Empathy and Coping Strategies Predict Quality of Life in Japanese Healthcare Professionals.

Burnout and secondary traumatic stress (STS), also referred to as compassion fatigue, are undeniable negative consequences experienced by healthcare professionals when working with patients. As frontline healthcare professionals are essential to communities, it is crucial to understand their mental health and how they cope with negative psychological responses. This study investigated the relationships between burnout, STS, compassion satisfaction, dispositional empathy, and stress management among Japanese healthcare professionals and students taking care of patients in clinical practice. The participants were 506 Japanese healthcare professionals and students (doctors, nurses, medical students, and nursing students) affiliated with Japanese Ministry of Defense Hospitals. The data were collected from March 2020 to May 2021. We assessed burnout, STS, and compassion satisfaction using the Professional Quality of Life Scale, dispositional empathy using the Interpersonal Reactivity Index, and coping with stress using the Coping Orientation to Problems Experienced Inventory (Brief-COPE). Exploratory factor analysis of the Brief-COPE yielded three factors: active coping; support-seeking; and indirect coping. Personal distress, a self-oriented emotional empathy index, was related to higher burnout and STS scores and lower compassion satisfaction. Empathic concern, an other-oriented emotional empathy index, was associated with lower burnout and higher compassion satisfaction. Active coping strategies were associated with lower burnout and higher compassion satisfaction, whereas indirect coping strategies were associated with higher burnout and STS scores. In a comparison of empathy in professional categories, nurses presented higher personal distress than nursing students, and medical doctors showed lower fantasy tendencies than medical students. These results imply the complex relationships between empathy, coping strategies, and psychological responses among healthcare professionals. Further longitudinal study is needed to explore these complex relationships and to develop more precise and effective psycho-educational interventions to prevent burnout and STS.

Improved volumetric measurement of brain structure with a distortion correction procedure using an ADNI phantom.

PURPOSE: Serial magnetic resonance imaging (MRI) images acquired from multisite and multivendor MRI scanners are widely used in measuring longitudinal structural changes in the brain. Precise and accurate measurements are important in understanding the natural progression of neurodegenerative disorders such as Alzheimer's disease. However, geometric distortions in MRI images decrease the accuracy and precision of volumetric or morphometric measurements. To solve this problem, the authors suggest a commercially available phantom-based distortion correction method that accommodates the variation in geometric distortion within MRI images obtained with multivendor MRI scanners. METHODS: The authors' method is based on image warping using a polynomial function. The method detects fiducial points within a phantom image using phantom analysis software developed by the Mayo Clinic and calculates warping functions for distortion correction. To quantify the effectiveness of the authors' method, the authors corrected phantom images obtained from multivendor MRI scanners and calculated the root-mean-square (RMS) of fiducial errors and the circularity ratio as evaluation values. The authors also compared the performance of the authors' method with that of a distortion correction method based on a spherical harmonics description of the generic gradient design parameters. Moreover, the authors evaluated whether this correction improves the test-retest reproducibility of voxel-based morphometry in human studies. RESULTS: A Wilcoxon signed-rank test with uncorrected and corrected images was performed. The root-mean-square errors and circularity ratios for all slices significantly improved (p < 0.0001) after the authors' distortion correction. Additionally, the authors' method was significantly better than a distortion correction method based on a description of spherical harmonics in improving the distortion of root-mean-square errors (p < 0.001 and 0.0337, respectively). Moreover, the authors' method reduced the RMS error arising from gradient nonlinearity more than gradwarp methods. In human studies, the coefficient of variation of voxel-based morphometry analysis of the whole brain improved significantly from 3.46% to 2.70% after distortion correction of the whole gray matter using the authors' method (Wilcoxon signed-rank test, p < 0.05). CONCLUSIONS: The authors proposed a phantom-based distortion correction method to improve reproducibility in longitudinal structural brain analysis using multivendor MRI. The authors evaluated the authors' method for phantom images in terms of two geometrical values and for human images in terms of test-retest reproducibility. The results showed that distortion was corrected significantly using the authors' method. In human studies, the reproducibility of voxel-based morphometry analysis for the whole gray matter significantly improved after distortion correction using the authors' method.

A preliminary study of orbitofrontal activation and hypersociability in Williams Syndrome.

