PCN reports : psychiatry and clinical neurosciences最新文献

Aim: Autism spectrum disorder (ASD) is a neurodevelopmental condition that markedly impairs the physical, emotional, and social domains of health-related quality of life (HRQOL). Children with ASD typically report lower HRQOL than their neurotypical peers. This study investigated the impact of self-esteem and depressive symptoms on HRQOL in children with ASD and explored the discrepancies between parent-reported and self-reported HRQOL.

Methods: This study involved 94 participants, comprising 50 children with ASD and 44 typically developed. HRQOL was measured using the J-KIDSCREEN-52 (self-reported and parent-reported). Self-esteem, depressive symptoms, and social support were assessed using the Rosenberg Self-Esteem Scale, the Depression Self-Rating Scale for Children, and the Multidimensional Scale of Perceived Social Support, respectively. Discrepancies between parent-reported and self-reported HRQOL were examined. Multiple regression analyses were performed to determine the influence of depressive symptoms and self-esteem on HRQOL.

Results: Children with ASD showed markedly lower HRQOL than their neurotypical peers. Discrepancies between parent-reported and self-reported HRQOL revealed differing perspectives. Higher depressive symptoms were strongly correlated with poorer HRQOL. Conversely, higher self-esteem was linked to better HRQOL, notably in terms of self-perception. Social support also markedly influenced HRQOL.

Conclusion: This study underscores the necessity of addressing depressive symptoms, self-esteem, and social support as interventions to enhance HRQOL in children with ASD. The differences between parent-reported and self-reported HRQOL highlight the need to incorporate both views into clinical assessments for comprehensive and effective interventions. Future research should explore these dynamics longitudinally and across diverse populations to refine the intervention strategies.

The City of Nagoya employs full-time school counselors in its schools. This activity report highlights the role of them in offering psychological support after the disaster.

Background: Delusional disorder, somatic type (DDST) is characterized by the presence of persistent delusions related to having a physical illness or bodily dysfunction, despite contradictory medical evidence. Antipsychotics like pimozide have shown efficacy in the treatment of DDST, and several case reports suggest that antidepressants may also be effective for this disorder. We are the first to report the effectiveness of escitalopram, which is a most selective and potent serotonin reuptake inhibitor, in a patient with DDST.

Case presentation: The case was a 62-year-old woman with DDST, presenting with oral somatic delusions. Escitalopram treatment (10 mg/day, increased to 20 mg/day) led to significant symptom improvement, and the symptoms of DDST had nearly resolved ∼5 weeks after the initiation of escitalopram. Single-photon emission computed tomography imaging during DDST symptoms showed reduced regional cerebral blood flow (rCBF) in the cerebral cortex, particularly in the temporal and parietal lobes, with follow-up imaging after 9 weeks of escitalopram treatment demonstrating rCBF improvement correlating with clinical recovery.

Conclusion: This case suggests that escitalopram was effective in treating DDST, providing further support for the involvement of serotonergic dysfunction in the pathophysiology of DDST. The improvement in rCBF following treatment suggests that DDST may be associated with reduced rCBF in the temporal and parietal lobes.

Aim: Previous studies have documented the beneficial effects of leisure activities on mental health. However, limited methods or scales are available to measure leisure activities for the evaluation of mental health or the intervention of mental disorders, and data on the therapeutic benefits of leisure activities for mental health are scarce. Furthermore, few studies have investigated the effects of leisure activities on the mental health of young individuals. Therefore, we developed the Leisure Activity Scale (LAS; a 7-item, 5-point scale) to assess the leisure activities of young adults, and aimed to confirm its reliability and validity.

Methods: This study involved 551 Japanese participants aged 18-25 years and was conducted through an online survey from September to November 2022. Reliability of the LAS was assessed through internal consistency analysis. To determine convergent and discriminant validity, the LAS was compared with various scales measuring psychometric properties, including depression, anxiety, work fatigue recovery, resilience, neuroticism, emotion regulation, well-being, and ill-being.

