Development and validation of the Epilepsy Self-Stigma Scale.

OBJECTIVE: Self-stigma is the internalization of negative public attitudes and is often experienced by patients with epilepsy (PWE). Greater self-stigma is associated with lower self-esteem and hinders therapeutic behavior. The study aims were to develop the Epilepsy Self-Stigma Scale (ESSS) to assess self-stigma in PWE and to examine the scale's reliability and validity. METHODS: We created a test scale based on items from an existing stigma scale and the results of a previous qualitative analysis we conducted. We recruited 200 outpatients from departments specializing in epilepsy (psychiatry, neurology, and pediatric neurology) at four facilities in Tokyo and Saitama prefecture, Japan, between September and December 2020. Participants also completed the Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory (BDI-II). RESULTS: Questionnaires were returned from 102 participants (response rate: 51%). After excluding two participants with incomplete questionnaires, data for 100 participants were analyzed (53 women, 47 men; mean age [standard deviation]: 39.86 [17.45] years). Exploratory factor analysis extracted eight items loading on three factors: internalization of stigma, societal incomprehension, and confidentiality. Cronbach's α for all items and each factor demonstrated acceptable internal consistency (α = 0.76-0.87). Test-retest reliability was confirmed using data from 21 participants who completed the scale twice (r = 0.72 to 0.90). ESSS total scores and subscale scores correlated with RSES and BDI-II scores (r = -0.30 to 0.55). The ESSS demonstrated substantial constructive validity. However, total scores did not significantly correlate with objective physician assessment of self-stigma. SIGNIFICANCE: The results showed that the eight-item ESSS has high reliability and validity. This scale could facilitate the examination of factors associated with self-stigma in PWE, which could inform the development of effective interventions for reducing stigma.

Quasi-cluster randomized trial of a six-month low-intensity group-based resistance exercise for hemodialysis patients on depression and cognitive function: a 12-month follow-up.

OBJECTIVE: This study aimed to examine the effects of a six-month group-based low-intensity resistance exercise program on depression and the cognitive function of hemodialysis patients. METHOD: We conducted a quasi-cluster randomized, open-label controlled study from October 2017 to December 2018. Forty-two patients undergoing hemodialysis completed the trial over six months; half participated in the resistance exercise group (n = 21, mean = 74.90 years of age, SD = 2.23, 66.67% female) and the other half were in a stretching control group (n = 21, mean = 72.57 years of age, SD = 2.26, 28.57% female). Depressive symptoms and cognitive function were the primary outcome measures. Behavioral and psychological problems associated with cognitive decline (NPI-Q), subjective insomnia, and exercise self-efficacy were secondary outcomes. Outcomes were measured at baseline, three-month (mid-intervention), six-month (end of intervention), and 12-month (six months after intervention) follow-ups. Linear mixed model analyses were used to determine short-term (immediately after intervention) and long-term (six months after intervention) effects. RESULTS: In depression, cognitive function, and the NPI-Q, there were no significant effects. In subjective insomnia, a short-term group-by-time interaction in the intervention group compared to the control group was found (ES = .43). However, the effect had disappeared by the 12-month follow-up. In exercise self-efficacy, short- and long-term group-by-time interactions were found. A significant short-term increase in the resistance exercise and a significant decrease in the stretching control was observed (ES = -.83). However, the effect was weakened in the long term (ES = -.38). CONCLUSION: The results showed that low-intensity group resistance exercise would reduce subjective insomnia and improve exercise self-efficacy, but the effect was not maintained by six months after the program.Trial registration: This study was registered on the University Hospital Medical Information Network Clinical Trials Registry (UMIN000029372). Trial registration: UMIN Japan identifier: UMIN000029372.

The self-stigma of patients with epilepsy in Japan: A qualitative approach.

