PCN reports : psychiatry and clinical neurosciences最新文献

Aim: Although alcohol consumption is known to be a trigger for suicide, the extent to which acute alcohol consumption influences suicide attempts in Japan is unclear. We investigated the actual state and background of alcohol-induced suicide attempts, that is, suicide attempts induced by acute alcohol consumption, in patients with severe suicide attempts admitted to the emergency department.

Methods: The subjects were suicide attempters over 20 years old who were admitted to the emergency department between 2010 and 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives of suicide attempts were retrospectively examined from medical records. We compared differences in the characteristics of data obtained from males and females with and without alcohol-induced suicide attempts, and used logistic regression analysis to evaluate the influence of those factors on alcohol-induced suicide attempts.

Results: Among the 801 suicide attempters over 20 years old during 2010 to 2021, 130 (16.2%) were alcohol-induced suicide attempters: 61 (18.9%) of 323 male suicide attempters and 69 (14.4%) of 478 female suicide attempters. Substance-induced disorders in both males and females, in addition to marital relations in males and living alone and personality disorders in females, had significant influence on alcohol-induced suicide attempts.

Conclusion: Acute alcohol consumption was found to be a trigger in approximately one in six suicide attempts and alcohol-induced suicide attempts were not unique in terms of substance dependence. We believe that focusing on those factors that seemed to influence alcohol-induced suicide attempts in the present study could provide clues regarding the prevention of alcohol-induced suicide attempts.

Aim: Post-intensive care unit (ICU) patients often experience physical or mental dysfunction. This study aims to investigate the relationship between sleep disturbances and mental and physical problems in patients discharged from the ICU to hospital wards, using both subjective and objective sleep measures.

Methods: Patients admitted to the ICU for at least 72 h between November 2021 and June 2022 were included in the study. On the seventh day after ICU discharge, we conducted an objective sleep assessment using an electroencephalogram-based mobile sleep-monitoring device. Patients self-administered severity ratings for fatigue, depression, and post-traumatic stress (PTS) symptoms. Insomnia symptoms were assessed using the insomnia severity index (ISI) before and after ICU admission.

Results: Thirty-five patients (median age 73) were included in the study. Higher ISI scores at ward were significantly correlated with higher levels of fatigue (r = 0.463, P = 0.005), depression (r = 0.343, P = 0.044), and PTS symptoms (r = 0.477, P = 0.004). Among the objective sleep measures, reduced N3 sleep (r = -0.480, P = 0.004) was significantly correlated with more severe PTS symptoms. However, no statistically significant correlations were found between objective sleep indicators and either fatigue or depression.

Conclusion: The observed reduction in N3 sleep and its association with PTS symptoms in this study might have reflected the physical and psychological stress experienced during intensive care. Subjective insomnia severity, which was related to fatigue, depression, and PTS symptoms in the ward, could be an important intervention target after ICU discharge.

This article introduces Shin Ihda's manifestation model of mood disorders. Ihda et al. reported eight cases of monozygotic twins with discrepancies in the onset and clinical presentation of mood disorders. The reports emphasize the prevalence of cyclothymic, melancholic-type, and manic-type personalities among the twins, as well as the differences in onset, clinical presentations, and course of the disorder, despite the twins being genetically nearly identical. Applying the twin study methodology, Ihda proposed the twins' developmental histories, personalities, and situations surrounding disorder onset as factors contributing to discrepancies in the clinical presentation and course of the disorder. Based on situation theory, he proposed a manifestation model of mood disorders, comprehensively explaining the development of a depression-prone personality through growth stages, situations that lead to depression or mania, and the disorder progression process based on inherent temperament. The model assumes five possible pathways: the revelation of underlying mood instability in defenseless cyclothymic personalities; the collapse of the illusionary feeling of omnipotence in manic-type individuals; the revelation of the need for objects in clinging individuals; the collapse of the illusionary feeling of integration with an authority figure through introjection in melancholic individuals; and neurosis. Ihda's insightful depiction of the specific interactions between genetics and environment has valuable implications for research and clinical practice.

Aim: Somatic symptom disorder (SSD) is prevalent in primary healthcare settings and is often challenging to diagnose and treat. This study examined the neurodevelopmental and personality traits of individuals with probable SSD.

