PCN reports : psychiatry and clinical neurosciences最新文献

Aim: Preventing suicide reattempts is important; however, few evidence-based treatments are available. In Japan, the ACTION-J study helped implement case management for suicide attempters in general hospitals and reduced suicide reattempts over a period of up to 6 months. Therefore, the current study aimed to evaluate the effectiveness of case management, modeled after the ACTION-J study, when applied in psychiatric hospitals, and examined the factors influencing suicide reattempts to propose more effective methods of support.

Methods: We conducted a 1-year follow-up study on suicide reattempts after discharge among participants who received case management interventions. Baseline characteristics were extracted, and Cox regression analysis was used to identify the factors influencing suicide reattempts.

Results: Of the 205 participants, 47 (22.9%) reattempted suicide during the observation period. Univariate analysis revealed that the factors significantly associated with suicide reattempts included younger age, adjustment disorder, dissociative disorder, history of previous suicide attempts, and the use of drug overdose as the method of the current attempt. Multivariate analysis showed that dissociative disorders were significant independent factors for suicide attempts.

Conclusions: Factors influencing suicide reattempts among participants in the case management intervention included younger age, adjustment disorder, dissociative disorder, history of previous suicide attempts, and overdose as the method of attempt. In addition to a history of previous suicide attempts and overdoses, which were previously reported, dissociative disorder was observed to strongly influence suicide reattempts, even after case management. Therefore, additional psychotherapeutic strategies, particularly for individuals with dissociative disorders or frequent suicide attempts, may be necessary.

Background: Two of the most common complaints seen in neurology clinics are Alzheimer's disease (AD) and mild cognitive impairment (MCI), characterized by similar symptoms. The aim of this study was to develop and internally validate the diagnostic value of combined neurological and radiological predictors in differentiating mild AD from MCI as the outcome variable, which helps in preventing AD development.

Methods: A cross-sectional study of 161 participants was conducted in a general healthcare setting, including 30 controls, 71 mild AD, and 60 MCI. Binary logistic regression was used to identify predictors of interest, with collinearity assessment conducted prior to model development. Model performance was assessed through calibration, shrinkage, and decision-curve analyses. Finally, the combined clinical and radiological model was compared to models utilizing only clinical or radiological predictors.

Results: The final model included age, sex, education status, Montreal cognitive assessment, Global Cerebral Atrophy Index, Medial Temporal Atrophy Scale, mean hippocampal volume, and Posterior Parietal Atrophy Index, with the area under the curve of 0.978 (0.934-0.996). Internal validation methods did not show substantial reduction in diagnostic performance. Combined model showed higher diagnostic performance compared to clinical and radiological models alone. Decision curve analysis highlighted the usefulness of this model for differentiation across all probability levels.

Conclusion: A combined clinical-radiological model has excellent diagnostic performance in differentiating mild AD from MCI. Notably, the model leveraged straightforward neuroimaging markers, which are relatively simple to measure and interpret, suggesting that they could be integrated into practical, formula-driven diagnostic workflows without requiring computationally intensive deep learning models.

This scoping review aims to examine the frequency and prevalence of neuropsychiatric disorders reported in patients infected with coronavirus disease 2019, and the mechanisms by which these develop during and post infection. A systematic search using relevant search terms and key words was done on six electronic databases of literature on neuropsychiatric conditions post-coronavirus disease 2019 infection from 2020 to 2023. Data were extracted following Joanna Briggs Institute guidelines, focusing on key findings, intervention details, and outcomes. We included 333 studies in the review. Studies indicated an elevated risk of neuropsychiatric disorders post-coronavirus disease 2019, with some risks remaining high 2 years after diagnosis. A significant prevalence of depressive, psychotic, and anxiety disorders, as well as post-traumatic stress symptoms were noted among coronavirus disease 2019 survivors. There was increased prevalence of insomnia and other sleep disturbances, mild to severe cognitive dysfunction, and eating disorders. Coronavirus disease 2019 infection is associated with a significant risk of developing various neuropsychiatric disorders, including schizophrenia, depressive disorders, anxiety, post-traumatic stress disorder, and cognitive dysfunction. Long-term monitoring and early interventions are essential to mitigate these risks and improve patient outcomes.

Aim: Neurological soft signs (NSSs) encompass subtle neurological abnormalities, often indicative of impaired motor and sensory integration, observed in various neuropsychiatric conditions. NSSs have been recently investigated as potential diagnostic markers in neurodegenerative dementias. We aimed to confirm an NSS increase in subjects with cognitive decline and evaluate them in the differential diagnosis of neurodegenerative dementias.

