医学部 精神神経科学

okochi tomo

  (大河内 智)

Profile Information

Affiliation
School of Medicine Faculty of Medicine, Fujita Health University

J-GLOBAL ID
201801014490348440
researchmap Member ID
7000023621

Research Areas

 1

Papers

 57
  • Kohei Ninomiya, Takeo Saito, Tomo Okochi, Satoru Taniguchi, Ayu Shimasaki, Rei Aoki, Takeo Hata, Taisei Mushiroda, Tetsufumi Kanazawa, Masashi Ikeda, Nakao Iwata
    Translational psychiatry, 11(1) 362-362, Jul 7, 2021  
    Pharmacogenetics/pharmacogenomics have enabled the detection of risk of human leukocyte antigen (HLA) variants for clozapine-induced agranulocytosis/granulocytopenia (CIAG). To apply this evidence to the clinical setting, we compared the cost-effectiveness of the proposed "HLA-guided treatment schedule" and the "current schedule" being used in Japan and the United Kingdom (UK) (absolute neutrophil count (ANC) cutoff at 1500/mm3); in the "HLA-guided treatment schedules," we considered a situation wherein the HLA test performed before clozapine initiation could provide "a priori information" by detecting patients harboring risk of HLA variants (HLA-B*59:01 and "HLA-B 158T/HLA-DQB1 126Q" for Japanese and Caucasian populations, respectively), a part of whom can then avoid CIAG onset (assumed 30% "prevention rate"). For the primary analysis, we estimated the incremental cost-effectiveness ratio (ICER) of "HLA-guided treatment schedule" and "current schedule" used in Japan and the UK, using a Markov model to calculate the cost and quality-adjusted life years (QALYs) over a 10-year time period. Furthermore, as an explorative analysis, we simulated several situations with various ANC cutoffs (1000/mm3 and 500/mm3) and plotted the cost/QALYs for each option to identify the best, or estimate the next best candidate option applicable in actual clinical settings. The primary probabilistic analysis showed that the "HLA-guided treatment schedule" was more cost effective than the "current schedule"; the ICER was £20,995 and £21,373 for the Japanese and the UK populations, respectively. Additional simulation revealed that the treatment option of ANC cutoff at 500/mm3 without HLA screening was the most cost-effective option; however, several options may be candidates to break away from the "current schedule" of ANC cutoff at 1500/mm3. Owing to its cost-effectiveness, we propose such pharmacogenetic-guided/pharmacogenomic-guided clozapine treatment for use in the real-world setting, which provides key information for optimization of clinical guidelines for high-risk patients for gradual change of clozapine treatment schedule under the safety consideration.
  • 青木 玲, 池田 匡志, 大河内 智, 齋藤 竹生, 谷口 賢, 二宮 光平, 芦澤 琢磨, 岩田 仲生
    日本神経精神薬理学会年会・日本生物学的精神医学会年会・日本精神薬学会総会・学術集会合同年会プログラム・抄録集, 50回・42回・4回 217-217, Aug, 2020  
  • 池田 匡志, 斎藤 竹生, 大河内 智, 岩田 仲生
    実験医学, 38(4) 556-559, Mar, 2020  
    代表的な精神疾患である双極性障害は遺伝要因が強く寄与する疾患であり、ゲノムワイド関連研究が導入されて以降、現在までに数十個の有意な関連領域が報告されている。そのなかでも、脂質代謝に重要な役割を示すfatty acid desaturase(FADS)遺伝子関連は、機能がきわめて明確な感受性遺伝子であり、この結果は双極性障害の脂質代謝異常仮説を支持するものである。事実、双極性障害患者でみられる脂質代謝異常(メタボリック症候群を含む)は、複数報告されており、その基盤となりうる結果とも言える。本稿では、双極性障害のゲノム研究を概説するとともに、この「双極性障害の脂質異常仮説」にも焦点を当て概説する。(著者抄録)
  • Kosei Esaki, Masashi Ikeda, Tomo Okochi, Satoru Taniguchi, Kohei Ninomiya, Ayu Shimasaki, Yasuyo Otsuka, Yoshiko Oda, Takaya Sakusabe, Keiko Mano, Takeo Saito, Nakao Iwata
    PloS one, 15(10) e0240466, 2020  
    Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDIpre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (Puncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDIpre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (Puncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.
  • Taro Kishi, Yuki Matsuda, Shinji Matsunaga, Masatsugu Moriwaki, Yoichiro Otake, Kaku Akamatsu, Tomo Okochi, Shigeki Hirano, Toshihiko Funahashi, Momoko Okuda, Hideaki Tabuse, Kiyoshi Fujita, Nakao Iwata
    Neuropsychiatric Disease and Treatment, 13 117-125, Jan 6, 2017  Peer-reviewed
    Objective: There are no direct comparisons between escitalopram and paroxetine controlled release in patients with major depressive disorder (MDD). Methods: We conducted a 24-week, rater-masked, randomized trial of escitalopram (5–20 mg/day) versus paroxetine controlled release (12.5–50 mg/day) in patients with MDD (UMIN000011191). Patients with the diagnosis of moderate-to-severe MDD (a 17-item Hamilton Rating Scale for Depression [HAMD-17], with total score at baseline being $20) were recruited to participate in a parallel, randomized, controlled trial. The primary outcome for efficacy was an improvement in the 21-item HAMD (HAMD-21) total score at 24 weeks. The secondary outcomes were the response, remission, and discontinuation rates and the incidence of individual adverse events. Results: A total of 88 patients with MDD (males, 61.4% mean age, 40.8�13.4 years) were recruited. The discontinuation rate was 58.0% (escitalopram, 55.8% paroxetine controlled release, 60.0%). Both escitalopram and paroxetine controlled-release treatment groups exhibited significant reduction in the HAMD-21 total score at 2, 4, 8, 12, and 24 weeks from the baseline. However, there were no significant differences in the HAMD-21 total score, response rate, remission rate, and discontinuation rate at any time point between the groups. In addition, there were no significant differences in the incidence of any individual adverse events (eg, nausea, vomiting, and somnolence) between the treatment groups. Conclusion: Our results suggest that escitalopram and paroxetine controlled release had similar efficacy and safety profiles in patients with MDD. One of the primary limitations of this study is the small sample size.

