Reliability and validity of ADHD diagnostic criteria in the Assessment System for Individuals with ADHD (ASIA): a Japanese semi-structured diagnostic interview

Background: With reports of a high prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults, publication of ADHD diagnostic criteria in DSM-5, and the urgent need for a relevant diagnostic instrument conforming to DSM-5, we developed the Assessment System for Individuals with ADHD (ASIA), a Japanese semi-structured diagnostic interview. We report here the reliability and validity of ASIA ADHD diagnostic criteria. Methods: ASIA ADHD criterion A corresponds to DSM-5 ADHD criterion A and has 144 original questions assessing nine inattention symptoms and nine hyperactivity-impulsivity symptoms, each having four childhood and four adulthood questions. The 144 questions are evaluated on a 3-point frequency scale. ASIA ADHD criteria B to E correspond to DSM-5 ADHD criteria B to E and are evaluated on a 2-point scale. ASIA was administered to 60 adults (mean age, 29.9 ± 9.0 years; 28 males; 36 ADHD and 24 non-ADHD participants diagnosed by consensus of two experts). Results: For ASIA ADHD criterion A, values of Cronbach's aα for the adulthood and childhood inattention and hyperactivity-impulsivity symptoms ranged from 0.64 to 0.90. Values of κ for two independent raters ranged from 0.98 to 1.00 for the 144 questions and raw agreement rates ranged from 0.97 to 1.00 for criteria B, C, D, and E. The consensus DSM-5 diagnoses endorsed 59 of the 60 ASIA diagnoses (ADHD and non-ADHD). The ADHD group scored significantly higher on 125 of the 144 questions for criterion A than the non-ADHD group. Correlations between ASIA total and subscale scores in adulthood and corresponding scores on the Japanese version of the Conners' Adult ADHD Scales-Self Report were high. Conclusions: ASIA ADHD criteria showed acceptable psychometric properties, although further investigation is necessary. The use of ASIA ADHD criteria could facilitate clinical practice and research into adult ADHD in Japan

Exaggerated envy and guilt measured by economic games in Japanese women with anorexia nervosa

Background: Anorexia nervosa (AN) patients are assumed to express high levels of guilt and envy. Ultimatum game (UG) is a standard behavioral task that focuses on interpersonal behavior when splitting a sum of money between two players. UG studies consistently demonstrate that people tend to decrease their inequity in outcomes, one explanation being that economically irrational decision-making may partly arise from the emotions guilt and envy. We assumed that AN patients would perform excessively fair in UG, reflecting high guilt and envy. Methods: We utilized UG to investigate the characteristics of guilt and envy among 24 Japanese AN patients and 22 age-matched healthy controls (HC). The relation between the outcome of UG and decision strategy confirmed by post-experimental questionnaires was analyzed. Results: As proposer, AN offered a larger amount to the responder compared with HC (p = 0.002) while, on the other hand, as responder, AN demanded much higher allocation to accept the offer compared with HC (p = 0.026). Regarding the strategy as responder, AN put more emphasis on fairness and less emphasis on monetary reward compared with HC (p = 0.046, p = 0.042, respectively). Conclusions: The results indicate that Japanese AN patients demonstrate strong preference for fairness, with high guilt and high envy. High sensitivity to guilt and envy of AN patients can affect not only their own behavior concerning eating attitude and body shape, but also decision-making in interpersonal situations. Behavioral experimental settings among social situations will enable us to evaluate and help actual decision-making in the real life of patients

Healthy Campus Trial: a multiphase optimization strategy (MOST) fully factorial trial to optimize the smartphone cognitive behavioral therapy (CBT) app for mental health promotion among university students: study protocol for a randomized controlled trial.

BACKGROUND: Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30-50% of university students meet criteria for some mental disorder, especially depression, in any given year. The university has traditionally provided many channels to promote students' mental health, but until now only a minority have sought such help, possibly owing to lack of time and/or to stigma related to mental illness. Smartphone-delivered cognitive behavioral therapy (CBT) shows promise for its accessibility and effectiveness. However, its most effective components and for whom it is more (or less) effective are not known. METHODS/DESIGN: Based on the multiphase optimization strategy framework, this study is a parallel-group, multicenter, open, fully factorial trial examining five smartphone-delivered CBT components (self-monitoring, cognitive restructuring, behavioral activation, assertion training, and problem solving) among university students with elevated distress, defined as scoring 5 or more on the Patient Health Questionnaire-9 (PHQ-9). The primary outcome is change in PHQ-9 scores from baseline to week 8. We will estimate specific efficacy of the five components and their interactions through the mixed-effects repeated-measures analysis and propose the most effective and efficacious combinations of components. Effect modification by selected baseline characteristics will be examined in exploratory analyses. DISCUSSION: The highly efficient experimental design will allow identification of the most effective components and the most efficient combinations thereof among the five components of smartphone CBT for university students. Pragmatically, the findings will help make the most efficacious CBT package accessible to a large number of distressed university students at reduced cost; theoretically, they will shed light on the underlying mechanisms of CBT and help further advance CBT for depression. TRIAL REGISTRATION: UMIN, CTR-000031307 . Registered on February 14, 2018

Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial

BACKGROUND: Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training. METHODS: We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N = 1093). The primary outcome was the change in PHQ-9 scores at 8 weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5 % false discovery rate using the Benjamini-Hochberg procedure. RESULTS: After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values <0.05). The higher the PHQ-9 total score at baseline (range: 5-14), the greater the decrease after 8 weeks. For each 5-point increase at baseline, the change from baseline to 8 weeks was bigger by 2.8 points. The more frequent the exercise habits (range: 0-2 points), the less effective the self-monitoring component. The difference in PHQ-9 change scores between presence or absence of self-monitoring was smaller by 0.94 points when the participant exercised one level more frequently. Additionally, the study suggested seven out of 36 PFs and 14 out of 160 EMs examined were candidates for future research. LIMITATIONS: Generalizability is limited to university students with subthreshold depression. CONCLUSIONS: These results provide some helpful information for the future development of individualized iCBT algorithms for depression

Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial

BACKGROUND: Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. OBJECTIVE: To examine the efficacy of five components of iCBT for subthreshold depression. METHODS: We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. FINDINGS: We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. CONCLUSIONS: There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. CLINICAL IMPLICATION: We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. TRIAL REGISTRATION NUMBER: UMINCTR-000031307

統合失調症における灰白質体積と客観的 Quality of Life

京都大学0048新制・論文博士博士(医学)乙第13231号論医博第2171号新制||医||1036(附属図書館)京都大学大学院医学研究科医学専攻(主査)教授 高橋 淳, 教授 宮本 享, 教授 富樫 かおり学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDFA

<研究論文>女性研究者の職業性ストレスと自我態度の特徴

In recent decades, women have advanced in many areas of scientific research. However, it is still perceived as a male-dominated field. Some studies have reported that stress reactions vary according to job type, sex, and personality. This study analyzes job-related stress and ego states in female researchers, using the Brief Job Stress Questionnaire (BJSQ) and the Todai-shiki Ego gram (TEG). The BJSQ revealed that quantitative and qualitative workload caused significantly higher stress levels in female researchers than in other female employees at the institution. Physical complaints and lack of family/friend support caused significantly higher stress levels in female researchers than in male researchers. The TEG revealed that female researchers had significantly higher scores for critical parent and adult ego states than the other female employees. For high-stress female researchers, scores for the nurturing parent ego state were associated with significantly lower stress levels than those for low-stress female researchers. This study demonstrated that scores for job-related stress and ego states in female researchers are inherent aspects of their occupation. Occupational health physicians and psychiatrists should help female researchers cope with job stress on the basis of these characteristic ego states.近年、女性の科学分野への進出は著しい。しかしながら、科学研究は、未だ男性優位の職域である。職業性ストレスは、職種、性別、及びパーソナリティによって異なることが、先行研究によって知られている。女性研究者は、特有のストレスに暴露されていると推測されるが、予防医学的研究はほとんどなされていない。我々は、女性研究者の健康管理のために、Brief Job StressQuestionnaire (BJSQ)とTodai-shiki Ego-gram(TEG)を用いて、職業性ストレスと自我態度の特徴を明らかにしようと試みた。BJSQでは、女性研究者は他の職種と比較して、量的労働負荷と質的労働負荷が有意に高かった。男女間で比較してみると、女性研究者は、身体的ストレス反応が有意に高かった。また、男性研究者に比し、家族や友人のサポートの不足をより強く感じていた。自我態度においては、critical parentとadultの自我態度の得点が、一般成人女性よりも有意に高かった。さらに、女性研究者を高ストレス群と低ストレス群に分けて、自我態度を比較してみると、高ストレス群では、nurturing parentの自我態度が有意に低かった。以上より、女性研究者は、特徴的な職業性ストレスと自我態度を有していることが示唆された。産業医や精神科医は、これらの特徴を踏まえながら、女性研究者に対してより適切な医学的助言を行うことが望ましいと考えられる

Development of a multi-dimensional scale for PDD and ADHD.

A novel assessment scale, the multi-dimensional scale for pervasive developmental disorder (PDD) and attention-deficit/hyperactivity disorder (ADHD) (MSPA), is reported. Existing assessment scales are intended to establish each diagnosis. However, the diagnosis by itself does not always capture individual characteristics or indicate the level of support required, since inter-individual differences are substantial and co-morbidity is common. The MSPA consists of 14 domains and each domain is rated by a nine-point quantitative scale. The clinical and behavioral features are projected onto a radar-chart, which facilitates understanding of the disorders both by the patients themselves and by those in their surroundings. We assessed 179 patients and analyzed features by six diagnostic subgroups, which showed relationships between features and diagnoses. The inter-rater reliability was satisfactory