PCN reports : psychiatry and clinical neurosciences最新文献

Background: Celiac disease (CD) is an autoimmune-mediated systemic disorder triggered by the ingestion of gluten. While it typically presents with gastrointestinal symptoms, it is also associated with various neuropsychiatric manifestations, including depression, migraine, developmental disorders, and epilepsy. In Asia, particularly in Japan, CD remains underdiagnosed, potentially delaying appropriate diagnosis and treatment for early intervention.

Case presentation: We report the case of a 16-year-old girl who presented with long-standing behavioral issues, including repeated theft and rule violations since elementary school. She was diagnosed with attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder, but responded poorly to psychiatric treatment. In light of her coexisting physical symptoms, including chronic gastrointestinal complaints and unexplained laboratory abnormalities, further evaluation, including a duodenal biopsy, was conducted. The diagnosis of CD was confirmed, and a gluten-free diet was initiated. Following dietary intervention, both her psychiatric and physical symptoms improved significantly, and no recurrence was observed during follow-up.

Conclusion: This case highlights the importance of considering CD as a differential diagnosis in adolescents with treatment-resistant psychiatric symptoms, especially when accompanied by physical signs suggestive of systemic disease. Early recognition and intervention with a gluten-free diet may improve both psychiatric and physical outcomes.

Aim: This study aimed to examine the impact of grief and depression on reduced productivity in and outside work among bereaved family members of individuals with cancer.

Methods: We used the data from the J-HOPE-4 study, a nationwide cross-sectional survey involving the bereaved families of individuals with cancer in inpatient hospices and palliative care units across Japan. We evaluated the participants' level of grief on the Brief Grief Questionnaire, their level of depression on the Patient Health Questionnaire, and their level of productivity loss on the Work Productivity and Activity Impairment Questionnaire.

Results: Of the participating 902 bereaved families, 98 individuals (10.9%) corresponded to probable prolonged grief disorder (PGD) and 367 (40.7%) to possible PGD. Of the 217 individuals (24.1%) corresponded to mild depression, 89 (9.9%) to moderate depression, and 44 (4.9%) to moderate-to-severe depression. The work-related productivity losses in possible and probable PGD samples were 12.6% and 15.7%, respectively. The work-related productivity losses due to mild, moderate, and moderate-to-severe depression were 8.8%, 19.4%, and 32.5%, respectively. The productivity losses outside work in individuals with possible and probable PGD were 21.6% and 30.9%, respectively. The productivity losses in mild, moderate, and moderate-to-severe depression were 22.6%, 32.8%, and 37.0%, respectively.

Conclusion: The impact of grief on productivity loss was comparable with that of mild to moderate depression. Both the severity of grief and depression were significantly associated with productivity losses outside work, while only depression was significantly associated with work-related productivity loss.

Aim: This pilot study evaluated the feasibility, safety, and preliminary effectiveness of a mindfulness-based weight loss program-Mindful Eating and Lifestyle (MEAL)-implemented in an occupational setting in Japan.

Methods: This retrospective study was conducted between July 31, 2019, and May 31, 2022, at a branch office of a manufacturing company. Of 5016 employees who received annual health check-ups in 2019, 632 met the company's occupational health criteria for weight management and were informed of the MEAL program. Eleven employees who participated in the MEAL program and provided written informed consent were included in this retrospective study. The MEAL program consisted of four 60-min group sessions over 2 months, incorporating third-wave cognitive behavioral therapy (CBT) strategies. Sessions included guided mindfulness practices (breathing and mindful eating to notice hunger, satiety, and emotions) and promoted flexible "quality over quantity" eating. Data on program completion, safety, and body weight were extracted from routine health records with prior informed consent. Paired t-tests were used to analyze weight change among participants with complete data.

Results: All 11 participants completed all four sessions, yielding a 100% completion rate. No adverse events were reported. Among the seven participants with complete weight data, a significant reduction in body weight was observed: from 76.1 kg (SD = 19.6) to 74.8 kg (SD = 19.4), with a mean difference of -1.4 kg (95% CI: -1.9 to -0.8; p = 0.001).

Conclusion: The MEAL program demonstrated high feasibility, safety, and potential short-term effectiveness in a real-world workplace setting. Further research is needed to confirm long-term outcomes and generalizability.

Aim: Cost and probability biases are known to predict improvements in symptoms of social anxiety disorder (SAD). This study developed a high-intensity mindfulness and cognitive behavioral group therapy (M-CBT) program-comprising mindfulness training, psychoeducation, cognitive restructuring, exposure exercises, and group　sharing-designed to reduce these biases. The intervention was delivered in a group format, and its preliminary efficacy in patients with SAD was evaluated in a pilot single-arm trial.

