Ryuichi Sagawa

Delirium Training Program for Nurses

Background Delirium is a common and serious clinical problem for hospitalized patients and is associated with an increased risk of morbidity and mortality and increased healthcare costs. Objective The objective of this study was to investigate the preliminary usefulness of a novel delirium training program to improve nurses’ self-confidence in caring for patients with delirium. Method One or more nurses were selected from each ward to become the “delirium-link nurses,” and these nurses would then pass on their special training to the other nurses in their ward. Results The outcome was evaluated with a self-reported 15-item measure to assess selfconfidence. A total of 390 nurses, including 32 delirium-link nurses, participated in this program. A significant effect was observed for 12 of the 15 items. Conclusion This brief program can improve nurses’ self-confidence in treating delirium patients; however, more work is needed to improve nurses’ ability to detect delirium early.

Etiologies of Delirium and Their Relationship to Reversibility and Motor Subtype in Cancer Patients

BACKGROUND Delirium is one of the most commonly encountered complications in patients with cancer. The etiology of delirium in cancer is often multi-factorial, and few reports have examined the causes of delirium. This study investigated the causes of delirium and their association with reversibility and motor subtypes of delirium in cancer patients. METHODS The subjects were inpatients with cancer who had been referred to our Department of Psychiatry and diagnosed with delirium by psychiatrists. The causes of delirium were determined using standard operationalized criteria. The association between delirium reversibility and each clinical factor was examined in detail and longitudinally. RESULTS Data were available from a total of 100 patients. Among them, 58% had hyperactive delirium and 14% had hypoactive delirium. Delirium improved in 56% of the patients after 1 week of standard treatment. The most frequent causes of delirium were opioids (29%), inflammation (27%), dehydration and/or sodium level abnormalities (15%). While two or more causes were identified in 40% or more of the cases, the cause of delirium was not identified in 20% of the patients. Neither reversibility nor motor subtypes of delirium was associated with any specific etiological factor. CONCLUSIONS When treating delirium, prevalences of the causes of delirium, as identified in this study, should be kept in mind. Further research is required to investigate what specific treatments may facilitate the prompt recovery from delirium among cancer patients.

Anticipatory nausea among ambulatory cancer patients undergoing chemotherapy: prevalence, associated factors, and impact on quality of life.

The purposes of this study were to investigate the prevalence of anticipatory nausea (AN), its associated factors, and its impact on quality of life (QOL) among ambulatory cancer patients receiving chemotherapy. Patients were randomly selected to participate in this study, and were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short‐form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ‐C30 questionnaire. Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe AN. The presence of AN was significantly associated with most domains of the investigated patients’ outcome, including psychological distress and perceived needs, with the exception of the health system and information domain of patients’ needs, and the physical functioning domain of QOL. Anticipatory nausea was also associated with QOL even after adjustments for age, sex, performance status, and psychological distress. The prevalence of AN in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including QOL, AN should not be neglected in current clinical oncology practice. (Cancer Sci 2010; 101: 2596–2660)

Good Death in Elderly Adults with Cancer in Japan Based on Perspectives of the General Population

To investigate concepts relevant to a good death in elderly adults with cancer.

Case of intrathecal baclofen-induced psychotic symptoms

voxamine, sertraline, paroxetine, milnacipran, mirtazapine) and thyroxine, her mood fluctuated frequently, including nine depressive phases and five hypomanic phases in the 26 months after the first admission, with euthymic periods lasting less than 3 weeks. Several drugs could not be used to sufficient doses due to side-effects; however, most drugs were used to adequate doses and durations. Consequently, she was admitted eight times (total duration: 332 days) due to depressive episodes. On her third and fifth admissions, six bilateral ECT sessions were performed consecutively for acute-phase severe depressive symptoms and moderate improvement was observed. During these two ECT sessions, medications were not changed. In consideration of the outcome of the two previous acute-phase ECT sessions, ambulatory continuationECT was started 26 months after the first admission. Continuation-ECT was administered weekly for the first month and subsequently reduced to biweekly administration. In the subsequent 12 months of C/M-ECT, she did not reach remission; however, her HRSD score decreased to 14 and her YMRS score decreased to 7, indicating reduced severity of depression and decreased hypomanic state. To date, she has not been hospitalized. Antidepressants, particularly tricyclic antidepressants, are reportedly responsible for inducing 20% of RC cases; however, in our patient, most hypomanic phases occurred when she was antidepressant-free. Regarding the C/M-ECT schedule, we could not extend beyond 2-week treatment intervals, which is similar to a report indicating that maintenanceECT could not be extended beyond 3-week treatment intervals for patients with BD. Although she did not achieve complete remission, our experience suggests that C/M-ECT could reduce the likelihood of re-admission by decreasing the severity of RC, thereby providing a cost-effective treatment. Except for one naturalistic study of 14 RC patients, research on the effectiveness of C/M-ECT is limited. In order to evaluate the efficacy of C/M-ECT and establish a standard protocol for BD, further study in a large sample or in a controlled study is needed.

A Case with Hodgkin Lymphoma and Fronto-temporal Lobular Degeneration (FTLD)-like Dementia Facilitated by Chemotherapy

We report a case of a 39-year-old man with Hodgkin lymphoma who developed depressive symptoms after starting adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy and later exhibited sexual disinhibition in addition to cognitive dysfunction (mainly executive dysfunction). Seven months after the start of adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy, he was finally diagnosed as having fronto-temporal lobular degeneration-like dementia facilitated by adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy. At the time of writing, the patients condition has persisted for more than 6 months after the discontinuation of adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy, and the changes in brain function brought on by the adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy may now be irreversible. This case points to the importance of being attentive to the appearance of neuropsychiatric symptoms and evaluating brain functions properly when performing anti-cancer chemotherapy.