PCN reports : psychiatry and clinical neurosciences最新文献

Aim: While considerable data on the alcohol drinking behavior of the general population are available for the United States and Europe, data from Asian countries are scarce. We attempted to estimate the social backgrounds and other factors associated with high Alcohol Use Disorders Identification Test (AUDIT) scores in Japan.

Methods: This web-based survey was conducted in 2023. In order to ensure the representativeness of the sample, the population distribution by age and region was determined from the Statistics Bureau Census Basic Population Summary. The survey questionnaire items included AUDIT, educational background, occupation, income, marital status, body mass index (BMI), age at the time of the first alcoholic drink, age at the start of habitual drinking, Kessler Psychological Distress Scale (K6), and Link's Devaluation Discrimination Scale.

Results: A total of 40,720 responses were received from people aged between 20 and 75 years old. The proportion of potential alcohol use disorder based on AUDIT score ≥15 was 9.2% in men and 2.0% in women. The number of people with AUDIT scores ≥15 tended to be high in men in their 50s and women in their 20s and 40s. Among those with AUDIT scores ≥15, the age at the first drink and age at the start of habitual drinking were significantly lower, and the K6 score was significantly higher.

Conclusion: This web survey showed an association between AUDIT scores and age at first drinking and mental health condition. Since this survey was a web-monitored survey, caution should be taken in generalizing the prevalence.

Aim: This study aimed to develop and validate a Japanese version of the Public Attitudes Toward Epilepsy (PATE-J) Scale to measure attitudes towards epilepsy among the general Japanese population.

Methods: The study employed a cross-sectional design using an online survey of 537 participants from the general public in Japan, with follow-up surveys at 2 weeks and 3 months. The PATE Scale was translated following standard guidelines and validated by conducting confirmatory factor analysis (CFA) on the complete data set to assess the original two-factor structure of the PATE Scale. Internal consistency assessment, and convergent validity testing with the Modified Epilepsy Stigma Scale (M-ESS), Perceived Devaluation Discrimination Scale (PDDS), and Epilepsy Knowledge Scale (EKS) were carried out.

Results: CFA confirmed the two-factor structure of the PATE-J, comprising "Personal Domain" and "General Domain." The model showed acceptable fit indices (χ²(76) = 607.974, comparative fit index = 0.849, Tucker-Lewis index = 0.820, root-mean-square error of approximation = 0.114, standardized root-mean-square residual = 0.078) and high reliability (Cronbach's α = 0.87 for Personal Domain and 0.75 for General Domain). Strong correlations with the M-ESS (r = 0.713, p < 0.001), and weaker correlations with the PDDS, along with a negative correlation with the EKS (r = -0.306, p < 0.001), highlighted the PATE-J's distinctiveness. No significant associations were found between demographic factors and PATE-J scores.

Conclusion: The PATE-J demonstrates strong psychometric properties and cultural relevance for measuring public attitudes toward epilepsy in Japan. Its validated two-factor structure supports cross-cultural comparisons and provides a reliable tool for assessing public attitudes, informing interventions, and guiding education campaigns.

Aim: This study examines the impact of COVID-19 pandemic-induced behavioral restrictions on child psychiatric inpatients in Japan, particularly focusing on limitations placed on outings and overnight stays as infection-control measures.

Methods: Data were collected from inpatients from the children's mental health registry between January 2016 and December 2022. The clinical data, such as age, gender, diagnosis, result of polymerase chain reaction (PCR) tests, frequency of outings and overnight stays before and after the pandemic, were compared.

Results: During the COVID-19 pandemic, the decrease in both outings and overnight stays among child psychiatric inpatients in Japan was statistically significant. As a result, home interactions with families decreased. In addition, diagnoses of hospitalized children increased significantly in cases of eating disorders and decreased in diagnoses of autism spectrum disorders.

Conclusion: These results underscore the need for flexible, individualized approaches to infection control that consider the mental health of hospitalized children.

Aim: Vaccines have been shown to have the highest efficacy in preventing infectious diseases through their ability to induce immunological memory against pathogens. An adverse reaction to a vaccine is an unexpected medical occurrence following immunization. Complex regional pain syndrome (CRPS) is a disease that has undergone much controversy regarding its onset post-vaccination. This systematic review aims to evaluate cases of CRPS post-vaccination to better understand the manifestation of the disease and its potential association with vaccines.

