To assess the performance of the Japanese version of the Patient Health Questionnaire-9 (J-PHQ-9) for depression in primary care.
Participants in both phases completed the J-PHQ-9, while patients in ...the second phase also completed the SF-8 (the short form for the health-related QOL scale SF-36). Subjects (n = 284; male = 107, female = 177) had to return the questionnaires to their health care professional within 48 hours and undergo a diagnostic evaluation interview based on the Japanese version of M.I.N.I-Plus.
93 patients were diagnosed as having major depressive disorder (MDD). In the J-PHQ-9, the optimal cutpoint ≥ 10 had sensitivity of 90.5% and specificity of 76.6%. As for the categorical algorithms, the sensitivity was 80.6%; specificity was 89.5%, and a positive likelihood ratio of 7.7. The Stratum-specific likelihood ratios (SSLRs) of the J-PHQ-9 scores of 0-9, 10-14, 15-19, and 20-27 for major depression were 0.10 (95% CI: 0.05-0.20), 1.67 (95% CI: 1.02-2.76), 5.41 (95% CI: 2.87-10.22), and 11.98 (95% CI: 5.39-26.63), respectively. The relationship between the severity of J-PHQ-9 and the MCS of SF-8 was significant (χ 2 ＝ 85.72, df = 4, P ≤ 0.0001).
This study has validated the J-PHQ-9 as a useful tool for the assessment of MDD in primary care in Japan.
•We assessed depression severity and diagnostic performance in the J-PHQ-9 in primary care settings in Japan.•Our results were similar to those in studies conducted in other nations using the PHQ-9.•J-PHQ-9 is suitable as a clinical tool of screening and monitoring for MDD in primary care in Japan.
1. When evaluating a person from the perspective of “mind,” “body,” and “behavior,” behavior needs to be carefully assessed.2. Behavior is usually attributed to mental symptoms such as thinking and ...intellectual ability.3. Behaviors seen in dementia patients that seem strange to others are called behavioral and psychological symptoms of dementia (BPSD). This is an example of inappropriate conceptualization of behavioral problems.4. The severity of depression needs to be assessed comprehensively including mood, thoughts, and behavior.5. Behavioral problems may provide useful information when depression is suspected.6. In the treatment of depression, comprehensive evaluation is necessary of inborn factors, environmental factors during personality development, environmental stress, and physical factors.
To validate the Japanese version of the Patient Health Questionnaire against the Mini-International Neuropsychiatric Interview-Plus in Japan 131 patients in 4 primary care settings and 2 general ...hospital settings participated. These patients completed the Patient Health Questionnaire and returned it to their physician within 48 hr. Subsequently, the subjects underwent a diagnostic evaluation interview based on the Mini-International Neuropsychiatric Interview-Plus by an interviewer blind to the results of the Patient Health Questionnaire screening. The Patient Health Questionnaire diagnosis was characterized using kappa values between 0.70 and 1.0 for Somatoform Disorder, Major Depressive Disorder, Panic Disorder, Bulimia Nervosa, Alcohol Abuse/Dependence, and Premenstrual Disorder. Sensitivities, specificities, and negative predictive values were very good (between 0.84 and 1.0) for the first 4 diagnoses but not Alcohol Abuse/Dependence or Premenstrual Disorder, as were the Positive predictive values (between 0.78 and 1.0). Findings show very good concordance of the Japanese version of the Patient Health Questionnaire with the Japanese version of the Mini-International Neuropsychiatric Interview–Plus.
Background
A mass‐casualty incident occurred on July 26, 2016, at Tsukui Yamayuri‐en, which is a welfare facility for people with intellectual disabilities. Nineteen residents with intellectual ...disabilities were killed, and 26 other residents and staff members were injured. Kitasato University Hospital Emergency and Disaster Medical Center treated many patients in serious condition at the site and in the hospital.
Aims
The authors investigated the symptom severity and distributions of posttraumatic stress disorder (PTSD) among the emergency medical staff in charge.
The subjects of this study were the staff members, mostly working at the Emergency and Disaster Medical Center, who treated the people injured in the incident.
Methods
We conducted a questionnaire survey using Impact of Event Scale‐Revised (IES‐R) on 104 staff members, and 79 responded.
Results
The IES‐R scores of nurses were significantly higher than those of doctors. There was no significant difference in the scores between male and female staff members, and there was no correlation between the score of each IES‐R subscale and age.
Conclusion
Results suggest that mental care should be provided to emergency medical staff, especially nurses who treat trauma patients involved in disasters and heinous crimes.
Mental care should be provided to emergency medical staff, especially nurses who treat trauma patients involved in disasters and heinous crimes.
