Factors associated with duration before receiving definitive diagnosis of narcolepsy among Japanese patients affected with the disorder.

BACKGROUND: Narcolepsy (NA) is a sleep disorder characterized by excessive daytime sleepiness and an increased propensity of rapid eye movement sleep. If left untreated, NA can lead to academic underachievement or job loss because of dozing off or mistakes caused by inattentiveness due to sleepiness. PURPOSE: Although untreated narcolepsy patients may suffer from many social disadvantages due to excessive daytime sleepiness, mostly it takes a long time to receive a definitive diagnosis of the disorder. This retrospective study investigated factors related to the period until definitive diagnosis among patients with narcolepsy in Japan. METHODS: We enrolled 181 consecutive patients (108 men, 73 women; mean age 37.6 ± 16.6 years old; narcolepsy with cataplexy/narcolepsy without cataplexy = 131:50). Multivariate logistic regression analysis was performed with period until definitive diagnosis as the dependent variable and descriptive clinical variables as the independent variables. RESULTS: The mean period until receiving the diagnosis among the participants was 9.9 ± 10.1 years. More than half of the patients first learned about the disorder from information provided by the media. Multivariate logistic analysis indicated that adult onset (p < 0.01), onset in 1995 or later (p < 0.001), and first learning about the disorder from a sleep disorder specialist physician or a general practitioner (p < 0.001) were associated with a time taken for receiving a definitive diagnosis less than or equal to the median value (7 years). CONCLUSION: Improving access to information about the concept of the disorder and the medical institutions specialized in sleep disorders, especially via the Internet, would be necessary to promote early diagnosis of the disorder.

[Recent progress of the ICD-11].

The ICD-11 is being developed for publication in 2015, while another important diagnostic classification system, the DSM-5, is being finalized and prepared for publication in 2013. This paper provided an overview of the revision process and also the current status of the drafts of both systems. In addition, the Global Clinical Practice Network, an online network created by the WHO for clinicians throughout the world to participate in the revision efforts for the ICD-11 by reviewing the proposals, providing feedback on them, and participating in field trials, is introduced.

[Assessment of psychological distress in cancer outpatients treated with chemotherapy].

PURPOSE: Few studies have been conducted to elucidate the psychological distress of cancer outpatients being treated with chemotherapy. In this study, we attempted to determine the types of psychological distress endured by cancer outpatients being treated with chemotherapy. METHODS: We investigated 194 outpatients with various malignancies, including hematological, esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, using the Japanese version of the Self-Rating Depression Scale, from June through December 2010, in our hospital. RESULTS: The results of the survey questionnaire indicated suspected adjustment disorders in 84 patients(43. 3%)and major depression in 14 patients(7. 2%). Medications prescribed for psychological distress were antianxiety drugs(18 patients: 9. 3%), antidepressant drugs(2 patients: 1. 0%), and sleeping pills(50 patients: 25. 8%). CONCLUSION: Our findings may be useful for the development of management strategies for psychological distress, and we suggest that there is a need for improvement in the quality of life of cancer outpatients being treated with chemotherapy.

Effects of nasal continuous positive airway pressure on panic disorder comorbid with obstructive sleep apnea syndrome.

BACKGROUNDS: Both obstructive sleep apnea syndrome (OSAS) and panic disorder (PD) are common disorders that often coexist. Continuous positive airway pressure (CPAP) has been established as the first-line treatment for OSAS. In this study, we examined the efficacy of CPAP on PD comorbid with OSAS by conducting a randomized crossover study using sham CPAP as control. METHODS: PD patients (n=12) with an apnea hypopnea index (AHI) of 20/h or higher completed the study. At baseline, the subjects were asked to write their own records pertaining to the frequency of attacks and their score on the panic disorder severity scale (PDSS), and then they participated in the randomized crossover trial period, which measured optimal CPAP and sham CPAP set at 4cmH(2)O during nighttime sleep for each 4-week assignment. RESULTS: The frequency of panic attacks, total PDSS score, and the frequency of alprazolam use for alleviating the attack symptoms were significantly decreased during the optimal CPAP period than during the baseline period and the sham CPAP period. Among the PDSS subitems, the frequency of attacks, panic distress, work impairment, and social impairment showed significant improvements during the optimal pressure period. CONCLUSION: Our results suggest that OSAS contributes to PD aggravation, and a combination of pharmaceutical treatment for PD and OSAS-specific treatments such as CPAP could be recommended for patients with PD comorbid with OSAS.

