関が関与する。かならずしも救急医療機関に精神科医が配置されているとは限らないため、行政が主体となって保健師などと救急医療機関が強い連携により退院後のケアを推進していく事業も認められる。自殺対策基本法による国家的な自殺未遂者ケアの推進を目的として、自殺総合対策大綱に位置づけられた自殺未遂者ケアのガイドラインとその普及の役割はきわめて重要である。ガイドラインは自殺未遂者ケアへの包括的なストラテジーを提示し、実務者の教育とケアの標準化に寄与するものである。ガイドラインが示す臨床手順を現場で応用することで、自殺リスクを減少させるため一助となる。また、精神科救急医療と救急医療のガイドラインは共役性をもたせ、自殺未遂者ケアの現場の実践において、円滑な支援体制の構築に役立つものと考えられる。加えて、ガイドラインを活用するうえでは、ガイドラインの適用範囲やハリスクス者ケアにおける個別性に配慮することが重要であると考えられる。(著者抄録)

I軸とII軸を併存した自殺企図患者へのAssertive case managementによる介入の効果 ACTION-Jの二次解析より

則本 和伸, 池下 克実, 奥地 一夫, 米本 直裕, 河西 千秋, 岸本 年史

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2021特別号 ) S602 - S602  2021年09月

I軸とII軸を併存した自殺企図患者へのAssertive case managementによる介入の効果 ACTION-Jの二次解析より

則本 和伸, 池下 克実, 奥地 一夫, 米本 直裕, 河西 千秋, 岸本 年史

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2021特別号 ) S602 - S602  2021年09月

【その後の自殺対策II-臨床に活かす自殺対策の展開-】自殺の再企図予防のための介入 これまでの知見、これからの課題

稲垣 正俊, 河西 千秋, 山田 光彦, 錦織 光

精神科治療学 ( (株)星和書店 )  36 ( 9 ) 1009 - 1014  2021年09月

　概要を見る

自殺予防のハイリスクアプローチとして、自殺未遂者の再企図予防介入法が開発されてきた。頻回の自傷を繰り返す患者に対する精神療法や精神科から退院する自殺未遂患者のフォローアップ等が挙げられるが、わが国では、自殺企図のために救命救急センターに搬送された患者の再企図予防として「積極的なコンタクトとその後のフォローアップ(集中的なケアとアウトリーチ・ケースマネジメント)」の効果が検証され、「救急患者精神科継続支援料」が算定可能となった。現在はこの介入法の普及と実装の段階に進んでいる。海外では、実施可能性を考慮してより簡便な「単回コンタクト(と簡易フォローアップ)」介入の効果が実臨床モニタリング研究から見出されている。その中で特に、自殺企図者を見逃さずに介入に導入する仕組みの重要さが示されており、わが国でも「救命救急入院料加算」をより積極的に活用して自殺未遂者を見逃さずに支援に結びつけていく必要があろう。(著者抄録)

Attitude to suicide prevention and suicide intervention skills among oncology professionals: An online cross-sectional survey in Japan.

Keisuke Inoue, Yoshitaka Kawashima, Hiroko Noguchi, Maiko Fujimori, Tatsuo Akechi, Chiaki Kawanishi, Yosuke Uchitomi, Yutaka J Matsuoka

Psychiatry and clinical neurosciences   75 ( 12 ) 401 - 402  2021年08月  [国際誌]

DOI PubMed

がん患者の自殺予防 がん患者の自殺リスク因子と自殺予防介入研究のレビュー

川島 義高, 米本 直裕, 稲垣 正俊, 井上 佳祐, 河西 千秋, 山田 光彦

日本うつ病学会総会・日本認知療法・認知行動療法学会プログラム・抄録集 ( 日本うつ病学会・日本認知療法・認知行動療法学会 )  18回・21回   209 - 209  2021年07月

TOPICS 神経精神医学 COVID-19感染拡大下の自殺予防

河西 千秋, 成田 賢治, 津山 雄亮

医学のあゆみ ( 医歯薬出版 )  277 ( 7 ) 551 - 553  2021年05月

DOI

もの忘れ外来を受診した高齢患者の抑うつとQOLの特徴

林 綾子, 津山 雄亮, 岩本 倫, 松山 清治, 村山 友規, 白石 将毅, 河西 千秋

老年精神医学雑誌 ( (株)ワールドプランニング )  31 ( 増刊II ) 190 - 190  2020年12月

救急医療と自殺予防 精神科救急における自殺予防活動 日本精神科救急学会の理念と取り組み

杉山 直也, 河西 千秋, 大塚 耕太郎

自殺予防と危機介入 ( (一社)日本自殺予防学会 )  40 ( 2 ) 30 - 35  2020年09月

　概要を見る

日本精神科救急学会は、1993年に創設された、多職種で構成される学術団体である。自殺予防に関する議論は盛んで、年次学術集会、学会誌の刊行、ガイドラインの発表、教育イベントの開催、政策提言等を行っている。精神科救急の理念と意義は「危機介入」と「脱施設化」の推進にある。急性期医療の充実を図り、スマートで可能な限り非制限的な危機介入によって、長期在院者の発生抑止を目指している。多くの先進諸外国が主軸とする「地域精神保健ケアサービスの共通理念」は学会理念に通じるとともに、自殺予防活動にも通じている。自殺予防は医療のみでなく、全人的に評価・対策する必要がある。そのため多職種連携による多面的対応が不可欠で、それは科学的根拠に基づき標準的に実施されることがより確実である。学会はこの考え方に立脚し、他の学術団体等と共役する形で活動を行ってきた。昨今の自殺者数の減少傾向に貢献しているのであれば、意義のあるものと考える。(著者抄録)

【精神科臨床評価マニュアル(改訂版)】(第1章)精神科臨床評価 全般 自殺の危機介入の統合

河西 千秋, 成田 賢治, 川島 義高

臨床精神医学 ( (株)アークメディア )  49 ( 8 ) 1018 - 1024  2020年08月

Two-day assertive-case-management educational program for medical personnel to prevent suicide attempts: A multicenter pre-post observational study.

Yoshitaka Kawashima, Naohiro Yonemoto, Chiaki Kawanishi, Kotaro Otsuka, Masaru Mimura, Yasushi Otaka, Kazuya Okamura, Toshihiko Kinoshita, Osamu Shirakawa, Reiji Yoshimura, Nobuaki Eto, Satoshi Hashimoto, Hirokazu Tachikawa, Taku Furuno, Tatsuya Sugimoto, Katsumi Ikeshita, Masatoshi Inagaki, Mitsuhiko Yamada

Psychiatry and clinical neurosciences   74 ( 6 ) 362 - 370  2020年06月  [査読有り]  [国際誌]

　概要を見る

AIM: Suicide attempters have a high risk of repeated suicide attempts and completed suicide. There is evidence that assertive case management can reduce the incidence of recurrent suicidal behavior among suicide attempters. This study evaluated the effect of an assertive-case-management training program. METHODS: This multicenter, before-and-after study was conducted at 10 centers in Japan. Participants were 274 medical personnel. We used Japanese versions of the Attitudes to Suicide Prevention Scale, the Gatekeeper Self-Efficacy Scale, the Suicide Intervention Response Inventory (SIRI), and the Attitudes Toward Suicide Questionnaire. We evaluated the effects with one-sample t-tests, and examined prognosis factors with multivariable analysis. RESULTS: There were significant improvements between pre-training and post-training in the Attitudes to Suicide Prevention Scale (mean: -3.07, 95% confidence interval [CI]: -3.57 to -2.57, P < 0.001), the Gatekeeper Self-Efficacy Scale (mean: 10.40, 95%CI: 9.48 to 11.32, P < 0.001), SIRI-1 (appropriate responses; mean: 1.15, 95%CI: 0.89 to 1.42, P < 0.001), and SIRI-2 (different to the expert responses; mean: -4.78, 95%CI: -6.18 to -3.38, P < 0.001). Significant improvements were found on all Attitudes Toward Suicide Questionnaire subscale scores, except Unjustified Behavior. The effect of training was influenced by experience of suicide-prevention training and experience of working with suicidal patients. CONCLUSION: The training program (which was developed to implement and disseminate evidence-based suicide-prevention measures) improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel. Specialized suicide-prevention training and experience with suicidal patients are valuable for enhancing positive attitudes and self-efficacy; furthermore, age and clinical experience alone are insufficient for these purposes.

DOI PubMed

Suicide prevention and postvention in hospitals in Japan: Current status and perspectives.

Keisuke Inoue, Chiaki Kawanishi, Kenji Narita, Yoshinori Cho, Kotaro Otsuka

Psychiatry and clinical neurosciences   74 ( 7 ) 414 - 415  2020年05月  [査読有り]  [国際誌]

DOI PubMed

自殺企図を契機にレビー小体型認知症の診断に至った1例

齋藤 京史郎, 岩本 倫, 佐久川 信, 松山 清治, 白石 将毅, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  122 ( 5 ) 395 - 396  2020年05月

Response to "suicide prevention among patients with cancer".

Yoshitaka Kawashima, Naohiro Yonemoto, Masatoshi Inagaki, Keisuke Inoue, Chiaki Kawanishi, Mitsuhiko Yamada

General hospital psychiatry    2019年11月  [査読有り]  [国際誌]

DOI PubMed

大学生の自殺予防プログラムの開発に関する予備的検討

太刀川 弘和, 安宅 勝弘, 石井 映美, 衛藤 暢明, 岡本 百合, 小田原 俊成, 河西 千秋, 梶谷 康介, 川島 義高, 白鳥 裕貴, 菅原 大地, 高橋 あすみ, 布施 泰子, 堀 正士, 丸谷 俊之, 松原 敏郎, 三井 信幸, 渡辺 慶一郎

大学のメンタルヘルス ( (NPO)全国大学メンタルヘルス学会 )  3   95 - 95  2019年11月  [査読有り]

成人期ADHDの心理検査における特徴

伊東 美波, 石井 貴男, 白石 将毅, 煤賀 隆宏, 谷内 早苗, 津山 雄亮, 河西 千秋

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  31 ( Suppl. ) S - 246  2019年11月

ACTION-Jのその後 二次解析、普及・啓発と新たな施策化 未遂者介入のエビデンスとこれからの可能性

米本 直裕, 川島 義高, 稲垣 正俊, 河西 千秋, 山田 光彦

自殺予防と危機介入 ( (一社)日本自殺予防学会 )  39 ( 2 ) 56 - 60  2019年09月

　概要を見る

本報告では、未遂者介入研究のレビューについて紹介し、そのエビデンスを解説する。加えて、最近の未遂者介入研究を解説し、今後の研究の課題と可能性について考察する。今後我が国において、さらに未遂者介入のエビデンスが蓄積され、未遂者の再企図の予防策が推進されることを望みたい。(著者抄録)

札幌市におけるゲートキーパー養成研修 地域住民がファシリテーターを務める参加型研修

川本 静香, 白石 将毅, 津山 雄亮, 河西 千秋

自殺予防と危機介入 ( (一社)日本自殺予防学会 )  39 ( 2 ) 102 - 105  2019年09月

Interventions to prevent suicidal behavior and ideation for patients with cancer: A systematic review

Yoshitaka Kawashima, Naohiro Yonemoto, Masatoshi Inagaki, Keisuke Inoue, Chiaki Kawanishi, Mitsuhiko Yamada

General Hospital Psychiatry   60   98 - 110  2019年09月  [査読有り]

　概要を見る

© 2019 Elsevier Inc. Objective: This study aimed to summarize interventions for suicide prevention in patients with cancer and highlight any methodological issues. Methods: We searched PubMed, PsycINFO, CINAHL, and the Cochrane database from their inception until July 2018. Additionally, we manually searched the references of included studies and recent systematic reviews of psychotherapy, antidepressants, and collaborative care for cancer patients with depression. Results: Of the 1365 retrieved articles, 11 randomized controlled trials and 11 intervention studies met the inclusion criteria. These were categorized by type of intervention: psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation and therapeutic walking, and cancer treatment. The trials showed little evidence to confirm the effects of suicide prevention strategies. Seven trials were designed to assess the efficacy of interventions treating depression. In all studies, suicidal behavior or ideation was reported as one of the secondary outcomes. Three trials did not report information about suicidal ideation, despite assessing depressive symptoms using scales that contained suicidal ideation items. Most trials demonstrated inadequate study quality. Conclusions: Our review summarized interventions for suicide prevention in patients with cancer and revealed methodological issues. The findings highlighted a need to explore new treatment strategies that focus on unique suicide risk factors among patients with cancer.