Methods: A sample of 93 subjects with dementia (34 with Alzheimer's disease [AD], 29 with frontotemporal dementia [FTD], 16 with Lewy body disease [LBD], and 14 with corticobasal syndrome [CBS]) and 93 healthy controls (HCs) were assessed using the 16-item Heidelberg NSS Scale.

Results: Subjects with neurodegenerative dementias exhibited significantly higher NSS scores than HCs (20.4 ± 7.9 vs. 5.7 ± 4.2, p < 0.01). Notably, those with CBS/LBD showed markedly elevated NSSs compared to those with AD and FTD (26.2 ± 6.7 vs. 18.4 ± 7.1 and 16.6 ± 6.5, respectively, p < 0.01). Diagnosis, Mini-Mental State Examination (MMSE), Frontal Assessment Battery, and anticholinergic burden were significant predictors of NSS expression in subjects with dementia. In HCs, only age and MMSE were significant predictors. A reduced Neurological Soft Signs (rNSS) Scale, including only five items that can be administered in less than a minute, demonstrated diagnostic performances comparable to the full NSS Scale.

Conclusion: NSSs are increased across neurodegenerative dementia subtypes, particularly in CBS and LBD. The Heidelberg NSS Scale, as well as its variant rNSS, may serve as quick and informative tools to be added to the visits in memory clinics.

Aim: This study aimed to investigate the relationship between improvement in depressive symptoms and activities of daily living (ADL) recovery in older patients with fractures in convalescent rehabilitation wards.

Methods: A retrospective observational study was conducted with 144 older patients with fractures and depressive symptoms (Geriatric Depression Scale score ≥ 5) on admission, who underwent rehabilitation at a Japanese hospital from 2018 to 2023. ADL recovery was assessed by the Functional Independence Measure (FIM). Patients were classified into three groups based on change in depressive symptoms: remission, partial improvement, and no improvement. Multivariate linear regression analysis was used to evaluate factors associated with change in the FIM score.

Results: Remission (β = 0.184, p = 0.019) and partial improvement in depressive symptoms (β = 0.204, p = 0.009) were positively associated with change in the FIM score. Conversely, antidepressant use (β = -0.250, p = 0.002) was negatively associated with change in the FIM score.

Conclusion: Remission and partial improvement in depressive symptoms positively contributes to ADL recovery in older patients with fractures. Comprehensive interventions addressing both depression and physical function may enhance rehabilitation outcomes. This may improve ADL recovery and long-term prognosis in older patients with fractures.

Aim: This study aimed to determine the effects of damage to various brain regions on moral judgment using a novel third-party punishment task with fully manipulated conditions.

Methods: We assessed 35 individuals with brain damage (26 with frontal lobe and nine with non-frontal lobe damage) and 30 healthy controls (HCs) using a moral judgment task consisting of 40 vignettes across five conditions, with varying degrees of intentionality and consequences. Participants rated the protagonist's "badness" and their aroused feelings. Cognitive impairments and empathetic traits were also assessed.

Results: Compared to HCs, individuals with brain damage judged protagonists to be more blameworthy than did HCs in vignettes where harmful intentions were absent (No Negligence, p = 0.02; No Harm, p = 0.02). The order of moral judgment ratings across conditions was consistent between groups, indicating preserved knowledge of social/moral norms in brain-damaged individuals. Although these are preliminary results, there are no significant differences in moral judgment ratings between individuals with frontal and non-frontal lobe damage.

Conclusion: This study revealed that individuals with damage to diverse brain regions show excessive punitive tendencies toward the actions of others without malicious intention. These effects cannot be fully explained by changes in empathy or emotional responses. Moral judgment ratings did not significantly differ between individuals with frontal and non-frontal lobe damage. However, given the small sample size of the non-frontal lesion group, these findings should be interpreted with caution, and further research is necessary to confirm this conclusion.

Background: Periodic psychosis of adolescence is a rare psychiatric condition observed in adolescent girls, characterized by recurrent episodes of diverse psychiatric symptoms, including behavioral inhibition, excitement, hyperactivity, hallucinations, and delusions. These episodes closely align with the menstrual cycle. Mood stabilizers, such as lithium carbonate, have demonstrated efficacy in managing this condition.

