PCN reports : psychiatry and clinical neurosciences最新文献

Aim: This study examined the longitudinal associations between psychosocial factors in the workplace and the emergence of premenstrual dysphoric disorder (PMDD) symptoms among Japanese female workers, with a particular focus on psychological distress as a potential moderator.

Methods: We conducted a 6-month follow-up of 2000 full-time Japanese female workers aged 20-39 without PMDD symptoms at baseline. PMDD symptoms were assessed at follow-up using a validated PMDD scale. Psychosocial factors in the workplace (job demands, job control, supervisor and coworker support, and workplace rewards) were measured at baseline using the New Brief Job Stress Questionnaire. Psychological distress was assessed using the Kessler 6 psychological distress scale (K6), and participants were stratified by K6 scores (K6 < 5 and K6 ≥ 5). Logistic regression analyses were performed.

Results: Of the eligible participants, 1064 completed both surveys (response rate: 61.6%). In the adjusted models, high job control was associated with the emergence of PMDD symptoms among all participants (odds ratio [OR] = 1.26, p = 0.025) and those with high psychological distress (OR = 1.37, p = 0.011). Job stability was negatively associated with the emergence of PMDD symptoms among participants with high psychological distress (OR = 0.48, p = 0.010). No significant associations were found among those with low psychological distress.

Conclusion: Job stability was a protective factor for the emergence of PMDD symptoms among female workers with high psychological distress, while job control may act as an enhancing factor in the overall sample and among those with high psychological distress. Ensuring job stability might be a measure to prevent PMDD symptoms, especially for female workers with high psychological distress.

Aim: Previous research has primarily explored the negative impacts of caregiving on young carers (YCs)' mental health during childhood and adolescence, with limited focus on emerging adulthood. In particular, quantitative evidence on the development of depression in YCs in emerging adulthood is limited, especially regarding its persistence after caregiving ends. To address this, we aimed to assess the mental health of emerging adults with YC experience by categorizing them into past YCs (pYCs) who no longer provide care and those who continue to provide care (current young adult carer/past YCs, cYAC/pYCs) alongside a non-YCs control group. We also aimed to identify factors contributing to depressive symptoms in these groups, focusing on caregiving-related environmental factors during childhood and adolescence.

Methods: Participants aged 18-25 were recruited online and divided into three groups. Demographic information, depressive/anxiety symptoms, well-being, and peer victimization were assessed, and binomial logistic regression analysis was performed to examine the factors contributing to depressive symptoms.

Results: A total of 162 cYAC/pYCs, 161 pYCs, and 534 non-YCs were analyzed. Both the cYAC/pYCs and pYCs groups had higher levels of depressive and anxiety symptoms than the non-YCs group, with no significant differences between cYAC/pYCs and pYCs. Multivariable analysis demonstrated that female sex, taking care of their own caregiver, solo family caregiving, and experiencing peer victimization were significant predictors of depressive symptoms.

Conclusion: Being a YC has lasting impacts on mental health and the risk of depressive symptoms, emphasizing the need for targeted interventions to support this vulnerable population.

Aim: Japan maintains exceptionally high psychiatric bed numbers and long hospitalization durations compared to global standards. This study examined prefecture-level associations between psychiatric bed supply, occupational therapy (OT) provision, and community welfare resources, and the average length of stay (ALOS).

Methods: We performed a cross-sectional ecological analysis utilizing the 10th National Database of Health Insurance Claims (NDB) Open Data and government hospital statistics from fiscal year 2023. Dataset aggregation covered all 47 prefectures. We calculated standardized indicators per 100,000 population for psychiatric bed density, inpatient and outpatient OT claims, and community-based disability welfare facilities. Standardized multivariate regression modeling was employed to identify variables independently associated with ALOS, strictly evaluating the contributions of regional medical and welfare systems.

Results: The analysis identified that psychiatric bed density was most strongly associated with longer ALOS, which is consistent with the supply-induced demand hypothesis. Crucially, however, the regression model revealed that higher utilization rates of outpatient OT and a greater density of community-based welfare facilities were significantly and independently associated with shorter ALOS. Conversely, the volume of inpatient OT provision did not demonstrate a significant independent effect on shortening hospital stays in the adjusted model.

Conclusion: At the prefectural level, psychiatric bed density was independently associated with longer ALOS, whereas outpatient OT utilization and community-based welfare facility density were independently associated with shorter ALOS. These findings suggest that community-based therapeutic and welfare resources may be relevant to shorter hospital stays, although causal inference is limited by the cross-sectional ecological design.

Aim: Questionnaire-based screening tools for Internet Gaming Disorder (IGD) are widely used in clinical and epidemiological research. However, discrepancies between child self-reports and parent reports may complicate the interpretation of screening results, particularly when cutoff-based classifications are applied.