Schizo-nomenclature: a new condition?

Some psychiatric diagnoses are stigmatic. In August of 2002, at the annual congress of the Japanese Society of Psychiatry and Neurology, the Society decided to change the name of schizophrenia in Japanese from seishinbunretsu-byo ('split mind disease') to togoshitcho-sho ('loss of coordination disorder'). In 2006 a survey was carried out among the 80 members of the Section on Classification, Diagnostic Assessment and Nomenclature of the World Psychiatric Association. Of the 21 responding, nine (45%) did not think that 'schizophrenia' was an appropriate term for the disease and half thought that the term 'schizophrenia' had a stigmatic meaning.

Relationship of nurse burnout with personality characteristics and coping behaviors.

Burnout of nurses at university hospitals was analyzed in relation to their personality characteristics and coping behaviors. A self-administered questionnaire regarding burnout (the Copenhagen Burnout Inventory), work-related stressors (the Nursing Job Stressor Scale), personality characteristics (Short-Form Eysenck Personality Questionnaire-Revised), and coping behaviors (the short Japanese version of Brief COPE) was used. We obtained answers from 778 nurses (response rate: 94.9%), and analyzed 707 female registered nurses. Multiple regression analysis showed that neuroticism was more closely related to personal, work-related, and client-related burnout than extroversion. Covariate structure analysis revealed that among the nurses with high neuroticism and low extroversion, client-related burnout was found to be correlated with stressors in relation to conflict with patients and with positive coping behaviors. Among the nurses with low neuroticism and high extroversion, client-related burnout correlated with the coping behavior of behavioral disengagement and conflict with patients. In both groups, an increase in quantitative workload was associated with a higher score for stressors arising from conflict with patients, leading to client-related burnout. These results suggest that acquisition of skills to cultivate appropriate coping behaviors might be useful for reducing client-related burnout in relation to nurses' personality characteristics. These findings need to be further endorsed by intervention studies.

Reliability and validity of the Japanese version of the Anxiety Sensitivity Index.

This preliminary study evaluated the reliability and validity of the Japanese version of the Anxiety Sensitivity Index (ASI). Its test-retest reliability and internal consistency were found acceptable. Factor analysis of the ASI yielded 4 anxiety-related factors: factor I is heart/lung failure concern; factor II, psychological concern; factor III, physical concern; and factor IV, social concern. In addition, multiple regression analysis showed that the ASI score significantly correlated only with the neuroticism-related category of the NEO-Personality Inventory Revised. The ASI mean scores of those with 5 or more according to the General Health Questionnaire (unhealthy) and those with 16 or more according to the Center for Epidemiological Studies Depressive Scale (depression) were significantly higher than in the healthy and nondepressive groups. Although further research is necessary to confirm the construct validity by factor analysis of the ASI, the Japanese version of the ASI is applicable for use in the Japanese population.

Factor structure of the Dimensional Assessment of Personality Pathology-Basic Questionnaire and its relationship with the revised NEO personality inventory in a Japanese sample.

The Dimensional Assessment of Personality Pathology, Basic Questionnaire (DAPP-BQ) was developed to assess 18 personality traits that provide a systematic representation of personality disorder. This study investigates the reliability and validity of the Japanese version of the DAPP-BQ and the relationship between the DAPP-BQ and Revised NEO Personality Inventory (NEO-PI-R) in a heterogeneous general population sample (n = 1485). Internal consistency (coefficient alpha) and test-retest reliability over a 3-week period was satisfactory for all scales. Factor analysis yielded 4 factors labeled "emotional dysregulation," "dissocial behavior," "inhibition," and "compulsivity" that accounted for 76.0% of the total variance. Subsequently, we investigated the relationships between the 18 dimensions and the 5 dimensions of the NEO-PI-R in a second heterogeneous general population sample (n = 717). Combined factor analysis of the 2 scales again yielded 4 factors accounting for 70.4% of the total variance. Finally, we used multiple regression analyses to examine the extent to which the 5 NEO-PI-R scales could be used to predict individual DAPP-BQ scales. These indicated that the NEO-PI-R does not have content that covers some DAPP-BQ dimensions, especially conduct problems, narcissism, and stimulus seeking.