DOI PubMed

厚生労働省自殺未遂者再企図防止事業 臨床現場におけるケース・マネージメント介入の実態

白石 将毅, 石井 貴男, 津山 雄亮, 岩木 敦子, 野呂 孝徳, 成田 賢治, 煤賀 隆宏, 田山 真矢, 木川 昌康, 河西 千秋

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2019特別号 ) S642 - S642  2019年06月

Protocol for a prospective multicentre registry cohort study on suicide attempters given the assertive case management intervention after admission to an emergency department in Japan: post-ACTION-J Study (PACS).

Chiaki Kawanishi, Takao Ishii, Naohiro Yonemoto, Mitsuhiko Yamada, Hirokazu Tachikawa, Toshifumi Kishimoto, Noa Tsujii, Satoshi Hashimoto, Toshihiko Kinoshita, Masaru Mimura, Yoshiro Okubo, Kotaro Otsuka, Reiji Yoshimura

BMJ open   8 ( 9 ) e020517  2018年10月  [査読有り]  [国際誌]

　概要を見る

INTRODUCTION: Suicide attempt is the most important risk factor for later suicide. A randomised-controlled, multicentre trial of postsuicide attempt case management for the prevention of further suicide attempts in Japan, named ACTION-J, has established effective interventions for prevention of suicide reattempts. The ACTION-J assertive case management intervention programme was adopted by the Japanese Ministry of Health, Labour and Welfare in 2016, when medical fees were revised. This nationwide programme is provided to patients who attempt suicide and who are admitted to emergency departments in Japan.The aim of the present study is to examine the current implementation status of the ACTION-J programme. The present study also aims to clarify which patients' and hospitals' factors affect the implementation of the programme. METHODS AND ANALYSIS: This is a prospective, multicentre, patient registry cohort study. Participants will be suicide attempters admitted to the emergency departments of medical facilities with both psychiatry and emergency departments. The assertive case management programme will be delivered to participants by a case manager for up to 24 weeks, based on psychiatric diagnoses, social risks and patient needs. The core feature of the programme is to encourage patients to participate in psychiatric treatment.The primary outcome will be the proportion of patients still participating in the case management intervention at 24 weeks after registration. The secondary outcomes will include measures of the fidelity of the case management intervention. The fidelity will be evaluated using a fidelity assessment manual developed by the study group. ETHICS AND DISSEMINATION: This observational study has been approved by the ethics board of Sapporo Medical University. Enrolment began in October 2016 and will continue until December 2018. Dissemination plans include presentations at scientific conferences and scientific publications. TRIAL REGISTRATION: UMIN000024474.

DOI PubMed

Psychiatric Consultations at an Emergency Department in a Metropolitan University Hospital in Northern Japan.

Masaki Shiraishi, Takao Ishii, Yoshiyasu Kigawa, Masaya Tayama, Keisuke Inoue, Kenji Narita, Masaru Tateno, Chiaki Kawanishi

Psychiatry investigation   15 ( 7 ) 739 - 742  2018年07月  [国際誌]

　概要を見る

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.

DOI PubMed

【自殺の現状をどう理解するのか】自殺企図の最前線、救急現場から精神科医療へどうつなげるか 自殺未遂者ケアに関わる教育研修プログラム

大塚 耕太郎, 河西 千秋

日本精神科病院協会雑誌 ( (公社)日本精神科病院協会 )  37 ( 6 ) 543 - 547  2018年06月  [査読有り]

日本自殺予防学会の歴史と法人化後の展望 学会による地域貢献 学会法人化後の教育・研修事業

河西 千秋, 大塚 耕太郎

自殺予防と危機介入 ( (一社)日本自殺予防学会 )  38 ( 1 ) 21 - 21  2018年03月

Antipsychotics promote GABAergic interneuron genesis in the adult rat brain: Role of heat-shock protein production

Hiroo Kaneta, Wataru Ukai, Hanako Tsujino, Kengo Furuse, Yoshiyasu Kigawa, Masaya Tayama, Takao Ishii, Eri Hashimoto, Chiaki Kawanishi

Journal of Psychiatric Research ( Elsevier Ltd )  92   108 - 118  2017年09月  [査読有り]

　概要を見る

Current antipsychotics reduce positive symptoms and reverse negative symptoms in conjunction with cognitive behavioral issues with the goal of restoring impaired occupational and social functioning. However, limited information is available on their influence on gliogenesis or their neurogenic properties in adult schizophrenia brains, particularly on GABAergic interneuron production. In the present study, we used young adult subventricular zone (SVZ)-derived progenitor cells expressing proteoglycan NG2 cultures to examine the oligodendrocyte and GABAergic interneuron genesis effects of several kinds of antipsychotics on changes in differentiation function induced by exposure to the NMDA receptor antagonist MK-801. We herein demonstrated that antipsychotics promoted or restored changes in the oligodendrocyte/GABAergic interneuron differentiation functions of NG2(+) cells induced by the exposure to MK-801, which was considered to be one of the drug-induced schizophrenia model. We also demonstrated that antipsychotics restored heat-shock protein (HSP) production in NG2(+) cells with differentiation impairment. The antipsychotics olanzapine, aripiprazole, and blonanserin, but not haloperidol increased HSP90 levels, which were reduced by the exposure to MK-801. Our results showed that antipsychotics, particularly those recently synthesized, exerted similar GABAergic interneuron genesis effects on NG2(+) neuronal/glial progenitor cells in the adult rat brain by increasing cellular HSP production, and also suggest that HSP90 may play a crucial role in the pathophysiology of schizophrenia and is a key target for next drug development.

DOI PubMed

The usefulness of combined brain perfusion single-photon emission computed tomography, Dopamine-transporter single-photon emission computed tomography, and 123I-metaiodobenzylguanidine myocardial scintigraphy for the diagnosis of dementia with Lewy bodies

Seiju Kobayashi, Kanae Makino, Shigeki Hatakeyama, Takao Ishii, Masaru Tateno, Tomo Iwamoto, Hanako Tsujino, Kazuhito Kawasaki, Kouhei Mikuni, Wataru Ukai, Tomonori Murayama, Eri Hashimoto, Kumiko Utsumi, Chiaki Kawanishi

Psychogeriatrics ( Blackwell Publishing Ltd )  17 ( 4 ) 247 - 255  2017年07月  [査読有り]

　概要を見る

Background: Current diagnostic criteria recommend neuroimaging as a diagnostic support tool for the clinical diagnosis of dementia with Lewy bodies (DLB). Because DLB causes characteristic impairments and disabilities, such as neuroleptic hypersensitivity, which may significantly increase morbidity and mortality, its prompt and correct diagnosis is very important. The aim of this study was to evaluate the extent to which diagnostic accuracy can be increased by using different combinations of brain perfusion single-photon emission computed tomography (bp-SPECT), 123 I-metaiodobenzylguanidine myocardial scintigraphy (MIBG scintigraphy), and DAT-SPECT. Taking finances and patient burden into consideration, we compared the tests to determine priority. Methods: Thirty-four patients with probable DLB (75.0 ± 8.3 years old 14 men, 20 women) underwent bp-SPECT, MIBG scintigraphy, and DAT-SPECT. Results: Our comparison of three functional imaging techniques indicated that MIBG scintigraphy (79%) and Dopamine-transporter (DAT) SPECT (79%) had better sensitivity for characteristic abnormalities in DLB than bp-SPECT (53%). The combination of the three modalities could increase sensitivity for diagnosis of DLB to 100%. Additionally, the ratio of patients with rapid eye movement sleep behaviour disorder was significantly higher in the positive finding group on MIBG scintigraphy than in the negative finding group. Conclusions: In terms of stand-alone diagnostic means, priority should be placed on MIBG scintigraphy or DAT-SPECT for the diagnosis of DLB. However, our results suggest that the combination of bp-SPECT, MIBG scintigraphy, and DAT-SPECT increased the accuracy of the clinical diagnosis of DLB.

DOI PubMed

大学生を対象とした日本の自殺予防研究に関する系統的レビュー

太刀川 弘和, 川島 義高, 小田原 俊成, 衛藤 暢明, 河西 千秋, 山田 光彦

CAMPUS HEALTH ( (公社)全国大学保健管理協会 )  54 ( 2 ) 186 - 191  2017年05月

　概要を見る

近年の自殺対策の発展に伴い、国内外を問わず、大学では様々な自殺予防の取り組みが行われている。しかし、これらのプログラムの有効性に関するエビデンスはほとんど検討されていない。そこで我々は、大学における自殺予防対策のエビデンスを得ることを目的として、国内の大学生の自殺予防研究に関する系統的レビューを実施した。方法は、まず2つの文献データベース(CiNii、医中誌)を用い、大学、学生、自殺関連事象をキーワードとする検索式検索を行った。次に検索された597編の論文から、(1)研究デザインが無作為化対照試験(RCT)、非無作為化対照試験(nRCT)、分割時系列試験(ITS)、前後比較試験(CBA)のいずれか、(2)研究対象者が大学生、(3)何らかの介入が行われている、(4)アウトカムが記載されている、という適格基準を満たす論文を抽出した。最後に適格論文の内容を吟味してエビデンスを検討した。結果、抽出された適格論文は、12編(内容重複5編)と少なかった。研究デザインはRCTが1編もなく、自殺リスク、アウトカムの評価は不十分であった。結果から、我が国の大学生の自殺予防対策には、現時点では十分なエビデンスがないことが示された。(著者抄録)

大学生を対象とした国内外の自殺予防研究に関する系統的レビュー

太刀川 弘和, 川島 義高, 小田原 俊成, 衛藤 暢明, 河西 千秋, 山田 光彦

CAMPUS HEALTH ( 全国大学保健管理協会 )  54 ( 1 ) 342 - 342  2017年03月  [査読有り]

大学生を対象とした国内外の自殺予防研究に関する系統的レビュー

太刀川 弘和, 川島 義高, 小田原 俊成, 衛藤 暢明, 河西 千秋, 山田 光彦

CAMPUS HEALTH ( (公社)全国大学保健管理協会 )  54 ( 1 ) 342 - 342  2017年03月  [査読有り]

