Hissei Imai

Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta‐analysis

Various control conditions have been employed in psychotherapy trials, but there is growing suspicion that they may lead to different effect size estimates. The present study aims to examine the differences among control conditions including waiting list (WL), no treatment (NT) and psychological placebo (PP).

Relationships between each category of 25‐item frailty risk assessment (Kihon Checklist) and newly certified older adults under Long‐Term Care Insurance: A 24‐month follow‐up study in a rural community in Japan

The 25‐item Kihon Checklist (KCL) is the official self‐administered questionnaire tool to screen frail older adults, consisting of seven categories: physical strength, nutritional status, oral function, houseboundness, cognitive function, depression risk and a score of more than 9 out of 1–20 items. The aim of the present study was to evaluate the relationships between each category of the KCL and newly certified cases under the Long‐Term Care Insurance (LTCI) in Japan during 24 months.

Importance of cognitive assessment as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2‐year follow up

To investigate which category in the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare can predict functional decline for community‐dwelling elderly people at a 2‐year follow up.

Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis

Introduction Many antidepressants are indicated for the treatment of major depression. Two network meta-analyses have provided the most comprehensive assessments to date, accounting for both direct and indirect comparisons; however, these reported conflicting interpretation of results. Here, we present a protocol for a systematic review and network meta-analysis aimed at updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression. Methods and analysis We will include all randomised controlled trials reported as double-blind and comparing one active drug with another or with placebo in the acute phase treatment of major depression in adults. We are interested in comparing the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will be the proportion of patients who responded to or dropped out of the allocated treatment. Published and unpublished studies will be sought through relevant database searches, trial registries and websites; all reference selection and data extraction will be conducted by at least two independent reviewers. We will conduct a random effects network meta-analysis to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. To rank the various treatments for each outcome, we will use the surface under the cumulative ranking curve and the mean ranks. We will employ local as well as global methods to evaluate consistency. We will fit our model in a Bayesian framework using OpenBUGS, and produce results and various checks in Stata and R. We will also assess the quality of evidence contributing to network estimates of the main outcomes with the GRADE framework. Ethics and dissemination This review does not require ethical approval. PROSPERO registration number CRD42012002291.

Cyclooxygenase in the vagal afferents: is it involved in the brain prostaglandin response evoked by lipopolysaccharide?

The vagal afferents are proposed to transmit abdominal immune signals to the brain. In this immune-brain communication, prostaglandins might play a mediator role. In fact, prostaglandin receptors are abundant in the vagal afferents. We examined here the presence of cyclooxygenase, an enzyme necessary for prostaglandin biosynthesis, in the vagal afferents of rats. We also tested whether the vagal afferents contribute to the elevation of prostaglandin E2 in the brain after intraperitoneal injection of lipopolysaccharide. Under normal conditions, cyclooxygenase-1-like immunoreactivity was constitutively expressed in the vagal afferents at their central terminals and in their cell bodies. Cyclooxygenase-2-like immunoreactivity was absent in the vagal afferents under normal as well as lipopolysaccharide-challenged conditions. Instead, cyclooxygenase-2-like immunoreactivity was induced in brain endothelial cells by the lipopolysaccharide challenge. The elevation of prostaglandin E2 in the cerebrospinal fluid after lipopolysaccharide challenge was not inhibited, but was rather enhanced, by the bilateral vagotomy. These results suggest that the vagal afferents potentially generate prostaglandins, which may locally modulate the vagal signal transmission, but that the vagal afferents are not essential to the elevation of prostaglandin E2 in the brain after intraperitoneal challenge with LPS.

Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland

Objectives To clarify the association between glucose intolerance and high altitudes (2900–4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. Design Cross-sectional epidemiological study on Tibetan highlanders. Participants We enrolled 1258 participants aged 40–87 years. The rural population comprised farmers in Domkhar (altitude 2900–3800 m) and nomads in Haiyan (3000–3100 m), Ryuho (4400 m) and Changthang (4300–4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). Main outcome measure Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. Results The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500–4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance. Conclusions Socioeconomic factors, hypoxaemia and the effects of altitudes >3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.

