Shun Nakajima

Development and validation of the Japanese version of the Athens Insomnia Scale

The aim of this study was to develop and validate a Japanese version of the Athens Insomnia Scale (AIS‐J).

Validation of the Japanese version of the Ford Insomnia Response to Stress Test and the association of sleep reactivity with trait anxiety and insomnia

OBJECTIVE Our study was conducted to validate the Japanese version of the Ford Insomnia Response to Stress Test (FIRST-J) and to clarify the association of the measure with trait anxiety and insomnia in healthy subjects and insomnia patients. METHODS We studied 161 healthy subjects and 177 insomnia patients who completed the FIRST-J, Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), and State-Trait Anxiety Inventory-Trait (STAI). The healthy subjects and the insomnia patients were classified, respectively, into two groups with high FIRST-J and low FIRST-J scores (divided by the median value of healthy subjects). RESULTS Cronbach α coefficients of the FIRST-J in the insomnia patients and healthy subjects were 0.89 and 0.87, respectively. Factor analysis revealed that the FIRST-J had a single-factor structure. The FIRST-J score significantly correlated with all other measures in the healthy subjects, though the score only correlated with the score of the STAI in the insomnia patients. The healthy subjects with high FIRST-J scores showed higher scores of the AIS and STAI than those with low FIRST-J scores. Furthermore, insomnia patients had a higher total score of the FIRST-J than the healthy subjects. CONCLUSIONS The FIRST-J is an important tool for assessing vulnerability to insomnia.

Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia

This study aimed to determine whether (1) cognitive behavioural therapy with behavioural analysis for insomnia (CBTi-BA) is more effective for insomnia and co-morbid depressive symptoms than treatment as usual (TAU) and (2) whether CBTi-BA promotes earlier reduction of the daily dose of hypnotic medication in chronic insomnia resistant to pharmacological treatment. A total of 63 patients with chronic insomnia aged 20-77 years who already received hypnotic medication regularly were assigned to two interventions: combined therapy or TAU alone. The subjects provided demographic information and completed self-rating scales for insomnia and depressive symptoms. After treatment, the combined therapy group showed significant decreases in the symptoms of both insomnia and depression and significant reductions in the daily dose of hypnotic medication compared with the group receiving TAU alone. In the combined therapy group, 71% of the participants reported a reduction in insomnia to normal levels and 79% succeeded in decreasing the daily dose of hypnotics to 50% or less of the baseline dose. These results revealed that CBTi-BA can reduce insomnia and depressive symptoms as well as the daily dose of hypnotic medication in patients with chronic insomnia resistant to pharmacological treatment.

Validity and clinical interpretability of Overall Anxiety Severity And Impairment Scale (OASIS).

BACKGROUND The Overall Anxiety Severity and Impairment Scale is a brief generic measure for anxiety that encompasses frequency and intensity as well as behavioral and functional aspects of anxiety. This study was conducted to elucidate aspects of reliability, validity, and interpretability, such as equivalence of factor loadings across non-clinical and clinical populations, convergence and discriminance of related variables, and performance of detecting diagnostic and medical status of anxiety disorders. METHODS Non-clinical and clinical Japanese populations were taken from a panelist pool registered with an internet survey company (total n=2830; 619 panic disorder, 576 for social anxiety disorder, 645 for obsessive-compulsive disorder, a 619 for major depressive disorder, and 371 for non-disorder panelists). Conventional measures of anxiety, depression, mental health and measures for discriminant validity were administered in addition to OASIS. RESULTS Exploratory and confirmatory factor analyses indicated good fit to data for the one-factor model of OASIS. Multi-group confirmatory factor analysis showed the equivalence of the factor loadings between those of non-clinical and clinical subsamples. The OASIS reliability was confirmed by internal consistency and test-retest coefficients. Receiver operating characteristic curve analyses showed that OASIS and conventional anxiety measures have fair performance for detecting diagnostic and medical status as anxiety disorders. LIMITATIONS Participants were limited to a Japanese population of people who had registered themselves at an internet survey company. CONCLUSIONS Along with useful information to interpret OASIS, the results suggest the reliability and validity of OASIS in Japanese populations. These results also suggest cross-cultural validity.

Reducing dysfunctional beliefs about sleep does not significantly improve insomnia in cognitive behavioral therapy.