The mental health of patients with epilepsy represents a substantial public health concern in Japan. For instance, the Japanese term for epilepsy, "tenkan", has the negative meaning of "mad" and "a violent temperament that is apt to be infatuated". Although epilepsy is now understood as a disease caused by abnormal neuronal activity in the brain, discrimination and stigma against people with epilepsy remain deeply rooted in Japanese culture. Understandably, this stigma can have a serious impact on the psychology and behavior of individuals with epilepsy. To our knowledge, no studies have clarified the formation process or examined the treatment of self-stigma in patients with epilepsy in Japan. Characterizing coping strategies and examining methods for reducing self-stigma will increase our understanding of the experiences of patients and facilitate effective psychiatric rehabilitation. Accordingly, the purpose of our study was to investigate the quality and degree of cognition regarding self-stigma and to examine coping strategies in patients with epilepsy living in the community. The participants were psychiatric outpatients aged 20-65 years who had been diagnosed with epilepsy and visited our psychiatric outpatient clinic between October 1 and December 31, 2016. We conducted semi-structured interviews with 20 patients who consented to participate. For data analysis, we used the content analysis method proposed. Our study revealed details of self-stigma in patients with epilepsy. Patients and their families are often aware of the presence of this self-stigma, and many do not know how to address it. In this study, we qualitatively examined self-stigma in patients with epilepsy on the basis of patient narratives. Per our findings, we would like to examine intervention methods for reducing self-stigma in patients with epilepsy.

Serum polyunsaturated fatty acids and risk of psychiatric disorder after acute coronary syndrome: A prospective cohort study.

BACKGROUND: Around 20% of patients with acute coronary syndrome (ACS) develop depression. Furthermore, some observational studies revealed baseline polyunsaturated fatty acids (PUFAs) may affect the prognosis of depression after ACS. This prospective cohort study examined the association between psychiatric disorder and PUFAs after ACS. METHODS: Subjects were ACS patients admitted to a Tokyo teaching hospital. Psychiatric morbidity as a primary endpoint was measured using structured interview 3 months after admission. At admission, serum n-3 and n-6 PUFAs were measured by gas chromatography and patients were interviewed to evaluate medical information. Multiple logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals to examine the association between PUFAs at baseline and psychiatric disorder after ACS. RESULTS: Between March 2014 and August 2016, 100 patients completed the follow-up assessment. Eleven patients (11%) showed some form of new-onset psychiatric disorder at 3 months, mainly depressive episode (major, 5; minor, 1) and PTSD (full, 1; partial, 2). Psychiatric disorder was predicted by serum linoleic acid level (OR=3.96) and Hospital Anxiety and Depression Scale total score (OR=1.34) at baseline. No significant associations were seen with other PUFAs. LIMITATIONS: The results were obtained from a single hospital and based on a small number of participants. There might be some patients with new-onset psychiatric disorder among the refused patients. CONCLUSIONS: Psychiatric disorder incidence in ACS patients might be lower in Japan than in Western countries. Reduced intake of linoleic acid-containing foods might prevent depression or PTSD after ACS.

Self-stigma in depressive patients: Association of cognitive schemata, depression, and self-esteem.

Many empirical studies have indicated that various psychosocial and psychiatric variables are correlated with levels of self-stigma. Treatment methods for reducing self-stigma have been investigated in recent years, especially those examining the relationship between negative cognitive schemata and self-stigma. This study examined the relationship of self-stigma with cognitive schemata, depression, and self-esteem in depressive patients. Furthermore, structural equation modeling (SEM) was conducted to evaluate three hypothetical models. Study participants were 110 patients with depression (54 men, 56 women; mean age=45.65years, SD=12.68; 83 diagnosed with mood disorders; 22 with neurotic, stress-related, or somatoform disorders; and 5 with other disorders) attending a psychiatric service. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Center for Epidemiologic Studies Depression Scale, and Rosenberg's Self Esteem Scale. The analysis indicated a better fit of the model that assumed self-stigma as mediator, suggesting that cognitive schemata influence self-stigma, while self-stigma affects depression and self-esteem. The tested models using SEM indicated that (1) self-stigma has the potential to mediate the relationship between cognitive schemata and depression, and (2) depression and self-stigma have a similar influence on self-esteem. Although low self-esteem is considered one of the symptoms of depression, when we aim to recover self-esteem, we do not only observe improvement in depressive symptoms; thus, approaches that focus on the reduction of self-stigma are probably valid.

Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients.

OBJECTIVE: There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. METHODS: We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. RESULTS: Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. CONCLUSIONS: Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.

Diagnoses of psychiatric disorders in hypothetical patients by non-psychiatric physicians in Japan.

OBJECTIVE: This study was undertaken to investigate non-psychiatric physicians' diagnoses of hypothetical patients in clinical scenarios with comorbid medical and psychiatric disease in Japan. METHODS: The non-psychiatric physicians were asked to diagnose eight clinical scenarios describing several typical behavioral health problems in the medical settings. RESULTS: A total of 155 non-psychiatric physicians participated. Many physicians had problems correctly diagnosing depression and hypoactive delirium with medically ill patients. CONCLUSIONS: It is time to incorporate new efficient and effective approaches, such as collaborative care system and proactive delirium prevention programs, to improve overall behavioral health diagnosis and treatment, rather than relying on the rapid recognition of behavioral health problems in primary care/general medical settings.