Highlights • Status epilepticus was induced for 1.5 and 4.5 h in a pilocarpine mouse model. • Anxiety-related behavior depended on status epilepticus duration. • Hippocampal BDNF levels were ...correlated with anxiety-related behavior. • BDNF in the hippocampus might cause anxiety-related behavior in adulthood.
Highlights • Long-term continuous video-EEG recording was performed with SNAP-25 knock-in mice. • A variety of epileptic seizures and discharges was observed in an ordered sequence. • A variety of ...progressive EEG changes was observed over 10 weeks. • Anxiety-like behavior appeared within a few days after multiple seizures. • Several changes with different time courses occurred in parallel in the brain.
Aim
In Japan, the Orange Plan was formulated in 2013 to promote community‐based integrated care systems, and in 2015, it was revised as the New Orange Plan. Since the introduction of these ...programmes, adequate research has not been carried out on how these measures affect regional dementia care. The aim of this study was to investigate the state of community‐based dementia treatment through a survey of medical consultation pathways, including dementia diagnosis, at the Sagamihara Municipal Medical Center for Dementia.
Methods
The participants included 1480 patients (585 men, 895 women) who presented for consultation at the Sagamihara Municipal Medical Center for Dementia for a differential diagnosis or treatment of dementia. The relationship between the path leading to medical consultation before pharmacotherapy and post‐consultation diagnosis was investigated.
Results
Significantly more participants who presented for consultation without a referral were not diagnosed with dementia than diagnosed. Furthermore, among participants referred from a non‐psychiatric clinic, significantly more patients were diagnosed with dementia than not. A significant difference was observed in a comparison of facility types and the use or non‐use of anti‐dementia drugs. Notably, the rate of anti‐dementia drug prescriptions was significantly higher in psychiatric hospitals and non‐psychiatric clinics. Furthermore, it is possible that approximately 30% of anti‐dementia drugs prescribed at each facility were not covered by insurance.
Conclusion
Community‐based integrated care systems aim to promote collaboration within each region aimed. However, appropriate pharmacotherapy methods for dementia patients have not been adequately communicated to non‐specialist physicians and local residents. For this reason, human resource solutions are needed to help medical staff deepen their understanding of dementia so that they can better provide dementia support to patients.
In the treatment of patients with schizophrenia,
(PRN) drugs are commonly prescribed for medical indications such as agitation, acute psychiatric symptoms, insomnia, and anxiety. However, ...high-quality evidence supporting the use of PRN medications is lacking, and these drugs are administered on the basis of clinical experience and habits. Therefore, the actual use of psychotropic PRN drugs and its influence on the patients' outcomes need to be investigated.
This study included 205 patients who underwent inpatient treatment for schizophrenia. We investigated the prescription of psychotropic drugs before admission and at discharge, as well as the dosing frequency of PRN drugs during hospitalization. We also examined the influence of psychotropic PRN drug use on hospitalization days, antipsychotic polypharmacy, and readmission rates.
Patients who used psychotropic PRN drugs during hospitalization had significantly longer hospitalization days (
= 7.5 × 10
) and significantly higher rates of antipsychotic polypharmacy (
= 2.4 × 10
) at discharge than those who did not use psychotropic PRN drugs. Moreover, a higher number of psychotropic PRN drugs used per day was associated with higher readmission rates within 3 months of discharge (
= 4.4 × 10
).
Psychotropic PRN drug use is associated with prolonged hospitalization, antipsychotic polypharmacy, and increased readmission rates in inpatients with schizophrenia. Therefore, psychiatric symptoms should be stabilized with regularly prescribed medications without the extensive use of psychotropic PRN drugs. Moreover, a system for monitoring and reexamining PRN drug use needs to be established.
Synaptosomal-associated protein of 25 kDa (SNAP-25) is a presynaptic protein essential for neurotransmitter release. Previously, we demonstrate that protein kinase C (PKC) phosphorylates Ser(187) of ...SNAP-25, and enhances neurotransmitter release by recruiting secretory vesicles near to the plasma membrane. As PKC is abundant in the brain and SNAP-25 is essential for synaptic transmission, SNAP-25 phosphorylation is likely to play a crucial role in the central nervous system. We therefore generated a mutant mouse, substituting Ser(187) of SNAP-25 with Ala using "knock-in" technology. The most striking effect of the mutation was observed in their behavior. The homozygous mutant mice froze readily in response to environmental change, and showed strong anxiety-related behavior in general activity and light and dark preference tests. In addition, the mutant mice sometimes exhibited spontaneously occurring convulsive seizures. Microdialysis measurements revealed that serotonin and dopamine release were markedly reduced in amygdala. These results clearly indicate that PKC-dependent SNAP-25 phosphorylation plays a critical role in the regulation of emotional behavior as well as the suppression of epileptic seizures, and the lack of enhancement of monoamine release is one of the possible mechanisms underlying these defects.
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