Cognitive behavioral therapy for a Japanese woman with olfactory reference disorder (ORD) comorbid with schizophrenia: A case study.

Background: Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is known about its successful treatment. A new cognitive behavioral model was developed based on cognitive behavioral therapy (CBT) for obsessive-compulsive disorder. Using this model, this study reports a successful treatment process of a 53-year-old female with ORD. Case Presentation: The patient's initial diagnosis was schizophrenia, and improvements were observed, such as the disappearance of persecutory delusions, through medication therapy. During this treatment process, it became clear that the patient's preoccupation with her own offensive body odor was not a hallucination or delusion caused by schizophrenia but rather a symptom of ORD. Within a limited 4-week hospitalization period, high-intensity CBT was provided by a clinical psychologist and a psychiatrist. Multiple CBT techniques were employed, including case formulation to identify her beliefs, reviewing safety-seeking behaviors, attention shift training, behavioral experiments, public opinion polls, mindfulness meditation, and exposure and response prevention. Conclusion: Following a seven-sessions intensive intervention over 3 weeks, her symptoms of ORD, anxiety, and depression reduced. High-frequency CBT practices could be beneficial in treatment of patients with severe ORD, addressing severe ORD cases, facilitating rapid improvement in both ORD symptoms and functioning.

The Role of Chorein Deficiency in Late Spermatogenesis.

VPS13A, also known as chorein, whose loss of function causes chorea-acanthocytosis (ChAc), is characterized by Huntington's-disease-like neurodegeneration and neuropsychiatric symptoms in addition to acanthocytosis in red blood cells. We previously reported that ChAc-model mice with a loss of chorein function exhibited male infertility, with asthenozoospermia and mitochondrial dysmorphology in the spermatozoa. Here, we report a novel aspect of chorein dysfunction in male fertility, particularly its role in spermatogenesis and mitochondrial integrity. An increase in anti-malondialdehyde antibody immunoreaction within the testes, predominantly observed at the advanced stages of sperm formation in chorein-deficient mice, suggests oxidative stress as a contributing factor to mitochondrial dysfunction and impaired sperm maturation. The chorein immunoreactivity in spermatids of wild-type mice accentuates its significance in sperm development. ChAc-model mice exhibit mitochondrial ultrastructural abnormalities, specifically during the late stages of sperm maturation, suggesting a critical timeframe for chorein's action in spermiogenesis. We observed an increase in TOM20 protein levels, indicative of disrupted mitochondrial import mechanisms. The concurrent decrease in metabolic enzymes such as IDH3A, LDHC, PGK2, and ACAT1 suggests a complex chorein-mediated metabolic network that is essential for sperm vitality. Additionally, heightened separation of cytoplasmic droplets from sperm highlights the potential membrane instability in chorein-deficient spermatozoa. Metabolomic profiling further suggests a compensatory metabolic shift, with elevated glycolytic and TCA-cycle substrates. Our findings suggest that chorein is involved in anti-ferroptosis and the maturation of mitochondrial morphology in the late stages of spermatogenesis, and its deficiency leads to asthenozoospermia characterized by membrane instability, abnormal cytosolic glycolysis, abnormal mitochondrial function, and a disrupted TCA cycle. Further analyses are required to unravel the molecular mechanisms that directly link these findings and to elucidate the role of chorein in spermatogenesis as well as its broader implications.

Successful Management and Birth After Perimortem Cesarean Delivery and Stillbirth Due to Anaphylaxis.

Perimortem cesarean delivery is an effective procedure for cardiopulmonary resuscitation during pregnancy. However, there are no reports documenting long-term outcomes in perimortem cesarean delivery survivors. This may be the first report of a successful live birth, occurring two years after perimortem cesarean delivery. A 29-year-old primipara was transferred to the emergency center on account of cardiopulmonary arrest, at 33 weeks of gestation. She was resuscitated 47 min after cardiopulmonary arrest by perimortem cesarean delivery amongst other treatment modalities, although the fetus died. Two months later, she was discharged with a preserved uterus, and no neurological damage. The couple suffered from posttraumatic stress disorder, which they overcame with the support of the multidisciplinary team, then gave birth to a healthy baby 2 years later. To overcome cardiopulmonary arrest during pregnancy, a seamless approach by a multidisciplinary team is essential for a good patient outcome.