Caffeic acid attenuates the decrease in cortical BDNF mRNA expression induced by exposure to forced swimming stress in mice.

We previously reported that caffeic acid produces antidepressive-like effects in the forced swimming test in mice, an animal model of depression. Increased evidence suggests that brain-derived neurotrophic factor (BDNF), a member of the neurotrophin family that has high affinity for the tyrosine kinase receptor B (TrkB), plays an important role in the pathophysiology and treatment of depression. The present study examined whether caffeic acid affects the expression levels of BDNF and TrkB mRNA in brain regions of mice subjected to a forced swimming test. Caffeic acid (4 mg/kg, i.p.) reduced the duration of immobility of mice in the forced swimming test. The levels of BDNF mRNA in the frontal cortex as well as TrkB mRNA in the amygdala were significantly decreased after the forced swimming test, and the former reduction was significantly inhibited by caffeic acid (4 mg/kg, i.p.). Caffeic acid (4 mg/kg, i.p.) did not modify the levels of BDNF and TrkB mRNA in brain regions of naive mice. These results suggest that caffeic acid can attenuate the down-regulation of BDNF transcription that results from stressful conditions.

Effects of a 5-HT7 receptor antagonist DR4004 on the exploratory behavior in a novel environment and on brain monoamine dynamics in mice.

The present study examined whether serotonin (5-hydroxytryptamine; 5-HT)7 receptors play a role in the modulation of emotionality in mice using the selective 5-HT7 receptor antagonist 2a-[4-(4-phenyl-1,2,3,6-tetrahydropyridyl)butyl]-2a,3,4,5-tetrahydrobenzo (c,d)indol-2-(1H)-one (DR4004). The emotionality of mice was evaluated in terms of exploratory activity in the hole-board test. The mice treated with DR4004 (2.5-10 mg/kg, i.p.) displayed a dose-dependent decrease in locomotor activity by moving less distance in the hole-board, and statistically significant decreases were observed at 5 and 10 mg/kg. On the other hand, DR4004 (10 mg/kg, i.p.) did not affect spontaneous motor activity. In a neurochemical study, decreases in amygdaloid dopamine and 5-HT turnover were observed in mice in which locomotor activity in the hole-board test was attenuated following the administration of DR4004 (10 mg/kg, i.p.). Also, a simple linear regression analysis revealed that locomotor activity on the hole-board was significantly correlated with dopamine and 5-HT turnover in amygdala. Furthermore, co-injection of the selective dopamine reuptake inhibitor 1-(2-[bis(4-fluorophenyl)methoxy]ethyl)-4-(3-phenylpropyl)piperazine (GBR12909; 1.25-5 mg/kg, i.p.) or the selective 5-HT reuptake inhibitor fluvoxamine (20 mg/kg, i.p.) significantly reversed the DR4004 (10 mg/kg, i.p.)-induced decrease in locomotor activity in the hole-board test. These findings constitute the behavioral evidence that 5-HT7 receptors may play a role in the modulation of emotionality. Furthermore, it is also suggested that amygdaloid dopamine and 5-HT neuronal systems may be involved in this modulation.

Prevalence of substance abuse among patients with physical diseases seen in an emergency room in Japan.

According to a nationwide general population survey on drug use in Japan, the lifetime prevalence of methamphetamine is low when compared to the United States. To confirm the hypothesis of a lower point prevalence of methamphetamine in an emergency room (ER) in Japan than in the United States, we collected blood specimens from an urban area of heavy methamphetamine prevalence in Tokyo, Japan, and analyzed the sera using REMEDi-HS based on an unlinked anonymity. Twenty kinds of drugs other than psychotropics were detected in 55 of 279 subjects (19.7%). Nineteen kinds of psychotropics were detected in twenty (7.2%) subjects. Psychotropics were detected in eleven patients with physical diseases and no acute intoxication. Methamphetamines were detected in three subjects (1.09%, 95% confidence interval 1.073-1.088) and in one of 46 subjects with injury (2.2%). It is necessary to look at the methodological differences between this study and previous studies; however, this finding supports the lower point prevalence of methamphetamine in an ER in Japan than in an ER in the United States.