Results: Factor analysis indicated that the 7-item LAS was the most appropriate measure for use in mental health (Cronbach's α coefficient = 0.756). Total LAS7 scores positively correlated with recovery experience, resilience, emotion regulation, and well-being, and negatively correlated with state anxiety. These were all weak correlations, with correlation coefficients of less than 0.3. Total LAS7 scores did not correlate with trait anxiety, neuroticism, or ill-being.

Conclusions: Our results demonstrated the reliability of the LAS, but its convergent validity was insufficient. The LAS can comprehensively assess leisure activities, although further improvement regarding its validity is needed.

Background: Clozapine-induced agranulocytosis (CLIA) is a rare but serious complication. Fever associated with CLIA is typically treated with broad-spectrum antimicrobials, but empiric antifungal therapy is rarely used. While bacterial and viral infections have been reported in CLIA cases, no cases of fungal infections complicated by CLIA have been documented. We report the first case of CLIA complicated by invasive pulmonary aspergillosis (IPA) in a patient with schizophrenia. The diagnosis of IPA was made using serum β-D-glucan, Aspergillus galactomannan antigen tests, and chest computed tomography (CT).

Case presentation: We present a case of a 51-year-old man with schizophrenia who developed CLIA complicated by IPA. The patient, diagnosed with treatment-resistant schizophrenia, was started on clozapine, but 9 months later he presented with fever, cough, leukopenia, and neutropenia. Clozapine was discontinued, and empirical treatments with cefepime and filgrastim were initiated. Serum β-D-glucan and Aspergillus galactomannan antigen tests were positive, and chest CT showed well-circumscribed nodules, leading to a probable diagnosis of IPA. Antifungal therapy was switched from micafungin to voriconazole according to guidelines. His neutropenia and fever improved, and he was re-transferred to a psychiatric hospital.

Conclusion: CLIA can be complicated by fungal infections. When patients with CLIA present with fever, fungal infections, including IPA, should be considered in the differential diagnosis. Serological tests, including β-D-glucan and Aspergillus galactomannan, are useful for the diagnosis of IPA as well as the appropriate use of antifungal agents in patients with CLIA.

Regarding the use of telemedicine after the COVID-19 pandemic, there has been little consideration of the patient's perspective. In this review, we aimed to examine the future direction of telemedicine by reviewing the literature that evaluated telemedicine from a patient-centered perspective and providers' perspective using a mixed research method. A search of studies containing keywords related to "telemedicine," "patient satisfaction," and "patient perspective" was conducted using MEDLINE from January 2014 to August 2024. The study was conducted using a mixed research method. Eleven articles were extracted, including studies that used combined evaluation by healthcare providers. The method of integration of quantitative and qualitative studies included eight convergent designs and three explanatory sequential designs. In quantitative surveys, patients' evaluations of telepsychiatry were generally favorable, with the main advantages being convenience and access. In qualitative surveys, heterogeneity in results was observed depending on patients' conditions and social factors, such as the presence of chronic diseases and stigma, while difficulties in symptom assessment were cited by healthcare providers. The continuation of telepsychiatry after a pandemic requires collecting detailed opinions of patients using mixed research methods, qualitative surveys, and evaluation and improvement through controlled studies and studies using large, diverse samples.

Aim: We developed a Japanese version of the Child and Adolescent Behavior Inventory (CABI) and evaluated its validity and reliability.

Methods: A total of 2433 parents and 108 students in grades 4 and above participated in this study. First, we assessed the agreement between the parents' evaluations of internalizing disorders (anxiety and depression modules) and their children's self-reports. The criterion-related validity of attention deficit hyperactivity disorder (ADHD)-inattention, ADHD-hyperactivity/impulsivity, and oppositional defiant disorder (ODD) modules was also evaluated. Subsequently, we investigated whether cognitive disengagement syndrome (CDS) items differed from the ADHD items through factor analysis and examined the relationship between CDS and internalizing problems. Finally, we established normative data to adapt the CABI for use in the Japanese population.

Results: Parents' observational evaluations of internalizing disorders showed moderate agreement with children's self-reports. The ADHD-inattention, ADHD-hyperactivity/impulsivity, and ODD modules demonstrated moderate to high criterion-related validity. Factor analysis revealed that the CDS module assesses symptoms distinct from ADHD symptoms. In the Japanese population, CDS exhibited a two-factor structure (daydreaming and mental confusion), with developmental changes observed across age groups. The internal consistency and test-retest reliability of the CABI are moderate to high.

