PCN reports : psychiatry and clinical neurosciences最新文献

Background: Klinefelter syndrome (KS) is a disease caused by a 47, XXY sex chromosome abnormality. It has been reported that KS not only causes physical problems but also confers the risk of developing psychiatric disorders, such as schizophrenia, bipolar disorder, and autism spectrum disorder.

Case presentation: Here we present a case of an 18-year-old male with complete KS who developed an acute psychotic episode after COVID-19 infection. The patient presented a catatonic state with stupor, rejection of others, and hallucinations that led him to self-injury. Psychotic symptoms improved in about 2 months with an antipsychotic, aripiprazole.

Conclusion: To our knowledge, this is the first report of a KS patient who acutely developed a psychotic disorder after COVID-19. Vulnerability to psychotic conditions of KS likely manifests as an acute psychotic episode facilitated by the neurotropic effects of COVID-19.

Background: Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition marked by intrusive thoughts and repetitive behaviors. In rare cases, severe contamination or defecation fears lead to extreme dietary restriction and life-threatening malnutrition. Although a handful of cases have been reported, none describe the use of modified electroconvulsive therapy (mECT) in this setting. This report details the first known case of mECT for refractory OCD complicated by critical malnutrition.

Case presentation: A 54-year-old woman with longstanding contamination obsessions who had undergone prior trials of selective serotonin reuptake inhibitors (SSRIs) and exposure-and-response-prevention (ERP)-based cognitive-behavioral therapy (CBT) developed a rapid worsening of defecation fears following the death of her primary psychiatrist. To avoid perceived fecal contamination, she progressively restricted her diet, losing weight from 52 to 32.1 kg (body mass index [BMI] 13.1) and escalating to a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 39/40. Hospitalization for nutritional rehabilitation did not prevent further weight loss; therefore, mECT was initiated on Day 14 under general anesthesia, delivering 19 sessions in total. Symptoms improved rapidly: by the 13th session, her Y-BOCS score had fallen to 18/40, and she was able to consistently resume adequate oral intake. At the 10-month follow-up, she maintained a weight of 50.3 kg and a stable psychiatric status on paroxetine and CBT.

Conclusion: mECT offers a rapid, effective intervention for treatment-refractory OCD complicated by critical malnutrition, achieving prompt symptom relief while simultaneously facilitating nutritional rehabilitation.

Aim: Developmental coordination disorder (DCD) is associated with motor impairments, behavioral and emotional challenges, and elevated parenting stress. While motor-skill training is an effective intervention for DCD, its impact on psychosocial effects remains uncertain. Therefore, in this study, we aimed to evaluate the effectiveness of combined motor-skill training and direct parental support-based intervention in reducing behavioral problems and parenting stress in Japanese children with probable DCD (pDCD).

Methods: A randomized controlled trial was conducted involving 20 children aged 6-15 years who met the diagnostic criteria for pDCD. Group comparisons were performed using the Mann-Whitney U test for non-normally distributed data. Participants were randomly assigned to either an intervention or a control group (n = 10/group). The intervention group received weekly 90-min sessions over 8 weeks, including task-oriented motor training, social skills development, and parental support. Primary outcome measures included the Movement Assessment Battery for Children-Second Edition, Child Behavior Checklist, and the Parenting Stress Index-Child Domain.

Results: No significant improvements in motor function were observed in either group. However, a significant reduction in both behavioral problems and parenting stress was observed in the intervention group, whereas no statistically significant changes were observed in the control group.

Conclusion: The integrated intervention may help reduce parenting stress and alleviate behavioral challenges in children with pDCD. These results highlight the importance of multidimensional support strategies that address both child and parental needs.

Background: Delusional misidentification of the self is a rare psychotic symptom in which individuals misidentify themselves. These symptoms are sometimes accompanied by psychotic renaming, reflecting profound psychological changes in the self. To date, such symptoms have not been fully understood through the lens of the minimal self, especially with respect to the sense of agency (SoA).

Case presentation: We report the case of a patient with schizophrenia who exhibited delusional misidentification of the self. He denied his original name, consistently referred to himself by a female name, and stated that he was a woman. He additionally reported various body alterations, including the belief that he had a female body. These psychological and bodily changes in the self are compatible with reverse intermetamorphosis, a specific subtype of delusional misidentification of the self. He also exhibited Capgras delusion involving his parents. Furthermore, as a distinctive feature, he described a sense of being inserted into and being controlled by an external agent who, strikingly, bore his original name.

Conclusion: These symptoms suggest that a pathophysiology underlying a marked disruption of SoA, accompanied by delusional compensatory mechanisms, may contribute to profound psychological changes in the self. Bodily alterations and a comorbid Capgras delusion may represent additional key pathophysiological features that further disturb the sense of self. A delusional agent may come to significantly dominate the original SoA, and paradoxically, this dominance may generate a unified sense of self centered on the delusional agent.

