PCN reports : psychiatry and clinical neurosciences最新文献

Background: Donepezil, an acetylcholinesterase inhibitor commonly used to treat Alzheimer's disease (AD), is generally well tolerated. There have been no previous reports on donepezil-induced obsessive-compulsive disorder (OCD).

Case presentation: The patient, a retired man in his 70s diagnosed with AD, displayed OCD symptoms following donepezil initiation, exacerbating post-stroke-specifically, a cerebral infarction in the right posterior limb of the internal capsule. Remarkably, the symptoms abated upon discontinuation of donepezil.

Conclusion: Caution should be exercised when using donepezil in patients with a history of stroke.

The behavioral variant of frontotemporal dementia (bvFTD) is thought to be the commonest clinical presentation of frontotemporal lobar degeneration and is predominantly characterized by changes in behavior. In patients lacking unequivocal biomarker evidence of frontotemporal neurodegeneration, the clinical diagnosis of bvFTD is often unstable. In response, we conducted a systematic review and critical appraisal of cognitive and behavioral tools that have sought to differentiate bvFTD from other conditions. A systematic literature review of PubMed, Scopus, and Web of Science was conducted on December 31, 2023 for cognitive and behavioral tools that differentiated bvFTD from other cohorts. Ninety-six studies were included. The quality appraisal of almost all studies was low and introduced a high risk of bias. The few studies that were of high quality had a prospective study design and recruited patients suspected (but not yet confirmed) to have bvFTD. These studies reported that behavioral tools (e.g., the Frontal Behavioral Inventory) and social cognition tests (e.g., the Ekman's Faces Test) had good test performance in differentiating bvFTD from a broad range of psychiatric and neurological conditions. Importantly, the review highlighted the extreme paucity of studies that have evaluated methods where, in Bayesian terms, there is genuine clinical uncertainty regarding a diagnosis of bvFTD. Most studies used healthy controls of typical Alzheimer's disease as comparators-groups that often have negligible pretest probability of bvFTD. In response, we propose a study design checklist for studies seeking to develop diagnostic algorithms in bvFTD research.

Background: Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder affecting many behaviors in daily life. Hyperactivity of the fronto-striato-thalamic circuit via the orbitofrontal cortex (OFC) is assumed to play a major role in the pathophysiology of OCD; however, its pathogenesis is not fully understood. Several reports have described the development of OCD after traumatic brain injury (TBI); however, the pathogenesis of post-TBI OCD remains unknown. Moreover, patients with TBI often have a variety of sequelae, including cognitive dysfunction and mood disorders, which make the diagnosis and treatment of OCD more complex.

Case presentation: We report the case of a 17-year-old Japanese male who developed OCD after traffic trauma. The patient developed a fear of contamination and checking compulsion after injuring his right OFC and left temporal lobe when he ran into a running truck during a suicide attempt. We believe that the patient's fear of contamination can be diagnosed as true post-TBI OCD. However, his memory impairment was significant, and we considered his checking compulsion to be strongly influenced by cognitive dysfunction due to TBI. We attempted behavioral therapy for OCD; however, sufficient results were not achieved because of the interference from the sequelae of TBI.

Conclusion: It is not rare for OCD symptoms to appear after TBI. Differentiating the OCD symptoms induced by brain injury or cognitive dysfunction associated with TBI is important to determine a treatment strategy.

Aim: This study investigated the association between COVID-19 pandemic-related work environment changes and suspected post-traumatic stress disorder (PTSD) in Japanese workers.

Methods: A web survey of 1104 workers was conducted in Japan between February 24 and March 2, 2021. The Japanese version of the Impact of Event Scale-Revised and questions regarding work environments and COVID-19 pandemic-related lifestyle changes were used.

Results: PTSD was suspected in 19.7% of respondents and was significantly higher in men (22.2%) than in women (17.2%). Being older and having an independent business were associated with decreased suspected PTSD risk. Longer online work hours, decreased sleep duration, and alcoholism were associated with increased suspected PTSD risk. When stratified by sex, long online work hours and fewer years of service were associated with increased suspected PTSD risk in men. An association between alcoholism and suspected PTSD was also observed in men. Younger age and decreased sleep duration were significantly associated with suspected PTSD in women.

Conclusion: Younger men with shorter work service duration were particularly vulnerable to pandemic-related PTSD, emphasizing the risks associated with long online work hours and alcoholism in men. Decreased sleep duration was a PTSD predictor in both sexes, suggesting its importance in PTSD prevention strategies for workers.

Aim: The aim of this study was to evaluate the short-term and long-term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment-resistant depression (TRD).

Methods: In this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI-II), and patient-perceived quality of life with the 36-Item Short-Form Survey (SF-36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention.

Results: At T1 endpoint, HDRS, BDI, SF-36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow-up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution.

Conclusion: Routine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long-term follow-up, emphasizing a more pronounced short-term efficacy of rTMS.

Aim: Graduate students are exposed to various types of stress. Thus, they are prone to mental health problems, and the most devastating result is suicide. The aim of this paper is to reveal the status of suicide among graduate students in Japan for 20 years.

Methods: We analyzed cumulative data on suicide among national university graduate students from annual surveys on causes of non-graduation in Japan for the 2002-2003 through 2021-2022 academic years. We asked all national universities with graduate schools to complete the surveys, and the participation rate was 91.1%.

Results: The total number of students in the surveys was 2,383,858, and the number of deaths by suicide was 347 (292 males, 55 females). Chi-squared test results showed significantly higher suicide mortality rates for the following groups: male (p < 0.001), temporary leave (p < 0.001), repeating the same year (p = 0.006), master's level (p = 0.005), and majoring in engineering (p < 0.001). Psychiatric diagnoses were detected among 44 students (12.7%). The largest distribution (27 cases) of International Classification of Diseases, Tenth Revision (ICD-10) codes among those whose diagnoses were evident was F3, mood disorders. Estimated motives for suicide were reported for only 36 students (10.4%), of which the most prevalent was job search failure. The most prevalent suicide method was hanging (151 cases, 43.5%).

Conclusion: Our findings indicate that student support facilities should recognize higher-risk groups for suicide among graduate students. Our study adds suggestions for suicide prevention on campus during future pandemics.

Aim: This study aimed to examine the effects of real-time online clinical practice using real-time virtual reality (VR) compared with 2D PC screening on reducing stigma toward dementia, and to investigate the feasibility of online clinical practice using VR.

Methods: A single-center, open-label, randomized controlled trial was conducted. Occupational therapy students were randomized to view occupational therapy evaluation screens for dementia patients using a VR headset or 2D monitor. The Attitudes Toward Dementia Scale (ADS), the Dementia Knowledge Scale (DKS), and Images of the Elderly with Dementia (IED) were assessed before and after the intervention. The level of clinical practice satisfaction and the System Usability Scale (SUS) were also assessed.

Results: The number of subjects in the intervention and control groups was 10 and 9, respectively. In ADS scores and IED, the main effect was shown in both groups and did not show interactions. In DKS scores, the main effect and interaction were not shown. The VR headset tended to be more usable than the 2D monitor in terms of usability. Satisfaction ratings indicated the characteristics of a realistic clinical experience through real-time VR viewing.

Conclusion: Real-time VR and 2D online clinical practice could reduce the stigma toward dementia, but there were no significant differences between the types. The real-time VR experience was more similar to actual clinical practice than a 2D PC screening due to the sense of immersion, but issues in blinding and lack of audio and video quality were found.