大学生を対象とした国内外の自殺予防研究に関する系統的レビュー

太刀川 弘和, 川島 義高, 小田原 俊成, 衞藤 暢明, 河西 千秋, 新井 哲明, 山田 光彦

全国大学保健管理研究集会プログラム・抄録集 ( (公社)全国大学保健管理協会 )  54回   93 - 93  2016年09月  [査読有り]

Effects of NRG1 genotypes on orbitofrontal sulcogyral patterns in Japanese patients diagnosed with schizophrenia

Asuka Yoshimi, Akira Suda, Fumi Hayano, Motoaki Nakamura, Kumi Aoyama-Uehara, Jun Konishi, Takeshi Asami, Ikuko Kishida, Chiaki Kawanishi, Tomio Inoue, Robert W. McCarley, Martha E. Shenton, Yoshio Hirayasu

Psychiatry and Clinical Neurosciences ( Blackwell Publishing )  70 ( 7 ) 261 - 268  2016年07月  [査読有り]

　概要を見る

Aim: Numerous reports have described differences in the distribution of orbitofrontal cortex (OFC) sulcogyral patterns between patients with schizophrenia (SZ patients) and healthy controls (HC). Alterations in OFC morphology are also observed in those at high risk for developing SZ and in first-episode SZ, suggesting that genetic associations may be extant in determining OFC sulcogyral patterns. We investigated the association between single nucleotide polymorphisms (SNP) in NRG1 and OFC sulcogyral patterns. Methods: A total of 59 Japanese patients diagnosed with SZ and 60 HC were scanned on a 1.5-T magnet. Patients were also assessed clinically. OFC sulcogyral patterns were evaluated for each participant, and genotyping was performed for four SNP in NRG1 (SNP8NRG243177, SNP8NRG221533, SNP8NRG241930, and rs1081062). Results: There were significant differences in the distribution of OFC sulcogyral patterns between SZ patients and HC (χ2 = 6.52, P = 0.038). SZ patients showed an increase in the frequency of Type III expression, which was associated with an earlier age of disease onset (β = −0.302, F = 4.948, P = 0.030). Although no difference was found in genotype frequencies between SZ patients and HC, an NRG1 SNP, SNP8NRG243177, was associated with Type II expression in SZ patients (β = 0.237, F = 4.120, P = 0.047). Conclusion: Our results suggest that OFC sulcogyral pattern formation in schizophrenia may be associated with NRG1 allele frequency, which is closely related to neurodevelopment.

DOI PubMed

自殺未遂者の抱える心理社会的問題に対するケース・マネージメント ACTION-Jの経験を通じて

安東 友子, 大塚 耕太郎, 川島 義高, 山田 光彦, 有賀 徹, 河西 千秋

精神保健研究 ( (国研)国立精神・神経医療研究センター精神保健研究所 )  ( 29 ) 103 - 108  2016年03月

　概要を見る

自殺未遂者の再企図は抑止しなければならない課題である。最近、救急医療部門に入院した自殺未遂者に対して、精神医学的評価、心理的危機介入、心理教育を行い、個別性の高い複合的かつ継続的なケース・マネージメント介入を実施すれば、その後6ヵ月にわたって自殺再企図を強力に抑止することが無作為化比較試験ACTION-Jにより明らかとなった。今回、筆者がACTION-Jにおいてケース・マネージメント介入を行った経験を踏まえ、自殺未遂者に対するケース・マネージメントを、実際の介入例を再構成した症例を提示して紹介した。ACTION-Jにおいて、ケース・マネージャーは自殺未遂者との面接を長期にわたり継続的に行い、情報を収集し、心理社会的問題をリストアップし、これらを整理したうえで地域の社会資源につなげる介入を行った。そしてその一環として病院内外での支援体制を構築し、連携の要として機能した。また、面接のたびに自殺企図再発のリスク評価を行った。ACTION-Jケース・マネージメントが、全国的に、恒常的に実施されるようになるものと期待される。(著者抄録)

J-GLOBAL

The effect of APOE ϵ4 allele on brain perfusion SPECT in late onset Alzheimer's disease by an automated program, 3DSRT

Seiju Kobayashi, Takao Ishii, Masaru Tateno, Hitoshi Sohma, Yasuo Kokai, Yoichi M. Ito, Tomo Iwamoto, Kengo Furuse, Hanako Tsujino, Hidetoshi Morii, Wataru Ukai, Eri Hashimoto, Kumiko Utsumi, Chiaki Kawanishi

Neuropsychiatry ( Future Medicine Ltd. )  6 ( 2 ) 55 - 63  2016年  [査読有り]

　概要を見る

Aim: The Apolipoprotein E (APOE) ϵ4 allele is a risk factor for developing Alzheimer's disease (AD), however its impact on cerebral functional changes in AD remains controversial. Previous studies reported conflicting results or failed to confirm any association, possibly because they failed to consider either the effect of patient age at onset or that of clinical stage. We performed functional neuroimaging studies using current improved techniques to re-examine the effect of APOE ϵ4 allele, taking both the age at onset and clinical stage into account. Methods: 111 late onset AD (LOAD) subjects were divided into 3 subgroups based on Clinical Dementia Rating (CDR). We investigated the influence of ϵ4 allele on functional cerebral changes in each group of LOAD by using cutting-edge analysis software, 3DSRT. Results: The APOE ϵ4 allele was significantly associated with relatively preserved cerebral blood flow in the cerebral cortices. The influence of APOE ϵ4 allele is not apparent in the mild stage, but is significantly demonstrable in the moderate stage. Conclusion: Dividing AD subjects into subgroups based on the severity as well as the age at onset is important for precise outcomes. This study may help resolve the uncertainties of previous studies which reported conflicting results or failed to confirm any association. We believe this is the first study focused on the effect of APOE ϵ4 allele on functional cerebral changes at each stage of AD.

DOI

【急性薬物中毒 精神疾患を持つ患者の自殺企図へのアプローチ】急性薬物中毒の実態と精神医学的および心理社会的アプローチの重要性 急性薬物中毒の心理社会的要因と患者へのアプローチ 自殺企図者の実状と再企図防止のための介入研究を中心に

井上 佳祐, 河西 千秋, 米本 直裕, 山田 光彦, 平安 良雄

薬局 ( (株)南山堂 )  66 ( 11 ) 2780 - 2784  2015年10月

　概要を見る

＜Key Points＞急性薬物中毒は、処方薬などを自殺、あるいは自殺の意図のない自傷の目的で服薬した結果で生じることが多い。救命救急センターなどに搬送される自損行為者の多くが、過量服薬による急性中毒患者である。過量服患者の心理社会的要因に対する有効な介入についてはエビデンスが乏しい。自殺対策のための戦略研究・ACTION-Jで開発されたケース・マネジメント介入は、自殺企図の再発予防に有効であることが明らかとなった。ACTION-Jの対象患者の多くの自殺企図手段が過量服薬であり、ACTION-Jのケース・マネジメントが、急性薬物中毒患者の再企図に有効であることが示唆されている。(著者抄録)

J-GLOBAL

【自殺予防のエビデンスと戦略研究の成果】自殺対策のための戦略研究ACTION-J その成果と施策化への進捗

河西 千秋, 安東 友子, 川島 義高, 山田 光彦

自殺予防と危機介入 ( (一社)日本自殺予防学会 )  36 ( 1 ) 21 - 25  2015年09月

J-GLOBAL

【自殺対策の現状】救急医療を起点とするエビデンスに基づく自殺未遂者ケア ACTION-J試験の成果と課題

川島 義高, 河西 千秋, 衞藤 暢明, 山田 光彦

精神医学 ( (株)医学書院 )  57 ( 7 ) 523 - 529  2015年07月

DOI J-GLOBAL

救命救急センターにおける自殺予防対策 これまでの我が国における自殺未遂者ケアと今後の課題

成重 竜一郎, 山田 光彦, 稲垣 正俊, 河西 千秋, 川島 義高, 大久保 善朗

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2015特別 ) S509 - S509  2015年06月  [査読有り]

救命救急センターにおける自殺予防対策 ACTION-Jのプライマリ・アウトカム ケース・マネージメント介入は自殺企図者の自殺再企図を抑止する

河西 千秋, 平安 良雄, 山田 光彦, 高橋 清久

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2015特別 ) S509 - S509  2015年06月  [査読有り]

心身医学における自殺予防の重要性 自殺企図者への対応 自殺対策のための戦略研究・ACTION-Jから得られた知見

河西 千秋, 平安 良雄, 山田 光彦

心身医学 ( (一社)日本心身医学会 )  55 ( 6 ) 609 - 609  2015年06月

J-GLOBAL

【自殺対策の現状】自殺企図の再発防止に対する複合的ケース・マネージメントの効果 多施設共同による無作為化比較試験(ACTION-J) その背景と成果・展望

河西 千秋, 米本 直裕, 山田 光彦, 平安 良雄

最新精神医学 ( (株)世論時報社 )  20 ( 3 ) 203 - 211  2015年05月

J-GLOBAL

Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: A meta-analysis

Masatoshi Inagaki, Yoshitaka Kawashima, Chiaki Kawanishi, Naohiro Yonemoto, Tatsuya Sugimoto, Taku Furuno, Katsumi Ikeshita, Nobuaki Eto, Hirokazu Tachikawa, Yohko Shiraishi, Mitsuhiko Yamada

JOURNAL OF AFFECTIVE DISORDERS ( ELSEVIER )  175   66 - 78  2015年04月  [査読有り]

　概要を見る

Background: A huge number of patients with self-harm and suicide attempt visit emergency departments (EDs). We systematically reviewed studies and examined the effect of interventions to prevent repeat suicidal behavior in patients admitted to EDs for a suicidal attempt.Method: We searched the databases of MEDLINE, PsychoINFO, CINAHL, and EMBASE through August 2013. Eligible studies were randomized controlled trials assessing the effects on repeat suicidal behavior of interventions initiated in suicidal patients admitted to EDs. Interventions in each trial were classified into groups by consensus. Meta-analyses were performed to determine pooled relative risks (RRs) and 95% confidence intervals (Os) of repetition of suicide attempt for interventions in each group.Results: Out of 5390 retrieved articles, 24 trials were included and classified into four groups (11 trials in the Active contact and follow-up, nine in the Psychotherapy, one in the Pharmacotherapy, and three in the Miscellaneous). Active contact and follow-up type interventions were effective in preventing a repeat suicide within 12 months (n=5319; pooled RR-0,83; 95% CI: 0.71 to 0.97). However, the effect at 24 months was not confirmed (n=925; pooled RR=0.98; 95% Cl: 0.76-1.22). The effects of the other interventions on preventing a repetition of suicidal behavior remain unclear.Limitation: Caution is needed regarding the heterogeneity of the effects.Conclusion: Interventions of active contact and follow-up are recommended to reduce the risk of a repeat suicide attempt at 12 months in patients admitted to EDs with a suicide attempt. However, the long-term effect was not confirmed. (C) 2014 Elsevier B.V. All rights reserved.

