PCN reports : psychiatry and clinical neurosciences最新文献

Background: Ketoacidosis, a life-threatening disease, can be caused by diabetes, alcohol consumption, and severe malnutrition, which are not uncommon in psychiatry. Diabetic and alcoholic ketoacidosis (AKA) are particularly frequent, and differentiating between these two is essential in terms of the substantially different treatment interventions. In recent years, the advent of sodium-glucose co-transporter 2 (SGLT2) inhibitors has made this distinction more difficult, mainly due to the increase in euglycemic diabetic ketoacidosis (euDKA)-ketoacidosis in normal or near-normal blood sugar levels-in the presence of SGLT2 inhibitors.

Case presentation: We describe a 52-year-old man's case of severe euDKA caused by an SGLT2 inhibitor with alcohol use disorder. We initially suspected mainly AKA due to his mild disturbance of consciousness, habitual high intake of alcohol, and almost normal blood glucose level (142 mg/dL). We administered supplemental fluids and vitamin B complex instead of insulin, which is needed for euDKA, but his disorientation and metabolic acidosis worsened. Upon recognizing his inadequate response to fluid replacement and considering his history of SGLT2 inhibitor use, we identified euDKA as the primary pathology. Implementing continuous insulin therapy and tight glycemic control resulted in a rapid improvement in the patient's condition.

Conclusion: Even with normal or near-normal blood sugar levels in a patient with suspected AKA, missing the possibility of euDKA can be fatal. Therefore, psychiatrists should remain vigilant for euDKA, especially in patients using SGLT2 inhibitors, by conducting frequent blood gas examinations.

Aim: Early detection and intervention for mental disorders are essential to prevent worsening symptoms. This study investigates the socioeconomic determinants of consulting a physician for mental distress among the general Japanese population, with a particular focus on individuals with moderate distress, a group often overlooked in early intervention strategies.

Methods: We analyzed data from the 2019 Comprehensive Survey of Living Conditions, a nationally representative dataset by the Ministry of Health, Labour and Welfare. The study included 2055 individuals aged 20-64 years. Consulting a physician for mental distress was defined based on self-reported consultations about worries or distress. Socioeconomic factors such as age, gender, employment, household income, smoking, and drinking status were examined using binary logistic regression, with mental distress levels measured by the Kessler Psychological Distress Scale (K6) as a key independent variable.

Results: Among respondents, 6.4% reported consulting a physician for mental distress. Higher levels of mental distress were significantly associated with increased consultation, while moderate distress showed no significant association compared to low distress. Younger individuals, women, employed persons, and drinkers were less likely to consult a physician. These findings indicate a potential care gap among moderate distress individuals who recognize their distress but do not seek professional help.

Conclusion: To address the unmet needs of individuals with moderate mental distress, flexible and accessible support channels such as anonymous consultations via social media and workplace mental health programs are urgently needed. Tailored interventions could enhance early help-seeking and prevent symptom escalation. Future research should explore targeted outreach strategies to close this support gap.

Aim: This study investigates patterns of stress responses (SR), stressors, and social support (SS) among high school students using a dataset from a web-based stress check system, aiming to identify students experiencing high stress or money worries.

Methods: After obtaining informed consent from both students and their parents, high school students were assessed using the Public Health Research Foundation-Type Stress Inventory and additional questions to screen for money worries. Latent class analysis was used to identify stress patterns, and multinomial logistic regression was applied to explore risk factors.

Results: Among all the students (n = 6894), five latent classes were identified: "high SR & low SS" (17.8%), "high SR & SS" (14.2%), "moderate SR" (29.8%), "low SR & SS" (11.8%), and "minimal SR" (26.4%). Students with money worries (n = 630) were 3.78 times more likely to be in the "high SR & low SS" class compared to the "minimal SR" class (odds ratio [OR] = 3.78, p < 0.001). Further analysis revealed that students with money worries could be divided into three groups: "low SR" (40.5%), "moderate SR" (28.4%), and "high SR" (31.1%). The low SR group had high SS, while the moderate and high SR groups reported lower SS.

