モーズレイ処方ガイドライン第14版（The Maudsley PrescribingGuidelines inPsychiatry 14thEdition）menu open
TOP統合失調症および関連する精神病抗精神病薬の副作用アカシジア

アカシジア

アカシジアは大部分の抗精神病薬でよくみられる副作用であるが，最近承認された抗精神病薬のいくつかを含む特定のSGAは，アカシジアのリスクが低いと考えられる1, 2。3件の無作為化非盲検試験を対象としたプール解析では3，精神病初回エピソード（FEP）におけるアカシジアの発生率は，ハロペリドールで57％，リスペリドンで20％，アリピプラゾールで18％，ziprasidoneで17％，オランザピンで4％，クエチアピンで3.5％であった。lumateperoneとpimavanserinは数ヵ国でしか市販されていないが，予備的データから，lumateperoneはアカシジアのリスクが低いと考えられ4，pimavanserinはハロペリドール誘発性アカシジアを改善する可能性がある5ことが示唆されている。

アカシジアの主な特徴は，落ち着きのない感覚を特徴とする精神的不安および不快感である6, 7。通常，これに伴い運動不穏状態がみられ，重度になると，患者は行きつ戻りつしたり，短時間しか座っていられなくなったりすることもある6, 7。アカシジアにより患者が主観的に感じる不快と自殺念慮の関連が推定されているが8, 9，まだ不確実さが残る。

高用量の抗精神病薬，抗精神病薬の多剤併用，用量の急激な増量を避けることによってアカシジアを予防できる可能性があることを示唆するエビデンスがいくつか認められる6, 10-12。アカシジアのリスクが低い抗精神病薬への切り替え，またはβ遮断薬，5-HT2A受容体拮抗薬，抗コリン薬の追加等，よく行われるアカシジアの薬物療法でさえ，ベネフィット・リスクバランスについてはエビデンスがあまりない13, 14。次の図に，持続する薬剤誘発性アカシジアの治療選択肢プログラムを提案する。

（長井　信弘）

参照文献
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