PCN reports : psychiatry and clinical neurosciences最新文献

Aim: To examine the effects of a multi-task cognitive activation therapy (MCAT) program combining motor and cognitive tasks in patients with schizophrenia.

Methods: Patients with schizophrenia who received psychiatric day care treatment were included in this study. The study used a mirror-image test with a 3-month pre-intervention and intervention period each. MCAT training was conducted twice a week for 12 weeks for a total of 24 sessions. The Brief Assessment of Cognition in Schizophrenia - Japanese version (BACS-J) and Facial Emotional Identified Test were used for the primary outcome; the secondary outcomes included the Positive and Negative Syndrome Scale (PANSS), and the Life Assessment Scale for the Mentally Ill (LASMI).

Results: Thirty-six patients completed the intervention. The Z-score of the BACS-J before and after the intervention period included verbal memory (-1.98 ± 1.60 before intervention, -1.50 ± 1.41 after intervention, P < 0.01, r = 0.47) and motor function (-1.47 ± 1.71 before intervention, -0.93 ± 1.50 after intervention, P < 0.01, r = 0.47). Significant improvement was observed in the composite score (-2.31 ± 1.51 before intervention, -1.92 ± 1.38 after intervention, P < 0.01, r = 0.52). Significant improvements were also observed on the PANSS comprehensive psychopathology scale and the LASMI interpersonal relationships scale. No other endpoints demonstrated significant improvements. The BACS-J composite score, which was the earliest BACS-J examination, was considered the baseline for all the participants in the moderate and severe groups. The severe group (n = 22) demonstrated significant improvements in the BACS-J verbal memory, composite score, and LASMI interpersonal relationships.

Conclusion: These results suggest that the MCAT may improve cognitive function and interpersonal relationships in patients with schizophrenia and severe or moderate cognitive impairment.

Aim: This study investigated the association between the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) and medication nonadherence (MNA) in living kidney transplantation (LKT) recipients.

Methods: This single-center prospective cohort study included 132 LKT recipients at Tokyo Women's Medical University Hospital between July 2020 and July 2021. Pretransplant psychosocial evaluations used the Japanese version of the SIPAT (SIPAT-J), and MNA was assessed 1 year posttransplant using the Basel Assessment of Adherence to Immunosuppressive Medication Scale^© (BAASIS^©). Participants completing both SIPAT-J and BAASIS^© evaluations (n = 111) were analyzed. Multivariable logistic regression analysis was conducted to examine the relationship between SIPAT scores and MNA, adjusting for age, sex, and employment status.

Results: Participants had a median age of 52 years; 63.1% were male. MNA was observed in 39.6% of recipients, primarily due to timing deviations (34.2%) and missed doses (11.7%). Higher SIPAT D (Lifestyle and Effect of Substance Use) scores were significantly associated with MNA (odds ratio = 1.304, 95% confidence interval = 1.006-1.692, P = 0.045). Other SIPAT subscales and total scores were not significantly associated with MNA.

Conclusion: To our knowledge, this is the first study to investigate the association between SIPAT and MNA in LKT recipients. MNA remains prevalent 1 year post-LKT, with lifestyle and substance use factors (SIPAT D) showing a significant association. These results underscore the importance of conducting comprehensive psychosocial evaluations, including assessments of lifestyle and substance use, prior to transplantation. Such evaluations may facilitate the identification of at-risk individuals and enable the implementation of targeted interventions to improve medication adherence and posttransplant outcomes.

Contemporary psychiatry is going through times of crisis. In this article, I will focus on the epistemological and historical aspect of the phenomenon. Three authors are the main references guiding the argumentation I offer in this text. They are Thomas Kuhn, Georges Lanteri-Laura and Juan Carlos Stagnaro. The text is intended as an introduction to the epistemological analysis of contemporary psychiatry, but it also proposes to look a little ahead in order to attempt a modest reflection on the future of the specialty.

Aim: The aging of the global population has made healthy aging and the extension of healthy life expectancy significant challenges for many societies. Mental health, including cognitive function, is critical to the quality of life of older adults. Oxytocin, a neuropeptide involved in social bonding and stress regulation, has been shown to exert neuroprotective effects, while S100B, a calcium-binding protein, has been linked to neuroinflammation and neurodegenerative disorders, such as Alzheimer's disease. However, the relationship between oxytocin and S100B levels during aging remains unclear. This study investigated the association between serum oxytocin and S100B levels in community-dwelling older adults.

Methods: This survey, conducted between November 2016 and September 2017 in Kurokawa-cho, Imari, Saga Prefecture, Japan, included community-dwelling older adults aged ≥65 years. Blood samples were collected to measure serum oxytocin and S100B levels using an enzyme-linked immunosorbent assay. The relationships among serum oxytocin, S100B, and cognitive function (Mini-Mental State Examination, Frontal Assessment Battery, and Clinical Dementia Rating) were analyzed using correlation and multiple regression analyses.