Methods: A systematic review of case reports was conducted employing the PRISMA 2020 guidelines. Outcomes of interest include type of vaccination, patient age, patient sex, time to symptom onset, and medical history including but not limited to previous autoimmune diseases, psychological illness, physical tissue trauma, and neurological disease.

Results: Initial querying of the five databases yielded 404 articles. Following a thorough review of articles, only 14 remained, comprising 18 cases. Studies included cases of CRPS development following tetanus, hepatitis B, hepatitis A, rubella, influenza, tetanus-diphtheria, human papillomavirus, and COVID-19 vaccine administration.

Conclusion: The limitations of evidence used in this study highlight the need for a greater output of higher-level evidence in the form of controlled trials and retrospective studies to help further elucidate the connection between vaccine use and the development of CRPS in patients. Currently, vaccines continue to be safe for global public use.

Background: Very late-onset schizophrenia-like psychosis (VLOSLP) is a psychotic disorder with an age of onset ≥60 years, and social isolation is a risk factor. Reports on the impact of interventions for isolation and loneliness on psychiatric symptoms in VLOSLP are limited.

Case presentation: An 87-year-old woman, widowed and living alone, developed psychosis, including paranoia, erotomania, and visual hallucinations, at 84 years old during a period when her interactions with others were limited by the COVID-19 pandemic and osteoarthritis. She was eventually brought to our hospital with a local dementia outreach team. She was admitted and diagnosed with VLOSLP with mild cognitive decline through imaging and neuropsychological tests confirming the absence of dementia. Immediately after admission, her psychotic symptoms became inactive. She was transferred to another psychiatric hospital to prepare for her move to a long-term care facility because her psychosis was alleviated. During admission, she enjoyed the company of others and occupational therapy, and her score on the UCLA Loneliness Scale Version 3 improved from 44 at admission to 35 at discharge.

Conclusion: The admission itself improved the patient's psychosis, which seemed to be related to the alleviation of isolation and loneliness.

Background: The population of pregnant women with schizophrenia is increasing. Managing schizophrenia during pregnancy poses unique challenges due to the potential effects of second-generation antipsychotics on maternal mental health and fetal development and changes in drug pharmacokinetics. Evidence on how physiological changes during pregnancy affect the levels of second-generation antipsychotics, particularly lurasidone, is limited. There are no data on effectively managing medications and decreasing side-effects during pregnancy.

Case presentation: We presented the case of a 34-year-old pregnant woman with schizophrenia who had a stable condition with lurasidone therapy before conception. However, she exhibited worsening psychiatric symptoms during the third trimester of pregnancy. Serial measurements of serum lurasidone levels were performed during late pregnancy. Despite maintaining the same dosage, her serum lurasidone levels significantly decreased during the third trimester (maximum decrease of ~65% compared with baseline) and rapidly increased during the postpartum period, coinciding with an improvement in psychiatric symptoms.

Conclusion: Decreased serum lurasidone levels during pregnancy may increase the risk of symptom worsening in patients with schizophrenia. Hence, clinicians should be knowledgeable about the risk of decreased drug levels and the need for therapeutic monitoring and dosage adjustments during pregnancy to maintain treatment efficacy and maternal and fetal health.

Aim: Few studies have investigated the association between premorbid personality and the prognosis of neurotic disorders. The aim of this study was to investigate the relationship between the presence of a "nervous personality" described in Morita's Shinkeishitsu theory and the duration of treatment in patients with neurotic disorders.

Methods: The study included 70 patients aged ≥15 years old who first visited the Department of Psychiatry, Toho University Omori Medical Center, between January 2010 and December 2010 and were diagnosed as having neurotic disorders. The subjects' medical records over a 10-year period from 2010 until 2020 were examined retrospectively to determine the influence of the presence of a "nervous personality" in the subjects on the duration of their treatment.

Results: There were no significant differences in the basic demographic characteristics or severity of illness at the first visit between groups with and without a "nervous personality." The mean and median duration of treatment were 25 months and 5 months in the group with a "nervous personality," and 5 months and 2 months in the group without a "nervous personality," respectively. Kaplan-Meier analysis revealed a significant difference in the duration of treatment between the two groups. Multiple regression analysis performed using treatment duration as the dependent variable identified only presence of a "nervous personality" among the independent variables as a significant factor influencing the duration of treatment, with the duration of treatment being 20 months longer in the group of subjects with a "nervous personality."

