PCN reports : psychiatry and clinical neurosciences最新文献

Background: Nonmotor symptoms are a critical focus in the management of Parkinson's disease (PD). Apathy is defined as a quantitative reduction in goal-directed activity, characterized by diminished initiative, interest, and emotional expression or responsiveness. It affects approximately 40% of patients with PD, severely impairing daily functioning and quality of life. Although electroconvulsive therapy (ECT) is well established for alleviating depressive symptoms in patients with PD, its efficacy in treating apathy remains largely unexplored.

Case presentation: We report the case of a 54-year-old man diagnosed with PD at age 49, whose motor symptoms were well controlled with optimized pharmacotherapy. However, at age 53, he developed profound apathy, characterized by a notable reduction in spontaneous movement and emotional expression. Given the lack of response to pharmacological adjustments, including a trial of venlafaxine, modified ECT (m-ECT) was initiated. The patient underwent 10 m-ECT sessions over 5 weeks (twice weekly) using propofol and succinylcholine. Following treatment, his apathy scale score improved substantially from 32 to 12, with no adverse effects on cognitive function.

Conclusion: This case highlights the potential efficacy of ECT for PD-related apathy. Further research is needed to elucidate its underlying mechanisms and assess the long-term outcomes of ECT in managing nonmotor symptoms in PD.

Aim: Major depressive disorder is a growing global concern with limited treatment options. Social stress contributes to its development, yet pharmacological prevention and mitigation remain underexplored. This study examined the effects of Saiko-ka-ryukotsu-borei-to (SRBT) on depressive and anxiety-like behaviors in mice exposed to social defeat stress (SDS).

Methods: C57BL/6J mice were subjected to daily 10-min interactions with larger, more aggressive ICR mice for 10 consecutive days to induce SDS. Immediately following each session, mice were orally administered SRBT, fluoxetine (Flu), or saline (Sal), and were assigned to the SD-SRBT, SD-Flu, and SD-Sal groups, respectively. Mice that received Sal without SDS exposure served as the normal control (NC) group. On the 11th day, behavioral assessments, including the elevated plus maze (EPM) test, tail suspension test (TST), and social interaction test (SIT), were conducted across the four groups. Plasma corticosterone levels were also measured.

Results: SDS significantly increased anxiety-like behavior in the EPM, as shown by reduced open arm time in the SD-Sal and SD-Flu groups. This effect was less evident in the SD-SRBT group. Although the SD-Flu group showed similar anxiety-like behavior to the SD-Sal group, no significant difference in open arm time was observed. SDS did not induce social avoidance or depressive-like behavior in the SIT or TST, nor did it alter plasma corticosterone levels.

Conclusion: This study suggested that SRBT has the potential to mitigate anxiety caused by social stress. However, further ongoing evaluation and investigation are required to assess the effectiveness of SRBT.

Aim: To investigate the relationship between the prescription of novel hypnotics (melatonin receptor agonists [MRAs] and orexin receptor antagonists [ORAs]) and the risk of hip fractures in a large cohort of Japanese patients.

Methods: In this retrospective study, we analyzed data from a large health insurance claims database. Among subscribers aged ≥50 years between April 2014 and September 2021, those assigned the disease code of hip fracture were included. Each patient's prescription history for hypnotics was examined to identify the exposure and non-exposure periods. The relationship between exposure to hypnotics and the development of hip fractures was analyzed using the Mayo-updated Cox proportional hazards regression model.

Results: In total, 269,097 patients developed hip fractures. The prescription of any hypnotic was significantly associated with hip fracture incidence (adjusted hazard ratio [aHR], 2.30; 95% confidence interval [CI], 2.27-2.32). In the analysis by class of hypnotics, the hazard ratio was highest for ORAs (aHR, 3.09; 95% CI, 3.03-3.16), followed by that for MRAs (aHR, 2.45; 95% CI, 2.38-2.52).

Conclusion: Novel hypnotics use was significantly associated with the development of hip fractures, and patients prescribed ORAs and MRAs should be cautioned about the risk of hip fractures.

Aim: This study evaluated daily functional difficulties among girls with EDs via the Questionnaire-Children with Difficulties (QCD). We examined the associations between daily functioning and physical, psychosocial, and clinical factors. Furthermore, we explored how school attendance status affected functioning during school hours and evenings.

Methods: We used the QCD and compared time-specific functioning between 179 girls with EDs (aged 6-15) and 640 age- and gender-matched community controls. We conducted multiple regression analyses to examine associations between the QCD scores and clinical and psychosocial variables, which included percent median body mass index (%mBMI), depressive symptoms, inpatient history, sleep duration, and sibling presence.

Results: Girls with EDs had significantly lower QCD scores than controls across all time domains, with pronounced impairments during after-school and evening periods. Multivariate analyses revealed that behavioral difficulties were associated with poorer functioning. However, sibling presence and weekday sleep duration had protective effects. No significant associations were observed with %mBMI, depressive symptoms, or separation anxiety.

