PCN reports : psychiatry and clinical neurosciences最新文献

Aim: Transcranial magnetic stimulation (TMS) is an emerging treatment for binge eating (BE). TMS uses noninvasive magnetic pulses to stimulate the prefrontal cortex, which plays a role in decision-making and self-regulation. Early research suggests that TMS can reduce BE episodes by modulating brain activity linked to cravings and compulsive behavior. This article aims to evaluate the efficacy and safety of a novel TMS device with ExoTMS™ Technology for alleviating BE symptoms.

Methods: Subjects underwent six TMS sessions and a 1-month follow-up. The Binge Eating Scale (BES) was administered at baseline, posttreatment, and follow-up to assess symptom severity. Weight was recorded at the same intervals. Therapy comfort was evaluated after the sixth session. The Subject Satisfaction Questionnaire was completed posttreatment and at follow-up. Adverse events and side effects were monitored throughout the study. Data from two identically designed studies were pooled for analysis.

Results: A total of 38 subjects were analyzed. BES scores significantly decreased posttreatment (-37.8%, p < 0.001) and at follow-up (-47.9%, p < 0.001). At 1 month, 73.7% of subjects achieved BE remission. Average weight loss was -1.3 ± 1.1 kg posttreatment and -1.8 ± 1.3 kg at follow-up. Comfort was rated positively by 92.1% of participants. At follow-up, 89.5% reported reduced cravings and snacking, 86.8% noted improved self-control and well-being, and 94.7% were satisfied with the treatment.

Conclusion: TMS shows promise as a safe and effective intervention for reducing BE symptoms, supported by both objective clinical measures and subjective patient-reported outcomes.

Background: Tardive dyskinesia (TD) is a movement disorder associated with long-term use of dopamine receptor-blocking agents. Valbenazine, a selective vesicular monoamine transporter 2 (VMAT2) inhibitor, effectively reduces TD symptoms, but it may also trigger or worsen depressive symptoms by reducing central dopamine and serotonin availability.

Case presentation: We report the case of a 52-year-old woman with major depressive disorder (MDD) and oral dyskinesia who experienced an acute mood deterioration after she began taking valbenazine 40 mg/day. She developed TD while receiving antipsychotic treatment for depression. After she achieved partial psychiatric improvement on lurasidone, we started valbenazine to address her dyskinesia. Within hours of the first dose, she reported markedly worse depressive symptoms, heightened anxiety, and significant functional decline, even though her dyskinesia improved. Her Hamilton Depression Rating Scale score increased from 30 before valbenazine to 40 the next day. We stopped valbenazine, and over the following month, she gradually regained mood stability.

Conclusion: This case shows that valbenazine can acutely worsen preexisting depression. Clinicians should actively evaluate psychiatric history, assess current mood stability before prescribing, and monitor patients closely to identify and address mood changes promptly.

Background: In post-disaster communities, an association between decreased walking activity and depressive symptoms has been reported. This study aimed to identify the associations between the frequency, intensity, time, and type (or style) (FITT) of walking and depressive symptoms.

Method: The 2018 survey of a cohort study was used to examine 924 individuals aged 20 years or older who were severely affected by the Great East Japan Earthquake. Participants were asked whether they walked intending to improve their health (health-conscious walkers: N = 335) and were cautious about their walking parameters. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and multivariate logistic regression analysis was used to evaluate the association between paying attention to FITT elements and depressive symptoms.

Results: In health-conscious walkers, the multivariate model showed that female (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.24-4.84) and paying attention to posture during walking (OR, 0.41; 95% CI, 0.21-0.81) were significantly associated with depressive symptoms (CES-D ≥ 16). In non-health-conscious walkers, evaluating multiple variables, including walking duration, showed that only a walking duration of less than 30 min per day (OR, 2.06; 95% CI, 1.19-3.56) was associated with depressive symptoms.

Conclusions: The current study indicated that paying attention to posture during walking had a significant negative association with depressive symptoms, suggesting that paying attention to posture while walking may be beneficial for mental health well-being. These findings may help improve the mental health of communities affected by a disaster through an intervention to promote regular walking.

[This corrects the article DOI: 10.1002/pcn5.70173.].