Misc.

 15
  • 岸 太郎, 松田 勇紀, 森脇 正詞, 川島 邦裕, 大竹 洋一郎, 向井 智彦, 大河内 智, 平野 茂樹, 田伏 英晶, 赤松 拡, 藤田 潔, 岩田 仲生
    Depression Journal, 2(1) 28-31, Apr, 2014  
    日本人大うつ病性障害患者に対するエスシタロプラムの有効性、認容性について検討した。エスシタロプラム群(ESC群)21例、パロキセチン徐放製剤群(PAR群)23例を対象とした。ESC群、PAR群において、反応率は4週後57.1%、60.9%、8週後53.4%、42.4%、寛解率は4週後23.8%、17.4%、8週後40.0%、27.8%であった。ESC群、PAR群において、すべての要因による中断率は、4週後19.1%、43.5%、8週後23.8%、47.8%で、ESC群で低い傾向を認めた。副作用による中断率は、4週後9.5%、9、1%、8週後9.5%、8.7%で、有意差は認めなかった。効果不十分による中断率はESC群は4、8週後とも0%であったが、PAR群は4週後17.4%、8週後21.7%で、ESC群が有意に低かった。死亡、心血管イベントを含む重篤な有害事象は両群とも認めなかった。
  • 大河内 智, 古川 修, 藤田 潔, 岩田 仲生
    臨床精神薬理, 16(4) 555-564, Apr, 2013  
    初発、再発(1ヵ月以内で抗精神病薬の内服歴がない)の統合失調症患者におけるblonanserin(BNS)の単剤治療の有用性について検討した。急性期症状を呈した初発あるいは再発統合失調症患者8例を対象に、8週間のオープンラベル試験を行った。BNS投与終了時の評価において8例中6例の患者で改善効果が得られた。8週間の試験を完了できた症例は4例であった。PANSS、CGI評価において、いずれも投与開始2週目時点で改善が認められた。特にPANSS-ECにおいては、投与開始1週の時点でベースラインからの改善が得られており、投与開始早期での治療反応性が示された。試験期間を通じて重篤な副作用は認められなかったが、錐体外路症状(EPS)が3例に認められ、その内2例(初発症例)はBNSの減量や抗パーキンソン薬併用といった対処を行ったが、EPSの改善は認められず中止に至っている。今回の結果から初発例では8〜16mg/日投与が適正な初期治療用量で、増量は慎重に行うことが望ましいと考えられた。(著者抄録)
  • 岩田 仲生, 大河内 智
    Pharma Medica, 30(3) 197-199, Mar, 2012  
    drugナイーブな急性期統合失調症患者8例(男性5例、女性3例、平均年齢37.3歳)を対象に、8週間のオープンラベル試験にてブロナンセリンの有効性と安全性を検討した。その結果、1)8週の試験を継続できたのは4例であった。残り4例中1例は症状改善で転院希望により、他の1例は効果不十分、2例は副作用により脱落となった。2)治療反応率は2週目4/8例、4週目3/5例で、8週目は継続できた4例とも改善しているため4/4例であった。だが、エンドポイントは6/8例であった。3)PANSS-ECスコアでは1週目ですでに改善がみられ、サブスコールスコアでは特に陽性症状で強い改善傾向が示された。CGIも2週目時点で改善が得られ、試験開始時点では半数以上が「重度異常」であったのに対し、エンドポイントでは半数以上が「軽度異常」となった。4)副作用は椎体外路症状が3例にみられ、1例は抗パーキンソン病薬併用にて軽減・完遂したものの、2例は抗パーキンソン薬併用にても改善せず、試験の中止となった。
  • 鶴田 敬子, 戸澤 香里, 福生 泰久, 大河内 智, 岸 太郎, 池田 匡志, 亀井 浩行, 尾崎 紀夫, 岩田 仲生
    日本医療薬学会年会講演要旨集, 21 331-331, Sep 9, 2011