Shunkichi Endo

Delirium in critical care unit patients admitted through an emergency room

Two hundred thirty-eight patients admitted consecutively to a critical care unit through an emergency room were assessed prospectively for the presence of delirium. Thirty-eight patients (16%) developed delirium. Delirium occurred with equal frequency in all disease categories. The presence of abnormal head imaging which required medical intervention did not predict the development of delirium. The median delay between admission and the development of delirious was 4 days, however, one-fourth of the patients were delirious on the day of admission. The patients with abnormal head imaging who required medical intervention had a higher frequency of onset of delirium on the first day compared with patients without. The delirium lasted a median of 5 days and resolved within a week in over 70% of patients. These results confirm that delirium is frequently present in patients who require acute critical care after emergency room evaluation. In this population, serious medical disease is a better predictor of the development of delirium than the presence of abnormal brain imaging which required medical intervention. Although delirious patients have longer lengths of stay, the presence of delirium does not predict higher mortality, as has been reported in other populations. This could be because delirious patients admitted to the critical care unit through the emergency room have fewer premorbid medical problems predisposing them to poor outcome.

Effects of trazodone hydrochloride and imipramine on polysomnography in healthy subjects

Polysomnography was performed on eight healthy men with trazodone hydrochloride, imipramine and placebo. Trazodone hydrochloride increased slow wave sleep significantly. Imipramine prolonged rapid eye movement (REM) latency and decreased the percentage of REM sleep significantly. Trazodone decreased stages 1 and 2 sleep, while imipramine increased it. These findings suggest that the antidepressive effect of trazodone might be different from that of imipramine with the suppression of REM sleep.

Effects of vitamin B12 on bright light on cognitive and sleep–wake rhythm in Alzheimer‐type dementia

The present study investigated the effects of vitamin B12 (VB12) on circadian rhythm in Alzheimer‐type dementia (ATD). Twenty‐eight ATD patients were treated with bright light therapy (BLT) for 8 weeks. For the latter 4 weeks, half were treated with VB12 with BLT (BLT + VB12). We evaluated the cognitive state with Mini‐Mental State Examination and the circadian rhythm with actigraphy after the fourth and eighth week. After the first 4 weeks BLT improved the circadian rhythm disturbances and cognitive state especially in the early stage of ATD. Although the latter 4 week‐BLT caused no significant effects on the circadian rhythm; BLT + VB12 improved the vigilance level during the daytime. These results suggest that VB12 has some efficiency to enhance vigilance for ATD patients.

Effects of trazodone on polysomnography, blood concentration and core body temperature in healthy volunteers

Polysomnography, blood concentration and core body temperature recordings were performed on 12 healthy volunteers with administration of trazodone and placebo. Trazodone increased slow wave sleep (SWS), and decreased the average, the highest and lowest core body temperature significantly compared to placebo. The blood concentration of trazodone correlated positively with amplitude (the difference between the highest and lowest temperature) and %SWS during the first period of a sleep phase divided into three periods, and negatively with the lowest temperature. The appearance time of the lowest temperature correlated negatively with %SWS.

Is Propranolol Effective in Primary Polydipsia

Objective: Psychiatric patients presenting with polydipsia are often difficult to treat with standard psychiatric interventions. Pharmacological intervention was attempted in these patients based on the hypothesis that angiotensin II, a potent dipsinogen, may be involved in the drinking behavior of patients with polydipsia. Beta-blockers inhibit renin release (and thus indirectly angiotensin II) by blocking beta receptors in the kidney. Methods: Three patients were identified as excessive water drinkers during their hospital admissions. All three patients were eunatremic but polydipsic at the time of study. Two of the three had histories of hyponatremia and required emergency medical treatment on more than one occasion. No patients had been controlled by strict fluid restriction. Trials of propranolol were initiated to control their water drinking. Results: After starting propranolol, two patients responded quickly. In one patient, fluid intake decreased from 2650 ± 647 to 1577 ± 361, p < .001. In the other, fluid intake decreased from over 7000 ml before starting propranolol to around 3000 ml. The mean noon body weight of the third patient, in whom it was not possible to document fluid intake or urine volume before and after administering beta-blocker, was 72.6 ± 2.6 Kg and 66.0 ± 1.0 Kg, respectively (p < .0001). Conclusions: These results suggest that propranolol may be useful for the treatment of polydipsia in patients with schizophrenia. Its efficacy could be related to inhibition of the renin-angiotensin system. Additional research using the controlled pharmacotherapeutic trials is required to confirm these findings.

