Yumi Nakano

Psychosocial predictors of successful delivery after unexplained recurrent spontaneous abortions: a cohort study

Objective:  To examine psychosocial predictors of successful pregnancy after recurrent spontaneous abortions (RSA).

Group cognitive behavior therapy for Japanese patients with social anxiety disorder: preliminary outcomes and their predictors

BackgroundA number of studies have provided strong evidence for the use of cognitive behavior therapy (CBT) in the treatment of social anxiety disorder (SAD). However, all of the previous reports were from Europe and North America and it is unknown whether Western psychological therapies are effective for SAD in non-Western cultures. The present pilot study aimed to evaluate CBT program for SAD which was originally developed for Western patients, among Japanese patients.MethodsFifty-seven outpatients who participated in group CBT for SAD were evaluated using eight self-reported and one clinician-administered questionnaires to measure various aspects of SAD symptomatology at the beginning and at the end of the program. Pre- and post-treatment scores were compared and the magnitude of treatment effect was quantified as well based once on the intention-to-treat (ITT) and once among the completers only. We also examined baseline predictors of the CBT outcomes.ResultsSeven patients (12%) did not complete the program. For the ITT sample, the percentage of reduction was 20% to 30% and the pre to post treatment effect sizes ranged from 0.37 to 1.01. Among the completers, the respective figures were 20% to 33% and 0.41 to 1.19. We found no significant pretreatment predictor of the outcomes.ConclusionGroup CBT for SAD is acceptable and can bring about a similar degree of symptom reduction among Japanese patients with SAD as among Western patients.

Change in quality of life and their predictors in the long-term follow-up after group cognitive behavioral therapy for social anxiety disorder: a prospective cohort study

BackgroundSocial anxiety disorder (SAD) is one of the most common anxiety disorders. The efficacy of cognitive behaviour therapy (CBT) has been examined but to date its effects on Quality of Life (QoL) have not been appropriately evaluated especially in the long term.The study aimed to examine, in the long term, what aspects of Quality of Life (QoL) changed among social anxiety disorder (SAD) patients treated with group cognitive behaviour therapy (CBT) and what predictors at baseline were associated with QoL.MethodsOutpatients diagnosed with SAD were enrolled into group CBT, and assessed at follow-ups for up to 12 months in a typical clinical setting. QoL was evaluated using the Short Form 36. Various aspects of SAD symptomatology were also assessed. Each of the QoL domains and scores on symptomatology were quantified and compared with those at baseline. Baseline predictors of QoL outcomes at follow-up were investigated.ResultsFifty-seven outpatients were enrolled into group CBT for SAD, 48 completed the whole program, and 44 and 40 completed assessments at the 3-month and 12-month follow-ups, respectively. All aspects of SAD symptomatology and psychological subscales of the QoL showed statistically significant improvement throughout follow-ups for up to 12 months. In terms of social functioning, no statistically significant improvement was observed at either follow-up point except for post-treatment. No consistently significant pre-treatment predictors were observed.ConclusionsAfter group CBT, SAD symptomatology and some aspects of QoL improved and this improvement was maintained for up to 12 months, but the social functioning domain did not prove any significant change statistically. Considering the limited effects of CBT on QoL, especially for social functioning, more powerful treatments are needed.

Videotaped experiments to drop safety behaviors and self-focused attention for patients with social anxiety disorder: Do they change subjective and objective evaluations of anxiety and performance?

Safety behavior (SB) and self-focused attention (SFA) have been posited as important maintenance factors in the cognitive model of social anxiety disorder (SAD). The present study reports the results of experiments to drop SB and SFA among clinically diagnosed patients with SAD employing their own idiosyncratic anxiety-provoking situations. The ratings for observable anxiety, belief in feared outcome and overall performance were better for role plays without SB and SFA than for role plays with them. The degree of drop in SFA predicted drop in observable anxiety and belief in feared outcome. Dropping SB and SFA, however, was unable to completely correct the cognitive distortion because the subjective ratings were still significantly worse than the objective ratings.

Cross-cultural study of conviction subtype Taijin Kyofu: proposal and reliability of Nagoya-Osaka diagnostic criteria for social anxiety disorder.

Conviction subtype Taijin-Kyofu (c-TK) is a subgroup of mental disorder characterized by conviction and strong fear of offending others in social situations. Although the concept of c-TK overlaps with that of social anxiety disorder (SAD), patients with c-TK often may not be diagnosed as such within the current Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. We propose the Nagoya-Osaka criteria to amend this situation. This study examined the cross-cultural interrater reliability of the proposed criteria. Eighteen case vignettes of patients with a variety of complaints focused around social anxieties were collected from 6 different countries, and diagnosed by 13 independent raters from various nationalities according to the original DSM-IV and the expanded criteria. The average agreement ratio for the most frequent diagnostic category in each case was 61.5% with DSM-IV and 87.6% with the modified DSM-IV with Nagoya-Osaka criteria (p < 0.001). These findings indicate that the Nagoya-Osaka criteria for SAD can improve interrater reliability of SAD.

Psychosocial Factors Regulating Natural-Killer Cell Activity in Recurrent Spontaneous Abortions

PROBLEM: The preconceptional natural‐killer cell (NK) activity predicts subsequent miscarriage among women with unexplained recurrent spontaneous abortion (RSA). Psycho‐neuro‐immuno‐endocrine network has recently been proposed as a mechanism for abortions. We therefore examined which psychosocial factors influenced the NK activity among women with RSA.
 METHOD OF STUDY: We measured the preconceptional NK activity of 61 women with a history two consecutive unexplained first‐trimester miscarriages and no live births. We also administered semi‐structured interviews and a battery of self‐report questionnaires to assess their social support, personality, self‐esteem and psychiatric symptoms.
 RESULTS: The preconceptional NK activity was negatively correlated with the womens neuroticism personality trait (r=−0.32, P=0.01) and current depressive symptoms (r=−0.26, P=0.05), and positively correlated with their self‐esteem (r=0.34, P=0.01).
 CONCLUSIONS: In addition to several substances such as transforming‐growth‐factor beta and granulocyte‐macrophase colony‐stimulating factor, we found that low neuroticism, low depression scale score and high self‐esteem contributed to high NK activity among women with RSA.