Methods: Patients (N = 10) diagnosed with SAD through a structured clinical interview participated in an eight-session M-CBT program. They completed a set of questionnaires assessing SAD symptoms, cost and probability biases, fear of negative evaluation, self-focused attention, depressive symptoms, subjective happiness, dispositional mindfulness, cognitive reappraisal, and suppression at pre-intervention, mid-intervention, post-intervention, and follow-up.

Results: Analyses using linear mixed-effects models revealed that high-intensity M-CBT produced improvements in SAD symptoms, cost and probability biases, depressive symptoms, subjective happiness, dispositional mindfulness, and cognitive reappraisal (p < 0.05). The intervention also yielded significant reductions in cost and probability biases from pre- to post-treatment and at follow-up, with large effect sizes (cost bias: Cohen's d = 0.85-1.27; probability bias: d = 1.07-2.42). In contrast, the effect sizes for SAD symptoms were moderate (d = 0.57-0.67).

Conclusions: These findings suggest that high-intensity M-CBT can alleviate SAD symptoms and reduce cost and probability biases. Moreover, delivering M-CBT in a high-intensity format appears to be effective for individuals with SAD. Future randomized-controlled trials are warranted to more rigorously confirm these effects.

Aim: To translate, culturally adapt, and psychometrically validate the Japanese version of the Death Literacy Index (DLI-J) and its short-form version (DLI-J-9) to assess death literacy among Japanese adults.

Methods: A multiphase mixed-methods design was employed. The process included forward translation, reconciled single translation, back translation, translation review, cognitive interviews (n = 8), and psychometric validation using a nationally representative online sample of 2500 Japanese adults aged 20-79 years. Participants completed an online survey, with a subsample (n = 300) completing a retest after 4 weeks. Confirmatory factor analysis (CFA), internal consistency, construct validity, and test-retest reliability were evaluated.

Results: The DLI-J demonstrated excellent psychometric properties. CFA supported the six-factor structure of the DLI-J (Tucker-Lewis index [TLI] = 0.940, comparative fit index [CFI] = 0.947, standardized root mean square residual [SRMR] = 0.048, and root mean square error of approximation [RMSEA] = 0.063) and the two-factor structure of the DLI-J-9 (TLI = 0.945, CFI = 0.960, SRMR = 0.042, and RMSEA = 0.069). Internal consistency was excellent for the total DLI-J scale (α = 0.959) and all subscales (α = 0.870-0.959). Convergent validity was supported by positive correlations with death competency, whereas discriminant validity was confirmed by negligible correlations with loneliness. Known-groups validity was established, with higher scores among bereaved individuals and end-of-life care professionals. The test-retest reliability was moderate to good (intraclass correlation coefficient [ICC] = 0.515-0.819). The overall DLI-J mean score was 3.82 (standard deviation = 1.91), lower than international benchmarks. Floor effects were observed in the hands-on care, accessing help, and community support subscales.

Conclusion: The DLI-J and DLI-J-9 are psychometrically robust instruments for assessing death literacy.

[This corrects the article DOI: 10.1002/pcn5.70243.].

Aim: Work-family conflict has been associated with depression, but it remains under-examined, particularly in population-representative studies. Furthermore, factors modifying this association have not been fully explored. This study investigates the associations of work-to-family conflict (WFC) and family-to-work conflict (FWC) with depressive symptoms in a community-representative Japanese working population. Whether social support and household income modified this association was also examined.

Methods: A baseline survey of the Japan Public Health Center-based Prospective Study for the Next Generation was conducted, employing a population-based cohort design across 16 municipalities in seven prefectural areas of Japan from 2011 to 2016, focusing on workers aged 40-64 years. A multiple logistic regression model was used to examine the association.

Results: A total of 56,636 participants were included. Multivariate adjusted odds ratios (ORs) of depressive symptoms for higher WFC were 2.94 (95% confidence interval (CI): 2.72-3.17) for men and 3.17 (95% CI: 2.95-3.39) for women, with reference to lower WFC; the ORs of depressive symptoms for higher FWC were 2.35 (95% CI: 2.19-2.53) for men and 2.99 (95% CI: 2.79-3.21) for women, with reference to lower FWC. In women, a statistically significant interaction with social support was observed.

Conclusion: WFC and FWC were associated with depressive symptoms in both genders in the Japanese working-age population. Additional studies are necessary to fully understand the modification of these associations.

Background: Schizophrenia spectrum disorders (SSDs) and autism spectrum disorder (ASD) share social-cognitive deficits, genetic architecture, and overlapping animal models, yet the neurochemical signatures that differentiate them remain unclear. This protocol describes a systematic review and meta-analysis of proton magnetic resonance spectroscopy (¹H-MRS) studies examining glutamate, glutamine, and their combined signals. The primary aim is to establish a human neurochemical benchmark to guide translational research.

