Effect of Toki-Shakuyaku-San on Regional Cerebral Blood Flow in Patients with Mild Cognitive Impairment and Alzheimer's Disease

The aim of this study was to examine the effect of toki-shakuyaku-san (TSS) on mild cognitive impairment (MCI) and Alzheimer's disease (AD) using single-photon emission computed tomography (SPECT). All subjects were administered TSS (7.5 g/day) for eight weeks. SPECT and evaluations using the Mini Mental State Examination (MMSE), Neuropsychiatric Inventory, and Physical Self-Maintenance Scale were performed before and after treatment with TSS. Three patients with MCI and five patients with AD completed the study. No adverse events occurred during the study period. After treatment with TSS, regional cerebral blood flow (rCBF) in the posterior cingulate was significantly higher than that before treatment. No brain region showed a significant decrease in rCBF. TSS treatment also tended to improve the score for orientation to place on the MMSE. These results suggest that TSS could be useful for treatment of MCI and AD

Decision-Making Based on Social Conventional Rules by Elderly People

Information used by older adults engaging in a social decision making task of judging a protagonist as a good or a bad person was investigated. Older (n = 100, 50 women, mean age = 63.6 years) and younger (n = 100, 50 women, mean age = 25.7 years) adults participated in a web-based survey. In Experiment 1, we assessed participants’ rapid decision-making processes when making good or bad judgments after reading consecutive sentences without reviewing previously read sentences. The percentages of good judgments were analyzed. In Experiment 2, two protagonists engaging in a deliberate decision-making process were presented, and participants were asked to judge better and worse protagonists. The percentages of behavior-based judgments were analyzed. Results of Experiment 1 indicated that older adults judged protagonists as “good” more often than younger adults. Especially, older adults judged protagonists with good behavior as being “good.” In Experiment 2, older adults made behavior-based judgments more than younger people. Additionally, older and younger adults used information on personalities of protagonists for making judgments in situations with bad outcomes, or incongruent. Moreover, multiple regression analysis suggested that people with more general trust engaged more, whereas people with more caution engaged less in making behavior-based judgments

A common brain network among state, trait, and pathological anxiety from whole-brain functional connectivity

Anxiety is one of the most common mental states of humans. Although it drives us to avoid frightening situations and to achieve our goals, it may also impose significant suffering and burden if it becomes extreme. Because we experience anxiety in a variety of forms, previous studies investigated neural substrates of anxiety in a variety of ways. These studies revealed that individuals with high state, trait, or pathological anxiety showed altered neural substrates. However, no studies have directly investigated whether the different dimensions of anxiety share a common neural substrate, despite its theoretical and practical importance. Here, we investigated a brain network of anxiety shared by different dimensions of anxiety in a unified analytical framework using functional magnetic resonance imaging (fMRI). We analyzed different datasets in a single scale, which was defined by an anxiety-related brain network derived from whole brain. We first conducted the anxiety provocation task with healthy participants who tended to feel anxiety related to obsessive-compulsive disorder (OCD) in their daily life. We found a common state anxiety brain network across participants (1585 trials obtained from 10 participants). Then, using the resting-state fMRI in combination with the participants' behavioral trait anxiety scale scores (879 participants from the Human Connectome Project), we demonstrated that trait anxiety shared the same brain network as state anxiety. Furthermore, the brain network between common to state and trait anxiety could detect patients with OCD, which is characterized by pathological anxiety-driven behaviors (174 participants from multi-site datasets). Our findings provide direct evidence that different dimensions of anxiety have a substantial biological inter-relationship. Our results also provide a biologically defined dimension of anxiety, which may promote further investigation of various human characteristics, including psychiatric disorders, from the perspective of anxiety

Effect of Toki-Shakuyaku-San on Regional Cerebral Blood Flow in Patients with Mild Cognitive Impairment and Alzheimer's Disease

The aim of this study was to examine the effect of toki-shakuyaku-san (TSS) on mild cognitive impairment (MCI) and Alzheimer's disease (AD) using single-photon emission computed tomography (SPECT). All subjects were administered TSS (7.5 g/day) for eight weeks. SPECT and evaluations using the Mini Mental State Examination (MMSE), Neuropsychiatric Inventory, and Physical Self-Maintenance Scale were performed before and after treatment with TSS. Three patients with MCI and five patients with AD completed the study. No adverse events occurred during the study period. After treatment with TSS, regional cerebral blood flow (rCBF) in the posterior cingulate was significantly higher than that before treatment. No brain region showed a significant decrease in rCBF. TSS treatment also tended to improve the score for orientation to place on the MMSE. These results suggest that TSS could be useful for treatment of MCI and AD

Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention : A retrospective cohort study.

