Kiyoaki Takeshi

Clinical practice and research activities for early psychiatric intervention at Japanese leading centres.

Aim: To describe clinical practice and research activities for early psychiatric intervention in Japan, a country with a huge number of psychiatric beds and a history of long‐stay, hospital‐based psychiatry.

Effects of aripiprazole on insight and subjective experience in individuals with an at-risk mental state.

Introduction: Although medication with antipsychotic for the psychosis prodrome has often caused some ethical issues, recent studies have shown that some novel antipsychotics are safer and more tolerable for young people. This study aimed to investigate whether the administration of aripiprazole would not only relieve the prodromal symptoms but also be tolerable for prodromal subjects and to evaluate the effect of medication on improvements in insight and subjective well-being. Methods: The Structured Interview for Prodromal Syndromes was performed for patients identified as having the psychosis prodrome. Psychiatric measures included the Scale of Prodromal Symptoms. Clinical insight was measured using the Scale to Assess Unawareness of Mental Disorder, and changes in subjective experience were assessed using the Subjective Well-being Under Neuroleptics, Short version. The time frame was the first 8 weeks after beginning study medication. Results: Thirty-six treatment-seeking prodromal patients (men, 42%; mean [SD] age, 23.4 [5.6] years) were enrolled. At the 12-week follow-up point, 30 participants (83%) remained in the trial. Improvements on the Scale of Prodromal Symptoms and Scale to Assess Unawareness of Mental Disorder scores were statistically significant at end point. Although the Subjective Well-being Under Neuroleptics, Short version total scores improved significantly at 4 weeks, however, they did not change significantly from baseline at 8 weeks. Conclusions: This trial suggests that aripiprazole not only produces a clinical benefit in prodromal subjects but also results in a high adherence to medication with immediate improvements in insight and subjective well-being. Although further placebo-controlled studies are needed, aripiprazole might be a first-line treatment for individuals at imminent risk for psychosis.

Reduced prefrontal cortex activation during divergent thinking in schizophrenia: a multi-channel NIRS study.

Relationships between deficits in verbal fluency and poor social functioning have been revealed in patients with schizophrenia. In previous studies, we demonstrated that deficits in idea fluency, which is ranked as a more complex type of verbal fluency and reflects divergent thinking ability, were more closely related to social dysfunction than deficits in simple word fluency. Although functional neuroimaging studies have provided detailed data regarding prefrontal dysfunction during word fluency tasks, the regions that relate to deficits in fluency of ideas and thoughts have not yet been clarified in schizophrenia patients. The purpose of the present study was to identify the prefrontal sub-regions responsible for deficits in idea fluency using near-infrared spectroscopy (NIRS), which is more practical than other imaging methods, and to investigate the relationships between lesions and idea fluency deficits and social dysfunction in patients with schizophrenia. Eighteen outpatients with schizophrenia and 16 healthy subjects were recruited for this case-controlled study. Using 24-channel NIRS, we measured changes in hemoglobin concentration in the prefrontal cortical surface area during idea and letter fluency tests. The analyses revealed that schizophrenia patients generally exhibited a smaller increase in the concentration of oxyhemoglobin in the frontopolar region than the controls during both the tests. However, the areas in which reduced activations were demonstrated in the patients differed remarkably between the idea and letter fluency tests: reduced activations were observed in the ventral region during the former test and in the dorsal region of the frontopolar cortex during the latter test. The reduced activations in each sub-region appeared to affect the related cognitive impairment, since the patients showed significant poorer performances than the controls on both the tests. Moreover, hypoactivity during idea fluency was significantly correlated with poor social functioning as assessed using the Global Assessment of Functioning (GAF) in the patient group. The results of the present study suggest that the ventral region within the frontopolar cortex is responsible for divergent thinking, which is associated with poor social functioning in patients with schizophrenia.

Poor outcome associated with symptomatic deterioration among help-seeking individuals at risk for psychosis: a naturalistic follow-up study

It remains debatable whether early intervention for psychosis is capable of meeting the needs of at‐risk subjects. The aims of this study were to describe the actual impact of interventions on subjective difficulties and to explore the factors that may be associated with a poor outcome.

Dyke-Davidoff-Masson Syndrome Demonstrated by Current MR images A Case Report

Current magnetic resonance imaging techniques demonstrated MR findings of Dyke-Davidoff-Masson syndrome in a 44-year-old man. Statistical parametric mapping analysis of the T1-weighted images showed focal atrophy in the basal ganglia. Three-dimensional white matter fibers of corticospinal tracts, corpus callosum and cingulate bundle were demonstrated using diffusion tensor data correlated to the patients clinical conditions.

Differences between subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia: a qualitative pilot study

BackgroundIn cases of untreated schizophrenia, the patients’ entourage often does not recognize the psychotic symptoms of the patient and the possibility that the patient may attempt suicide. The aim of this study was to investigate the discrepancies between the subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia.MethodsA semi-structured interview was carried out with seven near-fatal suicide attempters with untreated schizophrenia to examine the subjective experiences at the time of the suicide attempt. The families of the patients were also interviewed to determine their recognition of the patients’ psychotic symptoms and the suicidal ideation. The interview data were analyzed qualitatively.ResultsSix subjects were undergoing exacerbation of the psychotic symptoms at the time of exhibiting the suicide-related ideation. One subject had been in a prolonged depressive state before attempting suicide. Although all the patients experienced severe distress due to psychotic symptoms and depressive mood, they all exhibited only low level or no help-seeking behavior, and six of seven families had not recognized the change in the patient’s mental condition.ConclusionsAppropriate information about schizophrenia should be provided to the general public so that any help-seeking by the patients with this disease is not overlooked. In addition, accessible early intervention services for psychosis should be established.