Methods: This cross-sectional study utilized anonymous online surveys. In this study, individuals with a score of 23 or higher on the Somatic Symptom Disorder-B Criteria Scale (SSD-12) were defined as having probable SSD, and individuals with no somatic symptoms and who scored 0 were defined as the healthy control (HC) group. We compared groups regarding neurodevelopmental traits, personality traits, depression, and anxiety using self-report questionnaires and analysis of covariance. In addition, we examined the association between neurodevelopmental traits, emotional problems, and SSD in the probable SSD group using structural equation modeling.

Results: A total of 491 people with probable SSD and 532 age- and sex-matched HCs were analyzed. The scores for somatic symptom severity, depression, generalized anxiety, health anxiety, attention deficit/hyperactivity disorder traits, autism spectrum disorder traits, personality traits, and personality disorder traits showed significant differences between the probable SSD group and the HC group. In the probable SSD group, neurodevelopmental traits positively and directly affected emotional problems and SSD.

Conclusion: Most neurodevelopmental and personality traits were associated with probable SSD. When approaching patients suspected of having SSD, clinicians may consider not only somatic symptoms, but also neurodevelopmental traits, personality traits, depression, and anxiety.

Aim: Young patients with social communication difficulties are often diagnosed with autism spectrum disorder (ASD), social communication disorder (SCD), or social anxiety disorder (SAD). This study aimed to develop a questionnaire, especially focusing on the prescreening of SAD complicated by ASD/SCD.

Methods: The 12-item self-report Questionnaire for Difficulty in Social Communication (DISC-12) was developed and analyzed using exploratory factor analysis in 94 patients with ASD/SCD (35 with SAD, 59 without). An additional 17 patients with only SAD were included. Convergent validity was assessed via correlations with the Autism Spectrum Quotient (AQ) and Liebowitz Social Anxiety Scale (LSAS). DISC-12 scores and demographics were compared across ASD/SCD, ASD/SCD + SAD, and SAD groups. Receiver operating characteristic (ROC) analysis of DISC-12 subscales distinguished autistic traits from social anxiety.

Results: Factor analysis revealed a three-factor model for the DISC-12, comprising nonassertiveness, poor empathy, and interpersonal hypersensitivity. DISC-12 showed significant correlations with the AQ (r = 0.412, p < 0.001) and LSAS (r = 0.429, p < 0.001). Patients with ASD/SCD had higher Poor Empathy scores, while SAD patients had higher Interpersonal Hypersensitivity scores than the other groups. ROC analysis indicated that Poor Empathy and Interpersonal Hypersensitivity subscale scores effectively differentiated ASD/SCD from patients with SAD and vice versa.

Conclusion: DISC-12 is a rapid and effective prescreening tool for identifying both ASD and social anxiety, particularly in young patients with self-reported difficulties in social communication.

Aim: As it is difficult to examine the mental health of disaster victims immediately after a disaster through the rigorous procedures required for academic papers, the overall mental state of victims immediately after a disaster is not well understood. Therefore, this study aimed to investigate the actual mental health needs of victims during the transition from the acute and subacute phases to the chronic phase of the 2024 Noto Peninsula earthquake (NPE).

Methods: We obtained Emergency Medical Information System (EMIS) data for a period of ∼1 month during Disaster Psychiatric Assistance Team support from outside the prefecture in Suzu City and Noto Town. We then extracted the following variables of the supportees from the EMIS data: age, consultation stage, content of response, psychiatric treatment history, and diagnostic classification. We compared the variables between the 2 weeks immediately after the disaster (Phase 1) and the following 2 weeks (Phase 2).

Results: New consultations started mostly in Phase 1 and dropped in Phase 2. Consultations were initially dominated by victims with existing psychiatric disorders, but those on dementia-related problems and direct stress reactions to the disaster increased over time.

Conclusion: Information accumulated in the EMIS was useful for providing an overview of the mental state of communities affected by the 2024 NPE. The extracted findings may be useful for planning mental health measures for affected communities and preparing for future disasters, which may improve community resilience in affected areas.