Background: Psychiatric diseases are increasingly understood as a spectrum or continuous phenomena, ranging from healthy to severely affected, yet neurobiological correlates for these dimensions remain elusive. Regional alteration of iron levels in the central nervous system may reflect neuropathological processes that result in significant impairment of cognitive and behavioral functions. The aim of this study was to characterize brain iron distribution in individuals with common clinical psychiatric disorders and offspring of individuals affected by these disorders.

Methods: R2* magnetic resonance imaging (MRI) based multi-parameter mapping (MPM) algorithm was used to assess regional brain iron distribution in a) individuals diagnosed with bipolar disorder (BD), borderline personality disorder (BPD), attention-deficit/hyperactivity disorder (ADHD), and offspring (n = 80, age = 23 ± 7 y., 61% females), and b) healthy controls and offspring controls (n = 43, age = 25 ± 9, 56% females). Hierarchical cluster analysis (HCA) was used to identify group-divisive patterns of regional brain iron distribution.

Results: Three distinct clusters of regional brain iron distribution were found, differentiating patients and patient offspring from healthy controls and control offspring with 94% sensitivity (OR: 8.9; p = 0.038). Secondary analysis revealed no significant difference in brain iron distribution among BD, BPD, and ADHD diagnoses.

Conclusion: Our finding of a characteristic brain iron distribution pattern in individuals diagnosed with BD, BPD, and ADHD and offspring of diagnosed individuals supports that brain iron patterns may serve as neurobiological correlates for psychiatric disorders conceptualized as spectrum conditions. Further, longitudinal studies are needed to confirm whether pattern analysis of brain iron distribution may represent a transdiagnostic biomarker for a better understanding of underlying neuropathology in psychiatric disorders.

Aim: The co-occurrence of substance use and mental disorders, commonly referred to as a dual diagnosis, presents considerable challenges to the recovery process. Despite its clinical relevance, only a few studies have examined the characteristics correlated with dual diagnoses among individuals utilizing rehabilitation services. Thus, in this study, we aimed to identify the factors associated with dual diagnoses in study participants receiving care at drug rehabilitation support facilities.

Methods: We analyzed data from participants receiving care at drug rehabilitation support facilities, specifically the Drug Addiction Rehabilitation Centers. Multivariable logistic regression analysis was performed to examine the correlations among dual diagnoses and sociodemographic characteristics, facility utilization patterns, substance dependence, physical health, and recovery outcomes at the 1-year follow-up.

Results: Dual diagnosis was notably correlated with the female sex (adjusted odds ratio [AOR] = 4.18, 95% confidence interval [CI]: 2.01-8.67), history of incarceration (AOR = 2.10, 95% CI: 1.35-3.28), and prior treatment for substance use disorder (AOR = 2.22, 95% CI: 1.30-3.91). At the 1-year follow-up, participants with dual diagnoses exhibited poor recovery outcomes across multiple domains; they were more likely to be unemployed (AOR = 2.10, 95% CI: 1.35-3.31) and had greater difficulty maintaining drug abstinence (AOR = 1.85, 95% CI: 1.17-2.94).

Conclusion: Individuals with dual diagnoses were more likely to be female, have histories of incarceration, and have prior treatment experiences. After 1 year, they had poorer outcomes in terms of employment and drug abstinence, highlighting the need for tailored support in recovery programs.

Background: Perampanel (PER) may instigate psychiatric phenomena encompassing irritability and aggression. This study elucidates an epileptic patient in whom PER appeared to exacerbate preexisting psychosis, concomitant with lateralized rhythmic delta activity (LRDA).

Case presentation: A 30-year-old right-handed female initially exhibited focal aware seizures and focal to bilateral tonic-clonic seizures at 21 years of age. Despite administration of multiple antiseizure medications (ASM), she continued to experience weekly seizure episodes. At the age of 26 years, she underwent right selective amygdalohippocampectomy (SeAH) concurrent with vagus nerve stimulation (VNS) implantation. Following this intervention, the seizure frequency diminished from weekly to monthly, albeit not entirely eliminated. Five months postoperatively, the patient displayed paranoid delusions and auditory hallucinations. Her psychotic symptoms were assessed as de novo psychosis. In July of year Y-1, PER was coadministered with Valproic acid, Lacosamide, and Levetiracetam to optimize seizure control, with the dosage escalated to 6 mg by December of year Y-1. Simultaneously, in July of year Y, heightened irritability, aggression, and psychomotor agitation became prominent, necessitating hospitalization in August of year Y. An electroencephalogram (EEG) upon admission revealed LRDA over the right posterior quadrant. Subsequent cessation of PER administration culminated in the resolution of both exacerbated psychiatric symptoms and LRDA within approximately a week.