The present study examined to examine whether improvement of insomnia is mediated by a reduction in sleep-related dysfunctional beliefs through cognitive behavioral therapy for insomnia. In total, 64 patients with chronic insomnia received cognitive behavioral therapy for insomnia consisting of 6 biweekly individual treatment sessions of 50 minutes in length. Participants were asked to complete the Athens Insomnia Scale and the Dysfunctional Beliefs and Attitudes about Sleep scale both at the baseline and at the end of treatment. The results showed that although cognitive behavioral therapy for insomnia greatly reduced individuals’ scores on both scales, the decrease in dysfunctional beliefs and attitudes about sleep with treatment did not seem to mediate improvement in insomnia. The findings suggest that sleep-related dysfunctional beliefs endorsed by patients with chronic insomnia may be attenuated by cognitive behavioral therapy for insomnia, but changes in such beliefs are not likely to play a crucial role in reducing the severity of insomnia.

Assessing Depression Related Severity and Functional Impairment: The Overall Depression Severity and Impairment Scale (ODSIS)

Background The Overall Depression Severity and Impairment Scale (ODSIS) is a brief, five-item measure for assessing the frequency and intensity of depressive symptoms, as well as functional impairments in pleasurable activities, work or school, and interpersonal relationships due to depression. Although this scale is expected to be useful in various psychiatric and mental health settings, the reliability, validity, and interpretability have not yet been fully examined. This study was designed to examine the reliability, factorial, convergent, and discriminant validity of a Japanese version of the ODSIS, as well as its ability to distinguish between individuals with and without a major depressive disorder diagnosis. Methods From a pool of registrants at an internet survey company, 2830 non-clinical and clinical participants were selected randomly (619 with major depressive disorder, 619 with panic disorder, 576 with social anxiety disorder, 645 with obsessive–compulsive disorder, and 371 non-clinical panelists). Participants were asked to respond to the ODSIS and conventional measures of depression, functional impairment, anxiety, neuroticism, satisfaction with life, and emotion regulation. Results Exploratory and confirmatory factor analysis of three split subsamples indicated the unidimensional factor structure of ODSIS. Multi-group confirmatory factor analysis showed invariance of factor loadings between non-clinical and clinical subsamples. The ODSIS also showed excellent internal consistency and test–retest intraclass correlation coefficients. Convergence and discriminance of the ODSIS with various measures were in line with our expectations. Receiver operating characteristic curve analyses showed that the ODSIS was able to detect a major depressive syndrome accurately. Conclusions This study supports the reliability and validity of ODSIS in a non-western population, which can be interpreted as demonstrating cross-cultural validity.

Impact of frequency of nightmares comorbid with insomnia on depression in Japanese rural community residents: a cross-sectional study

OBJECTIVE Nightmares and insomnia are known to be associated with the development and aggravation of depression. Our community-based study was conducted to clarify the relation between the impacts of nightmares and insomnia on depression. METHODS A cross-sectional questionnaire-based survey was administered to residents of a rural community in Japan. In all, 2822 participants responded to questions assessing personal characteristics, the Pittsburgh Sleep Quality Index (PSQI) for assessing insomnia, and a 12-item version of the Center for Epidemiological Studies Depression scale (CES-D) for evaluating depression. Nightmare frequency was assessed using an item for nightmares on the PSQI. RESULTS Nightmares more frequently occurred in participants with insomnia than those without (P < .01). Multiple regression analysis revealed that the scores of both nightmares and insomnia were significantly associated with the increase in depression score (nightmares (β = 0.09, P < .01); insomnia (β = 0.39, P < .01)). Participants with coexisting nightmares and insomnia showed higher depression scores than participants with insomnia alone or those with nightmares who did not have insomnia (P < .01). CONCLUSIONS Insomnia and nightmares independently and additively impact the aggravation of depression.

Diabetes mellitus and hypertension in elderly highlanders in Asia.