DOI PubMed J-GLOBAL

横浜市立大学附属市民総合医療センター救命救急センターに搬送された自殺企図者の転帰に関する調査

井上 佳祐, 河西 千秋, 日野 耕介, 伊藤 翼, 高橋 雄一, 小田原 俊成, 平安 良雄

神奈川県精神医学会誌 ( 神奈川県精神医学会 )  ( 64 ) 3 - 7  2015年03月

　概要を見る

救命救急センターには、多くの自殺企図者が搬送され、そのほとんどが精神疾患を合併していることが知られているが、搬送・退院時の精神症状の評価は不十分だと報告されている。本研究では、横浜市立大学附属市民総合医療センター高度救命救急センターに入院した自殺企図者の転帰に影響を与えた因子を明らかにすることを目的として、平成22年4月1日から3年間の期間に同センターに入院した自殺企図者315名を、精神科病棟における継続的な精神科治療を要した群とそれ以外の群とに分類し、その属性と臨床情報を比較した。精神科病棟での継続的な精神科治療を要した群では、在院期間が長く、また統合失調症患者の割合が多いということが有意差をもって示された。これらの特徴が、転帰に関与している可能性が示された。(著者抄録)

当院横浜市立大学附属市民総合医療センター救命救急センターに搬送後、自殺企図者の転帰に関する調査報告

井上 佳祐, 日野 耕介, 伊藤 翼, 石橋 由梨, 吉松 尚彦, 加納 亜希子, 高橋 雄一, 河西 千秋, 小田原 俊成, 平安 良雄

神奈川県精神医学会誌 ( 神奈川県精神医学会 )  ( 64 ) 60 - 60  2015年03月

【精神障害の長期予後】自殺未遂の長期予後

衞藤 暢明, 河西 千秋

臨床精神医学 ( (株)アークメディア )  43 ( 10 ) 1489 - 1493  2014年10月

Assertive case management versus enhanced usual care for people with mental health problems who had attempted suicide and were admitted to hospital emergency departments in Japan (ACTION-J): A multicentre, randomised controlled trial

Chiaki Kawanishi, Tohru Aruga, Naoki Ishizuka, Naohiro Yonemoto, Kotaro Otsuka, Yoshito Kamijo, Yoshiro Okubo, Katsumi Ikeshita, Akio Sakai, Hitoshi Miyaoka, Yoshie Hitomi, Akihiro Iwakuma, Toshihiko Kinoshita, Jotaro Akiyoshi, Naoshi Horikawa, Hideto Hirotsune, Nobuaki Eto, Nakao Iwata, Mototsugu Kohno, Akira Iwanami, Masaru Mimura, Takashi Asada, Yoshio Hirayasu

The Lancet Psychiatry ( Elsevier Ltd )  1 ( 3 ) 193 - 201  2014年08月  [査読有り]

　概要を見る

Non-fatal suicide attempt is the most important risk factor for later suicide. Emergency department visits for attempted suicide are increasingly recognised as opportunities for intervention. However, no strong evidence exists that any intervention is effective at preventing repeated suicide attempts. We aimed to investigate whether assertive case management can reduce repetition of suicide attempts in people with mental health problems who had attempted suicide and were admitted to emergency departments. Methods: In this multicentre, randomised controlled trial in 17 hospital emergency departments in Japan, we randomly assigned people aged 20 years and older with mental health problems who had attempted suicide to receive either assertive case management (based on psychiatric diagnoses, social risks, and needs of the patients) or enhanced usual care (control), using an internet-based randomisation system. Interventions were provided until the end of the follow-up period (ie, at least 18 months and up to 5 years). Outcome assessors were masked to group allocation, but patients and case managers who provided the interventions were not. The primary outcome was the incidence of first recurrent suicidal behaviour (attempted suicide or completed suicide) secondary outcomes included completed suicide and all-cause mortality. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). Findings: Between July 1, 2006, and Dec 31, 2009, 914 eligible participants were randomly assigned, 460 to the assertive case management group and 456 to the enhanced usual care group. We noted no significant difference in incidence of first recurrent suicidal behaviour between the assertive case management group and the enhanced usual care group over the full study period (log-rank p=0·258). Because the proportional hazards assumption did not hold, we did ad-hoc analyses for cumulative incidence of the primary outcome at months 1, 3, 6, 12, and 18 after randomisation, adjusting for multiplicity with the Bonferroni method. Assertive case management significantly reduced the incidence of first recurrent suicidal behaviour up to the 6-month timepoint (6-month risk ratio 0·50, 95% CI 0·32-0·80 p=0·003), but not at the later timepoints. Prespecified subgroup analyses showed that the intervention had a greater effect in women (up to 18 months), and in participants younger than 40 years and those with a history of previous suicide attempts (up to 6 months). We did not identify any differences between the intervention and control groups for completed suicide (27 [6%] of 460 vs 30 [7%] of 454, log-rank p=0·660) or all-cause mortality (46 [10%] of 460 vs 42 [9%] of 454, log-rank p=0·698). Interpretation: Our results suggest that assertive case management is feasible in real-world clinical settings. Although it was not effective at reducing the incidence of repetition of suicide attempts in the long term, the results of our ad-hoc analyses suggested that it was effective for up to 6 months. This finding should be investigated in future research. Funding: The Ministry of Health, Labour, and Welfare of Japan.

DOI

【自殺と精神医学】「自殺企図の再発防止に対する複合的ケース・マネジメントの効果 多施設共同による無作為化比較研究(ACTION-J)」の展開

太刀川 弘和, 河西 千秋, 山田 光彦

精神科 ( (有)科学評論社 )  25 ( 1 ) 34 - 38  2014年07月

【精神科救急の最新知識】症候・精神疾患に対する対応 自殺企図

日野 耕介, 河西 千秋, 平安 良雄

臨床精神医学 ( (株)アークメディア )  43 ( 5 ) 665 - 671  2014年05月

研究と報告 医学教育における精神医学の知識習得と精神障害者に対する態度との関連

大山 寧寧, 河西 千秋, 平安 良雄

精神医学 ( (株)医学書院 )  56 ( 4 ) 293 - 298  2014年04月  [査読有り]

　概要を見る

精神障害者に対する偏見の克服は,精神保健の重要な課題である。筆者らは,医学部医学科学生における精神障害者に対する態度と精神疾患に関する学習機会との関連を検討した。調査は,精神医学講義を未受講の1年生73名と,系統的に精神医学講義を受講した4年生47名を対象とし,精神障害に対する態度測定尺度(AMD尺度)を用いて実施した。その結果,精神医学講義の受講群のほうが非受講群よりも社会的距離が有意に小さく(t(113)=2.16,p<.05),精神障害に関する専門的知識の習得は精神障害者への望ましい態度と関連があることが示唆された。(著者抄録)

救急医療従事者の自殺予防に関する知識と態度

戸井田 真木, 河西 千秋, 三宅 康史, 岸 泰宏, 大塚 耕太郎, 荒川 亮介, 河嶌 讓

精神医学 ( (株)医学書院 )  56 ( 1 ) 53 - 58  2014年01月

　概要を見る

日本では,自殺率が高止まりを続けていることから,自殺対策基本法と自殺総合対策大綱が施行・策定され,厚生労働省は,自殺未遂者対策に関連して救急医療従事者を対象とした自殺未遂者ケアのための研修会を実施している。筆者らは,2012年1月から2013年3月の期間に当該の研修会に参加した224名を対象に質問紙を用いた調査を行い,自殺予防対策に関する正しい知識と適切な態度を問うた。その結果,回答者の多くに,80%以上の正答率が示され,知識の設問に比して態度の設問において有意に高い正答率が得られた。また,自殺の予防可能性については97.0%が好ましい回答を示した。一方で,自殺と精神疾患の関連に関する理解の不足や自殺念慮を確認することへの躊躇などが明らかになった。今後,自殺を低減させていくためには,専門教育・専門職生涯教育における自殺予防の導入,そして効果的な自殺予防教育プログラムの開発が必要と考えられた。(著者抄録)

Effects of a training workshop on suicide prevention among emergency room nurses

Yasuhiro Kishi, Kotaro Otsuka, Keiko Akiyama, Tomoki Yamada, Yumiko Sakamoto, Yaeko Yanagisawa, Hiroshi Morimura, Chiaki Kawanishi, Hiroaki Higashioka, Yasushi Miyake, Steven Thurber

Crisis ( Hogrefe Publishing )  35 ( 5 ) 357 - 361  2014年  [査読有り]

　概要を見る

Background: Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. Aims: The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. Method: In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. Results: It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. Conclusion: It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.

DOI PubMed

[Current topics of treatment for mental disease and suicide prevention in Japan].

K Cho, Shekhar Saxena, Yutaro Setoya, Masatoshi Takeda, Shigenobu Kanba, Kotaro Otsuka, Chiaki Kawanishi, S Takahashi, Tetsuo Omori, Shinichiro Tanaka

Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica   116 ( 11 ) 897 - 906  2014年  [国内誌]

PubMed

One-year follow up after admission to an emergency department for drug overdose in Japan

Shuntaro Ando, Toshihiko Matsumoto, Sho Kanata, Aya Hojo, Daisuke Yasugi, Nobuaki Eto, Chiaki Kawanishi, Nozomu Asukai, Kiyoto Kasai

Psychiatry and Clinical Neurosciences   67 ( 6 ) 441 - 450  2013年09月  [査読有り]

　概要を見る

Aim The aim of the study was to investigate the incidence of and risk factors for repetition of suicidal behavior within a year after admission for drug overdose in Japan. Methods Patients admitted to the emergency department of a general public hospital in Tokyo for drug overdose of prescribed medicine and/or over-the-counter drugs between March 2008 and February 2009 were followed up after 1 year. Demographic characteristics, previous suicide attempts, and mental health state were examined by self-report questionnaire and interview at recovery from the initial attempt. Information about suicidal behavior during the follow-up period was obtained from the outpatient psychiatrists by postal questionnaire 1 year after discharge. Results Of 190 patients admitted to the emergency department, 132 patients answered the questionnaire and had the interview. Information about thefollow-up period for 66 patients was obtained. Of the 66 patients, 28 patients attempted suicide again and two patients committed suicide during the 1-year follow-up period. Psychiatric diagnosis of personality disorder and denial of suicidal intent at the time of recovery were associated with increased risk for another suicide attempt. Lethality levels of suicidal behaviors before and after admission were associated with each other. Conclusion The rate of fatal and non-fatal suicide attempt within a year after admission for self-poisoning was substantial. Psychiatric diagnosis of personality disorder was a risk factor for repetition of suicide attempt. Clinicians should pay attention to the means of previous suicide attempts even though the patient denies suicidal intent at recovery. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.