Aging-Related Catatonia with Reversible Dopamine Transporter Dysfunction in Females with Depressive Symptoms: A Case Series.

OBJECTIVES: The authors describe five depressive patients with initially decreased striatal accumulation of dopamine transporter (DAT) single-photon emission computed tomography (SPECT), which improved in parallel with clinical symptoms. METHODS: Patients who exhibited decreased striatal accumulation and recovery of DATSPECT were identified among patients with the symptoms of depression. Their clinical and neuroimaging data were reviewed. RESULTS: Five patients were identified. All patients were presenile or senile women who presented with catatonia subsequent to symptoms of depression that remitted with treatment. DAT-SPECT showed a decreased striatal accumulation in all patients, which increased after treatment. Two patients had met the diagnostic criteria of probable dementia with Lewy bodies (DLB), but no longer did so after their symptoms improved. CONCLUSIONS: Reversible DAT dysfunction observed in this study suggests that reversible impairment of dopaminergic transmission in the striatum partly underlies catatonia. Careful consideration should be given to diagnosing DLB in patients with decreased DAT-SPECT accumulation, especially when catatonia is present.

Vortioxetine as a potential alternative for patients with escitalopram-induced jitteriness/anxiety syndrome: A report of three cases.

Background: Jitteriness/anxiety syndrome is a recognized adverse effect observed during the initiation or change of dose in antidepressant treatment. Managing patients who develop this syndrome remains a challenge. While escitalopram is a widely used antidepressant known to cause these symptoms, this report explores vortioxetine as a therapeutic alternative. Case Presentation: Three distinct clinical scenarios were observed in patients who manifested jitteriness/anxiety syndrome while on escitalopram treatment for depression. Patient A was initiated on escitalopram and experienced an initial alleviation in depressive symptoms, but 3 months later displayed mood elevation, talkativeness, and increased activity, which disturbed his daily life. A transition to vortioxetine subsequently resolved the mood elevation. Patient B exhibited elevated mood, hyperactivity, irritability, and talkativeness just 6 days post-initiation of treatment with escitalopram. After the discontinuation of escitalopram and unsuccessful trials with aripiprazole, lurasidone, and lamotrigine, her depressive mood intensified, culminating in suicidal ideation. Starting vortioxetine led to a consistent improvement of her symptoms, and she resumed work and was emotionally stable. Patient C was initially diagnosed with bipolar disorder and faced a relapse into depression despite undergoing various treatments. After 2 weeks on escitalopram, she exhibited irritability and self-harm urges. Three months later, after being re-diagnosed with depressive disorders with anxious distress, vortioxetine was administered, which significantly reduced her depressive symptoms and allowed her to continue her education. Conclusion: Vortioxetine presents as a promising therapeutic alternative that is worth considering for patients with escitalopram-induced jitteriness/anxiety syndrome.

Novel pathogenic XK mutations in McLeod syndrome and interaction between XK protein and chorein.

OBJECTIVE: To identify XK pathologic mutations in 6 patients with suspected McLeod syndrome (MLS) and a possible interaction between the chorea-acanthocytosis (ChAc)- and MLS-responsible proteins: chorein and XK protein. METHODS: Erythrocyte membrane proteins from patients with suspected MLS and patients with ChAc, ChAc mutant carriers, and normal controls were analyzed by XK and chorein immunoblotting. We performed mutation analysis and XK immunoblotting to molecularly diagnose the patients with suspected MLS. Lysates of cultured cells were co-immunoprecipitated with anti-XK and anti-chorein antibodies. RESULTS: All suspected MLS cases were molecularly diagnosed with MLS, and novel mutations were identified. The average onset age was 46.8 ± 8 years, which was older than that of the patients with ChAc. The immunoblot analysis revealed remarkably reduced chorein immunoreactivity in all patients with MLS. The immunoprecipitation analysis indicated a direct or indirect chorein-XK interaction. CONCLUSIONS: In this study, XK pathogenic mutations were identified in all 6 MLS cases, including novel mutations. Chorein immunoreactions were significantly reduced in MLS erythrocyte membranes. In addition, we demonstrated a possible interaction between the chorein and XK protein via molecular analysis. The reduction in chorein expression is similar to that between Kell antigens and XK protein, although the chorein-XK interaction is a possibly noncovalent binding unlike the covalent Kell-XK complex. Our results suggest that reduced chorein levels following lack of XK protein are possibly associated with molecular pathogenesis in MLS.