Results: A total of 95 participants (25 men, 70 women; mean age: 78.03 ± 5.12 years) were analyzed. Our analysis showed that serum oxytocin levels were negatively associated with serum S100B levels even after adjusting for age, sex, years of education, and body mass index. However, no significant correlations were found between these biomarkers and overall cognitive function.

Conclusion: These findings suggest that the neuroprotective effects of oxytocin may influence blood S100B levels, though its direct role in cognitive function remains unclear.

Aim: Clinical attention to and understanding of women with impaired fetal bonding is important for early therapeutic intervention. This study aimed to clarify the clinical characteristics of women belonging to groups derived by cluster analysis of impaired maternal-fetal bonding.

Methods: A mixed-method approach was adopted. We conducted a two-wave internet survey targeting pregnant women less than 36 gestational weeks by using a questionnaire (33-item Dimensional Assessment of Mother Baby Organization Questionnaire [DAMBO Q33]) with subsequent online interviews (Dimensional Assessment of Mother and Baby Organization-Research Version). The maternal-fetal bonding disorder items in the DAMBO Q33 were entered into a two-step cluster analysis. Two representative cases from each of the clusters, except for the positive bonding cluster, were selected to describe their clinical pictures. Finally, quantitative data and qualitative data were integrated and interpreted.

Results: A two-step cluster analysis elicited four clusters: bonding disorder (n = 101), ambivalent bonding (n = 156), positive bonding (n = 173), and lack of bonding emotions (n = 122). Women in the bonding disorder cluster were characterized by seriously negative feelings towards the fetus. Women in the ambivalent bonding cluster wished to be pregnant but were not sufficiently ready for the transition into parenthood. Women in the lack of bonding emotions cluster were characterized by a lack of strong interest in pregnancy and the fetus.

Conclusion: Patterns of impaired maternal-fetal bonding were identified. We should not think of a pathological category of mental illness among them but recognize that such parents are targets for professional assessments and supportive (therapeutic) interventions. Understanding the meaning of getting pregnant and difficulties in the process of maternal role attainment is required.

Aim: The Mental Health Continuum-Short Form (MHC-SF) is an assessment tool used worldwide to assess emotional, social, and psychological well-being. This study examined the structure, reliability, and validity of the Japanese version of the MHC-SF among adolescents.

Methods: In total, 1588 adolescents aged 15-18 years completed the assessment (54.8% female; age mean ± standard deviation = 16.3 ± 0.94 years). The factor structure of the MHC-SF was evaluated using confirmatory factor analyses. The internal consistency, concurrent validity, and measurement invariance across sex and age were examined.

Results: A three-factor model of the MHC-SF yielded the best fit compared with the one- and two-factor models. Internal consistency was confirmed by a Cronbach's alpha (>0.8). Measurement invariance was observed across sex and age. Convergent and divergent validity were demonstrated by assessing the relationships with other measurements.

Conclusion: This study established a three-factor model of the MHC-SF in Japanese adolescents. We confirmed the reliability and validity of the Japanese version of the MHC-SF for assessing emotional, social, and psychological well-being in adolescents.

Aim: Dementia with Lewy bodies (DLB) is characterized by motor and non-motor symptoms. The degeneration of the dopaminergic pathway is a hallmark of DLB; for this reason, we aimed to study a recent dopamine transporter (DAT) positron emission tomography (PET) radioligand as a diagnostic tool for DLB.

Methods: In this study, we used DAT-PET with the radioligand [¹⁸F]FE-PE2I to distinguish DLB subjects from healthy controls (HCs). We also aimed to analyze how DAT binding correlated with clinical features, amyloid load, measured by PET, and cardiac metaiodobenzylguanidine scintigraphy (MIBG).

Results: Binding potential (BP _ND) values of [¹⁸F]FE-PE2I were higher in HCs versus DLB in striatum (1.82 ± 0.34 vs. 1.15 ± 0.34; p < 0.001; 95% Confidence Interval [CI]: 0.40-0.96), putamen (2.2 ± 0.36 vs. 1.41 ± 0.51; p < 0.001; 95% CI: 0.39-1.17), caudate (1.38 ± 0.30 vs. 0.88 ± 0.20; p < 0.001; 95% CI: 0.28-0.70), and substantia nigra (0.49 ± 0.091 vs. 0.42 ± 0.084; p = 0.0437; 95% CI: 0.003 to 0.14). After adjusting for age, substantia nigra did not differ between DLB and HCs (p: 0.46; 95% CI: -0.049 to 0.11); however, BP _ND values between DLB and HC in striatum (p: <0.001; 95% CI: 0.25-0.85), putamen (p: 0.0012; 95% CI: 0.31-1.13), and caudate (p: 0.0027; 95% CI: 0.13-0.55) were still significant. Striatum was the best area to correctly classify DLB subjects versus HC compared to the putamen, caudate, and substantia nigra (area under the curve = 0.95, 0.90, 0.93, and 0.73, respectively; 95 CI: 0.87-1.00, 0.79-1.00, 0.84-1.00, 0.55-0.92, respectively). Subjects with altered MIBG showed lower BP _ND compared to subjects with normal MIBG in the putamen.