DOI PubMed

横浜市立大学附属市民総合医療センターにおける、救命救急センターを拠点とした自殺未遂者への介入 現在の活動状況

伊藤 翼, 日野 耕介, 岡村 泰, 大山 寧寧, 高橋 雄一, 山田 朋樹, 河西 千秋, 小田原 俊成, 平安 良雄

日本社会精神医学会雑誌 ( (一社)日本社会精神医学会 )  22 ( 3 ) 391 - 391  2013年08月  [査読有り]

精神科救急と教育コース 救急医療における臨床心理士の役割

秋山 恵子, 三宅 康史, 東岡 宏明, 松月 みどり, 河西 千秋, 大塚 耕太郎, 岸 泰宏, 三上 克央, 柳澤 八重子, 河嶌 譲

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 )  16 ( 3 ) 298 - 298  2013年06月

精神科救急と教育コース 救急医療における精神症状評価と初期診療の標準化に向けて PEECコースの紹介

東岡 宏明, 三宅 康史, 松月 みどり, 河西 千秋, 大塚 耕太郎, 岸 泰宏, 三上 克央, 秋山 恵子, 柳澤 八重子, 坂本 由美子

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 )  16 ( 3 ) 298 - 298  2013年06月

Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia

Yohko Iwamoto, Chiaki Kawanishi, Ikuko Kishida, Taku Furuno, Mami Fujibayashi, Chie Ishii, Norio Ishii, Toshio Moritani, Masataka Taguri, Yoshio Hirayasu

BMC Psychiatry   12  2012年11月  [査読有り]

　概要を見る

Background: Antipsychotic drugs are considered a trigger factor for autonomic dysregulation, which has been shown to predict potentially fatal arrhythmias in schizophrenia. However, the dose-dependent effect of antipsychotic drugs and other psychotropic drugs on autonomic nervous system (ANS) activity remain unclear. The purpose of this study was to investigate the dose-dependent effect of antipsychotic drugs and other clinical factors on ANS activity in an adequate sample size of patients with schizophrenia.Methods: A total of 211 Japanese patients with schizophrenia and 44 healthy subjects participated in this study. ANS activity was assessed by means of heart rate variability (HRV) power spectral analysis. Antipsychotic drug treatment and various clinical factors were investigated for each participant. The patient group was categorized into three subgroups according to daily dose of antipsychotic drug, and HRV was compared between groups.Results: The results showed significantly decreased low-frequency and high-frequency components of HRV in the patient group compared to the control group. The high-dose group showed a significantly lower HRV than the medium-dose group and an even lower HRV than the low-dose group. In addition, a significant association between HRV and antipsychotic drug dose was identified by multiple regression analysis. HRV was not associated with age, sex, body mass index, duration of illness, or daily dose of other psychotropic drugs.Conclusion: These results suggest that antipsychotic drugs exert a significant dose-dependent effect on the extent of decline in ANS activity, and that optimal antipsychotic medication is required to avoid possible cardiovascular adverse events in patients with schizophrenia. © 2012 Iwamoto et al. licensee BioMed Central Ltd.

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Trait impulsivity in suicide attempters: Preliminary study

Chiho Doihara, Chiaki Kawanishi, Nene Ohyama, Tomoki Yamada, Makiko Nakagawa, Yohko Iwamoto, Toshinari Odawara, Yoshio Hirayasu

Psychiatry and Clinical Neurosciences   66 ( 6 ) 529 - 532  2012年10月  [査読有り]

　概要を見る

Suicide attempt is a risk factor for suicide. To investigate trait impulsivity among suicide attempters, 93 attempters admitted to an emergency department and 113 healthy controls were evaluated using the Japanese version of the Barratt Impulsiveness Scale (BIS-11J). Impulsivity was analyzed in relation to clinical data in the attempters. Total BIS-11J, attention impulsiveness, and motor impulsiveness scores were significantly higher in the attempters than in the controls. Both total BIS-11J and non-planning impulsiveness scores were significantly higher in attempters with schizophrenia and other psychotic disorders among the diagnostic groups. Control of impulsivity should be considered as one of the targets for suicide prevention. © 2012 The Authors. Psychiatry and Clinical Neurosciences.

DOI PubMed

初期研修医を対象としたうつ病診療教育からみた精神医学教育の課題

河西 千秋, 大山 寧寧, 秋山 恵子, 須田 顕, 中川 牧子, 鈴木 志麻子, 平安 良雄, 白川 教人

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2012特別 ) S - 430  2012年05月  [査読有り]

Effects of educating local government officers and healthcare and welfare professionals in suicide prevention

Isao Kaniwa, Chiaki Kawanishi, Akira Suda, Yoshio Hirayasu

International Journal of Environmental Research and Public Health   9 ( 3 ) 712 - 721  2012年03月  [査読有り]

　概要を見る

Suicide is a major public health issue. In Japan, local governments are responsible for suicide prevention, and local government officers are therefore expected to act as gatekeepers for suicide prevention. In this study, through a questionnaire survey, the authors examined the current knowledge and attitudes concerning suicide prevention among local government officers and healthcare and welfare professionals, and the effects of providing suicide prevention education on their knowledge of and attitudes toward suicide and its prevention. One hundred eighty-three local government officers and 432 healthcare/welfare professionals completed the survey before and after a single education session. Before the session, the local government officers and healthcare/welfare professionals showed mainly positive attitudes toward suicide prevention efforts, with little difference between the two groups. After the training, knowledge and attitudes were further improved for most questionnaire items. Respondents with one or more experiences of suicide prevention training showed significantly more knowledge and positive attitudes before the training than those with no such experience. Moreover, knowledge of depression and having a sympathetic attitude were found to be especially associated with the overall attitude that "suicide can be prevented". Training in suicide prevention was shown to be effective in promoting appropriate knowledge and attitudes among local government officers and healthcare/welfare professionals who are gatekeepers for preventing suicide. Our findings confirm the importance of suicide prevention education, and will contribute to creating a standard educational program on suicide prevention in Japan. © 2012 by the authors licensee MDPI, Basel, Switzerland.

DOI PubMed

日本医療機能評価機構における「院内自殺の予防と事後対応プログラム」の構築と研修の着手

橋本 廸生, 河西 千秋, 大塚 耕太郎, 加藤 大慈, 蛸島 章子, 横山 容子, 菅原 浩幸

医療の質・安全学会誌 ( (一社)医療の質・安全学会 )  6 ( Suppl. ) 152 - 152  2011年10月

Comparison of characteristics of suicide attempters with schizophrenia spectrum disorders and those with mood disorders in Japan

Makiko Nakagawa, Chiaki Kawanishi, Tomoki Yamada, Kanna Sugiura, Yoko Iwamoto, Ryoko Sato, Satoshi Morita, Toshinari Odawara, Yoshio Hirayasu

Psychiatry Research   188 ( 1 ) 78 - 82  2011年06月  [査読有り]

　概要を見る

Suicidality in patients with schizophrenia is high. To clarify the characteristics of suicidal behavior in patients with schizophrenia, we investigated suicide attempters with schizophrenia spectrum disorders in comparison with patients with mood disorders. One hundred patients with schizophrenia spectrum disorders and 155 patients with mood disorders admitted to an emergency department after a suicide attempt were interviewed in detail on items concerning 1) demographic characteristics, 2) previous suicidal behavior, and 3) index suicidal behavior. Differences between the two groups were subsequently analyzed. Patients with schizophrenia spectrum disorders showed a lower incidence of previous deliberate self-harm, and a higher incidence of a subsequent suicide attempt more than 1 year after the previous suicide attempt as well as a higher lethality of index suicide attempt compared to patients with mood disorders. Furthermore, the most common motive for making a suicide attempt in patients with schizophrenia spectrum disorders was having a mental problem. This study revealed the factors associated with suicide attempts among Japanese patients with schizophrenia spectrum disorders, and the nature of these factors makes it difficult to predict future attempts. This makes clear the importance of continuous long-term follow-up with careful attention to the mental symptoms and psychological burden for such patients. © 2010 Elsevier Ireland Ltd.

DOI PubMed

救急関連training courseの現状と展望 救急医療における精神科的評価PEECコースについて

三宅 康史, 有賀 徹, 大塚 耕太郎, 大橋 寛子, 河西 千秋, 岸 泰宏, 坂本 由美子, 守村 洋, 柳澤 八恵子, 山田 朋樹, 日本臨床救急医学会自殺企図者のケアに関する検討委員会

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 )  14 ( 2 ) 214 - 214  2011年04月

Diagnosis and treatment of akathisia in a cancer patient who cannot stand up or sit down, because of poor performance status: Factors that make the diagnosis of akathisia difficult, and diagnosis clues

Hideki Onishi, Makoto Wada, Tomomi Wada, Mei Wada, Mayumi Ishida, Chiaki Kawanishi, Keiko Mizuno, Hiroshi Ito, Masaru Narabayashi, Yasutsuna Sasaki

Palliative and Supportive Care   8 ( 4 ) 477 - 480  2010年12月  [査読有り]

　概要を見る

Objective: Akathisia is a common adverse effect of antipsychotics and, less commonly, antidepressants. Akathisia can cause great discomfort and is often described by the patient as a most distressing sensation however, the condition is often underdiagnosed or misdiagnosed. In oncological settings, neuroleptics and antidepressants that induce akathisia are also administered. However, reports of akathisia in oncology settings are few and a case of akathisia in a bedridden patient has not been reported as far as we know.Case report: A 72-year-old man with esophageal cancer who could not sit down or stand up was administered 5mg/day haloperidol to relieve agitation as a symptom of major depressive disorder. Three days after the administration of haloperidol, the agitation had become worse. Careful observation revealed that the patient sometimes showed slight rubbing movement of the lower extremities and slight twisting movements of the body, which were not observed before the administration of haloperidol. The patient moved his body and lower extremities to relieve restlessness, which had developed after the administration of haloperidol. Although symptoms were atypical, akathisia was suspected and discontinuation of haloperidol resolved the symptoms.Results and significance of results: In patients with poor performance status, clues leading to the correct diagnosis of akathisia might be absent, which would not be the case in patients who were able to walk, stand up, or sit down. Careful observations of patients before and after the administration of drugs that may cause akathisia may be required to ensure correct diagnosis. Copyright © Cambridge University Press 2010.

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Dopamine D2 receptor gene polymorphisms are associated with suicide attempt in the Japanese population

Akira Suda, Chiaki Kawanishi, Ikuko Kishida, Ryoko Sato, Tomoki Yamada, Makiko Nakagawa, Hana Hasegawa, Daiji Kato, Taku Furuno, Yoshio Hirayasu

Neuropsychobiology   59 ( 2 ) 130 - 134  2009年05月  [査読有り]

　概要を見る

Background: Some reports have suggested the involvement of the D 2 dopaminergic function in the expression of suicidal behavior. Here, we examined associations between suicide attempts and two kinds of functional polymorphisms in the dopamine D2 receptor (DRD2) gene, namely, TaqIA and -141C Ins/Del. Methods: Subjects included 120 suicide attempters and 123 unrelated volunteers. Those who attempted suicide were severely injured and were transferred to the emergency unit in our university hospital. To determine each genotype, we performed polymerase chain reaction and restriction fragment length polymorphism analyses. Results: We found significant differences in genotypic and allelic frequencies of -141C Ins/Del and TaqIA polymorphisms between suicide attempters and healthy controls (-141C Ins/Del, p = 0.01 TaqIA,p = 0.036). The Ins allele of -141C Ins/Del was significantly more frequent in suicide attempters (p = 0.011), as well as the A2 allele of TaqIA (p = 0.017). Haplotype analysis revealed no significant linkage disequilibrium between -141C Ins/Del and TaqIA polymorphisms (D′ = 0.226, r2 = 0.016, p = 0.10). Conclusions: These findings suggest that DRD2 gene polymorphisms may be involved in the biological susceptibility to suicide. Copyright © 2009 S. Karger AG, Basel.

