The prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in seriously injured survivors of motor vehicle accidents (MVAs) in Japan was investigated. Furthermore, ...predictive factors in the early stage for development of PTSD were evaluated.
Subjects were consecutive samples (
N=100) of patients hospitalized with severe MVA injuries surveyed at two time points: within 1 month after the MVA and then 6 months later. In the first survey, we conducted the Acute Stress Disorder Interview and compiled results of a self-rating questionnaire; in the second survey, we conducted a structured clinical interview via telephone.
The prevalence of ASD and PTSD were 9.0% and 8.5%, respectively. The shift from ASD to PTSD was more pronounced when we included partial diagnoses of ASD and PTSD. Three predictive factors for PTSD were identified through multiple logistic analysis: ASD-positive, presence of persistent physical disability and physical injury severity.
Even among severely injured MVA survivors, most acute stress symptoms subside over time. However, having ASD or partial ASD in the early stage, and the presence of physical disability as an aftereffect are strong predictive factors for PTSD. These findings validate the importance of evidence-based intervention for ASD to forestall PTSD.
Objective: Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, one major complication of ECT is the potential for temporary cognitive impairment. The ...purpose of this retrospective study was to explore the relationship between postictal confusion (PIC) and interictal disorientation (IID) as well as to clarify whether PIC is related to the improvement in symptoms or not. Materials: Patients with depression who were admitted to Juntendo University Hospital to receive ECT from April 2006 to January 2011 were recruited. Methods: PIC and IID for each patient was observed. The Hamilton Rating Scale to assess depression (Ham-D) was employed in depressive patients. All assessments were performed prior to first ECT session and a week after the final ECT session. Measurement and Results: Thirty-seven patients were registered, but eight patients were interrupted due to complications. PIC was associated with improvement of HamD (p=0.0459). IID prevalence was not significantly different between patients of PIC and non-PIC group. Conclusions: PIC is associated with a greater improvement after ECT, and is not related to IID.
Abstract Objective Efficacy and tolerability of risperidone oral solution (RIS-OS) and olanzapine orally disintegrating tablet (OLZ-ODT) were compared for the treatment of acute psychotic agitation. ...Method During a 2-month period, patients scoring ≥15 on the Excited Component for Positive and Negative Syndrome Scale (PANSS-EC) were assigned to treatment with OLZ-ODT ( n =34) or RIS-OS ( n =53) on psychiatric emergency situations, and assessed every 15 min. Results Two (OLZ-ODT and RIS-OS) by five (0-, 15-, 30-, 45- and 60-min time points) repeated-measures analysis of variance revealed only a significant main effect of time course on PANSS-EC ( F =82.2, P <.0001). No differences in the number of patients receiving additional injection due to worsening were found (OLZ-ODT, 11.8%; RIS-OS, 9.4%). No differences in rate of extrapyramidal symptoms and patient satisfaction with assigned treatment were found. However, patients in the OLZ-ODT group recovered significantly more from tachycardia than those in the RIS-OS group ( t =2.17, P =.03). Conclusion OLZ-ODT and RIS-OS treatments yielded similar improvements in acutely agitated patients who accepted oral medication. However, on one physiological parameter (i.e., tachycardia) OLZ-ODT might be superior to RIS-OS. Physiological indicators may also be useful for measuring levels of agitation.
Alzheimer's disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the ...elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture.
We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years average ± standard deviation (SD) requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants.
We recognized that activities of cognitive function (p < 0.001), eating (dysphagia) (p < 0.001), eating (feeding) (p < 0.001), and toilet use (p < 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p < 0.05), transfer and locomotion (p < 0.001), and bathing (p < 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p < 0.001), dysphagia (p < 0.01), feeding (p < 0.001), and toilet use (p < 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery.
These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.
No highly effective pharmacologic interventions to prevent delirium have been identified. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the ...prevention of delirium.
We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more. Seventy-two patients were randomly assigned using the sealed envelope method to receive suvorexant (15 mg/d; 36 patients) or placebo (36 patients) every night for 3 days. The primary outcome measure was incidence of delirium as determined by the DSM-5. Trained psychiatrists assessed for delirium.