Methods: Eligible studies will be those measuring ¹H-MRS glutamatergic metabolites at ≥3 T field strength in at least one of five brain regions: anterior cingulate cortex, dorsolateral prefrontal cortex, hippocampus, striatum, or thalamus. Adults (≥18 years) with SSD (stratified as ultra-high risk, first-episode psychosis, and treatment-resistant schizophrenia) and ASD diagnosed using standardized criteria will be compared to healthy controls. Systematic searches will be conducted in databases. Two independent reviewers will assess the risk of bias using the AXIS (Appraisal Tool for Cross-Sectional Studies) and MRS-Q (Magnetic Resonance Spectroscopy Quality Assessment Tool). Primary outcomes will be regional differences in metabolite concentrations. We will conduct random-effects meta-analyses integrating direct and indirect comparisons, with subgroup analyses by illness stage and medication status.

Results: We expect to identify both shared and distinct glutamatergic alterations across SSD subgroups and ASD, with potential stage-specific patterns in cortical and subcortical regions.

Conclusions: This comprehensive analysis aims to identify regional brain glutamatergic biomarkers differentiating SSD and ASD. These neurochemical signatures will provide an essential reference framework for validating and guiding reverse-translational research.

Prospero registration number: CRD420251003550.

Aim: 22q11.2 deletion syndrome (22qDS) is the most common copy-number-variation disorder, associated with multi-organ anomalies and elevated risk for schizophrenia and other neuropsychiatric conditions. Previous metabolomic studies have used blood samples, implicating mitochondrial dysfunction and amino acid imbalance, but no urinary metabolomic analysis has been reported. We aimed to characterize the urinary metabolomic profile of 22qDS.

Methods: We conducted an exploratory study comparing urine from 10 individuals with 22qDS and 10 age- and sex-matched healthy controls. Metabolites were quantified using capillary electrophoresis time-of-flight mass spectrometry and liquid chromatography time-of-flight mass spectrometry. Data were analyzed using principal component analysis and Wilcoxon rank-sum tests with false-discovery-rate adjustment.

Results: Principal component analysis indicated separation between groups. Several metabolites differed significantly, defined by a false discovery rate q < 0.20 and fold change > 1.5 or <0.67. Elevated metabolites in 22qDS included 2-hydroxyglutaric acid, p-cresol sulfate, p-cresol glucuronide, trimethylamine-N-oxide, and 3-indoxylsulfuric acid, whereas citrulline and lysine were reduced. These metabolites are implicated in mitochondrial dysfunction, amino acid imbalance, and gut microbial dysbiosis. A substantial proportion of altered metabolites corresponded to those previously reported in autism spectrum disorder (ASD), predominantly microbiota-related.

Conclusion: This first urinary metabolomic study of 22qDS demonstrates systemic metabolic alterations, including mitochondrial and microbiota-associated changes. The overlap with ASD is suggestive of a possible shared metabolic signature. Our findings provide initial insights into systemic and microbial contributions to neuropsychiatric vulnerability in this genetically defined high-risk population.

Aim: The coronavirus disease 2019 (COVID-19) pandemic has had a significant psychological impact on children and adolescents, increasing depression, anxiety, and suicide-related behaviors. In Japan, suicide remained the leading cause of death among individuals aged 10-19 years, with rates rising after the pandemic onset. However, few studies have examined these changes in psychiatric outpatient settings. We aimed to determine whether the prevalence of suicide-related behaviors and associated psychiatric symptoms-depression and anxiety-differed pre- and post-pandemic among elementary and junior high school students attending psychiatric outpatient clinics.

Methods: In this retrospective case-control study, we analyzed registry data from a child and adolescent psychiatric outpatient clinic in Japan. Patients were classified into pre- and post-COVID-19 groups based on the visit date (cutoff: March 2, 2020). Clinical characteristics were assessed at the initial visit through interviews and standardized rating scales: Depression Self-Rating Scale for Children, Spence Children's Anxiety Scale, and Attention-Deficit/Hyperactivity Disorder Rating Scale-IV. Group differences were examined using univariate and multivariate logistic regression analyses.

Results: Between 2016 and 2022, 2878 patients were included. The prevalence of suicide-related behaviors increased post-pandemic, from 3.0% to 6.9% among elementary school students and from 15.5% to 21.2% among junior high school students. In the post-COVID-19 group, elementary students more often exhibited antisocial behaviors and hyperactivity/conduct disorder diagnoses. Junior high students more often exhibited anxiety symptoms, particularly social anxiety, panic, and trauma-related fear.

Conclusion: Suicide-related behaviors significantly increased after the COVID-19 pandemic, with distinct clinical characteristics observed across age groups.