Prevalence of elevated serum anti-N-methyl-D-aspartate receptor antibody titers in patients presenting exclusively with psychiatric symptoms: a comparative follow-up study.

BACKGROUND: Increasing numbers of patients with elevated anti-N-methyl-D-aspartate (NMDA) receptor antibody titers presenting exclusively with psychiatric symptoms have been reported. The aim of the present study was to clarify the prevalence of elevated serum anti-NMDA receptor antibody titers in patients with new-onset or acute exacerbations of psychiatric symptoms. In addition, the present study aimed to investigate the association between elevated anti-NMDA receptor titers and psychiatric symptoms. METHODS: The present collaborative study included 59 inpatients (23 male, 36 female) presenting with new-onset or exacerbations of schizophrenia-like symptoms at involved institutions from June 2012 to March 2014. Patient information was collected using questionnaires. Anti-NMDA receptor antibody titers were measured using NMDAR NR1 and NR2B co-transfected human embryonic kidney (HEK) 293 cells as an antigen (cell-based assay). Statistical analyses were performed for each questionnaire item. RESULTS: The mean age of participants was 42.0 ± 13.7 years. Six cases had elevated serum anti-NMDA antibody titers (10.2 %), four cases were first onset, and two cases with disease duration >10 years presented with third and fifth recurrences. No statistically significant difference in vital signs or major symptoms was observed between antibody-positive and antibody-negative groups. However, a trend toward an increased frequency of schizophrenia-like symptoms was observed in the antibody-positive group. CONCLUSION: Serum anti-NMDA receptor antibody titers may be associated with psychiatric conditions. However, an association with specific psychiatric symptoms was not observed in the present study. Further studies are required to validate the utility of serum anti-NMDA receptor antibody titer measurements at the time of symptom onset.

Alterations in prefrontal cortical activity in the course of treatment for late-life depression as assessed on near-infrared spectroscopy.

AIM: To evaluate the severity of depression by measuring alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy. METHODS: Ten of 27 subjects hospitalized for late-life depression from May 2006 to June 2007, were examined. In these 10 subjects changes in hemoglobin concentration were measured on near-infrared spectroscopy during two types of the rock, paper, scissors game as the cognitive tasks affecting prefrontal cortical activity on 2 days, including 1 day on which depressive symptoms had slightly improved due to treatment, and then on another day >4 weeks later. Severity of depression and cognitive impairment were also simultaneously assessed. RESULTS: The change in oxygenated hemoglobin concentration during a difficult task (intentional loss task) was significantly larger than that during an easy task (try to win task) on the left side (left, P = 0.010; right, P = 0.059). On the left side there was a significant negative correlation between the ratio of oxygenated hemoglobin measurements on the second day to those on the first day, and the severity of depression on the second day (left, P = 0.012; right, P = 0.090). Thus, the more left prefrontal cortical activity tended to increase, the fewer depressive symptoms tended to be present on the second day of testing. CONCLUSIONS: Measuring of alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy, is feasible in subjects with depression.

Prefrontal cerebral activity during a simple "rock, paper, scissors" task measured by the noninvasive near-infrared spectroscopy method.

We conducted a noninvasive near-infrared spectroscopy (NIRS) study using the game of rock, paper, scissors (RPS) as a simple neurocognitive task for the prefrontal cortex (PFC) in 15 healthy volunteers. We employed an opposite "to lose" RPS task coupled with a normal "to win" RPS task, since the former requires inhibition of behavior, one of the most important functions of the prefrontal cortex. During the NIRS examination, subjects had to present one of the three RPS hands in response to hands displayed randomly on a computer screen every 1.5 s, and were required to show hands that lose to the computer, or that beat the computer. We measured the relative concentrations of oxyhemoglobin (oxy-Hb) using the prefrontal probes of the NIRS system during the tasks. The increases in oxy-Hb during the "to win" RPS task were small, but were quite large and laterally dominant during the "to lose" RPS task. The difference between the two tasks might have been due to the participants' cognitive conflict with losing on the RPS. We conclude that losing is better than winning on the RPS as a sensitive indicator in the NIRS examination of PFC.

[Case report of an elderly woman who developed a pain disorder following her husband's death].

We present the case of an elderly woman who developed a pain disorder following her husband's death. This patient consulted two or three gynecology clinics with anxiety due to external genital pain, the cause of which could not be identified. Subsequently, the patient came to our university hospital where she was diagnosed with "pain disorder" and "depression" by a psychiatrist. With medication and supportive psychotherapy, the patient showed positive clinical progress. The operational diagnosis of pain disorder was useful as it permitted the establishment of a diagnosis for a patient with pain, the cause of which could not be identified. In this case, the patient's external genital pain was thought to be a symptom of her loss of sexual identity and her depression following the death of her husband. It has been reported that such somatic pain appears when the patient does not mourn, leading to pathological symptons. Therefore, in supportive psychotherapy, it is important to listen carefully to the patients' complaints about their pain in order to provide them with the opportunity to finish grieving. As a complementary therapy to SSRI medication, supportive psychotherapy contributed strongly to this case's recovery.

[Remarkably low blood pressure induced by combination of SSRI and a small dose of TCA].

Recently, selective serotonin reuptake inhibitors (SSRI) have been frequently used as the first choice of antidepressants because of their safety in comparison with tricyclic antidepressive agents (TCA). On the other hand, when SSRIs are not effective, they are frequently replaced with another antidepressant. In that case, a small dose of a TCA is often added without cross tapering. We report two elderly patients with depression who exhibited markedly low blood pressure when a small dose of a TCA was added to a SSRI. The combination of a SSRI and a TCA can be hazardous because it can cause unexpected adverse effects especially in elderly patients.