Individuals with Williams syndrome (WS) demonstrate an abnormally positive social bias. However, the neural substrates of this hypersociability, i.e., positive attribution bias and increased drive toward social interaction, have not fully been elucidated. METHODS: We performed an event-related functional magnetic resonance imaging study while individuals with WS and typically developing controls (TD) matched positive and negative emotional faces. WS compared to TD showed reduced right amygdala activation during presentation of negative faces, as in the previous literature. In addition, WS showed a unique pattern of right orbitofrontal cortex activation. While TD showed medial orbitofrontal cortex activation in response to positive, and lateral orbitofrontal cortex activation to negative, WS showed the opposite pattern. In light of the general notion of a medial/lateral gradient of reward/punishment processing in the orbitofrontal cortex, these findings provide an additional biological explanation for, or correlate of positive attribution bias and hypersociability in WS.

Algorithm-guided treatment versus treatment as usual for major depression.

AIMS: The remission rates for patients with major depressive disorder (MDD) during algorithm-guided treatment (AGT), which consisted of four treatment strategy steps were prospectively compared with treatment as usual (TAU). METHODS: The remission rates of patients with mild or moderate MDD during AGT (n = 83) were compared with TAU (n = 127). RESULTS: The remission rate in the AGT group (60.2%) was approximately 10% greater than that in the TAU group (49.7%). The median number of days to achieve remission in the AGT group (93 days) was half as long as that in the TAU group (191 days). The hazard ratio of remission was 1.5 (95% confidence interval: = 1.2-1.8). A higher rate of lithium augmentation in the AGT group (20.5%) compared to the TAU (4.7%) may have led to the greater remission rate. Most participants who did not achieve remission either during the initial or second treatment steps dropped out from AGT. CONCLUSIONS: AGT may be superior to TAU for patients with mild or moderate MDD, based on the remission rates achieved. The later treatment steps in the AGT, however, were rarely utilized because participants who did not receive any benefit dropped out early.

Mental health in Japanese members of the United Nations peacekeeping contingent in the Golan Heights: effects of deployment and the Middle East situation.

This study evaluates the mental health of Japan Self-Defense Force (JSDF) members of the peacekeeping contingent in the Golan Heights before and since the Second Gulf War between 1998 and 2003. Before the war, the General Health Questionnaire 30 (GHQ30) scores during and after duty tended to be lower than those before duty; all scores were lower than those of adult Japanese men in general. After the war, GHQ30 scores did not significantly change between before, during, and after duty. Manifest Anxiety Scale (MAS) scores were not significantly different between groups. Stressors identified included problems with foreign language and familial matters at home. Post war stressors included work content and relationships with collaborating foreign army units. These findings suggest that the mental health of contingent members remained stable, with some variation in mental health conditions influenced by the situation in the Middle East. This study suggests that the stable mental condition of JSDF personnel during their deployment in the absence of combat, and that this could be enhanced by education about mental health issues and by providing counseling support to their families.

[Contribution of neuroimaging in the prediction of outcome in neuropsychiatric disorders and learning disabilities].

Recent advances in cognitive neuroscience methods reveal the potential of neuroimaging as be a useful tool in clinical and educational practice. In this review, we review the literature and provide evidence that functional and structural neuroimaging can detect changes with treatment. Further, we show promising initial results showing that the addition of neuroimaging measures can enhance conventional methods to predict outcome and prognosis. Examples are drawn from disorders such as attention-deficit / hyperactivity disorder (ADHD), depression, schizophrenia, obsessive-compulsive disorder (OCD), temporal lobe epilepsy, Alzheimer disease and developmental dyslexia. This evidence raises the intriguing possibility of utilizing neuroimaging data as a critical component in assessing and predicting cognitive abilities and

Prediction of children's reading skills using behavioral, functional, and structural neuroimaging measures.

The ability to decode letters into language sounds is essential for reading success, and accurate identification of children at high risk for decoding impairment is critical for reducing the frequency and severity of reading impairment. We examined the utility of behavioral (standardized tests), and functional and structural neuroimaging measures taken with children at the beginning of a school year for predicting their decoding ability at the end of that school year. Specific patterns of brain activation during phonological processing and morphology, as revealed by voxel-based morphometry (VBM) of gray and white matter densities, predicted later decoding ability. Further, a model combining behavioral and neuroimaging measures predicted decoding outcome significantly better than either behavioral or neuroimaging models alone. Results were validated using cross-validation methods. These findings suggest that neuroimaging methods may be useful in enhancing the early identification of children at risk for poor decoding and reading skills.