Case presentation: We report the case of a 14-year-old adolescent girl with periodic psychosis, successfully treated with lithium carbonate. Her symptoms first appeared at age 12 as transient episodes of insomnia, anxiety, and depressive mood. By age 14, she developed hallucinations and persecutory delusions, leading to hospitalization. Initial treatment with risperidone and aripiprazole was discontinued due to suspected neuroleptic malignant syndrome. During hospitalization, she experienced three distinct psychiatric cycles, each comprising a 2-week period of severe excitement, hyperactivity, hallucinations, and disorganized thinking, followed by a sudden decline in activity levels, with anxiety and fear becoming predominant. Despite adequate treatment with quetiapine and olanzapine, episodes continued to recur. Given the strong correlation between her psychiatric symptoms and menstrual cycle, she was diagnosed with periodic psychosis of adolescence. Lithium carbonate was introduced to prevent further cyclical episodes. The patient was discharged on day 153 of hospitalization. Six months after discharge, she had no recurrence of psychiatric symptoms.

Conclusion: This case underscores the potential efficacy of lithium carbonate for periodic psychosis of adolescence and the importance of understanding this rare but distinctive psychiatric condition.

Background: Nonconvulsive status epilepticus (NCSE) can present with symptoms resembling catatonia, such as stupor, staring, and immobility. Distinguishing between the two conditions using electroencephalography (EEG) is crucial. However, reports of NCSE coexisting with catatonia are rare.

Case presentation: We present a case of catatonia associated with schizophrenia complicated by NCSE. A 77-year-old woman with a 30-year history of well-controlled schizophrenia developed stupor and was admitted to our hospital. EEG revealed evolving spike-and-wave complexes, leading to a diagnosis of NCSE. Administration of levetiracetam improved the EEG findings, and subsequent monitoring confirmed resolution of epileptiform activity. However, the patient's stuporous state persisted despite the normalized EEG. Extensive workup showed no evidence of encephalitis or other neurological pathology. We diagnosed her with NCSE and catatonia associated with schizophrenia. Electroconvulsive therapy (ECT) was administered, resulting in complete resolution of the catatonic symptoms.

Conclusion: This case highlights three key points. First, stupor can result from both NCSE and catatonia associated with schizophrenia. Second, when no physical cause for NCSE is identified and symptoms persist despite EEG improvement following antiepileptic treatment, coexisting catatonia associated with schizophrenia should be considered. Finally, ECT was effective in treating catatonia associated with schizophrenia complicated by NCSE. In patients presenting with stupor, it is important to differentiate between NCSE and catatonia associated with schizophrenia and to recognize the potential for their coexistence.

Aim: The prevalence of mental health issues among children and adolescents in Japan is rising, including school refusal, suicide, and neurodevelopmental disorders. In response, the Ministry of Health, Labour, and Welfare (MHLW) introduced insurance incentives in 2014 to expand access to outpatient psychiatric services for Japanese youth.

Methods: This retrospective cohort study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan from fiscal years 2016 to 2022. Outpatient psychotherapy claims under the newly introduced insurance categories were analyzed by year, age group, sex, and prefecture. National trends and regional disparities were assessed using linear regression models.

Results: Nationwide outpatient psychotherapy claims nearly doubled, from 521.0 per 10,000 youth in fiscal year 2015 to 1034.5 in fiscal year 2022 (p < 0.001). The increase was most pronounced among adolescent girls. By fiscal year 2022, 94% of prefectures had implemented the policy. Some regions, such as Tokushima and Yamanashi, experienced more than a threefold increase. Nevertheless, regional disparities between prefectures remained.

Conclusion: The MHLW's insurance reforms significantly increased access to psychiatric care for children and adolescents across Japan. The combined impact of national financial incentives and local medical subsidies likely contributed to increased service utilization, given the reduction in additional costs for families. Ongoing policy efforts are needed to ensure equitable access and high-quality care nationwide.

Background: Tardive dyskinesia (TD) is a movement disorder related to long-term antipsychotic use and characterized by involuntary repetitive movements that often affect the oral and facial muscles. Although valbenazine, a vesicular monoamine transporter 2 (VMAT2) inhibitor, is an effective treatment of TD, it may induce drug-induced parkinsonism (DIP) in some patients. Electroconvulsive therapy (ECT) improves depressive symptoms and certain movement disorders; however, its role in managing TD, particularly in patients intolerant to VMAT2 inhibitors because of DIP, remains elusive.

Case presentation: Herein, we describe a 65-year-old Japanese woman with a history of major depressive episodes and oral dyskinesia. The patient was treated with valbenazine for oral dyskinesia; however, she developed DIP, requiring valbenazine discontinuation. After the worsening of depression, the patient was hospitalized and underwent 10 sessions of modified ECT, which remarkably helped improving depressive symptoms and oral dyskinesia.

Conclusion: This case suggests that ECT could be a viable treatment option for managing patients with depression and oral dyskinesia who are susceptible of valbenazine-induced parkinsonism.