Japanese version of the Quality of Relationship Inventory: Its reliability and validity among women with recurrent spontaneous abortion

Until now most of the research on social support has concentrated on general support in relationship to the whole group of people around each individual. In contrast, only a few studies have dealt with individual‐specific support (i.e. social support from a particular individual relationship). The Quality of Relationship Inventory (QRI) is a recently developed questionnaire to measure individual‐specific social support. We developed the Japanese version by means of back translation and ascertained its reliability and validity among the Japanese women who had had two recurrent spontaneous abortions without known organic etiologies. Factor analysis revealed that the Japanese QRI had a two‐factor structure, representing supportive and conflictual aspects of a particular relationship (named Factor‐S and Factor‐C, respectively). Each factor showed satisfactory reliability with Cronbachs alphas of 0.95 and 0.89. When the QRI scores were compared with the scales from the Social Support Questionnaire, a measure of general social support, the Factor‐C of the former with respect to the mother correlated negatively with the Social Support Satisfaction of the latter (r = – 0.40; 95% confidence interval (CI) – 0.64 to – 0.09). Childhood experiences with parents also showed expected correlations with the QRI: care received from the parent before age 16 years strongly predicted Factor‐S with that parent (r = 0.50, 95% CI 0.21–0.71 in the case of the mother; r = 0.54, 95% CI 0.27–0.73 in the case of the father). Although we still need to examine the Japanese QRI with different populations, it appears to be a promising measure of individual‐specific relationship for the Japanese population.

Parents, personality or partner? Correlates of marital relationships.

Background Intimate relationships play an important role in the psychological and physical well-being of women during and after pregnancy. Our previous analyses demonstrated the significant role of marital relations on the womans emotional status among a cohort of 61 married Japanese couples with a history of two consecutive spontaneous abortions. Methods The present analyses examined factors which may be related to the wifes perceived marital quality, including her parental rearing experiences, personality of the woman herself, or the personality of the husband. Results The wifes perception of care received from her mother correlated positively with her husbands care whereas overprotection received from the mother also correlated positively with the husbands control. A woman scoring high on the Conscientiousness scale of the five-factor model of personality tended to report more care, and a woman high on the Agreeableness scale less control from her husband, whereas a husband high on the Openness scale tended to show more care in his marital relation. Conclusion The continuity hypothesis between the quality of parental relations in childhood and the quality of intimate bonds in adulthood received partial support in a non-Western sample. This hypothesis merits further exploration, preferably within a more integrated model of marital quality.

Cognitive behavior therapy for psychological distress in patients with recurrent miscarriage

Objective To examine the reduction of psychiatric symptoms using individual cognitive behavior therapy (CBT) for women who suffer from recurrent miscarriage (RM) and depression and/or anxiety. Methods Patients with RM and a score of five or higher for K6, a self-report screening scale for depression/anxiety, were interviewed to find information about stressful situations, thoughts, and consequent behaviors that are common and potential causes of psychological distress among RM patients. We then performed individual CBT on 14 patients with RM and depression/anxiety, referring to a list from the interviews, and examined the effects of CBT by a paired t-test. Results Fourteen women received CBT. The mean number of intervention times was 8.9 sessions (standard deviation [SD], 4.6 sessions). The average Beck Depression Inventory-Second Edition and State–Trait Anxiety Inventory–state anxiety scores, self-report screening scales for depression/anxiety, decreased from 13.6 (SD, 8.2) and 49.0 (SD, 7.1) at baseline to 5.2 (SD, 4.4) and 38.0 (SD, 10.2) posttherapy, respectively. These changes were statistically significant. Conclusion The current preliminary open study confirmed that individual CBT was potentially useful for women with RM and depression and/or anxiety. This finding is the first step towards creating a comprehensive psychological support system for women with RM.

Ictal electroencephalographic correlates of posttreatment neuropsychological changes in electroconvulsive therapy : A hypothesis-generation study

Objectives: Electroconvulsive therapy (ECT) has been associated with memory and neuropsychological changes, but which features of ECT are associated with those changes have not been well investigated. The aim of this hypothesis-generation study was to examine correlations between ictal electroencephalographic (EEG) characteristics and cognitive side effects after ECT. Methods: Eight patients with major depressive disorder were examined with the Wechsler Memory Scale-Revised (WMS-R), the Stroop test, the Trail Making Test, and verbal fluency before and after ECT treatment. Seven ictal EEG measurements (eg, slow-wave phase amplitude, postictal suppression) were manually rated by 3 independent psychiatrists. The correlations between ictal EEG measurements, changes in WMS-R subset scores, and non-memory-related neuropsychological assessments were examined with Spearman rank correlation. Results: Verbal memory, general memory, attention/concentration, delayed memory of WMS-R subset scores, and the Stroop test scores improved significantly after ECT treatment. Postictal suppression and slow-wave amplitude correlated positively with delayed memory and visual/verbal discrepancy score. Slow-wave amplitude correlated negatively with letter fluency. The longer the polyspike wave duration, the higher the attention/concentration test results. Conclusions: Certain ictal EEG measurements were associated with changes in several neuropsychological test results that had improved 2 weeks after the final ECT treatment. A hypothesis-testing study with a larger sample is needed to verify the relationships between EEG measurements and neuropsychological test performance.