Conclusion: The observed LRDA in this case may represent cerebral dysregulation, possibly induced by PER, concurrent with the worsening of psychiatric sequelae. Psychosis during PER treatment could signify underlying brain dysfunction, highlighting the potential utility of EEG monitoring in managing these patients.

Aim: This prospective non-randomized controlled study examined the Autonomy-Supportive Circuit Training Program (ASCTP), a structured physical activity intervention. The primary objective was to assess and compare changes in internalizing (emotional symptoms) and externalizing (behavioral difficulties) traits between children with autism spectrum disorder (ASD) and those with subthreshold ASD following ASCTP participation.

Methods: A total of 28 boys (aged 4-10 years) were divided into an ASD (n = 14) and a non-ASD group (n = 14). The ASCTP intervention was developed and implemented in an exercise-focused daycare center for children with disabilities in Japan. The intervention consisted of a structured 45-min exercise program conducted once a week for 6 months. It emphasized an autonomy-supportive and standardized session structure, implemented by trained facilitators, and was specifically designed to support children's self-regulation and individualized activity selection. Emotional and behavioral traits were assessed pre- and post-intervention using the Strengths and Difficulties Questionnaire, completed by the parents. Additionally, the children's lifestyle habits (sleep, screen time, and breakfast consumption) were recorded pre- and post-intervention through parental reports.

Results: The ASD group showed a significant reduction in behavioral difficulties, whereas the non-ASD group exhibited an increase in behavioral difficulties (-1 [-2 to 0] vs. 1 [-1 to 1], adjusted p = 0.034, r = 0.45). Although no significant changes in emotional symptoms were present in either group, a decreasing trend was observed.

Conclusion: Participation in the ASCTP was associated with a reduction in behavioral difficulties in children with ASD, which may reflect the potential benefits of the structured framework of the program. Conversely, the increased behavioral difficulties observed in the non-ASD group may indicate the need for more flexible intervention approaches.

Aim: To understand the preferences of individuals with gender incongruence (GI) regarding gender-affirming surgery (GAS), including gonadectomy.

Methods: A prospective, multicenter survey was conducted in Japan targeting individuals aged 18 years or older with GI who had not yet undergone GAS. Participants completed a questionnaire about their GAS preferences, desired surgical procedures, the reasons for their preferences, and willingness to undergo gonadectomy even if it was not legally required.

Results: In total, 107 participants (82 assigned female at birth [AFAB] and 25 assigned male at birth [AMAB]; median age: 31) participated in the study. Of those, 69% desired GAS, 29% did not, and 2% were undecided. The primary reasons for desiring GAS were the need for legal gender change (positive feelings: 62%, unavoidable: 24%), mental stability (56%), and reducing gender dysphoria (54%). Conversely, the main reasons for not wanting GAS were difficulty in securing funds for surgery (58%), followed by resistance to gonadectomy (41%). Of the 53 AFAB participants, 52 individuals desired hysterectomy and oophorectomy, and 26 wanted only this surgery. Among the 22 AMAB participants, 13 individuals desired vaginoplasty; however, five withdrew due to concerns about costs or postoperative complications. Even without legal requirements, 47% said they would choose gonadectomy.

Conclusion: Reforming legal requirements for gonadectomy may alter the demand for or details of GAS in Japan, yet half of the participants still desire surgery. The primary reason for not undergoing surgery is the difficulty in securing funds, which is a significant finding.

Aim: Adverse childhood experiences (ACEs) have been reported to have a detrimental impact on future mental health. However, limited research exists on how mental health staff perceive service users' ACEs. This study examined the prevalence, types, and related factor of staff-perceived ACEs among community outreach service users using 4-year retrospective data.

Methods: In this retrospective study conducted using service records from the mental health outreach service in Japan, we collected demographic and clinical characteristics, as well as the number and types of ACEs perceived by staff at six assessment points, from registration to 4 years post-service initiation. We compared each clinical characteristic between groups with and without staff-perceived ACEs using independent t-tests and χ ² tests. To analyze changes in staff-perceived ACEs at six time periods, repeated measures mixed models were used, adjusting for sex, age, and diagnosis.

Results: Of the 143 participants whose data were analyzed, the prevalence of ACEs was 54.5%. ACEs were associated with younger age and receipt of public welfare owing to economic deprivation. The number of ACEs notably increased from registration to 6 months post-service initiation and continued to increase 2 years after service initiation and stabilized.

Conclusion: More than half of the participants had ACEs. Outreach service users with ACEs were generally younger and faced economic challenges. While most service users' ACEs are recognized within the first 6 months, it is important to note that they may gradually become apparent over a long period, such as 2 years.