DOI PubMed

「自殺企図者に対する救急外来(ER)・救急科・救命救急センターにおける手引き」作成の意義

三宅 康史, 大塚 耕太郎, 岸 泰宏, 坂本 由美子, 守村 洋, 柳澤 八重子, 山田 朋樹, 河西 千秋, 伊藤 弘人, 有賀 徹

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 )  12 ( 2 ) 259 - 259  2009年04月

自殺予防と救急看護 自殺企図患者に対する救急外来(ER)・救急科・救命救急センターにおける手引き 日本臨床救急医学会「自殺未遂者のケアに関する委員会」の取り組み

三宅 康史, 有賀 徹, 伊藤 弘人, 大塚 耕太郎, 河西 千秋, 岸 泰宏, 坂本 由美子, 守村 洋, 山田 朋樹, 柳澤 八恵子

日本救急看護学会雑誌 ( (一社)日本救急看護学会 )  10 ( 3 ) 59 - 63  2009年03月

Responses to patients with suicidal ideation among different specialties in general hospitals

Hiroto Ito, Kenji Kawano, Daisuke Kawashima, Chiaki Kawanishi

General Hospital Psychiatry   30 ( 6 ) 578 - 580  2008年11月  [査読有り]

　概要を見る

Objective: The purpose of this study was to examine whether there were any differences in responses to patients with suicidal ideation among specialties in general hospitals. Methods: A cross-sectional questionnaire study was conducted in 2007. The subjects of the study were chief physicians at 75 emergency departments, 69 internal medicine departments and 154 psychiatry departments in 161 general hospitals with psychiatric beds in Japan. Results: The physicians in internal and emergency medicine reported making arrangements for needed counseling services and recommending to patients that they talk to the people around them, whereas those in psychiatric departments reported asking patients to promise not to commit suicide (no-suicide contract) and making a next appointment for them. Conclusions: Internists and emergency physicians are likely to take different approaches when responding to patients with suicidal ideation than psychiatrists. © 2008 Elsevier Inc. All rights reserved.

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Trait aggression in suicide attempters: A pilot study

Chiho Doihara, Chiaki Kawanishi, Tomoki Yamada, Ryoko Sato, Hana Hasegawa, Taku Furuno, Makiko Nakagawa, Yoshio Hirayasu

Psychiatry and Clinical Neurosciences   62 ( 3 ) 352 - 354  2008年06月  [査読有り]

　概要を見る

Suicide attempt is a potent risk factor of subsequent suicide. Understanding the characteristics of suicide attempters is important for preventing suicide. The authors investigated aggression in medically serious suicide attempters at an emergency department. Trait aggression was evaluated in 55 suicide attempters and 71 healthy individuals as a control group using the Japanese version of the Buss-Perry Aggression Questionnaire (BAQ). Total BAQ scores (t = 2.782, P = 0.006) and the hostility scores (t = 3.735, P < 0.001) were significantly higher in the suicide attempters than the controls. It suggested that to focus on aggression and its management is one of the key components for preventing suicide. © 2008 The Authors.

DOI PubMed

首都圏の高度救命救急センターで入院治療を受けた重症自殺未遂者の特徴

中川 牧子, 山田 朋樹, 岩本 洋子, 河西 千秋, 小田原 俊成, 佐藤 玲子, 長谷川 花, 須田 顕, 平安 良雄

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2008特別 ) S - 374  2008年05月

Unexpectedly high prevalence of akathisia in cancer patients

Chiaki Kawanishi, Hideki Onishi, Daiji Kato, Ikuko Kishida, Taku Furuno, Makoto Wada, Yoshio Hirayasu

Palliative and Supportive Care   5 ( 4 ) 351 - 354  2007年12月  [査読有り]

　概要を見る

Objectives: Complications of neuropsychiatric disorders are often detected in cancer patients. Adjustment disorders, depression, or delirium are common psychiatric disorders in these patients, and drug-induced neuropsychiatric problems are sometimes referred for psychiatric consultation. Prochlorperazine and other antiemetic drugs that are phenothiazine derivates are also reported to cause akathisia due to the blockade of the dopamine receptor in the central nervous system, but the prevalence of akathisia in patients undergoing cancer treatment has not been reported. This study seeks to explore the prevalence of such drug-induced syndromes (e.g., akathisia) in this population. Methods: This present study was a prospective study. The subjects of this study were 483 consecutive patients with cancer who had been referred to the Department of Psychiatry in Kanagawa Prefecture Cancer Center from February 1, 2004, to November 30, 2005. Trained psychiatrists conducted a nonstructured psychiatric interview and neurologic examination to establish psychiatric diagnoses according to DSM-IV and the presence or absence of drug-induced extra pyramidal symptoms. The past and current medications used in their cancer treatment were also examined in detail for an accurate evaluation. Results: A psychiatric diagnosis was made in 420 (87.0%) of the 483 cancer patients examined, and akathisia, a drug-induced movement disorder, was unexpectedly prevalent among the patients 20 of 420 (4.8%) patients had developed akathisia from an antiemetic drug, prochlorperazine. Significance of results: Diagnosing such adverse drug reactions may be difficult due to complicating factors in cancer treatment, and the inner restlessness observed in akathisia is likely to be regarded as a symptom of a primary psychiatric disorder. The authors suggest that oncologists should optimize the use of antiemetic drugs and be aware of akathisia as a possible complication of cancer treatment. © 2007 Cambridge University Press.

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Detection and treatment of akathisia in advanced cancer patients during adjuvant analgesic therapy with tricyclic antidepressants: Case reports and review of the literature

Hideki Onishi, Wataru Yamamoto, Makoto Wada, Tomomi Nishida, Mei Wada, Yu Sunagawa, Toshimichi Miya, Chiaki Kawanishi, Masaru Narabayashi, Yasutsuna Sasaki

Palliative and Supportive Care   5 ( 4 ) 411 - 414  2007年12月  [査読有り]

　概要を見る

Objective: There is substantial evidence that tricyclic antidepressants are effective in the management of chronic pain, including cancer pain. In oncological settings, these agents are used as adjuvant analgesic drugs. However, cases of akathisia due to tricyclic antidepressants used as adjuvant analgesic therapy have not previously been reported. Case reports: Two cancer patients experiencing chronic pain who were refractory to nonsteroidal anti-inflammatory drugs and opioids were prescribed amoxapine as an adjuvant analgesic therapy for neuropathic pain. These patients developed inner restlessness and restless physical movements after amoxapine was prescribed. Although symptoms were atypical, akathisia was suspected and discontinuation of amoxapine resolved the symptoms. Results and significance of results: Akathisia should be considered in patients receiving adjuvant analgesic therapy with tricyclic antidepressants. Early detection and appropriate treatment will relieve this distressing symptom. Restless movements involving parts of the body other than the legs may be the clue to the diagnosis. © 2007 Cambridge University Press.

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Psychiatric assessment of suicide attempters in Japan: A pilot study at a critical emergency unit in an urban area

Tomoki Yamada, Chiaki Kawanishi, Hana Hasegawa, Ryoko Sato, Akiko Konishi, Daiji Kato, Taku Furuno, Ikuko Kishida, Toshinari Odawara, Mitsugi Sugiyama, Yoshio Hirayasu

BMC Psychiatry   7  2007年11月  [査読有り]

　概要を見る

Background: The incidence of suicide has increased markedly in Japan since 1998. As psychological autopsy is not generally accepted in Japan, surveys of suicide attempts, an established risk factor of suicide, are highly regarded. We have carried out this study to gain insight into the psychiatric aspects of those attempting suicide in Japan. Methods: Three hundred and twenty consecutive cases of attempted suicide who were admitted to an urban emergency department were interviewed, with the focus on psychosocial background and DSM-IV diagnosis. Moreover, they were divided into two groups according to the method of attempted suicide in terms of lethality, and the two groups were compared. Results: Ninety-five percent of patients received a psychiatric diagnosis: 81% of subjects met the criteria for an axis I disorder. The most frequent diagnosis was mood disorder. The mean age was higher and living alone more common in the high-lethality group. Middle-aged men tended to have a higher prevalence of mood disorders. Conclusion: This is the first large-scale study of cases of attempted suicide since the dramatic increase in suicides began in Japan. The identification and introduction of treatments for psychiatric disorders at emergency departments has been indicated to be important in suicide prevention. © 2007 Yamada et al licensee BioMed Central Ltd.

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Effects of CYP2D6 polymorphisms on neuroleptic malignant syndrome

Daiji Kato, Chiaki Kawanishi, Ikuko Kishida, Taku Furuno, Kyoko Suzuki, Hideki Onishi, Yoshio Hirayasu

European Journal of Clinical Pharmacology   63 ( 11 ) 991 - 996  2007年11月  [査読有り]

　概要を見る

Objective: Neuroleptic malignant syndrome (NMS) is one of the most serious adverse reactions to antipsychotic medications. We accumulated data on Japanese NMS patients and, in a study designed to examine the effects of drug metabolism on the occurrence of NMS, tested the possibility of association between NMS and CYP2D6 polymorphisms. Methods: We studied 53 patients who had experienced NMS and 112 healthy individuals. We determined what drugs the patients with NMS had been given and retrospectively identified candidates for drugs causing NMS. We screened the prevalence of CYP2D6 genotypes using polymerase chain reaction and restriction fragment length polymorphism analyses. Results: The prevalence of *5 alleles in the group of all patients with NMS was higher than that in the controls, though this difference was not statistically significant (10.4% vs. 5.4% P=0.107 odds ratio (OR) 2.05 95% confidence interval (CI) 0.87-4.80). No association was found between the frequency of *10 alleles and the occurrence of NMS. We found *4 and duplicated alleles in only one patient each among the patients with NMS. A total of 29 patients appeared to have developed NMS as a result of having taking CYP2D6 substrates. The prevalence of *5 alleles in these 29 patient was significantly higher than that in the controls (15.5% vs. 5.4% P=0.020 OR 3.25 95% CI 1.30-8.13). Conclusion: Our findings suggest that the CYP2D6*5 allele is likely to affect vulnerability to development of NMS. © 2007 Springer-Verlag.

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Neuronal and glial accumulation of α- and β-synucleins in human lipidoses

Kyoko Suzuki, Eizo Iseki, Takashi Togo, Akira Yamaguchi, Omi Katsuse, Kayoko Katsuyama, Seiichi Kanzaki, Kazumasa Shiozaki, Chiaki Kawanishi, Sumimasa Yamashita, Yukichi Tanaka, Shoji Yamanaka, Yoshio Hirayasu

Acta Neuropathologica   114 ( 5 ) 481 - 489  2007年11月  [査読有り]

　概要を見る

A number of the lysosomal storage diseases that have now been characterized are associated with intra-lysosomal accumulation of lipids, caused by defective lysosomal enzymes. We have previously reported neuronal accumulation of both α- and β-synucleins in brain tissue of a GM2 gangliosidosis mouse model. Although α-synuclein has been implicated in several neurodegenerative disorders including Parkinson's disease, dementia with Lewy bodies and multiple system atrophy, its functions remain largely unclear. In our present study, we have examined a cohort of human lipidosis cases, including Sandhoff disease, Tay - Sachs disease, metachromatic leukodystrophy, β-galactosialidosis and adrenoleukodystrophy, for the expression of α- and β-synucleins and the associated lipid storage levels. The accumulation of α-synuclein was found in brain tissue in not only cases of lysosomal storage diseases, but also in instances of adrenoleukodystrophy, which is a peroxisomal disease. α-synuclein was detected in both neurons and glial cells of patients with these two disorders, although its distribution was found to be disease-dependent. In addition, α-synuclein-positive neurons were also found to be NeuN-positive, whereas NeuN-negative neurons did not show any accumulation of this protein. By comparison, the accumulation of α-synuclein was detectable only in the pons of Sandhoff disease cases. This differential accumulation of α- and β-synucleins in human lipidoses may be related to functional differences between these two proteins. In addition, the accumulation of α-synuclein may also be a condition that is common to lysosomal storage diseases and adrenoleukodystrophies that show an enhanced expression of this protein upon the elevation of stored lipids. © Springer-Verlag 2007.