Conclusion: Daily functioning among girls with EDs is influenced by behavioral and familial factors, rather than nutritional status alone, and varies by time of day. Time-structured assessments, such as the QCD, may help clinicians tailor support strategies to vulnerable periods in their daily life.

Aim: This study aimed to examine the mental health of Japanese youth athletes during the second year of the COVID-19 pandemic and explore its associations with demographic and sport-related factors.

Methods: Three cross-sectional online surveys were conducted at a public high school in Japan in Spring 2021 (baseline; n = 1022), Fall 2021 (n = 1104), and Spring 2022 (n = 1066). Mental health was assessed using the Kessler-6 (K6), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scales. Participants were categorized as youth athletes (national-level competitors [NC] and local-level competitors [LC]) or nonathlete students (NAS). Logistic regression was used to identify the mental health risk factors.

Results: Compared to the baseline, youth athletes showed higher rates of poor mental health indicators in the second and third surveys. Among them, female athletes showed higher risks of depression and anxiety in both later surveys, whereas upper grade athletes had an increased risk of depression in the second survey. No consistent association was found between COVID-19 infection history and mental health.

Conclusion: Japanese youth athletes showed poorer mental health indicators at later points in the second year of the pandemic. Female and upper grade athletes may require targeted mental health support. Continuous monitoring is essential during extended public health emergencies.

Psychiatric symptoms are prevalent among people with epilepsy (PWE), yet psychiatric care remains underdeveloped in epilepsy services worldwide. Many psychiatrists lack sufficient familiarity with epilepsy, contributing to gaps in care. Japan, however, has a distinctive history where psychiatrists played a central role in epilepsy treatment, especially in managing epilepsy-related psychosis. This legacy, though fading, offers valuable insights. This review proposes a renewed framework to reestablish the psychiatrist's role in epilepsy care, informed by Japan's historical context and current global trends. The framework consists of five domains: (1) the historical relationship between psychiatry and epilepsy; (2) diagnosis and treatment of psychiatric symptoms in PWE; (3) psychosocial interventions; (4) interdisciplinary collaboration; and (5) future directions in training, research, policy, and clinical integration. While psychiatry's role in epilepsy has diminished in many countries, Japan may still retain structural and cultural foundations for reintegration. By redefining psychiatric involvement, we aim to inspire general psychiatrists and trainees to engage with epilepsy care. Reaffirming the psychiatric perspective is essential for delivering comprehensive, patient-centered care to PWE.

Background: Catatonia can arise from various conditions, not only psychiatric but also non-psychiatric etiologies. This diversity of underlying causes makes it challenging to identify the underlying etiology, which is crucial for appropriate management. Nitrous oxide (N₂O) is widely used for recreational purposes, and its adverse effects have become a growing concern. Chronic exposure can lead to vitamin B12 deficiency, which manifests both neurological and psychiatric symptoms, including catatonia. Vitamin B12 supplementation is an effective treatment, but the diverse clinical manifestations of N₂O toxicity, coupled with the diverse etiologies of catatonia, can delay diagnosis and intervention.

Case presentation: The patient, a healthy man in his 20s, had been receiving N₂O anesthesia regularly for pain relief while undergoing cosmetic hair removal. After his seventh inhalation, he developed a catatonia and was admitted to a previous hospital. After a comprehensive examination failed to identify the etiology, he was transferred to our hospital for psychiatric assessment. Intravenous benzodiazepine failed to improve his catatonia. Re-evaluation of the underlying etiologies of benzodiazepine-refractory catatonia raised the possibility of a vitamin B12 deficiency resulting from chronic N₂O exposure. Vitamin B12 supplementation promptly improved his catatonia, and the patient was discharged without any recurrence of his symptoms.

Conclusion: Catatonia developed in the present patient after multiple exposures to N₂O. Active vitamin B12 may be administered if N₂O is suspected of causing psychotic symptoms. Moreover, reassessing the differential diagnosis is worthwhile when managing refractory catatonia.

Background: Nephrogenic diabetes insipidus (NDI) is a well-known adverse effect of lithium, which occurs in approximately 20%-40% of long-term lithium users. Although rare, there have been reports of central diabetes insipidus (CDI) associated with lithium use. Herein, we report a patient with suspected CDI associated with chronic lithium therapy. Furthermore, we conducted a literature search for cases with CDI and discuss the pathogenesis of this case based on previous reports.

Case presentation: The patient was a 73-year-old man with bipolar disorder Type I. His psychiatric symptoms had been stable for many years. However, polyuria and weakness began to appear at the age of 73. Initially, lithium-induced NDI was suspected, but in the end, partial CDI was suspected because urinary osmolality did not exceed 300 mOsm/L even after water restriction, and administration of nasal arginine vasopressin solution partially increased urinary osmolality.

Conclusion: We have experienced a case in which CDI may have been induced by lithium. Although the effects of ageing and infection cannot be ruled out, it should be noted that when lithium-induced diabetes insipidus is suspected, CDI may also occur depending on the clinical context.