築地 茉莉子

BACKGROUND: Long-acting injectable formulations for HIV infection have been approved and are now available in Japan. Although not currently recommended as first-line drugs in Japanese or overseas guidelines, use of such formulations may increase, in accordance with patient conditions and preference. We determine the level of satisfaction with current anti-HIV drugs and analyzed the preferences of patients who favor long-acting injectable drugs based on their satisfaction level with the present anti-HIV drugs. METHODS: People living with HIV (PLWH) who had received antiretroviral therapy (ART) for at least one month and consented to the study between 1 April and 31 December 2021 were included in a survey conducted using a self-administered questionnaire. The content of the survey included satisfaction with seven items (tablet size, ease and feeling when taking the medicine, color, taste, portability, daily oral therapy, and co-payment) related to the anti-HIV drugs they were taking and their need for future drugs (dosage form, frequency of dosing, long-acting injectable, etc.). In addition, factors related to the need for long-acting injectable medications were analyzed with regard to the relationship with satisfaction with anti-HIV drugs. RESULTS: Overall, 667 patients available for analysis were included in this study. Satisfaction with anti-HIV drugs was highest with regard to "co-payment" and lowest with "daily oral therapy". Regarding the need for long-acting injectable medications, logistic regression analysis indicated that tablet size and daily oral therapy were significant predictors of patient preference for a once-every-eight-weeks intramuscular formulation in terms of their requirement for long-acting injectable medications (tablet size, OR = 2.14, 95%CI 1.030-4.430, p = 0.042; and daily oral therapy, OR = 1.75, 95%CI 1.010-3.030, p = 0.044). CONCLUSIONS: Patients currently receiving anti-HIV drugs who express dissatisfaction with tablet size and daily oral therapy may prefer a long-acting injectable formulation, taking into consideration patient age, employment status, ART history, frequency of daily dosage and concomitant medications other than ART.

BACKGROUND: Supporting people living with HIV using anti-retroviral therapy (ART) is important due to the requirement for strict medication adherence. To date, no data from longitudinal studies evaluating adherence by treatment-naïve people living with HIV are currently available. We investigated the adherence of treatment-naïve people living with HIV over time and examined the relationships among decisional conflicts, adherence, and health-related quality of life (HRQL). METHODS: The survey items included adherence (visual analogue scale [VAS]), decisional conflict (decisional conflict scale [DCS]), and HRQL (Medical Outcomes Study HIV Health Survey [MOS-HIV]). The DCS and MOS-HIV scores and the VAS and MOS scores were collected electronically at the ART initiation time point and at 4-, 24-, and 48-week post-treatment time points. RESULTS: A total of 215 participants were enrolled. The mean DCS score was 27.3 (SD, 0.9); 23.3% of participants were in the high-score and 36.7% in the low-score groups. The mean adherence rates at 4, 24, and 48 weeks were 99.2% (standard error [SE], 0.2), 98.4% (SE, 0.4), and 96.0% (SE, 1.2), respectively. The least-square means of the MOS-HIV for the DCS (high vs. low scores) were 64.4 vs. 69.2 for general health perceptions and 57.7 vs. 64.0 for HRQL, respectively. CONCLUSION: Adherence among treatment-naïve people living with HIV was maintained at a higher level, and HRQL tended to improve with ART. People with high levels of decisional conflict tended to have lower HRQL scores. Support for people living with HIV during ART initiation may be related to HRQL.

当院で試みた精神科実習プログラムに対する学生の満足度、精神疾患・精神疾患患者に対する意識の変化、学習到達度を調査した。2018年10月～2020年2月に当院での病院実習中に精神科実習プログラムに参加した学生42名を調査対象とした。実習満足度、精神疾患・精神疾患患者に対する意識の変化および学習到達度について、精神科実習プログラム開始前と終了直後の2回の質問紙調査ならびにプログラム終了後に学生が自由記載した実習成果報告書により分析した。満足度の関連構造分析の結果、目的変数の「精神科実習は満足のいくものであった」に対する5段階評価(1:非常に満足、2:満足、3:普通、4:不満、5:非常に不満)の平均点は1.8であった。次に、精神疾患・精神疾患患者に対するイメージに関する項目の4段階評価(1:大変よくあてはまる～4:全くあてはまらない)では、各項目ともポジティブなイメージについては精神科実習プログラム参加前よりも参加後の評価点が低下し、ネガティブなイメージについては本プログラム参加前よりも参加後の評価点が上昇していた。精神科薬物療法に関する知識は「服薬アドヒアランスを確認する方法」「精神症状を評価する方法」「ドパミンD2受容体遮断によって生じる可能性のある症状」「知っている向精神薬の名前」について、いずれも精神科実習プログラム参加前よりも参加後に統計学的に有意に回答数が増えていた。

Neuropsychiatric disorders are among the most represented disorders in the 2013 revision of the Model Core Curriculum for Pharmaceutical Education in Japan. However, it is reported that many pharmacy students have a negative impression of neuropsychiatric disorders because they do not know how to interact with psychiatric patients. To deepen students' understanding of pharmacotherapy for psychiatric disorders, Chiba University Hospital provides a one-day psychiatric clinical practicum in which pharmacy students perform a pharmaceutical intervention. In this practicum, students first had a group discussion about the case, assessed the pharmaceutical problem, and considered pharmacotherapy solutions to the problem on their own. Then, the students interviewed the patients directly to collect pharmaceutical-related information. Finally, the students participated in a conference and presented their own pharmacotherapy solutions to the problem. In this study, we conducted a questionnaire survey and assessed the students' reports in order to investigate their satisfaction with the practicum, changes in their impression of psychiatric disorders or patients with psychiatric disorders, and the level of knowledge they attained. The results showed that almost all students were satisfied with the practicum. The students' impression of psychiatric disorders or patients with psychiatric disorders changed in a positive direction. It seems that students came to realize the role and responsibility of the pharmacist in medical teams. These findings suggest that the practicum led to a positive change in the students' impression of psychiatric patients through conversations with the patients, assessment of pharmacotherapy from a pharmaceutical point of view, and proposing prescriptions.