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Monoamine metabolites level in CSF is related to the 5-HTT gene polymorphism in treatment-resistant depression

Ikuko Kishida, Eleni Aklillu, Chiaki Kawanishi, Leif Bertilsson, Hans Ågren

Neuropsychopharmacology   32 ( 10 ) 2143 - 2151  2007年10月  [査読有り]

　概要を見る

The serotonin (5-hydroxytryptamine) transporter (5-HTT) is considered to affect the pathogenesis of mood disorders. Large number of genetic association studies between 5-HTT functional polymorphisms and vulnerability of mood disorders and therapeutic response to antidepressants has been carried out. We investigated the influence of 5-HTT-linked polymorphic region (5-HTTLPR) and 5-HTT 17 bp variable number of tandem repeat polymorphism (5-HTTVNTR) polymorphisms on concentrations of monoamine metabolites in cerebrospinal fluid (CSF) among treatment-resistant patients with mood disorders. Subjects were 119 Swedish patients with persistent mood disorders and 141 healthy subjects. In 112 of these patients, we measured 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol in CSF. Genotyping for 5-HTT polymorphisms from genomic DNA was carried out by PCR. There was no significant difference in allele/genotype frequency between patients and healthy subjects. In patients with mood disorders, we found significant difference in mean 5-HIAA concentration between 5-HTTLPR genotypes (p=0.03). Although the 5-HIAA concentration showed a tendency to be higher in short (S) carriers than in non-S carriers of the 5-HTTLPR in patients (p=0.06), when considering patients with major depressive disorder (MDD), the 5-HIAA concentration was significantly higher among S carriers than among non-S carriers (p=0.02). Moreover, the 5-HIAA concentration was higher in S/S subjects compared to long (L)/L (p=0.0001) and L/S (p=0.002) subjects in patients with MDD. Similarly, there was higher HVA concentration in S/S subjects compared to L/L (p=0.002) and L/S subjects (p=0.002). There was no effect of 5-HTTVNTR. Our findings show that the 5-HTTLPR polymorphism affects 5-HIAA and HVA concentrations among treatment-resistant patients with mood disorders. © 2007 Nature Publishing Group All rights reserved.

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Perospirone in treatment of Huntington's disease: A first case report

Tomohide Roppongi, Takashi Togo, Shinichi Nakamura, Takeshi Asami, Asuka Yoshimi, Kazumasa Shiozaki, Daiji Kato, Chiaki Kawanishi, Yoshio Hirayasu

Progress in Neuro-Psychopharmacology and Biological Psychiatry   31 ( 1 ) 308 - 310  2007年01月  [査読有り]

　概要を見る

Huntington's disease (HD) is a hereditary disorder clinically characterized by involuntary movements, cognitive decline and psychiatric symptoms. We report on a patient with HD, whose involuntary movements and psychiatric symptoms were clinically improved with perospirone, a second-generation antipsychotic agent with antagonistic effects on serotonin 5-HT2A and dopamine D2 (D2) receptors, as well as a unique agonistic effect on serotonin 5-HT1A (5-HT1A) receptors. The fact that perospirone antagonizes D2 receptors could explain its effects on the hyperkinetic syndrome, while its agonistic effects on 5-HT1A receptors may explain the amelioration of psychiatric symptoms (fear and anxiety) in this patient. Future studies would be valuable to elucidate the utility of perospirone for the treatment of involuntary movements and psychiatric symptoms in HD. © 2006 Elsevier Inc. All rights reserved.

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Knowledge and attitude towards suicide among medical students in Japan: Preliminary study

Ryoko Sato, Chiaki Kawanishi, Tomoki Yamada, Hana Hasegawa, Haruka Ikeda, Daiji Kato, Taku Furuno, Ikuko Kishida, Yoshio Hirayasu

Psychiatry and Clinical Neurosciences   60 ( 5 ) 558 - 562  2006年10月  [査読有り]

　概要を見る

Japan has one of the highest suicide rates in the world. Suicides numbered 32 863 in 1998 and have exceeded 30 000 in every subsequent year. Education of those involved in general and psychosocial patient care can contribute greatly to suicide prevention. The authors administered a brief knowledge and attitude assessment questionnaire concerning suicide to students in their first, third, and fifth years at a Japanese medical school. Participants numbered 160 (94 men with a mean age of 21.8 years, SD = 3.01, and 66 women with a mean age of 21.2 years, SD = 2.64) 59 first year, 52 third year, and 49 in their fifth year. The questionnaire consists of eight multiple-choice questions asking knowledge of suicide and one open-ended question asking attitude. In the knowledge part, only about half of the items were answered correctly (mean score was 4.21, SD = 1.28). A significant difference was observed in prevalence of attitudes as categorical variables between student years (P = 0.001). Sympathetic comments increased along with student years, while critical comments decreased. Given the frequent and interventional opportunities of primary-care medical contacts, poor understanding of suicide from the medical viewpoint was of concern. Moreover, judgmental attitudes were common, especially in earlier school years. Better informed, more understanding physicians and other health professionals could contribute greatly to prevention. © 2006 The Authors.

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Quetiapine-induced neuroleptic malignant syndrome in dementia with Lewy bodies: A case report

Akiko Kobayashi, Chiaki Kawanishi, Takehiko Matsumura, Daiji Kato, Ryoko Furukawa, Ikuko Kishida, Yoshio Hirayasu

Progress in Neuro-Psychopharmacology and Biological Psychiatry   30 ( 6 ) 1170 - 1172  2006年08月  [査読有り]

　概要を見る

Patients with dementia with Lewy bodies (DLB) are particularly vulnerable to adverse effects of neuroleptics this sensitivity is included among the clinical diagnostic criteria for DLB. Recently atypical neuroleptics, which carry less risk of extrapyramidal side effects than typical agents, have come into increasing use in treating psychotic symptoms and behavioral disturbances related to DLB. The present report is the first to describe a DLB patient who developed neuroleptic malignant syndrome (NMS) induced by quetiapine, an atypical neuroleptic known to have relatively infrequent extrapyramidal side effects in DLB patients. Physicians should be aware of the possibility of the occurrence of NMS in DLB even when atypical neuroleptics are administered. © 2006 Elsevier Inc. All rights reserved.

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CYP2D6 gene deletion allele in patients with neuroleptic malignant syndrome: Preliminary report

Daiji Kato, Chiaki Kawanishi, Ikuko Kishida, Taku Furuno, Takehiko Matsumura, Hana Hasegawa, Kyoko Suzuki, Yoshio Hirayasu

Psychiatry and Clinical Neurosciences   59 ( 4 ) 504 - 507  2005年08月  [査読有り]

　概要を見る

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse reaction to psychopharmacologic treatment. Reported herein are two NMS patients with schizophrenia who were found to possess a CYP2D6 gene deletion allele (CYP2D6*5). The deletion results in decreased CYP2D6 activity, possibly leading to drug accumulation. Both patients with NMS had been treated with neuroleptics, including CYP2D6 substrates. Polymerase chain reaction (PCR) followed by restriction fragment length polymorphism analyses and long PCR were performed to detect CYP2D6 genotype. One patient was found to possess *5/*10 the other had a *1/*5 genotype. The present preliminary report suggests that pharmacokinetic factors cannot be excluded and the CYP2D6 polymorphism is possibly associated with the etiology of NMS.

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[Mandatory postgraduate training in psychiatry in Yokohama City University and the affiliated medical facilities under the new system of postgraduate clinical education in Japan].

Reiko Sato, Chiaki Kawanishi, Kazumasa Shiosaki, Naoya Sugiyama, Shuichiro Fujiwara, Atsushi Ozawa, Toshinari Odawara, Yoshio Hirayasu

Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica   107 ( 8 ) 841 - 5  2005年  [国内誌]

PubMed

Increased incidence of CYP2D6 gene duplication in patients with persistent mood disorders: Ultrarapid metabolism of antidepressants as a cause of nonresponse. A pilot study

Chiaki Kawanishi, Stefan Lundgren, Hans Ågren, Leif Bertilsson

European Journal of Clinical Pharmacology   59 ( 11 ) 803 - 807  2004年01月  [査読有り]

　概要を見る

Objective: Recent studies have revealed that genetic polymorphisms of cytochrome P450 2D6 (CYP2D6) are among the factors that determine the interindividual differences in the metabolism and response to antidepressants. We investigated the relationship between persistent mood disorders and the duplication of the CYP2D6 gene, which encodes an enzyme with increased activity. Methods: We screened the prevalence of the CYP2D6 genotypes in 108 patients with persistent mood disorders using long polymerase chain reaction (PCR) and the real-time PCR methods. Clinical correlates with the genotypes were also analyzed. Results: Among the 108 patients, 81 had failed to respond to antidepressants shown to be metabolized by CYP2D6. Of those 81, 8 had a CYP2D6 gene duplication (9.9%, 95% confidence interval 3.4-16.4%) which was higher than the 0.8-1.0% incidence previously observed in healthy Nordic Caucasians. The worst week scores of the Hamilton Depression Rating Scale were higher in the patients with the duplication compared with those without the duplication (P = 0.026, student's t-test). Conclusion: These results suggest that the CYP2D6 gene duplication is a possible factor that influences the development of persistence in patients with mood disorders probably by ultrarapid drug metabolism.

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Lack of association in Japanese patients between neuroleptic malignant syndrome and the TaqI A polymorphism of the dopamine D2 receptor gene

Ikuko Kishida, Chiaki Kawanishi, Taku Furuno, Takehiko Matsumura, Hana Hasegawa, Naoya Sugiyama, Kyoko Suzuki, Yoshiteru Yamada, Kenji Kosaka

Psychiatric Genetics   13 ( 1 ) 55 - 57  2003年03月  [査読有り]

　概要を見る

Objective: The molecular basis of neuroleptic malignant syndrome (NMS) is unclear, but clinical studies have noted a genetic predisposition. A recent genetic study suggested an association between NMS and the TaqI A polymorphism in the dopamine D2 receptor (DRD2) gene. We further examined the association in a larger number of subjects. Methods: We studied 49 Japanese patients previously diagnosed with NMS, and 123 schizophrenic patients treated with neuroleptics without occurrence of NMS. PCR and RFLP analyses were performed to screen the TaqI A polymorphism. Results: The TaqI A1 allele frequency was 0.408 in NMS patients and 0.415 in patients without NMS. No significant differences in allelic or genotypic frequencies were observed between the two groups. Conclusions: We cannot conclude that the TaqI A polymorphism is associated with development of NMS. © 2003 Lippincott Williams & Wilkins.

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A patient with treatment-resistant schizophrenia and cytochrome P4502D6 gene duplication

Chiaki Kawanishi, T. Furuno, I. Kishida, T. Matsumura, K. Kosaka

Clinical Genetics   61 ( 2 ) 152 - 154  2002年02月  [査読有り]

　概要を見る

We describe a patient with treatment-resistant schizophrenia who had a duplication in the cytochrome P450IID6 (CYP2D6) gene. This severely ill 71-year-old-woman had responded poorly to several neuroleptics. Molecular genetic study revealed CYP2D6 gene duplication, which results in excessive activity of CYP2D6 that metabolizes various commonly used neuroleptics. The mutation may have contributed to treatment resistance in this case.

