PCN reports : psychiatry and clinical neurosciences最新文献

Aim: Studies show gambling disorders are associated with attention-deficit hyperactivity disorder (ADHD). The association between gambling disorders and autism spectrum disorder (ASD) has not been well studied, although ASD is often comorbid with ADHD and is associated with gaming disorder. The aim of this study was to estimate the prevalence of ASD and ADHD traits comorbid with gambling disorders and to examine the relationships between these traits and gambling problems in a clinical population.

Methods: This single-site cross-sectional study was conducted at a Japanese addiction outpatient clinic treating gambling disorders. The Autism-Spectrum Quotient (AQ) test and the Adult ADHD Self-Report Scale (ASRS) were used to screen ASD and ADHD. The Problem Gambling Severity Index (PGSI) was used to assess the severity of the gambling problems. We calculated the prevalence of suspected ASD and ADHD with 95% confidence intervals (CI) based on a binomial distribution and performed univariate analyses to examine the relationships between the AQ and ASRS scores and the total PGSI score.

Results: We included 97 of 197 potential participants. After screening the participants using the AQ and ASRS, we found that the prevalence of ASD traits was 29.8% (95% CI: 21.0%-40.2%), while the prevalence of ADHD traits was 26.0% (95% CI: 17.9%-36.2%). Univariate regression analyses revealed that the total AQ score was inversely associated with the total PGSI score. However, the total ASRS score and some ASRS subscores were positively associated with the total PGSI score.

Conclusion: ASD and ADHD may be prevalent among patients with gambling disorders in clinical settings.

Aim: The purpose of this study was to examine factors affecting depression trait among male intimate partner violence (IPV) victims in Japan utilizing a multiple linear regression analysis.

Methods: A web-based questionnaire survey was conducted. Male IPV victims living in Japan were recruited to answer the questionnaire on the website on February 25-26, 2021. A total of 16,414 subjects were enrolled, of whom 1466 respondents were included in the study. Other than IPV exposure, information about sociodemographic characteristics, past traumatic experiences and psychiatric history was collected. The Domestic Violence Screening Inventory (DVSI), a 20-item questionnaire regarding IPV exposure, and the Patient Health Questionnaire-9 (PHQ-9) were used to determine the intensity and the type of IPV harm and to screen for depression, respectively.

Results: The victims were more frequently subject to psychological abuse than to physical violence. Based on PHQ-9 scores, 10.7% of respondents exhibited moderate to severe depression. In the DVSI score, 79.2% of respondents required "observation and support." The lowest level of academic attainment (junior high school), positive psychiatric history, foregoing divorce to avoid adverse childhood experiences of their offspring, childhood exposure to domestic violence, younger age, having no children, and experience of school bullying were shown to be significantly associated with depression trait.

Conclusion: Male IPV harm has a multilayered complexity. The sociodemographic characteristics and experiences of victims' own have a greater impact on depression trait than direct violent harm, suggesting that the violence-focused support might be inadequate for male victims. Comprehensive supports are urgently needed.

Pathography is a medical anthropological approach that examines the relationship between creation and psychiatric disorders through psychopathological and psychoanalytical lenses using case studies. Since it was first defined in the mid-1960s, pathography in Japan has kept pace with current advances in psychopathological research. However, to date, the findings of pathographic research in Japan have not been published in English. Therefore, the purpose of this paper is to introduce the history, methodology, and development of pathography in Japan to the English-speaking world, accompanied by some classical examples. The paper first describes the history of pathography, from its origins in ancient Greece to important research in the field, including examples of publications and translations. Next, the paper presents the methodology of classical pathography as an approach that shares clinical psychopathology and psychiatric evaluation methods. This topic also introduces five main theses on the relationship between creativity and psychiatric disorders: opposition ("in spite of"), parallelism ("because of"), substitution ("instead of"), intrinsic ("belonging to"), and sublimation ("subsequent to"). Finally, the paper describes the development of pathographic research in Japan by summarizing the pathographies of several figures, including both creators and characters in literary works, and introducing the latest research on salutography, a newly developed field of study that explores the relationship between creativity and mental health. The paper concludes with a few words about the current limitations of pathography and suggestions for ethical considerations with respect to privacy legislation.

The present article spotlights challenging conceptual and epistemological issues regarding delusions. A research history of various approaches to delusions in Europe, the United States, and Japan reveals the difficulty of defining delusions. Facing these difficulties, the standard concept of delusions has become thinner than the traditional ones, making its boundary with minority opinions vaguer. Nevertheless, clinical typology and epistemological approaches are contributing to the continuous conceptual refinement of delusions. Both standpoints validate and promote each other in elaborating the characteristics of delusions and their boundaries with non-delusions. In addition, epistemological inquiries into delusions shed new light on the extraordinarily difficult problems in the relationship among belief, knowledge, certainty, and delusions, contributing to epistemology in general. These approaches to delusions promote the evolution of the concept of delusions and related epistemological inquiries.

