Masatoshi Suzuki

Impact of 16-slice computed tomography in percutaneous coronary intervention of chronic total occlusions

The main reason for failure of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is because the calcified plaque prevents the guide wire crossing the occlusion. We aimed to identify the route, and characterize plaque components within CTO, using 16‐slice computed tomography (MSCT). Twenty three angiographic CTO in 22 patients (mean age 69 ±± 5 years, 17 males) were included. All patients had undergone MSCT prior to PCI. Images were analyzed for lesion visibility and plaque characteristics of CTO. The presence and location of calcified plaque within the CTO were systematically assessed. Each lesion was classified as a noncalcified, moderately calcified, or exclusively calcified plaque. Procedural failure was defined as the inability to cross a guide wire through the occlusion. All coronary routes of CTO segment were visualized. MSCT revealed three markedly bent CTO segments (13.0%), which could not be identified by coronary angiography only. Calcified plaques were detected in 30 lesions of 19 CTO segments (82.6%), but were not detected in the other four. The majority of calcified plaque was located in the proximal lesion, or both proximal and distal lesions. Fifteen out of 30 calcified lesions (50.0%) were exclusively calcified plaques. Overall procedural success was obtained in 21 CTOs (91.3%). MSCT can accurately identify the route of the CTO segment and evaluate both distribution and amount of the calcified plaque within it. Even with the complicated and/or calcified lesions, PCI success rate was excellent under MSCT guidance. MSCT should become a useful tool in PCI of CTO.

Low Openness on the Revised NEO Personality Inventory as a Risk Factor for Treatment-Resistant Depression

Background Recently, we reported that low reward dependence, and to a lesser extent, low cooperativeness in the Temperature and Character Inventory (TCI) may be risk factors for treatment-resistant depression. Here, we analyzed additional psychological traits in these patients. Methods We administered Costa and McCraes five-factor model personality inventory, NEO Personality Inventory-Revised (NEO-PI-R), to antidepressant-treatment resistant depressed patients (nu200a=u200a35), remitted depressed patients (nu200a=u200a27), and healthy controls (nu200a=u200a66). We also evaluated the relationships between scores on NEO and TCI, using the same cohort of patients with treatment-resistant depression, as our previous study. Results Patients with treatment-resistant depression showed high scores for neuroticism, low scores for extraversion, openness and conscientiousness, without changes in agreeableness, on the NEO. However, patients in remitted depression showed no significant scores on NEO. Patients with treatment-resistant depression and low openness on NEO showed positive relationships with reward dependence and cooperativeness on the TCI. Conclusions Many studies have reported that depressed patients show high neuroticism, low extraversion and low conscientiousness on the NEO. Our study highlights low openness on the NEO, as a risk mediator in treatment-resistant depression. This newly identified trait should be included as a risk factor in treatment-resistant depression.

Expert consensus on hospitalization for assessment: a survey in Japan for a new forensic mental health system

BackgroundIn Japan, hospitalization for the assessment of mentally disordered offenders under the Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity (the Medical Treatment and Supervision Act, or the MTS Act) has yet to be standardized.MethodsWe conducted a written survey that included a questionnaire regarding hospitalization for assessment; the questionnaire consisted of 335 options with 9 grades of validity for 60 clinical situations. The survey was mailed to 50 Japanese forensic mental health experts, and 42 responses were received.ResultsAn expert consensus was established for 299 of the options. Regarding subjects requiring hospitalization for assessment, no consensus was reached on the indications for electroconvulsive therapy (ECT) or for confronting the offenders regarding their offensive behaviors.ConclusionsThe consensus regarding hospitalization for assessment and its associated problems were clarified. The consensus should be widely publicized among practitioners to ensure better management during the hospitalization of mentally disordered offenders for assessment.

Utility of the Neurobehavioral Cognitive Status Examination (COGNISTAT) in differentiating between depressive states in late-life depression and late-onset Alzheimer’s disease: a preliminary study

BackgroundIt is often difficult to differentiate between the depressive states seen in late-life depression and late-onset Alzheimer’ disease (AD) in the clinical setting.MethodsThirty-four outpatients were recruited, all fulfilling the criteria of aged 65xa0years or above, scores of 14 or more on the Hamilton depression rating scale (HAM-D), and 26 or less on the Mini-Mental State Examination (MMSE). At the initial visit, they were administered the Neurobehavioral Cognitive Status Examination (COGNISTAT). At 1xa0month, a diagnosis of either senile depression (nxa0=xa024) or Alzheimer’ disease (nxa0=xa010) was made.ResultsThe COGNISTAT revealed that the late-life depression group showed significantly higher scores in orientation and comprehension subtests compared with the AD group. At the study endpoint (6xa0months after treatment), MMSE detected significant improvements in the late-life depression group (nxa0=xa015), but no changes in the late-onset AD group (nxa0=xa07). Scores for memory, similarities, and judgment on the second COGNISTAT were significantly improved in the depressed group, whereas calculation scores deteriorated significantly in the AD group.ConclusionThe COGNISTAT could prove useful in differentiating late-life depression from late-onset AD, despite similar scores on MMSE.