Conclusion: Our findings suggest that money worries may be linked to higher stress levels among students. A web-based child stress check could be a valuable tool for identifying students at risk of mental health issues and money worries. Further research is necessary to explore stress-check systems for adolescents.

Aim: In adolescence, peer relationships and leisure engagement become central to well-being. This study aimed to characterize the hobbies of boys with autism spectrum disorder (ASD) and examine whether engagement in peer-shared hobbies is associated with higher quality of life (QOL) across school stages (upper elementary vs. middle school).

Methods: This exploratory cross-sectional study included boys with ASD in Japan (N = 71). Participants reported hobby types and whether they engaged in these hobbies with friends. QOL was assessed using a validated child-reported instrument with six subscales and a total score. Group differences (with vs. without peer-shared hobbies) were tested for each school stage using independent-samples t-tests; effect sizes (Cohen's d) and both uncorrected and Holm-Bonferroni-adjusted p-values were reported. Proportions were compared with χ ² tests.

Results: Many boys expressed a desire to play with friends, but only 36.8% of upper elementary boys and 21.2% of middle school boys did so. Middle school boys with peer-shared hobbies showed higher unadjusted total QOL than those without such hobbies (e.g., t(31) = 2.55, p = 0.016; d = 1.04), with small-to-large advantages on several subscales; however, these differences did not remain statistically significant after Holm-Bonferroni correction. Age-group comparisons suggested increasing difficulty in achieving peer-shared hobby engagement from late childhood to adolescence.

Conclusion: Findings suggest that hobby-based engagement with peers may be an important-but underrealized-pathway to better QOL in boys with autism. Larger, preregistered studies are warranted to confirm these associations and inform interventions that leverage shared hobbies as a scaffold for social connection and well-being.

Neurofeedback, a technique enabling individuals to regulate their brain activity in real time, has gained momentum as both a clinical intervention and a tool for cognitive and performance enhancement. This review synthesizes findings from 65 studies to evaluate the current state of neurofeedback research. We outline its historical development, methodological approaches, and technological innovations, including advances in connectivity-based and multimodal feedback paradigms. Applications across clinical disorders, such as attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), depression, and autism, as well as performance optimization, are critically examined, with emphasis on efficacy, limitations, and translational challenges. To enhance transparency, we summarize methodological trends and provide integrative insights that cut across individual studies. We further discuss persistent limitations, including methodological heterogeneity and placebo-related concerns, and highlight future directions such as personalization, multimodal integration, and interdisciplinary collaboration. By consolidating evidence across diverse domains, this review positions neurofeedback as a rapidly evolving field with significant therapeutic and translational potential.

Aim: The Effectiveness of Guideline for Dissemination and Education in Psychiatric Treatment (EGUIDE) project has improved psychiatrists' adherence to guidelines and their treatment behavior for hospitalized patients. However, treatment behavior toward outpatients has not been sufficiently investigated. This study aimed to examine the effects of the EGUIDE program on the clinical behavior of psychiatrists toward outpatients with major depressive disorder (MDD).

Methods: A comparative study was conducted among outpatients at seven facilities. The study included 255 patients who had received a primary diagnosis of MDD at the initial visit and had been followed for 6 months or more since the initial visit. The prescription types were investigated at the 6-month follow-up. The primary outcomes were the rate of severity diagnosis, the rate of antidepressant monotherapy without other psychotropics, the rate of antidepressant monotherapy, the rate of no anxiolytic/hypnotic prescriptions, and the rate of intermittent psychotropic medication prescription. The secondary outcomes were the imipramine equivalent dose of antidepressants and the diazepam equivalent dose of anxiolytics/hypnotics.

Results: Patients treated by psychiatrists who were participating in the EGUIDE project had a significantly higher rate of severity diagnosis than patients treated by psychiatrists who were not participating in the EGUIDE project. However, there were no significant differences in the other primary outcomes. In terms of the secondary outcomes, the diazepam equivalent dose was significantly lower in patients treated by psychiatrists who were participating in the EGUIDE project.

Conclusion: Participation in the EGUIDE project was associated with improved severity diagnosis rates among outpatients with MDD, but its effect on prescribing behaviors was limited.