[Preliminary reports on psychiatric practice in correctional facilities].

In October 2001, Nanashakon, a council composed of seven psychiatry-related organizations in Japan, decided to launch an investigation into forensic psychiatry in Japan, and established a working team (WT) for this purpose. From its establishment to March 2004, the WT performed surveys and analyses of the current situation of preliminary reports by psychiatric experts (preliminary reports) and of psychiatric practice in correctional facilities. Based on the results, the WT has presented proposals including guidelines for preliminary reports. In January 2002, the WT conducted an awareness survey on the status quo of testimony by psychiatric experts and forensic psychiatry, targeting the members of the Japanese Society of Psychiatry and Neurology, and obtained 666 replies. The survey revealed various critical opinions such as skepticism over the current punishment imposed on criminal patients with mental disorders. In February 2002, the WT obtained data on preliminary reports (2,042 cases) compiled prior to prosecution in FY2000 from the Japanese Ministry of Justice. Reviewing the details and differences between the evaluation by psychiatrists and the decision by public prosecutors, the WT pointed out the ambiguity of criteria used for the evaluation of competency of weak-minded persons and the criteria for criminal punishment. Around the same time, the WT was also asked by a news agency to analyze the preliminary reports of 50 district public prosecutor offices. The results revealed marked regional differences in the operation of the preliminary evaluation system for competency. In January 2003, the WT collected 146 preliminary reports from around the country for comparison and review, and again found conspicuous individual and regional discrepancies in the format and content. Based on these results, the WT conducted a hearing of 41 expert opinions on preliminary reports, and in January 2004, proposed guidelines outlining a format model of preliminary reports, and a training and authorizing system for forensic psychiatrists, to standardize preliminary reports and enhance their reliability. In February 2004, the WT conducted a questionnaire survey on the current situation of psychiatry in correctional facilities, targeting doctors with experience working under these circumstances. Fifty-one replies were obtained. Most of the respondents approved of the current system. However, to incite arguments in this area, attempts were made to draw critical responses and discussion by presenting data on the current situation of psychiatric practice in correctional facilities.

Caffeic acid produces antidepressive- and/or anxiolytic-like effects through indirect modulation of the alpha 1A-adrenoceptor system in mice.

We previously reported that caffeic acid produce antidepressive- and/or anxiolytic-like effects in two different types of stress models. It has recently been reported that caffeic acid affects the alpha1A-adrenoceptor system. The present study examined whether the alpha1A-adrenoceptor system is involved in the antidepressive- and/or anxiolytic-like effects of caffeic acid. Caffeic acid reduced the duration of immobility and freezing of mice produced by forced swimming and conditioned fear stress, respectively. These effects of caffeic acid were suppressed by the alpha1- and alpha1A-adrenoceptor antagonists. However, caffeic acid did not alter the binding of [3H]prazosin to alpha1A-adrenoceptor in mouse cortical membranes. These results suggest that indirect modulation of the alpha1A-adrenoceptor system may be involved in the antidepressive- and/or anxiolytic-like effects of caffeic acid.

Psychosocial factors associated with quality of life in Japanese patients with human immunodeficiency virus infection.

The purpose of this study was to identify psychosocial factors, including coping style, that are associated with quality of life (QOL) in Japanese patients with human immunodeficiency virus (HIV) infection and to clarify the difference in coping style between patients with hemophilia and patients with sexually transmitted infection. We administered the World Health Organization QOL-26 questionnaire, the Mental Adjustment Toward Cancer scale, and the Social Support scale to 50 patients with HIV infection. Regarding QOL scores, Fighting Spirit was the positive coping style; Helplessness/Hopelessness and Anxious Preoccupation were negative coping styles. Psychological QOL scores in patients with hemophilia were lower than those in patients with sexually transmitted infection. Patients with hemophilia had a significantly weaker Fighting Spirit than patients with sexually transmitted infection.