Toshiko Kamo

Insight and clinical correlates in schizophrenia

It is not clear to what extent poor insight is inherent in schizophrenic psychopathology or is related to clinical factors. It is clinically important to elucidate this point to know how some insight remains intact in schizophrenia. Sixty-three ICD-10 schizophrenics were recruited. Insight was measured by Davids three-dimensional scale, which deals with the awareness of the need for treatment, of the illness, and of psychotic experiences. Clinical factors that may influence insight were grouped into objective psychopathology, subjective experience, and treatment settings, according to the normal development of insight starting from objective illness, through subjective perception of it, to seeking treatment. Psychopathology was measured by the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and the subjective experience was measured by a checklist of our own. Positive symptoms, especially disordered thought, hallucinations, and delusions, had a modest inverse correlation with awareness of illness and of psychotic experiences, but these were not correlated with alogia or other negative symptoms. Later age at the first onset was significantly correlated with poor awareness of psychotic experience, but no correlation of subjective experience with insight emerged. Awareness of the need for treatment was significantly higher in outpatient than in inpatient groups, and was not correlated with any other variables. Poor awareness of illness and of psychotic experience seems to be a trait of the acute rather than the chronic psychopathology of schizophrenia. Poor awareness of psychotic experience was related to later onset. Awareness of the need for treatment seems to improve, even in the absence of awareness of illness or of psychotic experience, in outpatient settings--the effects of social interaction may be relevant to this.

A nationwide survey of seasonal affective disorder at 53 outpatient university clinics in Japan

A nationwide survey of seasonal affective disorder (SAD) was performed from autumn 1990 to spring 1991 with the cooperation of 53 outpatient university psychiatric clinics in Japan. Forty‐six SAD patients were identified among 5265 depressed outpatients. SAD was generally reported to occur in 1–3% of the depressed outpatients newly attending each facility. Hours of sunshine were found to be a more relevant variable influencing the prevalence of SAD than latitude or the mean temperature in December. The unexpectedly low percentage (20–30%) of SAD patients with atypical vegetative symptoms suggests that SAD patients who have no prior knowledge of SAD and those who are recruited via the media have different vegetative symptom profiles.

Subjective experience and related symptoms in schizophrenia

We had previously extracted two types of subjective experience of schizophrenia (SES); first, a feeling of inadequacy in stream of speech, thought, and action, associated with a distorted sense of self, and second, a feeling that excessive thoughts are filling and sticking to ones head, causing negative affective burden such as misery and oppression. This study tried to validate their content using conventional symptom clusters as external validators. Subjects were 63 patients from two hospitals in Tokyo meeting ICD-10 criteria for schizophrenia. Positive, negative, and depressive psychopathology were measured by the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of the Negative Symptoms (SANS), and Hamiltons Depression Scale (HDS). The two types of SES were measured by an original scale. The first type of SES correlated significantly with the negative symptoms of alogia, avolition, and attention, whereas the second correlated with positive and depressive symptoms. To analyze how schizophrenia is experienced by patients, qualitative and comprehensive descriptions, such as indicated by our subjective factors, will be useful.

Efficacy and pharmacokinetics of fluvoxamine maleate in patients with mild depression undergoing hemodialysis

Abstract  Seven Japanese patients on maintenance hemodialysis who were comorbid with mild depression were medicated with 50 mg/day fluvoxamine maleate for 28 days. Effectiveness was obtained in four out of seven patients (57%). The plasma fluvoxamine concentrations were examined in three patients. The plasma fuvoxamine concentration decreased by 22% by hemodialysis. There is a tendency for the dialyzed rate of fluvoxamine to become lower if the plasma albumin concentration is higher. The half‐life of fluvoxamine was possibly shortened more in the patient with hypoalbuminaemia. The plasma fluvoxamine concentration reached a steady state 8 days after the start of medication and thereafter. The time required to reach steady state was lengthened when compared with the results in normal Japanese volunteers.

Fulfillment of the premenstrual dysphoric disorder criteria confirmed using a self-rating questionnaire among Japanese women with depressive disorders.

BackgroundSome women with depressive disorders experience severe premenstrual symptoms. However, there have been few studies in which premenstrual symptoms in women suffering from depressive disorders were assessed. In this study, we aimed to investigate premenstrual symptoms in women with depressive disorders using the premenstrual dysphoric disorder (PMDD) scale.MethodsWe administered questionnaires to 65 Japanese female outpatients who had been diagnosed with a major depressive disorder or dysthymic disorder and to 303 healthy women as control subjects. The questionnaire consisted of items on demographics and the PMDD scale, which was modified from the premenstrual symptoms screening tool (PSST) developed by Steiner et al. (Arch Womens Ment Health 2003, 6:203-209).ResultsTwenty-eight women (43.1%) with depressive disorder fulfilled certain items of the PMDD scale. These women are considered to have coexisting PMDD and a depressive disorder, or to have premenstrual exacerbation (PME) of a depressive disorder. On the other hand, 18 women (5.9%) in the control group were diagnosed as having PMDD. The depressive disorder group who fulfilled the PMDD criteria had more knowledge of the term premenstrual syndrome (PMS) and took more actions to attenuate premenstrual symptoms than the control group with PMDD.ConclusionsOur findings demonstrated that the occurrence of severe premenstrual symptoms is much higher in women with depressive disorders than in healthy subjects. This is partially due to this group containing women with PME, but mainly due to it containing women with PMDD. The higher percentage of PMDD suggests similarity between PMDD and other depressive disorders. Furthermore, educating healthy Japanese women and women with depressive disorders about premenstrual symptoms and evidence-based treatment for them is necessary.