Conclusions: The scores of each CABI module were found to be reliable and valid within the Japanese sample. Future clinical research should focus on the evaluation of CDS, which is often comorbid with ADHD.

Aim: While considerable data on the alcohol drinking behavior of the general population are available for the United States and Europe, data from Asian countries are scarce. We attempted to estimate the social backgrounds and other factors associated with high Alcohol Use Disorders Identification Test (AUDIT) scores in Japan.

Methods: This web-based survey was conducted in 2023. In order to ensure the representativeness of the sample, the population distribution by age and region was determined from the Statistics Bureau Census Basic Population Summary. The survey questionnaire items included AUDIT, educational background, occupation, income, marital status, body mass index (BMI), age at the time of the first alcoholic drink, age at the start of habitual drinking, Kessler Psychological Distress Scale (K6), and Link's Devaluation Discrimination Scale.

Results: A total of 40,720 responses were received from people aged between 20 and 75 years old. The proportion of potential alcohol use disorder based on AUDIT score ≥15 was 9.2% in men and 2.0% in women. The number of people with AUDIT scores ≥15 tended to be high in men in their 50s and women in their 20s and 40s. Among those with AUDIT scores ≥15, the age at the first drink and age at the start of habitual drinking were significantly lower, and the K6 score was significantly higher.

Conclusion: This web survey showed an association between AUDIT scores and age at first drinking and mental health condition. Since this survey was a web-monitored survey, caution should be taken in generalizing the prevalence.

Aim: This study aimed to develop and validate a Japanese version of the Public Attitudes Toward Epilepsy (PATE-J) Scale to measure attitudes towards epilepsy among the general Japanese population.

Methods: The study employed a cross-sectional design using an online survey of 537 participants from the general public in Japan, with follow-up surveys at 2 weeks and 3 months. The PATE Scale was translated following standard guidelines and validated by conducting confirmatory factor analysis (CFA) on the complete data set to assess the original two-factor structure of the PATE Scale. Internal consistency assessment, and convergent validity testing with the Modified Epilepsy Stigma Scale (M-ESS), Perceived Devaluation Discrimination Scale (PDDS), and Epilepsy Knowledge Scale (EKS) were carried out.

Results: CFA confirmed the two-factor structure of the PATE-J, comprising "Personal Domain" and "General Domain." The model showed acceptable fit indices (χ²(76) = 607.974, comparative fit index = 0.849, Tucker-Lewis index = 0.820, root-mean-square error of approximation = 0.114, standardized root-mean-square residual = 0.078) and high reliability (Cronbach's α = 0.87 for Personal Domain and 0.75 for General Domain). Strong correlations with the M-ESS (r = 0.713, p < 0.001), and weaker correlations with the PDDS, along with a negative correlation with the EKS (r = -0.306, p < 0.001), highlighted the PATE-J's distinctiveness. No significant associations were found between demographic factors and PATE-J scores.

Conclusion: The PATE-J demonstrates strong psychometric properties and cultural relevance for measuring public attitudes toward epilepsy in Japan. Its validated two-factor structure supports cross-cultural comparisons and provides a reliable tool for assessing public attitudes, informing interventions, and guiding education campaigns.

Aim: This study examines the impact of COVID-19 pandemic-induced behavioral restrictions on child psychiatric inpatients in Japan, particularly focusing on limitations placed on outings and overnight stays as infection-control measures.

Methods: Data were collected from inpatients from the children's mental health registry between January 2016 and December 2022. The clinical data, such as age, gender, diagnosis, result of polymerase chain reaction (PCR) tests, frequency of outings and overnight stays before and after the pandemic, were compared.

Results: During the COVID-19 pandemic, the decrease in both outings and overnight stays among child psychiatric inpatients in Japan was statistically significant. As a result, home interactions with families decreased. In addition, diagnoses of hospitalized children increased significantly in cases of eating disorders and decreased in diagnoses of autism spectrum disorders.

Conclusion: These results underscore the need for flexible, individualized approaches to infection control that consider the mental health of hospitalized children.