To the Editor: We found the report of shorter life spans in elderly highlanders in Bolivia most interesting, but the actual prevalence rates of hypertension or diabetes mellitus (DM), which may be associated with life span, are unknown in elderly highlanders. Highlanders have long-term evolutionary and cultural adaptation to hypoxia and low natural food resources, although recently lifestyle changes appear to be entering highland areas. To investigate global socioeconomic influences on lifestyle-related diseases in highland people, the prevalence of DM and hypertension in elderly highlanders living in three areas in Asia with different altitudes was studied. The study population consisted of consecutive elderly volunteers aged 60 and older who took part in our medical camps held in three highland communities: 97 Tibetans (mean age SD, 66.6 5.2; male/female 64/34) living in a nomadic area in Haiyan county, China (altitude 3,000– 3,200 m), 209 Tibetans (66.1 5.9; 87/122) in Jiegu town in Yushu county, Qinghai, China (3,700 m), and 117 older Ladakhi adults (69.3 6.8, 48/69) in Domkhar Village, Ladakh, India (2,900–3,800 m). Blood pressure was examined twice in a sitting position, and a 75-g oral glucose tolerance test was administered for the diagnosis of DM or impaired glucose tolerance (IGT) under World Health Organization criteria. Body mass index (BMI; kg/m) was highest in the elderly subjects in Yushu (27.3 4.6) and lowest in those in Domkhar in Ladakh (22.1 3.1). Systolic and diastolic blood pressure (SBP/DBP; mmHg) (142 26/91 15) in the elderly subjects in Yushu and DBP (87 15) in those in Domkhar were significantly higher than those in Haiyan (130 26/79 15). The prevalence of hypertension (BP 4140/90 or taking hypertensive medicine) was highest in Yushu and lowest in Haiyan. Fasting blood sugar (mg/dL) and blood sugar 2 hours after intake of 75 g of glucose were highest in the elderly subjects in Yushu (110 34, 142 60). The prevalence of glucose intolerance (DM or IGT) was highest in those in Yushu. Prevalence of IGT in Domkhar was significantly higher than in Haiyan. Jiegu, with a population of 23,000, is the seat of Yushu County (population 67,000) in a nomadic area of Qinghai on the Tibetan plateau; with socioeconomic globalization, it is a rapidly developing area (population in 1996, 6,460). The participants in Jiegu had various occupational histories, including active or retired nomad, farmer, or official worker, although most elderly subjects now have with an urban lifestyle. Elderly subjects in Jiegu had the highest prevalence of obesity (BMI425.0), hypertension, and DM of the three areas. The conditions are highly suggestive of being closely associated with a modernized lifestyle with its various food markets and good accessibility to transportation. Domkhar in Ladakh, west Himalayas, is a rural village with a population of 1,500 people. It is not easily accessible to traffic. Domkhar has seen effects from socioeconomic globalization only in the past a few years. Most residents

Disaster-related psychiatric disorders among survivors of flooding in Ladakh, India

Background: Heavy rainfall in northern India in August 2010 caused flash floods, seriously damaging homes and infrastructure. There have been no major disasters in the history of Ladakh, and no surveys on post-disaster psychiatric disorders have been conducted in this area. Aims and methods: To examine the impact of this disaster in Ladakh one month post-disaster, we visited Choglamsar, located near the town of Leh, where the flood had the most severe impact. In total, 318 survivors (mean age: 58.6 years; female–male ratio: 59.7%; Tibetan refugees: 86.2%) participated in the survey. We used the two-item Patient Health Questionnaire (PHQ-2) along with questions covering background characteristics and disaster exposure. A psychiatrist interviewed the survivors with a single or double positive score in the PHQ-2 or with post-traumatic stress disorder (PTSD) symptoms. Results and conclusion: There were only two PTSD cases and five of major depressive disorders. PTSD and depression were less common in the Tibetan cultural areas than in other areas. The social background and temperamental characteristics of the Tibetan culture may play a suppressive role in psychiatric disorders.

STRONG ASSOCIATION BETWEEN POLYCYTHEMIA AND GLUCOSE INTOLERANCE IN ELDERLY HIGH-ALTITUDE DWELLERS IN ASIA

and discontinuing the anticoagulant drugs, bowel rest, correction of PT with intravenous vitamin K with fresh-frozen plasma, and correction of anemia if present. Surgical intervention is indicated only if there is significant intramural hemorrhage, bowel perforation, ischemia, or peritonitis. Efforts to measure the quality of medication use in elderly patients have traditionally focused on inappropriate medications and doses, although a more-comprehensive approach to measuring the quality of medication use in elderly patients has been recommended. The most important determinant of risk for adverse drug reaction–related hospital admission in older patients is the number of drugs being taken. When considering only severe adverse drug reactions, risk is also related to age and frailty. In a previous study, poor adherence of elderly patients was responsible for 31% of overanticoagulation cases. These admissions could potentially be avoided with better anticoagulation control. Long-term warfarin use requires close monitoring of the coagulation profile to prevent this complication. Physician and patient awareness of the risk of bleeding when using warfarin is especially important for elderly patients. Clearer advice to older patients on the risk of nonadherence is important in such case.