Assertive case management versus enhanced usual care for people with mental health problems who had attempted suicide and were admitted to hospital emergency departments in Japan (ACTION-J): a multicentre, randomised controlled trial.

BACKGROUND: Non-fatal suicide attempt is the most important risk factor for later suicide. Emergency department visits for attempted suicide are increasingly recognised as opportunities for intervention. However, no strong evidence exists that any intervention is effective at preventing repeated suicide attempts. We aimed to investigate whether assertive case management can reduce repetition of suicide attempts in people with mental health problems who had attempted suicide and were admitted to emergency departments. METHODS: In this multicentre, randomised controlled trial in 17 hospital emergency departments in Japan, we randomly assigned people aged 20 years and older with mental health problems who had attempted suicide to receive either assertive case management (based on psychiatric diagnoses, social risks, and needs of the patients) or enhanced usual care (control), using an internet-based randomisation system. Interventions were provided until the end of the follow-up period (ie, at least 18 months and up to 5 years). Outcome assessors were masked to group allocation, but patients and case managers who provided the interventions were not. The primary outcome was the incidence of first recurrent suicidal behaviour (attempted suicide or completed suicide); secondary outcomes included completed suicide and all-cause mortality. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). FINDINGS: Between July 1, 2006, and Dec 31, 2009, 914 eligible participants were randomly assigned, 460 to the assertive case management group and 456 to the enhanced usual care group. We noted no significant difference in incidence of first recurrent suicidal behaviour between the assertive case management group and the enhanced usual care group over the full study period (log-rank p=0·258). Because the proportional hazards assumption did not hold, we did ad-hoc analyses for cumulative incidence of the primary outcome at months 1, 3, 6, 12, and 18 after randomisation, adjusting for multiplicity with the Bonferroni method. Assertive case management significantly reduced the incidence of first recurrent suicidal behaviour up to the 6-month timepoint (6-month risk ratio 0·50, 95% CI 0·32-0·80; p=0·003), but not at the later timepoints. Prespecified subgroup analyses showed that the intervention had a greater effect in women (up to 18 months), and in participants younger than 40 years and those with a history of previous suicide attempts (up to 6 months). We did not identify any differences between the intervention and control groups for completed suicide (27 [6%] of 460 vs 30 [7%] of 454, log-rank p=0·660) or all-cause mortality (46 [10%] of 460 vs 42 [9%] of 454, log-rank p=0·698). INTERPRETATION: Our results suggest that assertive case management is feasible in real-world clinical settings. Although it was not effective at reducing the incidence of repetition of suicide attempts in the long term, the results of our ad-hoc analyses suggested that it was effective for up to 6 months. This finding should be investigated in future research. FUNDING: The Ministry of Health, Labour, and Welfare of Japan.

[Psychotropic medication in the patients with end-stage renal disease].

The majority of psychotropic drugs are well tolerated in the patients with end-stage renal disease. There are exceptions for which tolerance and safety are questionable. These include psychotropic drugs such as milnacipran, sulpiride, lithium carbonate, memantine, gabapentin, pregabalin and topiramate.

Estimation of anxiety and depression in patients with early stage breast cancer before and after radiation therapy.

BACKGROUND: Most previous studies about anxiety and depression in patients undergoing radiotherapy have only measured the quantity of general depression and anxiety and have not studied specific periods of involvement. The aim of this study was to assess anxiety and depression among early breast cancer patients, and the anxiety experienced immediately before and after radiotherapy. METHODS: Women who started radiotherapy for stage I or II breast cancer (n = 172) were asked to answer two questionnaires: the Hospital Anxiety and Depression Scale (HADS) and Radiotherapy Categorical Anxiety Scale immediately before and after radiation therapy. RESULTS: The results showed that the mean scores of anxiety and depression (HADS and Radiotherapy Categorical Anxiety Scale) decreased after radiotherapy. The mean score of depression (HAD-D) in the group receiving conventional radiotherapy was higher than in those receiving hypofractionated radiotherapy before and after radiotherapy. The mean scores of anxiety and depression (HADS) in the endocrine therapy group were lower than in the group without endocrine therapy before treatment. However, the scores after treatment of both groups were not significant. CONCLUSION: Some intervention may be needed to decrease the temporary anxiety and depression raised during radiotherapy for early stage breast cancer patients. This is especially so for patients who do not receive concurrent endocrine therapy and choose the conventional radiotherapy course.