Autonomic arousal in cognitive conflict resolution.

Although cognitive efforts were reported to elicit global autonomic arousal, which cognitive processes associate with autonomic arousal has not been clear. We investigated autonomic arousal using event-related skin conductance responses (SCRs) during the Stroop color-word task. After baseline SCR deflections were determined in each trial block, SCRs were compared between cognitive conflict conditions (incongruent vs. congruent stimuli), between tasks assigned (word reading vs. color naming), and between erroneous and correct responses. Baseline SCRs were significantly greater at the beginning of each trial block. SCRs were significantly greater with incongruent than congruent stimuli while SCRs differed little between word reading and color naming. SCRs were greater when responses were incorrect. The results suggested that autonomic arousal occurs during cognitive conflict resolution in addition to mental set adoption for a task and in error awareness.

Activation time course of responses to illusory contours and salient region: a high-density electrical mapping comparison.

Until recently, early visual areas (V1/V2) were believed to respond mainly to illusory contours (ICs). At present, however, functional neuroimaging suggests that the human lateral occipital complex (LOC), a higher tier than V2, responds strongly to ICs and that IC-related activation in V1/V2 in fact might be driven by feedback input from the LOC. When Kanizsa-type ICs are modified by rounding the corners of the inducers and misaligning them slightly, the impression of an enclosed salient region (SR) remains, although ICs no longer are perceived. Stanley and Rubin (Stanley, D.A., Rubin, N., 2003. fMRI activation in response to illusory contours and salient regions in the human lateral occipital complex. Neuron, 37, 323-331) found that the LOC responded to SR, suggesting that the LOC subserves a rapid but crude region-based segmentation process preceding boundary completion in V1/V2. The present study compared the time course of cortical responses to ICs with those to SR using high-density (74-channel) event-related potentials (ERPs). Scalp mapping and statistical analysis indicated that shared negative modulation for ICs and SR was distributed bilaterally over the lateral occipital scalp at a latency of 70 to 180 ms. Slightly later, a weak negative modulation occurred with ICs but not SR at the occipital pole scalp from 170 to 180 ms. Dipoles for early and late modulations were fitted optimally in the LOC and occipital pole, respectively. The present results suggested that IC-related cortical activation could be separated into region-based segmentation and subsequent boundary completion.

The early influence of albumin administration on protein metabolism and wound healing in burned rats.

Hypoalbuminemia is often claimed to impair wound healing, and therefore albumin has traditionally been administered to derive beneficial effects on general physiologic conditions including the nutritional state. However, the influence of albumin administration on systemic protein metabolism and wound healing is still unclear. Therefore, the objective of this study was to investigate the influence of albumin administration on protein metabolism and wound healing in burned rats. After receiving basic total parenteral nutrition (TPN) for 4 days, Sprague-Dawley rats underwent a 6-cm skin incision in the back and a burn involving 20 percent of the whole body surface. The rats were divided into three groups. Group I continued to receive basic TPN. Group II was given basic TPN, but 20 percent of the total nitrogen was replaced by albumin. Group III was administered basic TPN plus albumin equivalent to 20 percent of the total nitrogen of basic TPN. Group IV had the skin incision but no burn, receiving only basic TPN. All the groups were euthanized 4 days after the burn or skin incision. The wound healing potential in terms of tensile strength was enhanced by replacement and addition of albumin (groups II and III, respectively) after a 20 percent burn. Hydroxyproline levels in the wound tended to increase in group II, and significantly increased in group III. Whereas albumin replacement (group II) did not remarkably change the protein metabolism, albumin addition (group III) significantly increased both protein synthesis (S) and breakdown (B) with the S/B ratio and nitrogen balance remaining the same as with albumin-free nutrition (group I). The urinary 3-methyl-histidine/creatinine ratio significantly increased after burn in group III. We conclude that intravenous albumin administration enhanced incisional wound healing in burned rats. Increased protein synthesis with concurrent myolysis and protein breakdown by albumin addition (group III) was observed during wound healing.

Medication algorithm for mood disorders: Present status and future direction in Japan.