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No evidence of an association between CYP2D6 polymorphisms among Japanese and dementia with Lewy bodies

Taku Furuno, Chiaki Kawanishi, Eizo Iseki, Hideki Onishi, Naoya Sugiyama, Kyoko Suzuki, Kenji Kosaka

Psychiatry and Clinical Neurosciences   55 ( 2 ) 89 - 92  2001年  [査読有り]

　概要を見る

Dementia with Lewy bodies (DLB) is the second most frequent degenerative dementia among the elderly, following Alzheimer-type dementia (ATD). An association of DLB with CYP2D6*4, one of the cytochrome P450IID6 (debrisoquine 4-hydroxylase CYP2D6) gene polymorphisms, was reported previously, but this is controversial. Moreover, these reports have been restricted to Caucasian populations. Therefore, we compared frequencies of CYP2D6*3, *4, and *10 mutant alleles in 17 Japanese DLB patients to those among Alzheimer-type dementia (ATD) patients and healthy controls. Polymerase chain reaction amplification and restriction fragment length polymorphism analyses were used for genotyping. No significant difference of genotype or mutant allele frequencies was detected between DLB, ATD, and healthy controls. The present results do not support the suggestion that the CYP2D6 gene is related to DLB susceptibility, at least in the Japanese population.

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Pelizaeus-Merzbacher disease: Three novel mutations and implication for locus heterogeneity

Hitoshi Osaka, Chiaki Kawanishi, Ken Inoue, Hideki Onishi, Takuya Kobayashi, Naoya Sugiyama, Kenji Kosaka, Atsuo Nezu, Katsunori Fujii, Katsuo Sugita, Kazuo Kodama, Keiko Murayama, Shigeo Murayama, Ichiro Kanazawa, Seiji Kimura

Annals of Neurology ( Wiley )  45 ( 1 ) 59 - 64  1999年01月  [査読有り]

DOI

Mutation involving cytochrome P450IID6 in two Japanese patients with neuroleptic malignant syndrome

Chiaki Kawanishi, Yoshikazu Shimoda, Jun Fujimaki, Hideki Onishi, Kyoko Suzuki, Tokiji Hanihara, Naoya Sugiyama, Kenji Kosaka

Journal of the Neurological Sciences   160 ( 1 ) 102 - 104  1998年09月  [査読有り]

　概要を見る

Cytochrome P450IID6 (CYP2D6) plays an important role in the hepatic metabolism of various psychotropic drugs. We detected a mutation of the CYP2D6 gene in two patients who previously had episodes of neuroleptic malignant syndrome (NMS). They were homozygous for a mutated CYP2D6J allele conferring a poor-metabolizer phenotype. Possession of this trait may contribute to susceptibility to NMS.

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Japanese Creutzfeldt-Jakob disease patients exhibiting high incidence of the E200k PRNP mutation and located in the basin of a river

Tomohiro Miyakawa, Ken Inoue, Eizo Iseki, Chiaki Kawanishi, Naoya Sugiyama, Hideki Onishi, Yoshiteru Yamada, Kyoko Suzuki, Kiyoshi Iwabuchi, Kenji Kosaka

Neurological Research ( Forefront Publishing Group )  20 ( 8 ) 684 - 688  1998年  [査読有り]

　概要を見る

Seven cases with Creutzfeldt-Jakob disease (CJD) located in the basin of the Fuji river (Fuji area) in Japan were examined genetically and clinicopathologically. The onset of the disease was between 1989 and 1995. All cases were from different families, although 3 cases were family members of previously reported CJD patients. They had clinical and/or neuropathological features, corresponding to subacute spongiform encephalopathy. Five of the 7 cases, including the 3 familial cases, had the E200K mutation in the gene encoding prion protein (PRNP). It is suggested that there is a small cluster of CJD patients with a founder effect of the E200K mutation in the Fuji area, because the incidence of CJD with the E200K mutation appears to be much higher in this area than other areas in Japan. The disease penetrance of the 5 cases with the E200K mutation seems to be low, and they may have an age-related incidence in the Fuji area. These findings support the hypothesis that the phenotypes of CJD patients with the PRNP mutations are linked to the position of the mutation, but not related to ethnic or environmental factors.

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Pancreatic exocrine dysfunction associated with mitochondrial tRNA(Leu(UUR)) mutation

Hideki Onishi, Tokiji Hanihara, Naoya Sugiyama, Chiaki Kawanishi, Eizo Iseki, Yasuko Maruyama, Yoshiteru Yamada, Kenji Kosaka, Saburo Yagishita, Hisahiko Sekihara, Shinobu Satoh

Journal of Medical Genetics   35 ( 3 ) 255 - 257  1998年  [査読有り]

　概要を見る

We report on pancreatic exocrine dysfunction in families that have the mitochondrial tRNA(Leu(UUR)) gene mutation. These families exhibited maternally inherited diabetes mellitus (DIM) and an A to G substitution at nt 3243 of the mitochondrial tRNA(Leu(UUR)) gene (A3243G mutation). Pancreatic necropsy samples from one proband showed accumulation of degenerated mitochondria in pancreatic acinar cells. Pancreatic exocrine dysfunction was recognised by a functional pancreatic study. This study indicates that exocrine pancreatic dysfunction may be associated with the A3243G mutation.

PubMed

Lack of association between neuroleptic malignant syndrome and polymorphisms in the 5-HT(1A) and 5-HT(2A) receptor genes

Chiaki Kawanishi, Tokiji Hanihara, Yoshikazu Shimoda, Kyoko Suzuki, Naoya Sugiyama, Hideki Onishi, Tomohiro Miyakawa, Yoshiteru Yamada, Kenji Kosaka

American Journal of Psychiatry ( American Psychiatric Association )  155 ( 9 ) 1275 - 1277  1998年  [査読有り]

　概要を見る

Objective: The molecular basis of neuroleptic malignant syndrome is unclear, but studies suggest that genetic factors are involved in its pathogenesis. Considering possible involvement of the serotonergic system in neuroleptic malignant syndrome, the authors examined the association between neuroleptic malignant syndrome and polymorphisms of the 5-HT(1A) and 5- HT(2A) receptor genes. Method: The authors examined the frequencies of gene polymorphisms in the 5-HT(1A) (Arg219Leu) and 5-HT(2A) (Thr25Asn and His452Tyr) receptor genes in 29 patients previously diagnosed with neuroleptic malignant syndrome, 94 neuroleptic-treated patients with schizophrenia who had no history of neuroleptic malignant syndrome, and 94 healthy comparison subjects. Polymerase chain reaction and restriction fragment length polymorphism analyses were used to screen gene mutations. Results: No polymorphic allele was detected in the patients who had experienced the neuroleptic malignant syndrome. Conclusions: The authors cannot conclude that polymorphisms in the 5-HT(1A) and 5HT(2A) receptor genes are factors determining susceptibility to the neuroleptic malignant syndrome.

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Residues at the subunit interfaces of the nicotinic acetylcholine receptor that contribute to α-conotoxin M1 binding

Naoya Sugiyama, Pascale Marchot, Chiaki Kawanishi, Hitoshi Osaka, Brian Molles, Steven M. Sine, Palmer Taylor

Molecular Pharmacology ( American Society for Pharmacology and Experimental Therapy )  53 ( 4 ) 787 - 794  1998年  [査読有り]

　概要を見る

The two binding sites in the pentameric nicotinic acetylcholine receptor of subunit composition α2βγδ are formed by nonequivalent α-γ and α- δ subunit interfaces, which produce site selectivity in the binding of agonists and antagonists. We show by sedimentation analysis that 125I-α- conotoxin M1 binds with high affinity to the α-δ subunit dimers, but not to α-γ dimers, nor to α, γ, and δ monomers, a finding consistent with α- conotoxin M1 selectivity for the αδ interface in the intact receptor measured by competition against α-bungarotoxin binding. We also extend previous identification of α-conotoxin M1 determinants in the γ and δ subunits to the α subunit interface by mutagenesis of conserved residues in the α subunit. Most mutations of the α subunit affect affinity similarly at the two sites, but Tyr93Phe, Val188Lys, Tyr190Thr, Tyr198Thr, and Asp152Asn affect affinity in a site-selective manner. Mutant cycle analysis reveals only weak or no interactions between mutant a and non-α subunits, indicating that side chains of the α subunit do not interact with those of the γ or δ subunits in stabilizing α-conotoxin M1. The overall findings suggest different binding configurations of α-conotoxin M1 at the α-δ and α-γ binding interfaces.

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Depressive disorder due to mitochondrial transfer RNA(Leu(UUR)) mutation

Hideki Onishi, Chiaki Kawanishi, Tae Iwasawa, Hitoshi Osaka, Tokiji Hanihara, Ken Inoue, Yoshiteru Yamada, Kenji Kosaka

Biological Psychiatry   41 ( 11 ) 1137 - 1139  1997年06月  [査読有り]

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A new restriction-site polymorphism in the human proteolipid protein gene

Chiaki Kawanishi, Hitoshi Osaka, Ken Inoue, Hideki Onishi, Yoshiteru Yamada, Kenji Kosaka

Clinical Genetics   51 ( 1 ) 75  1997年  [査読有り]

PubMed

A case of Turner syndrome with schizphrenia: Genetic relationship between turner syndrome and psychosis

Chiaki Kawanishi, Masaaki Kono, Hideki Onishi, Norio Ishii, Kazuhiko Ishii

Psychiatry and Clinical Neurosciences ( Blackwell Publishing )  51 ( 2 ) 83 - 85  1997年  [査読有り]

　概要を見る

An 82-year-old woman with Turner syndrome and schizophrenia, and her 46- year-old daughter with schizophrenia are described, 45X/46XX chromosomal mosaicism was identified in the peripheral leukocytes of the mother, who showed several Turner dysmorphisms and cavum septi pellucidum in the brain. She had a normal reproductive life-span. The daughter resembled the mother in terms of schizophrenic symptoms, but she did not show any signs of Turner syndrome and the genetic relationship with psychosis are discussed.

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Neuropathological evaluation and apolipoprotein E gene polymorphism analysis in diffuse Lewy body disease

Chiaki Kawanishi, Kyoko Suzuki, Toshinari Odawara, Eizo Iseki, Hideki Onishi, Tomohiro Miyakawa, Yoshiteru Yamada, Kenji Kosaka, Naoki Kondo, Takayuki Yamamoto

Journal of the Neurological Sciences ( Elsevier B.V. )  136 ( 1-2 ) 140 - 142  1996年  [査読有り]

　概要を見る

We performed a quantitative neuropathological investigation of senile plaques and neurofibrillary tangles in the brains of 14 Japanese patients with diffuse Lewy body disease (DLBD), and examined apolipoprotein E (APOE) gene polymorphism in these patients. Most DLBD brains had as many senile plaques as those with Alzheimer-type dementia (ATD), but fewer neurofibrillary tangles. The APOE ε4 allele frequency in DLBD was 39.3%, similar to that previously reported in pathologically diagnosed ATD. DLBD and ATD are. clinically and pathologically distinct, but may have common mechanisms with regard to the formation of amyloid deposition based on these findings. Future investigation of the pure form of DLBD may clarify the association between Lewy body dementia and APOE.

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