Methods: Participants were 58 adolescents (aged 10-18 years) attending child and adolescent psychiatry outpatient clinics and their parents. Gaming-related problems were assessed using parallel screening instruments: the Internet Gaming Disorder Scale for Children (IGDS-C) and the Parental version of the Internet Gaming Disorder Scale (PIGDS). Parent-child agreement was examined using dimensional analyses (Pearson's correlation), paired comparisons (paired t-test with Wilcoxon signed-rank test as a sensitivity analysis), and categorical agreement indices (concordance rate, Cohen's κ, and McNemar's test) based on the conventional cutoff score.

Results: Parent- and child-reported IGDS scores were moderately correlated (r = 0.61, p < 0.001), indicating substantial dimensional concordance. However, parents reported significantly higher IGDS scores than children (mean difference = -1.09, p < 0.001), a finding confirmed by the Wilcoxon signed-rank test. Categorical agreement based on cutoff-based screening classifications was low (κ = 0.16), with most discordant cases reflecting parent-positive and child-negative classifications. McNemar's test demonstrated a significant asymmetry in these discrepancies.

Conclusion: Although parent and child IGDS scores demonstrate meaningful dimensional concordance, the application of fixed cutoff-based screening classifications substantially reduces agreement, a pattern that may reflect differences in evaluative thresholds between informants. These findings highlight limitations of relying solely on self-reported cutoff-based measures and underscore the need for multi-informant, dimensional approaches when interpreting IGD screening results in youth.

[This corrects the article DOI: 10.1002/pcn5.70272.].

Aim: Hikikomori, a condition involving prolonged social withdrawal, has become a major public health and social challenge in Japan and many countries. While support institutions are essential for reaching this population, little is known about how their organizational characteristics influence collaboration with other services.

Methods: We conducted a nationwide cross-sectional survey of 1024 hikikomori-related support institutions in Japan between February and March 2021. Institutions were classified using K-means cluster analysis based on staff size, collaboration count, and case volume. Multiple regression models assessed associations between these attributes and levels of external collaboration with health and welfare organizations.

Results: Three distinct institutional clusters were identified. Institutions serving more diverse populations showed higher levels of interorganizational collaboration; a lean, outreach-oriented "Collaborative Core" subgroup exhibited the strongest external engagement.

Conclusion: Structural features such as diversity, functional capacity, and outreach orientation were associated with network collaboration. Policymakers and administrators should consider these structural attributes when designing inclusive and coordinated public mental health services for socially withdrawn populations. The proposed framework may serve as a model for similar contexts across countries.

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a potentially life-threatening neurological condition characterized by thunderclap headaches and multifocal cerebral arterial vasoconstriction resolving within 3 months. Context-dependent diagnostic bias in psychiatric settings may delay recognition of life-threatening conditions including RCVS.

Case presentation: A 52-year-old Japanese woman with bipolar II disorder stable on lithium developed recurrent thunderclap headaches 9 days after mild COVID-19 infection. Headaches were consistently triggered by hot showers, reached maximal intensity within seconds, and were described as the worst headache of her life. Initial neurosurgical evaluation included non-contrast head CT but attributed symptoms to tension-type headache without vascular imaging. The patient, dissatisfied with this explanation, sought re-evaluation through our psychiatry outpatient clinic. Psychiatric consultation identified characteristic RCVS features, prompting urgent referral to a headache specialist. Magnetic resonance angiography on Day 31 revealed multifocal segmental vasoconstriction confirming RCVS. Calcium channel blocker treatment led to complete symptom resolution with radiological resolution confirmed at Day 100.

Conclusion: This case illustrates how context-dependent diagnostic bias can dangerously delay RCVS recognition in psychiatric settings. Thunderclap headache warrants immediate neuroimaging regardless of psychiatric comorbidity. Psychiatric consultation enabled appropriate diagnosis through collaborative evaluation with specialist neurology, underscoring the essential role of consultation-liaison psychiatry at the medical-psychiatric interface.

This scoping review mapped the existing literature on the application of asenapine for delirium management in patients with cancer, including prevention and treatment, while summarizing current research trends. The review followed the methodological framework proposed by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. PubMed and Ichushi-Web were searched on June 30, 2025, using the keywords "asenapine," "delirium," and "cancer." Eligible studies included reports on asenapine management for delirium in patients with cancer. Two reviewers independently screened records and extracted data. Among the six records identified, three studies met the inclusion criteria and were included in this review. Two of these were retrospective observational studies, and one was a case report. One retrospective study described six terminally ill patients treated with sublingual asenapine, showing marked improvement in agitation, as measured using the Richmond Agitation-Sedation Scale. The other study analyzed 20 patients with advanced cancer and reported reductions in the Agitation Distress Scale scores, particularly among those with poor performance status. Moreover, this case report highlighted the successful use of sublingual asenapine in a patient with aphagia unresponsive to other antipsychotic agents. Across the studies, asenapine was generally well-tolerated, with one suspected dysarthria and no serious adverse events. The current evidence is limited in quantity and quality, and no preventive studies were identified. While preliminary findings suggest that sublingual asenapine may be useful and well-tolerated for treating delirium in patients with cancer, further high-quality studies are warranted.