精神科救急医療 ガイドライン（2） - jaep.jp

1 2 Guidelines for Psychiatric Emergency Treatment(2) (Pharmacological Treatment) Version 2009 1990 2003 QT 2009 2007 2007 7 2008 15 2009 25

2 4 21 12 9 I 1 1. 1 2. 1 3. 3 4. 5 5. 7 6. 10 7. 10 II 16 1. 16 2. 17 III 22 1. 22 2. 24 3. 25 4. 26 5. 27 -1- I. 1. 1) 2.

3 1 1) 2) 3) -2- 1. 2009 CT NoYe sYe sN o 2005 Marder 2006 2 2009 -3- 2

4 CT CPK 3. 1) haloperidol risperidone olanzapine -4- 2) lorazepam Modified Overt Aggression Scale (OAS) Brief Psychiatric Rating Scale (BPRS) Hostility-suspiciousness factor 72 risperidone, olanzapine, quetiapine, haloperidol haloperidol (Villari et al.

5 2008) Olanzapine haloperidol 3 20mg Positive and Negative Syndrome Scale (PANSS) Agitation subscale 1 (Kinon et al. 2004) Lorazepam risperidone haloperidol BPRS PANSS 30 90 (Veser et al. 2006) 172 haloperidol risperidone olanzapine BPRS 40% haloperidol (Crespo-Facorro B et al. 2006) haloperidol olanzapine risperidone PANSS Excitement Component (PANSS-EC) 1 olanzapine (Hatta et al. 2008a) quetiapine chlorpromazine olanzapine risperidone 2008 risperidone 1625 PANSS agitation subscale 15 256 (Pajonk FG et al.

6 2005) 88 risperidone 7 14 4 68% PANSS 50% (Yoshimura et al. 2005) Quetiapine 100mg 150mg 200mg 50% 120 40% PANSS-EC (Currier et al. 2006) 40% 25% 2 400mg -5- (Smith et al. 2005) Aripiprazol PANSS-EC 2 6 (Marder et al. 2007) olanzapine risperidone benzodiazepine haloperidol benzodiazepine Quetiapine perphenazine Chlorpromazine (Allen et al. 2005) 2008 12 170 31% 78% risperidone 1 Olanzapine 8% levomepromazine 6% olanzapine 52% levomepromazine 14% risperidone 12% haloperidol 11% quetiapine 9% zotepine 7% lorazepam 6% 2007 (Hatta et al.

7 2008) risperidone olanzapine 1 9 9 1 6 risperidone olanzapine 1 4. 1) haloperidol promethazine 2) haloperidol biperiden haloperidol benzodiazepine 37 2mg lorazeam 5mg haloperidol 30 4 BPRS Clinical Global Impressions (CGI) -6- (Foster et al. 1997) haloperidol lorazepam 9 lorazepam 11 60 OAS (Bieniek et al.

8 1998) 98 haloperidol lorazepam (Battaglia et al. 1997) lorazepam diazepam haloperidol diazepam (Marder 2006) 200 lorazepam (4mg) haloperidol 10mg promethazine 25-50mg haloperidol promethazine 2 (Alexander et al. 2004) 316 haloperidol 5-10mg haloperidol 5-10mg promethazine 25-50mg haloperidol promethazine 20 (Huf et al. 2007) 120 10 haloperidol 300 olanzapine haloperidol promethazine 4 olanzapine 43% haloperidol promethazine 21% (Raveendran et al.

9 2007) haloperidol promethazine Midazolam 111 midazolam 5mg haloperidol 5mg lorazepam 2mg midazolam SD14 haloperidol SD25 lorazepam SD20 midazolam (Nobay et al. 2004) midazolam haloperidol lorazepam midazolam 301 midazolam haloperidol promethazine 20 midazolam 89% haloperidol promethazine 67% midazolam (TREC Collaborative Group 2003) 1 90% midazolam 1 midazolam RCT haloperidol promethazine-7- (Huf et al.

10 2005) 1 haloperidol 68% levomepromazine 24% diazepam 4% levomepromazine 46% haloperidol 17% diazepam 12% hydroxyzine 2% 2% Levomepromazine 9 7 1 20 30 (Dubin 1988; Taylor D et al. 2001) 5. 1) haloperidol benzodiazepine barbiturate haloperidol benzodiazepine 2) Benzodiazepine flumazenil 3) Benzodiazepine barbiturate 4) haloperidol 5) benzodiazepine benzodiazepine haloperidol haloperidol benzodiazepine barbiturate haloperidol benzodiazepine benzodiazepine haloperidol benzodiazepine (Hatta et al.