Study of Nocturnal Sleep and the Carryover Effects of Triazolam and Brotizolam Using Neurophysiological and Subjective Methods

In the present study, the effects of short-acting benzodiazepines on nocturnal sleep and the carryover effects of these drugs were studied. The study involved 10 young, healthy male subjects who had given their written informed consent to participate. Either a placebo (PLA), 0.125 mg triazolam (TRZ), 0.25 mg TRZ or 0.25 mg brotizolam (BRZ) was administered to the subjects in a double-blind crossover design by randomized allocation with a single oral administration at 23.00 h. A polysomnography (PSG) was recorded for each subject from 23.00 to 07.00 h the following day. Then, the Stanford Sleepiness Scale (SSS) and Kwansei Gakuin Sleepiness Scale (KSS) were checked between 07.55 and 08.00 h, and the sleep latency test (SLT) was performed between 08.00 and 08.20 h. Event-related potentials (ERPs) were then recorded with an oddball paradigm; the reaction time (RT) was measured simultaneously. According to the PSG, treatment with 0.25 mg TRZ resulted in a statistically significant increase in the percentage of stage 2 sleep (p < 0.05) and a reduction in the percentage of rapid eye movement sleep (p < 0.05) compared with PLA. None of the drugs had any effect on the percentage of slow-wave sleep compared with PLA. With regard to carryover effects, although none of the drugs had any effect on SSS, KSS, RT or ERPs, BRZ did cause a statistically significant decrease in sleep latency (p < 0.05) compared with PLA. TRZ (0.125 and 0.25 mg) and 0.25 mg BRZ exerted different effects on SLT. We suggest that these different effects are attributable to differences in the half-life of these hypnotics.

A fundamental bias in calculating dimensions from finite data sets

Abstract One bias inherent in calculating dimension for limited time-series data is investigated. The bias is derived from the fluctuation of the distribution of measures in the phase space and distorts the scaling with respect to each reference point to be concave up or down. These distortions are pronounced for the experimental data whose number of points is not sufficient and whose scaling region is restricted to a relatively small interval. It is possible that the Grassberger–Procaccia algorithm and all its modified ones are affected by the bias. We evaluate the distortion quantitatively and show the procedure required for the correction of the bias taking the case of an electroencephalogram (EEG).

Oral cenesthopathy examined by Rorschach test

Abstract  Experience of abnormal pains and unusual sensations in the mouth without a somatic base, for example abnormal mucus secretion, pulling sensation on the jaw or teeth, or a vibrating sensation, is termed ‘oral cenesthopathy’. Psychological factors were investigated in terms of cognitive functions and personality tendencies, using Rorschach test in 28 patients with this condition (three men and 25 women). In oral cenesthopathy patients (i) the processing of new information is inefficient; (ii) the necessary resources for social adaptation are lacking, emotional control is inadequate, and uncomfortable emotions are expressed less; and (iii) with regard to interpersonal interaction, less interest is shown in others, trust in others is diminished, and they tend to have a higher Coping Deficit Index.

Access to the emergency psychiatry system in Japan

Although the need for an emergency psychiatry system is increasing in Japan because of a shift to providing psychiatric care from hospitalization to community-based services, little attention is being given to what the general population expects from the health care system. To ascertain the expectations of the general population about how emergency psychiatric cases should be handled, the authors distributed a questionnaire to 1000 people containing 12 characteristic psychiatric emergency cases. The results showed that most expected psychiatric care to be rendered in a general hospital. This was different from the opinion held by most mental health professionals who felt that mental health hospitals should be the core hospitals of emergency psychiatry. Although there was a higher expectation for police officers or paramedics to provide emergent psychiatric care, the general population expected less from public health centers which now provide mental health service in the community. To connect emergency psychiatry with the community, the general hospital must play a larger role in the system through training programs for general hospital psychiatrists as well as nonpsychiatrist professionals, paramedics, and police officers.

Changes in regional cerebral blood flow on recovery from depression—comparison of vascular depression and non-vascular depression

Abstract Cerebrovascular or vascular change is frequent in elderly patients with depression. The concept of vascular depression (VD) has been a topic of interest in neuropsychiatry. During the last decade, functional neuroimaging studies have reported that recovery from depression was associated with increased regional cerebral blood flow (rCBF) in specific regions. However, the majority of studies have been confined to depression without cerebrovascular changes. Therefore, this study was undertaken to examine changes in rCBF on recovery from vascular depression. We measured rCBF in nine patients with ‘vascular depression’ and 11 patients with ‘non-vascular depression’ using 123I-IMP single photon emission computed tomography (SPECT) during illness and after recovery. The results showed that VD has significantly lower mean rCBF than non-VD during both depressed and remitted state, localized to the left anterior frontal region. This suggested that persisting left frontal hypoperfusion may lead to longer duration or higher frequency of relapse. Both VD and non-VD showed significantly higher mean rCBF in remitted state than in depressed state, especially left anterior temporal rCBF correlated with recovery from depression. This suggested that left temporal activity might be a state or episode-dependent marker for both VD and non-VD