The Japanese version of the Posttraumatic Diagnostic Scale: Validity in participants with and without traumatic experiences

The Posttraumatic Diagnostic Scale (PDS) is a brief, self-report questionnaire developed for the diagnostic screening and assessment of the severity of posttraumatic stress disorder (PTSD); the PDS is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV). We investigated the validity and reliability of the Japanese version of the PDS in a clinical (n=109) and a non-clinical (n=116) sample, recruited from an outpatient psychiatric facility and a university student population, respectively. The Japanese versions of the PDS and the Clinician-Administered PTSD Scale (CAPS/DSM-IV) were administered to the participants. The Japanese PDSs diagnostic sensitivity and specificity exceeded 90%. The correlation between the severity scores assessed by the Japanese PDS and the CAPS was also high (r=0.92). The findings suggest that the Japanese version of the PDS is useful for diagnostically screening PTSD and assessing symptom severity.

Long‐Term Course of Seasonal Affective Disorders: A Preliminary Report

In recent years, increasing interest has been centered on seasonal affective disorder (SAD), leading many researchers to investigate various aspects of SAD. To our knowledge, however, no systematic study on the long-term course of SAD has been reported. Nevertheless, there has been no clinical confirmation of the stability of this condition over a long period of time. Therefore, in this paper we report our observations of the long-term courses of patients with SAD. Our first purpose in this study was to determine whether a patient undergoes a switch from SAD to nonseasonal affective disorder (NONSAD), and vice versa, and if so, which factors would be associated with such a switch in individual cases.

Fifty Young Women's Seasonal Changes in Mood and Behavior in Tokyo

Since the Description of Seasonal Affective Disorder (SAD)4 the interest in seasonal influences on affective illness has increased. On the other hand, seasonal changes in mood and behavior in the normal population have been recognized well since ancient times but there have been only a few studies.l Seasonality of individuals have to be observed more concretely nowadays because not only for the request of the epidemiological investigation{, the proportion of patients with SAD in a population, but also to elucidate the mechanism of onset of SAD. Methods

Inflammatory markers and their possible effects on cognitive function in women with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) has been associated with increased inflammation, albeit with some controversy. Another key feature of PTSD is compromised function in wide-ranging cognitive domains. Increased peripheral inflammation can contribute to cognitive dysfunction, although this relationship has not been studied in patients with PTSD. Here, we examined blood inflammatory markers in adult patients with PTSD compared to healthy controls taking account of potentially confounding effects of childhood maltreatment and comorbid major depressive disorder (MDD), and explored the association between inflammation and cognition. We enrolled 40 women with PTSD, most of whom developed the disorder after interpersonal violence during adulthood, and 65 healthy control women. Diagnoses were made based on DSM-IV. History of childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Blood samples were collected for the measurement of 5 inflammatory markers including interleukin-6 (IL-6), soluble IL-6 receptor, interleukin-1β, high-sensitivity tumor necrosis factor-α, and high-sensitivity C-reactive protein. Compared to controls, patients with PTSD showed significantly higher IL-6 levels (p = 0.009) and lower scores on all RBANS domains (all p < 0.01). IL-6 levels in patients were not significantly associated with the presence/absence of comorbid MDD or CTQ scores. IL-6 levels in patients were significantly negatively correlated with RBANS visuospatial construction (p = 0.046), language (p = 0.008), attention (p = 0.036) and total score (p = 0.008). These results suggest that elevated IL-6 is associated with PTSD and that the lower cognitive function in PTSD may be due at least partly to increased inflammation.

Cognitive function in Japanese women with posttraumatic stress disorder: Association with exercise habits

BACKGROUND Posttraumatic stress disorder (PTSD) has been associated with cognitive impairments, yet little is documented on the cognitive function of PTSD patients in Asian countries. It is shown that regular exercise can reduce PTSD symptoms, while no study has investigated the association between exercise and cognition in PTSD patients. This study aimed to examine cognitive functions of Japanese women with PTSD, and to explore the association between regular exercise and cognitive functions. METHODS Forty-two women with DSM-IV PTSD and 66 demographically matched healthy control women participated in this study. Most of the patients developed PTSD after experiencing interpersonal violence. Cognitive functions were assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Regular exercise habit was assessed by a self-reported questionnaire. RESULTS Compared to controls, PTSD patients performed significantly more poorly in all cognitive domains examined, including immediate memory, visuospatial construction, language, attention, delayed memory, as well as the total score of RBANS (all p < 0.001). Compared to PTSD patients without the habit of exercise, those who habitually exercised showed significantly better performance on delayed memory (p = 0.006), which survived after controlling for potentially confounding variables in a multiple regression model. LIMITATIONS The cross-sectional design and relatively small sample size limited our findings. CONCLUSIONS PTSD in Japanese women is associated with pervasively impaired cognitive functions, including notable impairments in verbal memory. Such memory deficits might be improved by regular exercise, although further studies are needed to investigate the causal relationship between exercise and cognition in PTSD.