精神医学63巻3号

2021年03月発行

特集 サイコーシスとは何か—概念，病態生理，診断・治療における意義

サイコーシスと薬物療法

著者： 盛本翼¹

所属機関： ¹奈良県立医科大学精神医学講座

ページ範囲：P.381 - P.386

抄録　陽性症状の強度と期間が一定の閾値を超えた場合，一般に抗精神病薬が使用される。初回エピソードサイコーシスに抗精神病薬を開始する場合は，出現し得る副作用や症状が寛解したあとの治療期間，症状が再燃した際の対応方法などを含めた治療戦略を，患者や家族と共有しておく必要がある。
　At risk mental state(ARMS)に抗精神病薬を用いる目的は，精神病発症の予防ではなく，認知行動療法などの心理社会的治療を行うための症状改善にすべきである。ARMSに対する抗うつ薬や多価不飽和脂肪酸の有効性を示した報告があるが，決定的な結論は得られておらず，今後の検討が必要である。

参考文献

1)McGlashan TH, Zipursky RB, Perkins D, et al：Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 163：790-799, 2006

2)McGorry PD, Nelson B, Phillips LJ, et al：Randomized controlled trial of interventions for young people at ultra-high risk of psychosis：twelve-month outcome. J Clin Psychiatry 74：349-356, 2013

3)Davies C, Cipriani A, Ioannidis JPA, et al：Lack of evidence to favor specific preventive interventions in psychosis：a network meta-analysis. World Psychiatry 17：196-209, 2018

4)National Institute for Health and Clinical Excellence(NICE)：Psychosis and Schizophrenia in adults：prevention and management. 2014

5)Schmidt SJ, Schultze-Lutter F, Schimmelmann BG, et al：EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry 30：388-404, 2015

6)Fusar-Poli P, Nelson B, Valmaggia L, et al：Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state：impact on psychopathology and transition to psychosis. Schizophr Bull 40：120-131, 2012

7)McGorry PD, Nelson B, Markulev C, et al：Effect of ω-3 polyunsaturated fatty acids in young people at ultrahigh risk for psychotic disorders：the NEURAPRO randomized clinical trial. JAMA Psychiatry 74：19-27, 2017

8)Cornblatt BA, Lencz T, Smith CW, et al：Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry 68：546-557, 2007

9)Fusar-Poli P, Frascarelli M, Valmaggia L, et al：Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis：OASIS 6-year naturalistic study. Psychol Med 45：1327-1339, 2015

10)Amminger GP, Schäfer MR, Papageorgiou K, et al：Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders：a randomized, placebo-controlled trial. Arch Gen Psychiatry 67：146-154, 2010

11)Amminger GP, Schafer MR, Schlogelhofer M, et al：Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study. Nat Commun 6：7934-7934, 2015

12)Amminger GP, Nelson B, Markulev C, et al：The NEURAPRO biomarker analysis：long-chain omega-3 fatty acids improve 6-month and 12-month outcomes in youths at ultra-high risk for psychosis. Biol Psychiatry 87：243-252, 2020

13)Zipursky RB, Odejayi G, Agid O, et al：You say “schizophrenia” and I say “psychosis”：just tell me when I can come off this medication. Schizophr Res 27：S0920-9964(20)30085-2. doi：10.1016/j. schres. 2020.02.009. Online ahead of print, 2020

14)Leucht S, Cipriani A, Spineli L, et al：Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia：a multiple-treatments meta-analysis. Lancet 382：951-962, 2013

15)Ceraso A, Lin JJ, Schneider-Thoma J, et al：Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 8：CD008016, 2020

16)Kane JM：Treatment strategies to prevent relapse and encourage remission. J Clin Psychiatry 68(Suppl 14)：27-30, 2007

17)Gitlin M, Nuechterlein K, Subotnik KL, et al：Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. Am J Psychiatry 158：1835-1842, 2001

18)Emsley R, Oosthuizen PP, Koen L, et al：Symptom recurrence following intermittent treatment in first-episode schizophrenia successfully treated for 2 years：a 3-year open-label clinical study. J Clin Psychiatry 73：e541-547, 2012

19)Barnes TR, Drake R, Paton C, et al：Evidence-based guidelines for the pharmacological treatment of schizophrenia：updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 34：3-78, 2020

20)Flint AJ, Meyers BS, Rothschild AJ, et al：Effect of continuing olanzapine vs placebo on relapse among patients with psychotic depression in remission：the STOP-PD II randomized clinical trial. JAMA 322：622-631, 2019

21)Arendt M, Rosenberg R, Foldager L, et al：Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders：follow-up study of 535 incident cases. Br J Psychiatry 187：510-515, 2005

22)Niemi-Pynttäri JA, Sund R, Putkonen H, et al：Substance-induced psychoses converting into schizophrenia：a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry 74：e94-99, 2013

23)Moilanen J, Haapea M, Miettunen J, et al：Characteristics of subjects with schizophrenia spectrum disorder with and without antipsychotic medication-a 10year follow-up of the Northern Finland 1966 Birth Cohort study. Eur Psychiatry 28：53-58, 2013

24)Wils RS, Gotfredsen DR, Hjorthøj C, et al：Antipsychotic medication and remission of psychotic symptoms 10years after a first-episode psychosis. Schizophr Res 182：42-48, 2017

25)日本神経精神薬理学会：統合失調症薬物治療ガイドライン．医学書院，pp18-19, 2016