Adding smartphone-based cognitive-behavior therapy to pharmacotherapy for major depression (FLATT project): study protocol for a randomized controlled trial

BackgroundMajor depression is one of the most debilitating diseases in terms of quality of life. Less than half of patients suffering from depression can achieve remission after adequate antidepressant treatment. Another promising treatment option is cognitive-behavior therapy (CBT). However, the need for experienced therapists and substantive dedicated time prevent CBT from being widely disseminated.In the present study, we aim to examine the effectiveness of switching antidepressants and starting a smartphone-based CBT program at the same time, in comparison to switching antidepressants only, among patients still suffering from depression after adequate antidepressant treatment.Methods/designA multi-center randomized trial is currently being conducted since September 2014. The smartphone-based CBT program, named the “Kokoro-App,” for major depression has been developed and its feasibility has been confirmed in a previous open study. The program consists of an introduction, 6 sessions and an epilogue, and is expected to be completed within 9 weeks by patients. In the present trial, 164 patients with DSM-5 major depressive disorder and still suffering from depressive symptoms after adequate antidepressant treatment for more than 4 weeks will be allocated to the Kokoro-App plus switching antidepressant group or the switching antidepressant alone group. The participants allocated to the latter group will receive full components of the Kokoro-App after 9 weeks.The primary outcome is the change in the total score on the Patient Health Questionnaire through the 9 weeks of the program, as assessed at week 0, 1, 5 and 9 via telephone by blinded raters. The secondary outcomes include the change in the total score of the Beck Depression Inventory-II, change in side effects as assessed by the Frequency, Intensity and Burden of Side Effects Rating, and treatment satisfaction.DiscussionAn effective and reachable intervention may not only lead to healthier mental status among depressed patients, but also to reduced social burden from this illness. This paper outlines the background and methods of a trial that evaluates the possible additive value of a smartphone-based CBT program for treatment-resistant depression.Trial registrationUMIN-CTR: UMIN000013693 (registered on 1 June 2014)

Association between risk perception, subjective knowledge, and depression in community-dwelling elderly people in Japan

Risk perception is one of the core factors in theories of health behavior promotion. However, the association between knowledge, risk perception, and depressed mood in depression is unknown. The aim of this study was to clarify the relationships between subjective knowledge, risk perception, and objective scores of depression in community-dwelling elderly people in Japan. A total of 747 elderly participants (mean age: 76.1, female: 59.8%) who completed the 15-item Geriatric Depression Scale (GDS-15) along with items assessing subjective knowledge and risk perception were included in the analysis. We assessed the correlation between subjective knowledge and risk perception, and then compare GDS-15 scores by level of subjective knowledge and risk perception. Subjective knowledge was weakly associated with risk perception and related to lower GDS-15 scores in a dose-response pattern, which did not change after adjusting for age, gender, basic activities of daily living (ADL), instrumental ADL, years of education and history of depression. There was no significant association between risk perception and GDS-15 scores. The relationship between knowledge, risk perception, and depressed mood in younger generations is unclear, but warrants examination.

Depression and subjective economy among elderly people in Asian communities: Japan, Taiwan, and Korea

The objective of this study is to investigate the cross-cultural relationship between depressive state and subjective economic status, as well as subjective quality of life (QOL) and activities of daily living (ADL) among elderly people in communities in Japan, Taiwan, and Korea. We studied 595 subjects aged 65 years or older in three Asian communities (261 subjects in T town in Japan, 164 in D town in Taiwan, and 170 in H town in Korea). The Geriatric Depression Scale-15, a self-rating questionnaire assessing ADL, subjective QOL, social situations, and past and current medical status, was used. Depression of the elderly was associated with dependence in basic ADL, subjective QOL, and subjective sense of low economic status. After adjusting for the effects of age, sex, and basic ADL, subjective sense of low economic status was closely associated with depression in community-living elderly people in all three communities in Asia. In conclusion, absolute and objective economic status is an important contributing factor to depressive state or psychosocial deterioration, however, we should pay more attention to the roles of perception of low economic status in determining depressive state in community-dwelling elderly people.

Protocol registration and selective outcome reporting in recent psychiatry trials: new antidepressants and cognitive behavioural therapies

The selective reporting of favorable outcomes has a serious influence on our evidence base. However, this problem has not yet been systematically investigated in the field of psychiatry. Our study aimed to evaluate registration and outcome reporting in randomized controlled trials (RCTs) of standard treatments for depression: cognitive behavioural therapy (CBT) or new‐generation antidepressants (ADs).