Conclusion: The presence of a "nervous personality," as described in Morita's Shinkeishitsu theory, may prolong the required duration of treatment in patients with neurotic disorders.

The individual efficacy and safety of intravenous racemic (IV) ketamine, psilocybin, and theta burst stimulation (TBS) for major depressive disorder have been demonstrated through meta-analyses of randomized controlled trials (RCTs), but the comparative usefulness of these novel treatments has not yet been fully examined. We systematically searched the CENTRAL, Medline, CINHAL, and ClinicalTrials.gov databases for randomized controlled trials up to July 4, 2024. Random-effects network meta-analyses were conducted to compare the Comparative antidepressant effects and safety of intravenous racemic ketamine, psilocybin and theta burst stimulation for major depressive disorderantidepressant efficacy, tolerability, and acceptability of IV ketamine, psilocybin, and TBS. Twenty-eight RCTs were included. All treatments were superior to placebo, with IV ketamine and psilocybin showing significantly greater antidepressant efficacy than TBS. No significant differences were detected between all treatments and placebo in tolerability and acceptability. In a subgroup analysis focusing on short periods of 1 week or less, only IV ketamine was significantly more effective than placebo. In another subgroup analysis focusing on periods of 4 weeks or longer, IV ketamine and psilocybin showed significantly better antidepressant effects than placebo. The confidence in the evidence ranged from very low to moderate. Specifically, there is a scarcity of studies on psilocybin and a lack of direct comparison trials. The findings suggest that IV ketamine and psilocybin may be more effective treatments compared to TBS. Additionally, IV ketamine may have an advantage in terms of rapid onset of action. The number of included studies is limited, especially for psilocybin, and therefore the current findings are preliminary, necessitating further accumulation of direct-comparison RCTs.

Aim: To analyze the drinking habits of individuals who overdosed on over-the-counter (OTC) drugs, such as cough suppressants, antitussives, antipyretic analgesics, and combination cold medications, in Japan.

Methods: This cross-sectional study analyzed data collected from 2881 participants through a national survey conducted in Japan in 2023. Through a self-administered questionnaire, the participants were categorized into OTC (overdosed OTC drugs in the past year) and control (did not overdose OTC drugs) groups. Variables related to drinking habits, social background, smoking habits, use of other medications, such as analgesics, tranquilizers, controlled drugs, and products containing high concentrations of caffeine, and perception of OTC drugs were compared between the two groups. Additionally, we matched the participants in the OTC (n = 25) and control (n = 100) groups by sex and age in a 1:4 ratio to assess these variables. Multivariate analyses were performed to examine how these factors are associated with drinking habits in individuals with OTC drug overdose.

Results: OTC drug overdose was prevalent among teenagers and those in their 50s, and was associated with habitual binge drinking and consumption of energy drinks. Those overdosing on OTC drugs obtained them mostly from drugstores and pharmacies.

Conclusion: This is the first study to show a relationship between drinking habits and OTC drug overdose. An understanding of the characteristics of drinking habits in those who overdose on OTC drugs can help reduce fatal health risks in this population.

Background: Attention-deficit/hyperactivity disorder (ADHD) symptoms, including executive function, emotional regulation, and motivation, can persist into adulthood and are often associated with mental illnesses. Cognitive behavioral therapy (CBT) may help ADHD adults in Japan, but the lack of studies and the variability in group CBT approaches make its effects unclear. Japan lacks unified CBT programs and adult ADHD guidelines, making it difficult to implement international individual CBT recommendations due to cultural differences. This study will assess the feasibility of a novel CBT program for Japanese adult ADHD patients.

Methods: This feasibility study will be open, nonrandomized, single-arm, multicenter study. Twelve ADHD patients aged 20-65 years who are currently receiving treatment will be included based on Conners' Adult ADHD Rating Scale (CAARS) clinical severity threshold. An intervention phase of 12-16 weeks and a 12-week follow-up will total 24-28 weeks for all participants. The intervention will use a new CBT program tailored to individual assessments.

Results: The primary objective is to determine feasibility using dropout rates, adverse events, and CAARS score changes between Weeks 1 and 16. The secondary outcomes will assess long-term effects of treatment beyond the intervention period and provide descriptive statistics on sex, depression, quality of life, and autistic scores in relation to the intervention outcomes. The full analysis set and per protocol set will be used for statistical analysis.

Conclusions: This study is essential for the development of CBT interventions in accordance with Japan's healthcare system that are tailored to the unique needs of its population.