Aim: In Japan, drug-related issues are diverse, and the use of cannabis and pharmaceuticals is rising. This study aimed to clarify the differences in clinical characteristics and treatment resource utilization by drug type.

Methods: We analyzed data from 891 individuals from the 2024 Nationwide Psychiatric Hospital Survey, which comprised 368 who used methamphetamine or cannabis (illegal drug group) and 523 who used hypnotics, anti-anxiety, or over-the-counter medications (pharmaceutical group). Clinical characteristics and use of treatment resources were compared by estimating risk differences and conducting logistic regression analyses.

Results: The pharmaceutical group had more young women, individuals who engaged in self-harm, and those with comorbid psychiatric disorders than the illegal drug group. The illegal drug group had more males and individuals aged 30 years or older, with many meeting criteria for dependence syndrome. Moreover, they showed significantly higher use of outpatient group therapy, self-help groups, and rehabilitation facilities. In the logistic regression analysis, the pharmaceutical group was independently associated with female sex, self-harm, and comorbid psychiatric disorders, and were less likely to use outpatient group therapy but more likely to have a history of psychiatric hospitalization.

Conclusion: Illegal drug users more frequently accessed addiction-specific services, whereas pharmaceutical users were more likely to receive psychiatric interventions. This suggests that pharmaceutical users have difficulty accessing traditional rehabilitation resources. Therefore, there is a need for a more comprehensive system that collaborates with general psychiatric care and offers flexible and tailored support.

Aim: Although numerous Interprofessional Education (IPE) programs exist for students, those specifically designed for actual professionals remain limited. To address this, we developed the Psychiatric Staff Education Program for Transdisciplinary Approach (PsySEPTA), an online IPE program tailored for mental health and related professionals. PsySEPTA provides systematic training covering both foundational psychiatric knowledge and interprofessional collaboration. This study investigates how participation in PsySEPTA influences participants' network structures, using network analysis.

Methods: Before and after the one-year program, we conducted surveys using the name generator method. Participants were asked to list up to four professionals with whom they regularly collaborate in their workplace. We then performed network analysis and computed various structural metrics.

Results: We analyzed the responses of 53 participants from 12 different professions. Degree centrality showed mixed patterns of change across professions. Highly connected professions (initial degree ≥ 40) showed decreased centrality post-program (e.g., nurses decreased from 82 to 74, midwives from 60 to 55, mental health social workers from 46 to 40), while several less connected professions increased (e.g., care managers from 6 to 14, public health nurses from 19 to 21, social workers from 9 to 11). The betweenness centralization, overall network metrics, increased after the program.

Conclusion: This study is among the few that examine the evolution of professional communication networks associated with an IPE program for working professionals. The findings suggest that PsySEPTA may have helped participants expand their scope of collaboration, potentially enabling more seamless and effective interprofessional engagement.

Aim: This study examines the issues of over-the-counter (OTC) drug abuse among adolescents from the perspective of deliberate self-harm and suicide. It aims to elucidate the clinical characteristics of psychiatric disorders related to OTC drug use and explore treatment approaches in the context of self-harm and suicide prevention.

Methods: The study analyzed 93 adolescent cases (ages 10-19) of psychiatric disorders primarily attributed to OTC drug use, extracted from the "2024 Nationwide Survey on Drug-Related Psychiatric Disorders in Psychiatric Medical Facilities in Japan." Cases were categorized into two groups based on the presence or absence of incidents of deliberate self-harm within the past year. Clinical variables were compared between the two groups.

Results: Incidents of deliberate self-harm within the past year were observed in 82.8% of the cases. Clinical features significantly associated with deliberate self-harm included being female, having an educational level of high school dropout or lower (including current enrollment in middle or high school), and engaging in sub-threshold drug use not meeting the diagnostic criteria for addiction. Furthermore, recent OTC drug use, severity of substance use disorder, and the presence of comorbid psychiatric disorders were not associated with "deliberate self-harm" among adolescents with OTC-related psychiatric disorders. The use of existing medical or non-medical resources designed for drug addiction treatment was also not associated with self-harming behavior.

Conclusion: From the standpoint of suicide and self-harm prevention, conventional approaches centered on substance use disorder treatment and recovery support may not be sufficiently effective for this population.