We found that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (0% n/N = 0/36 vs 17% 6/36, respectively, P = .025). Comparison by log-rank test also showed that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (χ² = 6.46, P = .011). Analysis of variance revealed a tendency for main effect of treatment (F = 3.79, P = .053) on the sleep-wake cycle disturbance score (item 1) of the Japanese version of the Delirium Rating Scale-Revised-98 (DRS-R-98-J). There were no significant differences in adverse events.
Suvorexant administered nightly to elderly patients admitted for acute care may provide protection against delirium. Larger studies are needed to show the potential of suvorexant to improve the circadian core domain of delirium.
UMIN Clinical Trials Registry identifier: UMIN000015681.
The aim of this study was to investigate the reliability and the validity of the Japanese version of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR ...2010-J), and its quantification scale, the Fibromyalgia Symptom Scale (FS-J). In this study, we divided patients with chronic pain without psychiatric disorders other than depression into two groups according to the 1990 ACR Diagnostic Criteria for Fibromyalgia, a fibromyalgia group and a non-fibromyalgia group (rheumatoid arthritis, osteoarthritis, and gout). Patients in both groups were assessed using the ACR 2010-J and FS-J. Seventy-seven of 94 (82%) patients in the fibromyalgia group met the ACR 2010-J, whereas 9% (4/43) of the non-fibromyalgia group did so, with a sensitivity of 82%, specificity of 91%, positive predictive value of 95%, negative predictive value of 70%, and positive likelihood ratio of 8.8. Mean total scores on the FS-J significantly differentiated the fibromyalgia from the non-fibromyalgia group. The scale had high inter-rater reliability and high internal consistency. With a cutoff score of 10, the positive likelihood ratio was 10.1. Our findings indicate that the ACR 2010-J and FS-J have high reliability and validity, and are useful for assessing fibromyalgia in Japanese populations with chronic pain. As regards the positive likelihood ratio, that of the FS-J might be suitable as a positive test.
Abstract Objective To discuss the risk that bladder distention resulting from anticholinergic side effects of antipsychotics can cause iliac vein compression syndrome (IVCS) and subsequent pulmonary ...embolism (PE). Method Case report, review of the literature and discussion. Results We report the case of a 65-year-old man with depression who experienced PE associated with IVCS due to a distended urinary bladder resulting from anticholinergic side effects. PE disappeared after conservative therapy with heparin followed by warfarin. Conclusion When drugs with anticholinergic effects are given to immobilized patients such as those with severe depression, close observation including monitoring of urine volume is needed to prevent IVCS caused by drug-induced urinary retention, and subsequent PE.
The case of a 64‐year‐old patient with pica and severe mental retardation who was admitted to our hospital for treatment of recurrent cholecystitis is reported. Abdominal ultrasound showed sludge in ...the gallbladder, but no stones. Abdominal CT revealed a foreign body in the duodenum resembling a suction cup of the type commonly used in kitchens and bathrooms. The object could not be removed because it was deeply embedded in the hypertrophic intestinal mucosa. A nasogastric tube was inserted for feeding, since the object impeded the passage of solid foods. The patient's fever and abdominal pain subsequently resolved, and laboratory data improved. The indwelling feeding tube prevented recurrence of cholecystitis. Since pica is common not only in patients with mental retardation but also in dementia patients, the present case may also relate to the treatment of acute abdominal conditions in dementia patients.
Aim: Treatment of medical comorbidities among psychiatric patients is an expected role of general hospital psychiatric wards. The purpose of this study was to clarify whether locked wards of general ...hospitals are necessary in the treatment of psychiatric patients with severe medical comorbidities.
Methods: A cross‐sectional study concerning patients who required admission due to both somatic and psychiatric diseases was performed all over Tokyo during a 2‐month period. Demographic and clinical characteristics of patients who were admitted to locked wards of general hospitals were compared with those of patients admitted to open wards of general hospitals.
Results: In locked wards, the rate of organic mental disorders, median Lack of Judgment and Insight from the Positive and Negative Syndrome Scale, and rate of diseases requiring surgery were significantly higher than those in open wards. The rate of patients with medical comorbidities who could not be admitted was significantly higher for open wards than for locked wards. Furthermore, the rate of patients with both medical comorbidities and attempted suicide who could not be admitted was significantly higher for open wards than for locked wards.
Conclusion: Locked wards may be necessary to treat severe psychiatric patients with severe medical comorbidities.
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