Background:Several studies have investigated the association between benzodiazepine receptor agonist (BZDRA) use during the perioperative period and an elevated incidence of delirium. However, no study has focused on the time course of BZDRA use, including continuation, discontinuation, initiation, and no use. This study aimed to examine the influence of the time course of BZDRA use on post-operative delirium.Methods:This retrospective cohort study was conducted by reviewing medical records. We included patients who were scheduled for surgery under general anesthesia and had been referred to a liaison psychiatrist for pre-operative psychiatric assessment. The patients were classified into four groups based on the pre- and post-operative time course of oral BZDRA use, as follows: continuation, discontinuation, initiation, and no use (never used). The primary outcome was the prevalence of post-operative delirium in non-intensive care unit settings. We also performed stratified analyses according to age, the presence of cognitive impairment, the presence of delirium history, and antipsychotic drug use on admission.Results:Among 250 patients, 78 (31%) developed post-operative delirium. The Discontinuation group had a higher rate of delirium (49%, 24/49) than the other groups (Continuation [14%, 4/29]; Initiation [38%, 3/8], Never used [29%, 47/164], p = 0.008).Conclusions:Abrupt discontinuation of BZDRAs during the perioperative period may be a risk factor for post-operative delirium and should therefore be avoided

Structural covariance of neostriatal and limbic regions in patients with obsessive-compulsive disorder

Background: Frontostriatal and frontoamygdalar connectivity alterations in patients with obsessive-compulsive disorder (OCD) have been typically described in functional neuroimaging studies. However, structural covariance, or volumetric correlations across distant brain regions, also provides network-level information. Altered structural covariance has been described in patients with different psychiatric disorders, including OCD, but to our knowledge, alterations within frontostriatal and frontoamygdalar circuits have not been explored. Methods: We performed a mega-analysis pooling structural MRI scans from the Obsessive-compulsive Brain Imaging Consortium and assessed whole-brain voxel-wise structural covariance of 4 striatal regions (dorsal and ventral caudate nucleus, and dorsal-caudal and ventral-rostral putamen) and 2 amygdalar nuclei (basolateral and centromedial-superficial). Images were preprocessed with the standard pipeline of voxel-based morphometry studies using Statistical Parametric Mapping software. Results: Our analyses involved 329 patients with OCD and 316 healthy controls. Patients showed increased structural covariance between the left ventral-rostral putamen and the left inferior frontal gyrus/frontal operculum region. This finding had a significant interaction with age; the association held only in the subgroup of older participants. Patients with OCD also showed increased structural covariance between the right centromedial-superficial amygdala and the ventromedial prefrontal cortex. Limitations: This was a cross-sectional study. Because this is a multisite data set analysis, participant recruitment and image acquisition were performed in different centres. Most patients were taking medication, and treatment protocols differed across centres. Conclusion: Our results provide evidence for structural network-level alterations in patients with OCD involving 2 frontosubcortical circuits of relevance for the disorder and indicate that structural covariance contributes to fully characterizing brain alterations in patients with psychiatric disorders

Literature Review on Intervention Studies to Enhance Resilience of Nurses

本研究では、国内外で報告されている看護師のレジリエンスを高める介入研究をレビューし、実施方法および有効性について示唆を得ることを目的に文献検討を行った。国内文献は、医学中央雑誌web 版とGoogle Scholar を用いて「レジリエンス」AND「看護師」をキーワードに原著論文に限定した。国外文献は、Pub Med、Scopus を用いて、「resilience」AND「nurse」をキーワードに2013 ～ 2023 年の10 年間とした。国内文献1302 件、国外文献513 件から、関連要因を検討した文献、患者や学生を対象とした文献、尺度開発、概念分析、実態調査、重複論文は除外し、19 件の文献を分析対象とした。看護師のレジリエンスを高めるプログラムの構成では、対面の他、在宅トレーニングやオンラインを用いた介入も行われていた。プログラムの内容は、認知行動療法や心理学教育に基づき、多種多様な介入がみられ、複数のプログラムを組み合わせて行っていた。介入の有効性を評価する指標は、レジリエンスの他、ストレス、不安、抑うつ、自己効力感、燃え尽き症候群、セルフコンパッション、生活の質に関する尺度等が用いられていた。文献検討を行ったほとんどの研究が肯定的であり、有益な介入であると結論付けていた。 以上から、看護師のレジリエンスを高める介入は、レジリエンスのどの概念を強化するのかの目標を定め、これに基づき対象者に応じた実現可能なプログラムを構築し、目標を評価する適切な指標を用いて検証することが要点となると考えられた。そして、看護師のレジリエンスを高めるための介入研究を積み重ね検証していく必要性が示唆された。departmental bulletin pape