Aim: Teachers experience a heavy workload and mental stress, which contributes to significant sleep problems. This study investigated the relationships between sleep complaints (sleep induction, awakenings during the night, poor overall quality of sleep, and sleepiness during the day), work engagement, and workplace psychological safety in public elementary school teachers in Japan.

Methods: A cross-sectional online survey was conducted among 96,421 elementary school teachers in Japan. Participants reported on their sleep complaints, work engagement, workplace psychological safety, and demographic and work-related characteristics (age, sex, and years of experience, working hours per day). Multivariate logistic regression analyses were conducted to examine the relationships between work engagement, workplace psychological safety, and sleep complaints.

Results: The study confirmed the high prevalence of sleep complaints among Japanese elementary school teachers. Both work engagement and workplace psychological safety were negatively associated with sleep complaints. Specifically, teachers working more than 13 h a day were significantly more likely to report complaints related to sleep induction and awakenings during the night. After adjusting for the confounding effects of working hours, the associations between work engagement, workplace psychological safety, and sleep complaints remained statistically significant.

Conclusion: The findings suggest that addressing teachers' sleep complaints requires not only alleviating workload but also fostering a supportive organizational environment that promotes work engagement and workplace psychological safety. These insights can inform the development of policies and support measures to improve teachers' working conditions and overall well-being.

Background: Obsessive-compulsive disorder (OCD) can cause physical complications, and psychiatric treatment sometimes improves these complications. However, it remains unclear whether managing a physical complication can contribute to the improvement of psychiatric symptoms or may alter the trajectory of psychiatric treatment.

Case presentation: We report on a woman in her 50s with severe, long-standing, treatment-resistant OCD centered on contamination fears and compulsive defecation rituals. She rarely sought psychiatric help, and her symptoms worsened. Her compulsions led to rectal prolapse and fecal incontinence, which in turn exacerbated her OCD in a vicious cycle. After laparoscopic rectopexy resolved her incontinence, a marked reduction in repetitive cleaning behaviors occurred, including decreased time spent in the toilet and reduced toilet paper use. The physical improvement was followed by psychiatric engagement, regular outpatient visits, and subsequent therapeutic progress.

Conclusion: This case illustrates that a physical intervention could do more than alleviate somatic distress; it could act as a catalyst for psychiatric care. By breaking the cycle between a physical symptom and a compulsive behaviors, the surgical treatment created a crucial opening for establishing trust and motivation. This highlights the importance of integrated, cross-disciplinary collaboration in managing complex OCD cases where somatic and psychiatric symptoms are deeply intertwined.

Aim: This study examined the conditions of drug abuse and dependence as well as the psychosocial characteristics of patients transported to an emergency department for over-the-counter (OTC) drug overdose.

Methods: Participants were patients who presented to the emergency department due to an overdose of OTC drugs. Patients were evaluated using the Drug Abuse Screening Test-20 (DAST-20), Mini International Neuropsychiatric Interview (MINI), and an original questionnaire.

Results: The study included 52 patients from four emergency medical facilities (20 males and 32 females) with a mean age of 23.6 years (standard deviation = 10.1). The DAST-20 indicated that 17 patients (32.7%) experienced moderate or severe drug abuse. The average score for suicide risk on the MINI was 23.7 (median: 27). The severity of OTC drug abuse and dependence significantly correlated with drug overdose history (r = 0.44, p < 0.01), OTC drug type (antitussives and expectorants) (r = 0.36, p < 0.01), experience with OTC drug abuse (r = 0.53, p < 0.01), overdose purpose (relief of distress) (r = 0.41, p < 0.01), and overdose purpose (suicide) (r = -0.52, p < 0.01). The severity of drug abuse and dependence was best predicted by the combination of experience with OTC drug abuse, an advisor, and suicidal purpose (R ² = 0.53, p < 0.001).

Conclusion: It is crucial to investigate patient experiences with OTC drug abuse and their motivations and backgrounds for overdosing. Support for abuse and dependence should be provided in the early stages of treatment.