Aim: Stigma among healthcare professionals toward people who use drugs (PWUDs) must be addressed for recovery. However, research on this topic is limited in Japan, therefore we developed a brand-new scale through coproduction with PWUDs to measure stigma and conducted a survey using the developed scale to examine what influences stigma towards PWUDs in Japanese healthcare settings.

Methods: Based on interviews with PWUDs and their families, we developed a survey containing 24 questions on stigma toward PWUDs. The survey was sent to healthcare professionals working in the public sector. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to determine the factor construct. Generalized linear mixed model (GLMM) analyses with each factor of the stigma questions set as a dependent variable were conducted to discover the specific contribution of each variable to professionals' stigma.

Results: The six factors suggested by the EFA showed a good fit, as confirmed by the CFA of the stigma questions. GLMM discovered that "currently providing treatment services to PWUDs," "having PWUDs close to themselves," and "experiencing violence by the client when providing treatment services" were significantly associated with higher stigma scale scores. "Experience in receiving support," "attending self-help groups," and "using peer-based recovery support with PWUDs" were significantly associated with lower stigma scale scores.

Conclusion: The scale coproduced with local PWUDs can be a reliable tool to measure the stigma PWUDs face in Japan. Further results indicate that interaction with recovered PWUDs should be promoted.

Aim: We intended to elucidate the relationship between mentalizing capacity and affective states by investigating the mediatory role of emotion dysregulation.

Methods: A sample of nonclinical Iranian adults (N = 445) completed a battery of online self-report measures comprising the Positive and Negative Affect Schedule (PANAS), Mentalization Scale (MentS), and Difficulties in Emotion Regulation Scale (DERS).

Results: Correlational analyses demonstrated that self- and other-related mentalizing were significantly and inversely associated with emotion dysregulation, which in turn was strongly linked with positive and negative affects. Using structural equation modeling, the results delineated emotion dysregulation as a mediator between self- and other-related mentalizing and affective states, predicting higher negative and lower positive affects. However, motivation to mentalize failed to predict positive affects and only contributed to lower negative affects directly.

Conclusion: Mentalizing capacity was found to be indirectly linked with affective states through emotion dysregulation; hence, along with the previously substantiated association between emotion dysregulation and affective states and the partially established relationship between mentalizing capacity and affective states, we propose mentalizing incapacity to be at fault in the development of affective difficulties.

Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.

This paper will focus on the works of one of Japan's representative psychiatrists, Yomishi Kasahara, particularly on his works in the 1970s in which he proposed the concept of student apathy, and will discuss how this work was carried over into a contemporary topic, the study of "Hikikomori." Kasahara's well-known paper "Clinical Classification of Depression" (Kasahara and Kimura, 1975) described the present state of patients with Type III as "they do not have a complete set of symptoms as in Type I, but sometimes show dependency, strong exaggeration, complication of other neurotic symptoms, little tendency of self-reproaching, and tendency of accusing others"; the two subtypes as Type III-1 "those that remain at the neurotic level" and Type III-2 "those that transiently drop to the psychotic level." We have summarized and introduced below the case presented in the paper with this Type III-1. From today's perspective, where the concept of "Hikikomori" exists, this case could be considered as a typical case of "Hikikomori," that is, a person with a tendency to avoid social roles and responsibilities and to immerse oneself in areas with no responsibilities, such as hobbies. "Hikikomori" was discovered in the late 1980s, but to be precise, it was just that the concept emerged. The same clinical condition had already been brilliantly found by Kasahara in the 1970s under the concept of "apathy syndrome," which was distinguished from depression.

Background: Nocturnal eating behavior in patients with sleep-related eating disorder (SRED) is difficult to control and can become chronic, causing weight gain and psychological distress. Here, we report a case of SRED comorbid with major depressive disorder successfully treated by switching from brotizolam to suvorexant, that is, from a benzodiazepine to an orexin receptor antagonist.

Case presentation: A 25-year-old woman complained of night snacking with partial/complete amnesia and sleepwalking for 1 year. She had a diagnosis of major depressive disorder at age 20 and was on paroxetine and brotizolam for depression and insomnia. At 24 years of age, she experienced her second depressive episode, then her amnestic nocturnal eating became prominent. Even after improvement in depressive symptoms, she experienced uncontrollable nocturnal eating episodes every 2 days, resulting in weight gain of over 10 kg. After a partial amnestic eating episode following an awakening from stage N2 sleep was confirmed through video polysomnography, she was diagnosed with SRED. Considering her strong desire to resolve involuntary eating, we instructed her to discontinue brotizolam and start suvorexant. Subsequently, her nocturnal eating completely disappeared. She experienced rebound insomnia, which improved within 1 month. She was then continued on 10 mg of suvorexant and has not experienced nocturnal eating for 2 years.

Conclusion: This case highlights the importance of discontinuing benzodiazepines in the treatment of SRED, but also suggests the potential benefit of orexin receptor antagonists in the treatment of SRED. The efficacy of orexin receptor antagonists in idiopathic SRED should be tested in future studies.