[Mental care for cancer patients in the clinical practice of consultation-liaison psychiatry].

Psycho-oncology is one of the most important fields of consultation-liaison psychiatry (CLP), and it can be said that there is a substantial overlap between both fields. In recent years, there has been a particular focus on medical care for cancer patients provided by palliative care teams. This type of medical care has the following two characteristics from the perspective of the organizational theory of CPL. One is that this type of medical care has elements of both medical care of a consultation model and medical care of a liaison model. The other is that dual team medicine combining team medicine within a palliative care team and team medicine between the palliative care team and a primary doctor and floor nurses is performed. Such an understanding is important in order to enrich medical care provided by palliative care teams in the future. Moreover, in clinical CLP, there are some characteristics that are frequently and specifically observed in cancer patients. Among those, patients may have a feeling of helplessness due to the absence of effective self-care and limitations on the ability of the patients to act by themselves. An empowerment approach is effective for this, and we have described the actual methods for carrying out such an approach.

The INTERMED Japanese version: inter-rater reliability and internal consistency.

OBJECTIVE: The intent of this study was to establish the inter-rater reliability and the internal consistency of the Japanese version of the INTERMED. METHODS: The study included a series of patients referred to psychiatric consultation service or palliative care service. The study participants were independently scored using the INTERMED by the raters. RESULTS: The INTERMED-Japanese version had high inter-rater reliability (intraclass correlation coefficient=0.98) and high internal consistency (alpha=.89). All four domains (biological, psychological, social, and health care domains) were positively correlated. Based on a cutoff score of 20/21, a κ of 0.79 was found. CONCLUSIONS: The INTERMED is an easy and useful proactive biopsychosocial screening tool, which could be a reasonable utility under the current Japanese health care situations. Future studies focusing on the INTERMED utility in improving health care delivery for patients with complex biopsychosocial care needs has to be demonstrated in various medical settings in Japan.

An investigation of anxiety about radiotherapy deploying the Radiotherapy Categorical Anxiety Scale.

BACKGROUND: Radiotherapy is one of the major methods for treating cancer, but many patients undergoing radiotherapy have deep concerns about receiving radiation treatment. This problem is not generally appreciated and has not been adequately studied. METHODS: The objective of this investigation was to empirically investigate the anxieties that cancer patients feel towards radiotherapy by using questionnaires to classify and quantitatively measure their concerns. A preliminary interview to develop a questionnaire was carried out with 48 patients receiving radiotherapy to discover their anxieties about on-going treatments. Subsequently, a main study was performed using a questionnaire with 185 patients to classify their types of anxiety and to ascertain the reliability and validity of the responses. Confirmatory factor analysis was then carried out with a 17-item Radiotherapy Categorical Anxiety Scale. RESULTS: Three anxiety factors were abstracted by factor analysis: (1) adverse effects of radiotherapy, (2) environment of radiotherapy, and (3) treatment effects of radiotherapy. Reliability, content validity, and concurrent validity were obtained. The adequacy of the three-factor model of anxiety concerning radiotherapy was confirmed. CONCLUSION: A 17-item Radiotherapy Categorical Anxiety Scale was formulated to quantitatively measure the specific types of anxiety among cancer patients receiving radiotherapy.

Gender differences in the fear of terrorism among Japanese individuals in the Washington, D.C. area.

INTRODUCTION: Few studies have focused on public responses to terror threat among the Asian community in the United States. An Internet-based survey was conducted among 87 Japanese individuals living in the Washington, D.C. area to examine the risk factors for perceiving high fear of terrorism. METHODS: The subjects were members of four Japanese community organizations based in the greater Washington region. Their degree of the fear of terrorism was assessed using a five-point Likert scale (Fear of Terrorism Score; FTS), ranging from 0 (not at all) to 4 (extremely). A score of 2 or more was defined as a high FTS. RESULTS: Bivariate analysis revealed that a high FTS was associated with being ≥36 years old, female, married, a permanent U.S. resident, a housewife, and having lived in the Washington or New York area during the September 11, 2001 attacks (p<0.05). In a multivariate model, being female was a predictor of high FTS (odds ratio=6.3, 95% confidence interval: 1.3-40.8, p=0.024). CONCLUSIONS: Japanese women living in the Washington area were six times more likely to perceive high fear of terrorism than men.