Background: Kleine-Levin syndrome (KLS) is a rare sleep disorder marked by recurrent episodes of severe hypersomnolence with accompanying cognitive, behavioral, or mood disturbances. Infections are frequently reported before symptom onset and have been proposed as potential triggers, although a definitive causal relationship has not been established. Although relapses of KLS after COVID-19 infection have been described, only one possible case of new-onset KLS associated with COVID-19 has been reported, in which a definitive diagnosis was not established.

Case presentation: We describe a 17-year-old male who developed KLS following a confirmed COVID-19 infection. After his clinical recovery, he began experiencing hypersomnolent episodes every few months, each lasting approximately 2 weeks and accompanied by decreased motivation and appetite. As the illness progressed, he developed persistent nausea lasting several weeks before each hypersomnolent episode, suggesting the emergence of a prodromal phase. Treatment with lithium and adjunctive modafinil showed limited efficacy in preventing recurrence or reducing episode severity. Each complete cycle comprising prodromal, hypersomnolent, and recovery phases lasted over a month and significantly disrupted his academic and social functioning.

Conclusion: This case represents the first diagnostically confirmed report of new-onset KLS following COVID-19 infection and suggests a possible autoimmune mechanism triggered by SARS-CoV-2. These findings emphasize the importance of comprehensive clinical assessment beyond objective test results and underscore the urgent need for effective treatment strategies tailored to the heterogeneous and disabling nature of KLS.

Aim: "Young carers (YCs)" are children under the age of 18 who undertake adult caregiving roles, including household chores, family care, nursing, and emotional support. Despite the growing attention to YCs in Japan, public understanding remains limited. This study aims to develop a scale to measure YCs' knowledge and examine its reliability and validity.

Methods: A web-based survey was conducted in October 2023 with 300 participants aged 22-70 years. Participants were divided into three groups based on their subjective awareness of YCs: unaware, aware but unfamiliar, and aware and familiar. After excluding dishonest responses, data from 218 individuals (mean age = 53.2 ± 10.5 years) were analyzed. A 57-item questionnaire was developed, and exploratory factor analysis (principal factor method, Promax rotation) was conducted. Reliability was assessed using Cronbach's α, and discriminant validity was examined through multivariate analysis of covariance (MANCOVA), controlling for gender, marital status, and parental status.

Results: Factor analysis identified 29 items across three factors: excessive family roles, care-related daily life challenges, and hidden impacts of caring. The scale showed high internal consistency (α = 0.91-0.97). MANCOVA revealed significant differences in the knowledge scores according to subjective awareness (Wilks' Λ = 0.71, F(6, 420) = 9.22, p < 0.001), supporting discriminant validity. Greater awareness of YCs was associated with greater knowledge of YCs' circumstances.

Conclusion: These findings suggest that this scale may help assess the public understanding of YCs. Future studies should investigate variations in YCs' knowledge across different occupations, beliefs, and cultural contexts.

Background: 22q11.2 deletion syndrome is associated with schizophrenia, seizures, and often experience intolerance to antipsychotics. Periventricular nodular heterotopia (PNH) is a neuronal migration disorder that can also be observed in individuals with 22q11.2 deletion syndrome. However, to our knowledge, the use of clozapine in adolescent patients with treatment-resistant schizophrenia and comorbid 22q11.2 deletion syndrome and PNH has not been previously reported.

Case presentation: A 17-year-old female with treatment-resistant schizophrenia was referred to our hospital. She presented with auditory hallucinations, disorganized behavior, and insomnia. Multiple antipsychotics, mood stabilizers, benzodiazepines, and modified electroconvulsive therapy were either ineffective or poorly tolerated due to extrapyramidal symptoms. Brain magnetic resonance imaging (MRI) performed under sedation revealed PNH. Genetic testing confirmed a diagnosis of 22q11.2 deletion syndrome. Clozapine was initiated with close monitoring, and her symptoms gradually improved following a slow titration. She was discharged after approximately 6 months and has remained clinically stable for 15 months.

Conclusion: Brain MRI and genetic testing-even when performed under sedation-may be valuable diagnostic tools in adolescents with treatment-resistant schizophrenia. Furthermore, the presence of structural brain abnormalities does not preclude the efficacy of clozapine, which may remain a viable and effective treatment option in such cases.