Background: Psychosocial factors significantly influence outcomes following heart transplantation (HT). In Japan, the prolonged waiting period for HT often requires a ventricular assist device (VAD), demanding strict adherence to self-care regimens to prevent complications. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) identifies psychosocial barriers to successful transplantation. This case report describes the use of SIPAT-guided psychological support for an adolescent awaiting HT.

Case presentation: A 16-year-old Japanese male with dilated cardiomyopathy underwent evaluation for HT. The SIPAT assessment revealed a total score of 25, with elevated scores in readiness for illness management (SIPAT A: 11) and social support (SIPAT B: 12), indicating challenges with understanding his condition and unstable family dynamics. Tailored interventions included psychotherapy and family psychoeducation. Following VAD implantation, initial nonadherence to self-care prompted further evaluation using the Wechsler Adult Intelligence Scale-Fourth Edition, which revealed deficits in processing speed and verbal comprehension. A transtheoretical model-guided intervention was then implemented to improve self-care behaviors. Periodic SIPAT assessments during routine check-ups facilitated ongoing monitoring and timely interventions. Over 25 months, the SIPAT scores improved (14 and 15) and no adverse outcomes, such as infections, emergency hospitalizations, or nonadherence behaviors, were observed.

Conclusion: This case highlights the effectiveness of early SIPAT-guided psychological support and multidisciplinary interventions in addressing complex psychosocial issues in adolescents during the VAD waiting period. It underscores the critical need for regular psychosocial assessments and individualized care to optimize transplantation outcomes.

Aim: We aimed to evaluate the understanding of delirium among multidisciplinary medical staff and assess whether a brief e-learning course improved their knowledge on the topic.

Methods: A total of 611 medical staff members participated in the study, including 32 physicians, 393 nurses, 33 nursing assistants, 21 pharmacists, and 132 other multidisciplinary staff, which included non-clinical personnel. A 20-question delirium knowledge test was administered both before and after a 40-min, on-demand e-learning course.

Results: At baseline, there was limited understanding that delirium involves a disturbance of consciousness, can be triggered by physical illness or medications, and that few medications are recommended for its treatment. Furthermore, visual hallucinations were not widely recognized as a common type of hallucination in delirium. However, care strategies and non-pharmacological interventions for delirium were well understood even before the course. After the brief e-learning course, knowledge scores significantly increased, demonstrating a large effect size of 0.53. Physicians and pharmacists achieved higher overall knowledge scores after the course compared to other occupational groups.

Conclusion: Education and targeted dissemination efforts regarding the causes, diagnosis, and pharmacological treatment of delirium are essential for enhancing delirium knowledge among multidisciplinary staff. The leadership role of a "liaison" psychiatrist is pivotal for ensuring effective delirium care and fostering a team-based approach in clinical practice.

Aim: The aim of this study is to estimate the rate of patients who screened positive for gaming disorder (GD) in ICD-11 among adolescents with psychiatric and/or developmental disorders by using two screening tests: a nine-item screening test for GD, GAMing Engagement Screening test (GAMES Test), and the Ten-Item Internet Gaming Disorder Test (IGDT-10).

Methods: Subjects were 257 adolescent patients attending a psychiatric clinic in Sapporo, Japan. They were asked to complete two questionnaires. The total score on the IGDT-10 was calculated by two different scoring methods, original version (OV) and modified version (MV). The three groups were also compared on the basis of their clinical diagnoses.

Results: Of the 203 respondents, 42 (20.7%) screened positive using the GAMES Test. With respect to the IGDT-10, only eight (3.9%) screened positive using the IGDT-10 OV scoring, while 55 (27.1%) screened positive using the IGDT-10 MV. The most notable finding was that the mean total scores on the GAMES Test and the IGDT-10 MV were significantly higher in the attention deficit hyperactivity disorder group than in the other two groups (depression and autism spectrum disorder).

Conclusion: The results of this study showed that adolescents with mental health problems had a higher rate of screening positivity on self-rated screening tools for GD than the general population. Because excessive gaming has a wide range of adverse effects on adolescents' mental health, early detection of probable GD is crucial. Screening for GD should be part of routine clinical practice.