A Study of Remitted and Treatment-Resistant Depression Using MMPI and Including Pessimism and Optimism Scales

Background The psychological aspects of treatment-resistant and remitted depression are not well documented. Methods We administered the Minnesota Multiphasic Personality Inventory (MMPI) to patients with treatment-resistant depression (nu200a=u200a34), remitted depression (nu200a=u200a25), acute depression (nu200a=u200a21), and healthy controls (nu200a=u200a64). Pessimism and optimism were also evaluated by MMPI. Results ANOVA and post-hoc tests demonstrated that patients with treatment-resistant and acute depression showed similarly high scores for frequent scale (F), hypochondriasis, depression, conversion hysteria, psychopathic device, paranoia, psychasthenia and schizophrenia on the MMPI compared with normal controls. Patients with treatment-resistant depression, but not acute depression registered high on the scale for cannot say answer. Using Students t-test, patients with remitted depression registered higher on depression and social introversion scales, compared with normal controls. For pessimism and optimism, patients with treatment-resistant depression demonstrated similar changes to acutely depressed patients. Remitted depression patients showed lower optimism than normal controls by Students t-test, even though these patients were deemed recovered from depression using HAM-D. Conclusions The patients with remitted depression and treatment-resistant depression showed subtle alterations on the MMPI, which may explain the hidden psychological features in these cohorts.

Effects of add-on tipepidine on treatment-resistant depression: an open-label pilot trial

Objective Treatment-resistant depression is a challenging problem in the clinical setting. Tipepidine has been used as a non-narcotic antitussive in Japan since 1959. Methods We administered tipepidine to 11 patients with treatment-resistant depression. Tipepidine was given for 8 weeks as an augmentation. Results Tipepidine significantly improved depression scores on the Hamilton Rating Scale for depression. Add-on treatment with tipepidine significantly improved scores on the trail making test and Rey auditory verbal learning test. However, no changes were observed in blood concentrations of stress-related hormones (adrenocorticotropic hormone, cortisol, dehydroepiandrosterone sulphate) with tipepidine augmentation. Conclusion Tipepidine might be a potential therapeutic drug for treatment-resistant depression.

Personality traits as predictors for the outcome of lithium augmentation in treatment-resistant depression.

The NEO Personality Inventory-Revised (NEO) and the Temperament and Character Inventory (TCI) were administered to patients with treatment-resistant depression (n=21) before lithium augmentation. Analysis showed that the poor outcome group (n=11) had lower openness scores on the NEO, and lower cooperativeness scores on the TCI compared with the good outcome group (n=10). These findings may be predictors of poor responsiveness to lithium augmentation in the treatment of antidepressant-resistant depression.

Effects of Add-on Ramelteon on Cognitive Impairment in Patients with Schizophrenia: An Open-label Pilot Trial.

Objective This open-label study examined the effects of ramelteon on cognitive functions in 10 outpatients with schizophrenia. Methods Ramelteon (8 mg/day) was administered to 10 patients with schizophrenia for six months. The verbal fluency test, Trail-Making Test, the Wisconsin Card Sorting Test, the Stroop Test, the Digit Span Distraction Test, Iowa Gambling Task, the Rey Auditory Verbal Learning Test were evaluated at baseline and 6 months after treatment with ramelteon. Results Ramelteon improved significantly the scores of Rey Auditory Verbal Learning Test. Additionally, ramelteon exerted improvements in the verbal fluency and Iowa Gambling Task in 4 patients. Conclusion Ramelteon could be a potential therapeutic drug, in adjunctive treatment of learning and memory deficits seen in patients with schizophrenia.

Effectiveness of Enteral Formula with Enriched Polyunsaturated Fatty Acids in the Treatment of Anorexia Nervosa: A Pilot Open Case Study

Little is known about the association between polyunsaturated fatty acids (PUFAs) and eating-related patho- physiology in anorexia nervosa (AN). The aim of this study was to determine whether nutritional treatment with enteral formula, rich in PUFAs, affects (1) the concentrations of PUFA and brain-derived neurotrophic factor (BDNF) in serum, and (2) the depressive symptoms and eating-related pathophysiology in patients with AN. Thirteen patients with AN par- ticipated in this study. Serum PUFA and BDNF concentrations were measured before and after receiving the enteral for- mula, and eating-related psychopathology and depressive symptomatology were assessed using the eating disorder inven- tory-2 (EDI-2) and the Hamilton Depression Rating Scale (HDRS), respectively. Body mass index (BMI) and HDRS scores showed significant improvement after treatment. Patients receiving the nutritional treatment, enteral formula with enriched PUFAs, favorably adhered to the treatment, and showed significant improvements in BMI and depressive symp- toms. Randomized controlled studies are required to further examine the effectiveness of PUFAs in AN.