Conclusion: Our study showed that [¹⁸F]FE-PE2I PET represents a potential diagnostic tool with high accuracy in discriminating DLB patients versus HC, which is valuable for clinical practice.

Aim: The aim of this study was to investigate whether psychiatrists around the world believe they might encounter cases of hikikomori (prolonged social isolation), and how they formulate and treat such cases.

Methods: A hikikomori case vignette was sent to psychiatrists of 34 countries around the world. Participants rated for the vignette: frequency of similar cases in one's practicing country; and aspects of formulation, diagnosis, suicide risk, and treatment plan.

Results: In total, 344 complete responses from 34 countries were returned. Eight countries/areas had 10 or more respondents: Japan (61), South Korea (54), Nepal (48), Iran (40), Thailand (32), India (23), Hong Kong (12), and UK (10); the remainder were placed in the "others" group (64). Respondents from all countries except Thailand felt that similar cases were seen. Diverse patterns of response were obtained regarding formulation and treatment. Japan, South Korea, and "others" favored psychosocial aspects in the formulation, while Iran, Nepal, and India favored biological factors. Most respondents felt the case could be treated by an outpatient visit, while others preferred hospitalization. Psychotherapy was rated highly as an intervention; Iran, South Korea, and "others" also rated pharmacotherapy highly.

Conclusion: Despite its limitations as an exploratory study, we found evidence that hikikomori-like cases might exist around the world. However, opinions on how such cases should be formulated and treated vary significantly among countries. We believe this reflects how the experience of hikikomori is dependent on the related sociocultural context. Further comparative work, preferably with standardized assessment tools, will help to clarify how society might influence the individual experiences of practitioner and hikikomori patients.

Aim: Epilepsy-related stigma significantly impacts quality of life, with severity noted in Asian countries. This study compared public attitudes towards epilepsy in Japan and Malaysia, two Asian nations with distinct religious and healthcare backgrounds.

Methods: We used the Public Attitudes Toward Epilepsy (PATE) scale, including its Japanese version (PATE-J), to survey 113 Japanese and 130 Malaysian participants. Demographic data and PATE scores were compared using t-tests and χ² tests. Covariance analysis (ANCOVA) was conducted to adjust for potential confounding factors such as age and education level.

Results: No significant differences were found in PATE total scores (P = 0.484), general domain (P = 0.101), or personal domain (P = 0.217) between Japan and Malaysia. However, after adjusting for age and education using ANCOVA, education significantly influenced the general domain (F = 4.512, P = 0.012) and total scores (F = 3.302, P = 0.038), while country (F = 7.191, P = 0.008) and age (F = 6.633, P = 0.011) were significant for the personal domain. Malaysian participants were significantly younger (P < 0.001) and had higher education levels (P < 0.001) compared to Japanese participants.

Conclusion: While no significant differences in epilepsy-related stigma were observed between Japan and Malaysia, demographic variations in age, education, and regional characteristics may have masked potential cultural differences. The adjusted analysis underscores the importance of controlling for these factors to better elucidate cultural influences on epilepsy stigma formation in Asia.

Anhedonia is a transdiagnostic domain that leads to poor disorder outcome and low remission rates. This narrative review describes a broad range of interventions targeting anhedonia, including pharmacological, neuromodulatory, behavioral, and lifestyle-based approaches. Drugs such as vortioxetine, agomelatine, bupropion, ketamine, and brexpiprazole show promising anti-anhedonic effects, while traditional antidepressants, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and, even more so, selective serotonin reuptake inhibitors (SSRIs), are less effective. Neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous auricular vagus nerve stimulation, proved effective at improving anhedonia, particularly when used in targeted areas. Psychotherapeutic interventions, including behavioral activation, mindfulness-based strategies, and savoring techniques, also help re-engage patients with pleasurable activities and enhance positive affect. Innovative treatments, such as aticaprant and psilocybin, showed promising results. Substantial evidence suggests that improving anhedonia leads to better psychosocial functioning, quality of life, and sustained remission. Although most data come from short-term studies, several long-term analyses suggest that maintaining hedonic improvements is feasible and beneficial. The reviewed evidence underscores the importance of routine assessment of anhedonia and the integration of symptom-specific strategies. Tailoring interventions to address individual patterns of reward disruption may optimize outcomes for patients with anhedonia.