Delayed sympathetic hyperactivity following electroconvulsive therapy in patients with catatonic schizophrenia.

Recently, we encountered patients with catatonic schizophrenia who developed severe tachycardia, atrial fibrillation, and hypertension approximately 10 min after electroconvulsive therapy (ECT). Therefore, to examine whether delayed sympathetic hyperactivity occurs following ECT in patients with catatonic schizophrenia, we performed spectral analysis of heart rate variability (HRV). Nine patients with catatonic schizophrenia, 5 with noncatatonic schizophrenia, and 24 with mood disorders who received ECT consecutively were enrolled. The HRV frequency components were measured at baseline and during each 5-min time interval from the end of the ictal response to 35 min. The power spectrum of HRV was divided into 2 components: a high-frequency component (HF) and a low-frequency component (LF). The ratio of LF to HF (LF/HF) is an index of sympathetic activity. LF/HF demonstrated a transient increase between 5 and 10 min after ECT in the catatonic schizophrenia group compared to that in the mood disorder group. ECT in patients with catatonic schizophrenia is associated with delayed, transient sympathetic hyperactivity. These patients may be at an increased risk for developing tachycardia, atrial fibrillation, and hypertension following ECT.

Evaluation of a one-question interview for depression in a radiation oncology department in Japan.

This study aims to clarify the validity of the brief screening measure of depression in Japan. It was the single-item interview "Are you depressed?" that provided a reliable and remarkable accurate screen in North America. The study was conducted on 282 participants receiving radiotherapy for cancer. The criterion diagnosis were given by the Structured Clinical Interview for DSM-(SCID). On the basis of the receiver operating characteristic (ROC) analyses, we compared the results obtained using single-item interview with major and minor depressive disorders defined by DSM-TR and calculated the sensitivity, specificity and likelihood ratio (LR). The result of the present study indicated a sensitivity of 42% (95% CI 22-61%) and a specificity of 86% (95% CI 82-91%), and LR of 3.1. In conclusion, single-item interview "Are you depressed?" did not have sufficient sensitivity.

Disability and patient's appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan.

The aim of this study was to evaluate the factors responsible for depressed mood in rheumatoid arthritis (RA). Clinical and laboratory measures were collected from 4558 RA patients enrolled in a large clinical cohort study for RA conducted at the Institute of Rheumatology, Tokyo Women's Medical University (IORRA study). A two-question depressed screening included in the U.S. Preventive Services Task Force recommendation were utilized to identify "depressed patients." A total of 1875 (41.1%) were identified as "depressed patients" who presented with symptoms suggestive of depression. Patient's Visual Analog Scale (VAS) for general health (43.3 mm vs 24.6 mm, P < 0.0001) and pain (40.9 mm vs 23.8 mm, P < 0.0001) and the disability index scores measured by the Health Association Questionnaire (HAQ) (0.986 vs 0.574, P < 0.0001) were significantly higher in depressed patients than in nondepressed patients. The presence of three or more comorbidities (odds ratio [OR] 2.157, P < 0.0001), infection (OR 1.754, P < 0.0001), and joint surgery (OR 1.878, P < 0.0001) were significantly correlated with depressed mood in RA. The results of the Generalized Linear Model analysis showed that HAQ disability index (P < 0.0001) and patient's VAS for general health (P < 0.0001) were also strongly and significantly associated to the response variable "probability of depressed patients." Patient appraisal of poor general health and greater disability were associated with depressed mood in RA.

Assessment of psychological responses in patients about to receive radiotherapy.

PURPOSE: Radiotherapy is considered to be associated with psychological distress. We assessed the mental status, anxiety, and the factors associated with these in cancer patients about to receive radiotherapy. MATERIALS AND METHODS: Hospitalized patients about to receive radiotherapy participated. Psychological status was assessed by a psychiatrist, based on interview about the type of anxiety related to cancer or radiotherapy as well as self-rating questionnaires. RESULTS: Eligible data were collected from 94 patients. The incidence of mental disorders was 20%. The total mood disturbance scores were significantly higher in patients with poor performance status. The most common type of anxiety regarding radiotherapy was acute adverse effect, and the predictors were palliative treatment and living alone. CONCLUSION: Mental disorders, mood disturbance, and anxiety in patients cannot be neglected in radiation oncology practice. Especially careful attention should be paid to patients with these predictive factors.