Medication algorithms have been used extensively in treating psychiatric patients, while geographic variations among these reflect the local history of the practice of psychiatry in each region. Here we review algorithms used for mood disorders in Japan in terms of their utility, problems, and possible future development. The first Japanese algorithm for mood disorders was completed in 1997 by the Japanese Psychopharmacology Algorithm Project (JPAP). Development of the JPAP algorithm was evidence-based, giving major but not exclusive weight to clinical trial outcomes. Unlike others, the JPAP algorithm suggests possible addition of a benzodiazepine to first-line antidepressant treatment for major depression. When the first-choice antidepressant fails, the algorithm recommends monotherapy with another antidepressant over "add-on" therapy. Clinical problems with the JPAP algorithm include lack of guidance concerning how to change from one drug to another. Psychiatry in Japan provides less formal structure for post-graduate education and undertakes less communication with the general public than in many countries. This makes use of an algorithm important for improving quality of practice, provided that clinicians remain aware of the advantages, limitations, and problems of algorithms.

The effectiveness of lithium augmentation of milnacipran: preliminary data using the modified Japanese Psychopharmacology Algorithm.

Medication algorithms based on the best evidence available together with expert consensus are considered to promote logical consistent clinical decision making in the choice of antidepressant drugs. We report our preliminary results using the modified algorithm established by the Japanese Psychopharmacology Algorithm Project (JPAP). Subjects were 24 patients with major depressive disorders who presented to the outpatient clinic of the Department of Psychiatry at the National Defense Medical College prior to any treatment for the current episode. Ultimately, 15 patients recovered with treatment according to our protocol, including 7 who recovered upon treatment with first-line drugs; the most effective of these was paroxetine, followed by fluvoxamine and then milnacipran. Six patients recovered with second-line treatments. Among these, a combination of milnacipran and lithium was most effective, with recovery of 4 of 4 patients. We have formed a strong impression that augmentation therapy, especially with milnacipran plus lithium, is likely to be effective if the first-line antidepressant is ineffective. Investigation of more cases will be needed to confirm or refine details of the algorithm and, more generally, to determine the best approach to antidepressant medication.

The effect of paroxetine on Taijinkyofusho: a report of three cases.

Taijinkyofusho is a culture-related syndrome conceptualized in Japan. While previous studies suggest its psychopathological similarities to social phobia and obsessive-compulsive disorder, introspection regarding shame and low self-esteem is particularly linked to Japanese culture. We present three cases of Taijinkyofusho: Cases 1 and 2 show neurotic features while Case 3 shows delusional thoughts. Paroxetine was used for treatment but was productive in only the first two cases. Phobic and obsessive thought patterns were altered in Cases 1 and 2, suggesting that the significant core symptoms were responding to the treatment. In the future, large-scale pharmacological studies will be necessary to investigate treatment outcomes Taijinkyofusho. Such studies would contribute to providing information for effective treatment as well as for examining relationships between Taijinkyofusho and related disorders.

[Angina attack caused by 5-fluorouracil infusion--report of a case and review of the literature].

Cardiac toxicity of 5-fluorouracil (5-FU) has been rarely reported. We encountered a case of angina attack caused by 5-FU. A 58-year-old Japanese woman underwent sigmoidectomy for a sigmoid colon carcinoma with multiple liver metastases. Two months after surgery, she received chemotherapy comprising hepatic arterial infusion of 5-FU. During the 2nd chemotherapy session 7 days after the first, she complained of anterior chest pain. Her electrocardiograms showed elevations of the ST segment in almost all leads, confirming the diagnosis of angina pectoris. Soon after the third chemotherapy session the same type of attack occurred again. The close association of the attacks with 5-FU administration suggested that the angina might have been induced by 5-FU. Further attacks were avoided by discontinuing the 5-FU thereafter. The incidence of cardiac toxicity 5-FU has been reported to be 1.6-7.6%. Labianca et al. found 17 cases of 5-FU-associated cardiopathy, 15 of which were angina pectoris, out of 1,083 patients treated with the drug for various kinds of neoplasm. Analysis of 6 domestic cases including ours revealed that all patient lacked a previous history of cardiac disease except one who had an arrhythmia. There seemed to be no dose-dependent correlation with 5-FU-induced angina. Cardiac events were found even in the earlier phase of chemotherapy. Since 5-FU is widely used in the treatment of a number of gastrointestinal malignancies, one should bear in mind its cardiac toxicity, manifested as angina pectoris.