Predictive accuracy of the Historical-Clinical-Risk Management-20 for violence in forensic psychiatric wards in Japan.

BACKGROUND: Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries. AIMS: Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan. METHODS: A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo. Forensic psychiatrists were trained in use of the HCR-20 and asked to complete it as part of their admission assessment. The completed forms were then retained by the researchers and not used in clinical practice; for this, clinicians relied solely on national legally required guidelines. Violent outcomes were determined at 3 and 6 months after the assessment. Receiver operating characteristic analysis was used to calculate the predictive accuracy of the HCR-20 for violence. RESULTS: Area under the curve analyses suggested that the HCR-20 total score is a good predictor of violence in this cohort, with the clinical and risk sub-scales showing good predictive accuracy, but the historical sub-scale not doing so. Area under the curve figures were similar at 3 months and at 6 months. CONCLUSIONS: Our results are consistent with studies previously conducted in Western countries. This suggests that the HCR-20 is an effective tool for supporting risk of violence assessment in Japanese forensic psychiatric wards. Its widespread use in clinical practice could enhance safety and would certainly promote transparency in risk-related decision-making. Copyright © 2016 John Wiley & Sons, Ltd.

Extremely high-accuracy correction of air refractive index using two-colour optical frequency combs.

Optical frequency combs have become an essential tool for distance metrology, showing great advantages compared with traditional laser interferometry. However, there is not yet an appropriate method for air refractive index correction to ensure the high performance of such techniques when they are applied in air. In this study, we developed a novel heterodyne interferometry technique based on two-colour frequency combs for air refractive index correction. In continuous 500-second tests, a stability of 1.0 × 10(-11) was achieved in the measurement of the difference in the optical distance between two wavelengths. Furthermore, the measurement results and the calculations are in nearly perfect agreement, with a standard deviation of 3.8 × 10(-11) throughout the 10-hour period. The final two-colour correction of the refractive index of air over a path length of 61 m was demonstrated to exhibit an uncertainty better than 1.4 × 10(-8), which is the best result ever reported without precise knowledge of environmental parameters.

Widely and continuously tunable terahertz synthesizer traceable to a microwave frequency standard.

We constructed a widely and continuously tunable terahertz frequency synthesizer traceable to a hydrogen maser linked to coordinated universal time. Photomixing of two optical frequency synthesizers, linked to the hydrogen maser via dual optical frequency combs, gave this THz synthesizer frequency uncertainty of 10⁻¹². To demonstrate the potential of wide and continuous tunability in the THz synthesizer, we tuned its output frequency up to 50 GHz discretely and 1.26 GHz continuously in the F-band while maintaining the unprecedented frequency uncertainty by using a uni-traveling-carrier photodiode as a photomixer. This THz synthesizer will be a powerful tool for broadband, high-precision THz spectroscopy and THz frequency metrology.

High-accuracy self-correction of refractive index of air using two-color interferometry of optical frequency combs.

Long-path pulse-to-pulse interferometers of two-color frequency combs are developed using fundamental and second harmonics of a mode-locked fiber laser. Interferometric phase difference between two-color frequency combs was precisely measured by stabilizing the fundamental fringe phase by controlling the repetition frequency of the comb, and a stability of 10(-10) for 1000 s was achieved in the measurement of an optical path length difference between two wavelengths. In long-term measurements performed for 10 h, results of phase variation of interferometric measurements were highly consistent with the fluctuations in the calculated difference of refractive indices of air at two wavelengths with an accuracy of 10(-10). The difference between the measured optical distances corresponding to two wavelengths and the optical distance corresponding to the fundamental wavelength were used in the two-color method; high-accuracy self-correction of the fluctuation of refractive index of air was performed with an uncertainty of 5 × 10(-8) for 10-h measurements when the maximum refractive index change was on the order of 10(-6).