OBJECTIVES: Safe and efficient methods for introducing clozapine to patients with treatment-resistant schizophrenia (TRS) are needed. We investigated risk factors for clozapine discontinuation in the early phase of its introduction. METHODS: We conducted a nested case-control study at 14 psychiatric hospitals in Chiba, Japan. Data from pre-registered TRS patients were collected at 7 time points within 12 weeks before and after the start of clozapine introduction. We examined the demographic data, prior and concomitant psychotropic drugs, strategies for switching from prior antipsychotics, and blood test and Global Assessment of Function results. The Clinical Global Impression-Severity Scale was retrospectively scored at 12 weeks before and after clozapine introduction. RESULTS: Of 228 patients, clozapine treatment was continued in 213 (93.4 %) and discontinued in 15 (6.6 %) patients within 12 weeks. Clinical symptoms were improved to mild symptoms with a response rate of 14.9 %. Prior antipsychotics and concomitant psychotropic drugs except for mood stabilizers were significantly decreased. Histories of smoking (OR = 3.32, 95 %CI: 1.11-9.93) and antipsychotic treatment at chlorpromazine-equivalent doses <1200 mg within the past 5 years (OR = 3.93, 95 %CI: 1.24-12.50), but not antipsychotic switching strategy, were associated with clozapine discontinuation. Eosinophilia was the most frequent reason for discontinuation (n = 3, 20 %) and was associated with concomitant valproate at 4 weeks after the introduction. CONCLUSION: Clozapine is an effective option for TRS patients (especially those treated with higher doses of prior antipsychotics) in Japan. Clinicians should be cautious about concomitant valproate in the early phase of clozapine introduction due to a high risk of eosinophilia.

症例1は40歳代男性で、7年前に糖尿病性腎症による慢性腎不全の精査中にHIV感染症が判明し、抗レトロウイルス療法(cART)を開始した。6年前に維持透析を導入した。通院は不定期で、服薬アドヒアランスおよびHIV-RNA量のコントロールは不良であった。B型肝炎を発症して受診した。cARTが抗HBV作用を持たない核酸系逆転写酵素阻害剤(NRTI)スペアリングレジメンとなっていたこと、アドヒアランス不良の経緯から複雑な服用方法はさらなる治療効果の低下を引き起こすと考えられたこと、透析がすでに導入されていたことから、cARTをツルバダ配合錠(TVD)を用いたNRTIレジメンへ変更した。HIV-RNA量は検出限界以下を維持するとともにCD4数の上昇を認めた。症例2は70歳代男性で、9年前にカンジダ食道炎の診断をきっかけにHIV感染症が判明した。cARTを開始し、HIV-RNA量ならびにCD4数のコントロールは良好であったが腎機能低下を認めた。慢性腎不全の進行により血液透析を導入した。HBs抗体陽性であることを考慮してNRTIをTVDへ変更した。CD4数は上昇し、HIV量は検出限界以下を維持した。

Recently, certification systems for Board-Certified Psychiatric Pharmacy Specialists (BCPPS) and Board-Certified Pharmacists in Psychiatric Pharmacy (BCPPP) were established by the Japanese Society of Hospital Pharmacists (JSHP) in 2008, to meet the increasing needs for specialists in psychiatric pharmacy. However, there was no report on the background and opinion of pharmacists who have intention to take the BCPPS or BCPPP and/or seminar programs for BCPPS or BCPPP. The Chiba Society of Hospital Pharmacists has started to provide a seminar program certified by the JSHP to study psychiatry for pharmacists and also investigated the participants' background, demand for the program, and issues in taking the BCPPS or BCPPP using questionnaires. We found that many participants wanted lectures to obtain information on issues they face in routine work as well as for certification testing. For many participants, satisfying the requirements for applying for the BCPPS or BCPPP was one of the most important issues in receiving the qualifications. We found that over 40% of participants working at community pharmacies intended to take the BCPPS or BCPPP, although working experience at a community pharmacy does not entitle them to apply for the BCPPS or BCPPP. The intention of community pharmacists indicates that discussion of the requirements for BCPPS or BCPPP certification systems is necessary to improve psychiatric community care. We will plan a practical seminar program with feedback from this investigation.

千葉県病院薬剤師会における精神科専門・認定薬剤師講習会実施の試みと参加者の背景及び専門・認定薬剤師取得に際しての問題点に関するアンケート調査を実施した。「千葉県精神科専門・認定薬剤師講習会」と題した認定講習会を千葉県病薬の精神科専門薬剤師特別委員会で企画検討し、平成20年度は4回実施した。講習会の参加者は認定試験出題基準に関連する事項のほか、日常業務の疑問や課題解決につながる講習の要望が強いこと、専門・認定薬剤師講習会が不足していること、認定申請資格の不足が取得のネックとなっていることが示された。また、現在では認定申請資格に該当しない調剤薬局薬剤師にも高い取得意向が認められることが明らかとなり、専門薬剤師認定制度の検討が求められることが示唆された。