Depressive episodes with psychotic symptoms are prevalent among the older adults, emphasizing the need to differentiate them from dementia with Lewy bodies (DLB), in which depressive and psychotic ...symptoms commonly coexist. In contrast, psychotic symptoms occur more frequently in depressive episodes of bipolar disorder (BD) than in major depressive disorder (MDD). Although MDD is a significant risk factor for dementia, studies exploring the relationship between BD and dementia are lacking. This report details the case of a 74-year-old female who experienced severe psychotic depression that led to suicide attempts during a long-term course of young-onset BD. Ultimately, she was diagnosed with DLB based on her neurocognitive symptoms and results of the neuroimaging examination. She had experienced multiple relapses in the past, predominantly characterized by depressive episodes in her old age. Notably, she had never undergone lithium treatment, which is known for its potential efficacy in preventing relapse and dementia. Recent systematic reviews and meta-analyses have suggested that patients with BD have a higher risk of dementia than the general population, and that lithium usage is associated with a reduced risk. Moreover, patients with BD have been suggested to have an elevated risk of developing Parkinson’s disease (PD), and the pathophysiological relationship between BD and PD may be attributed to dopamine dysregulation resulting from multiple relapses. Future research is imperative to identify strategies for preventing dementia in patients with BD and to develop interventions for the comorbidities of BD and DLB.
Benzodiazepines are used in the treatmentof anxiety and insomnia. On the other hand, they not only have side effects such as drowsiness, poor concentration, and muscle relaxation but also persistent ...cognitive decline. Even if we try to reduce the dose of these drugs to improve drug-induced cognitive function, it is difficult to do so due to dependence and worsening insomnia. I report four cases in which cognitive dysfunction was improved by switching from benzodiazepines to orexin receptor antagonists (suvorexant and lemborexant ). Orexin receptor antagonists were effective to improve cognitive impairment. In cognitive dysfunction caused by benzodiazepines, switching to orexin receptor antagonists may be effective.
Objective
There are only a few treatment algorithms for first‐episode schizophrenia. Moreover, all the algorithms apply to acute treatment, but not maintenance treatment. Therefore, we aimed to ...develop acute and maintenance treatment algorithms for first‐episode schizophrenia.
Methods
The algorithm committee of the Japanese Society of Clinical Neuropsychopharmacology developed pharmacological treatment algorithms for the acute phase, agitation, and maintenance phase of first‐episode schizophrenia.
Results
The acute treatment algorithm focuses on drug‐naïve patients with first‐episode schizophrenia who are not old or very agitated and recommends first‐line treatment with aripiprazole, second‐ or third‐line treatment with risperidone/paliperidone or olanzapine, and fourth‐line treatment with clozapine. Long‐acting injection of the current antipsychotic agent can be used for poor medication adherence or based on patient preference. The agitation treatment algorithm recommends first‐line treatment with lorazepam and second‐ or third‐line treatment with quetiapine or levomepromazine and clearly instructs that the medication used for agitation should be reduced and then discontinued after remission of agitation. The maintenance treatment algorithm recommends the gradual reduction of antipsychotics to the minimum effective dose after remission of positive symptoms.
Conclusions
We hope that our unique algorithms will be used broadly and will contribute to minimizing patients' burden related to antipsychotic treatment.
Risperidone is the first new generation antipsychotic drug to become available as a long-acting injection (LAI). The purpose of this study was to evaluate the effects of switching from oral ...risperidone to risperidone LAI (RLAI) on cognitive function in stable schizophrenia patients compared with the effects of continuing oral risperidone.
Sixteen stable patients who had received risperidone monotherapy for at least 3 months were enrolled (the RLAI group). Before and 24 weeks after switching to RLAI, the Japanese-language version of the Brief Assessment of Cognition in Schizophrenia (BACS-J) and the Positive and Negative Syndrome Scale (PANSS) were administered. To exclude the possibility of learning effects on the BACS-J results, 14 patients with stable schizophrenia who continued oral risperidone treatment were also assessed (the RIS group).
The two groups did not differ with respect to changes in the PANSS score, and no emergent side effects, including extrapyramidal symptoms, were observed. The BACS-J score for verbal memory exhibited greater improvement in the RLAI group than in the RIS group (
= 0.047).
The results of this preliminary study suggest that switching from oral risperidone to RLAI may improve verbal capability more than continuing with oral risperidone. However, these findings must be replicated in a larger, double-blind study.
Tardive dystonia associated with antidepressant use is rare and often under-recognized. We had an experience with trazodone, which is used for delirium and insomnia prescribed in general hospital, ...inducing tardive dystonia.
A 61-year-old Japanese woman had been treated for schizophrenia. She was moved to general hospital because of consciousness disturbance. She was prescribed trazodone (25 mg/day) for delirium and insomnia. After she was discharged, she returned to the psychiatric hospital with tardive dystonia. Her dystonia symptoms improved with 3 days of discontinuing trazodone.
In the present case, long-term use of trazodone induced tardive dystonia. Discontinuing trazodone rapidly improved tardive dystonia.
ObjectivesThe purpose of this study was to evaluate the impact of a 4-week walking intervention on subjective sleep quality.DesignA prospective open-label study.ParticipantsA total of 490 healthy ...workers were included in the study. The 490 participants were divided into a group of 214 participants with exercise habits (exercising group, EG) and a group of 276 participants without exercise habits (non-EG).InterventionsA walking intervention with a target of walking 10 000 steps daily for 4 weeks.Outcome measuresThe Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered twice (before the start and after the end of the study).ResultsOverall, the walking intervention improved the participants’ PSQI global score, sleep latency (minutes), sleep duration (hours), perceived sleep quality factor and daily disturbance factor. Among the EG participants, the walking intervention significantly improved the PSQI global score and perceived sleep quality. Among the non-EG participants, the walking intervention significantly improved the PSQI global score, sleep latency, sleep duration and perceived sleep quality.ConclusionsA walking intervention might reduce the sleep latency and increase total sleep duration in working persons without exercise habits.
PDF
