BPSD and care burden

Purpose : We investigated the cognitive function, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADLs) of elderly individuals admitted in care facilities. Moreover, the factors affecting the care burden experienced by facility staffs were examined. Method : 24 care facilities for elderly individuals participated in the study. The Revised Hasegawa Dementia Scale (HDS-R), Japanese version of the Neuropsychiatric Inventory (NPI), and Crichton Geriatric Behavioral Rating Scale (CGBRS) were used to evaluate cognitive function, BPSD, and ADL, respectively. The short Japanese version of the Zarit Burden Interview was used to assess the care burden. A multiple regression analysis was conducted with data obtained from 464 elderly individuals who fulfilled all the scales. Results : The care burden was correlated to the scores of HDS-R, but not with those of dysphoria/depression and disinhibition of NPI, restlessness of CGBRS, and subjective mood of CGBRS (R2 = 0.309, p < 0.005). Conclusion : Dysphoria/depression, disinhibition, restlessness, and subjective mood, but not cognitive decline, have an effect on the care burden experienced by facility staffs who manage elderly individuals. These results indicated that the appropriate diagnosis and treatment of BPSD are important in reducing the burden of facility staffs

Clinical factors influencing resilience in patients with anorexia nervosa

Purpose: This study was to elucidate clinical factors influencing resilience in anorexia nervosa (AN) patients. Patients and methods: Twenty female patients with AN (median age =30.0 years, quartile deviation =6.8) and 40 female healthy controls (HCs) (median age =30.0 years, quartile deviation =8.6) participated in the present study. Resilience was assessed with the Connor–Davidson resilience scale (CD-RISC). Clinical symptoms were evaluated with the structured interview guide for the Hamilton depression rating scale (SIGH-D) and the eating disorder inventory-2 (EDI-2). Results: Scores of the CD-RISC in the AN group were lower than those in the HC group, and the SIGH-D score in the AN group was higher than that in the HC group. Scores of interoceptive confusion, interpersonal difficulty and negative self-image subscales of the EDI-2 negatively correlated with the CD-RISC score. Moreover, stepwise regression analysis showed that negative self-image score was an independent predictor of the CD-RISC score. Conclusion: These results suggest that among these clinical factors including psychopathologies, self-dissatisfaction and feeling of being rejected by others are the most important influencing factors on an AN patients’ resilience

Refeeding Hypophosphatemia in Anorexia Nervosa

Objective: Refeeding in patients with anorexia nervosa (AN) is associated with a risk of refeeding syndrome (RS), which is a disruption in metabolism with a variety of features including hypophosphatemia. We evaluated the risk factors for refeeding hypophosphatemia (RH) during nutritional replenishment in Japanese patients with AN. Methods: We retrospectively examined clinical data for 99 female inpatients (mean age 30.9 ± 10.7 years, range: 9 to 56 years). Results: RH (phosphate <2.3 mg/dL) occurred within 4.8 ± 3.7 days of hospital admission and was still observed at 28 days after admission in 21 of the 99 cases (21.2%). Oral or intravenous phosphate was given to some patients to treat or prevent RH. Patients with RH had a significantly lower body mass index, were older, and had higher blood urea nitrogen than those without RH. Severe complications associated with RH were recorded in only one patient who showed convulsions and disturbed consciousness at day 3 when her serum phosphate level was 1.6 mg/dL. Conclusion: The significant risk factors for RH that we identified were lower BMI, older age, and higher blood urea nitrogen at admission. No significant difference in total energy intake was seen between the RH and no RH groups, suggesting that RH may not be entirely correlated with energy intake. Precisely predicting and preventing RH is difficult, even in patients with AN who are given phosphate for prophylaxis. Thus, serum phosphate levels should be monitored for at least 5-10 days after admission

Social and cognitive functions in schizophrenia

Purpose: The purpose of the present study was to examine clinical factors related to social function in people with schizophrenia. Patients and methods: The participants were 55 stabilized outpatients with schizophrenia. Their mean age was 39.36 (SD =10.65) years. Social function was assessed using the Quality of Life Scale (QLS). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. Results: Neither the MCCB cognitive domain score nor composite score was correlated with the QLS scores. However, of the 10 MCCB subtests, the Trail Making Test Part A and the Brief Assessment of Cognition in Schizophrenia-Symbol Coding (BACS-SC) scores were positively correlated with the QLS scores. Among clinical variables, especially the PANSS negative syndrome scale score had a strong negative correlation with the QLS scores. Stepwise regression analyses showed that the PANSS negative syndrome scale score was an independent predictor of the QLS scores, and although the BACS-SC score predicted the QLS common objects and activities subscale score, the association was not so strong compared to the PANSS negative syndrome scale score. Conclusion: These results indicate that speed of processing evaluated by BACS-SC could predict some aspect of social function but negative symptoms have a much stronger impact on global social function in people with schizophrenia

Life skills in schizophrenia

Objective : The purpose of the present study is to examine clinical factors related to life skills in people with schizophrenia. Method : The participants were 51 stabilized outpatients with schizophrenia. Their mean age was 38.91 (SD = 10.73) years. Life skills were assessed using the Life skills profile (LSP). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). Results : Cognitive function was not correlated with the LSP scores at all. Among clinical symptoms, scores of the PANSS positive and negative syndrome scales, the CDSS, and the DIEPSS had negative correlations with the LSP total score and the subscales. Stepwise regression analyses showed that the CDSS and PANSS negative syndrome scale scores were independent predictors of the LSP total score and two of the subscales. Conclusions : These results indicate that cognitive function is not associated with life skills but clinical symptoms such as depressive and negative symptoms have considerable impacts on life skills in people with schizophrenia

Social cognition in anorexia nervosa

Background: The purpose of this study was to investigate the characteristics of social cognition in patients with anorexia nervosa (AN). Methods: Eighteen female patients with AN (mean age =35.4±8.6 years) and 18 female healthy controls (HC) (mean age =32.8±9.4 years) participated in the study. Their social cognition was assessed with the Social Cognition Screening Questionnaire (SCSQ). Results: The results showed that total score of the SCSQ and scores of theory of mind and metacognition were significantly lower in AN group than those in HC group. Moreover, significant differences in theory of mind, metacognition, and total score of the SCSQ remained when the effects of depression, anxiety, and starvation were eliminated statistically. Conclusion: These results suggest that patients with AN may have difficulty inferring other people’s intention and also monitoring and evaluating their own cognitive activities. Therefore, these features may explain some aspects of the pathology of AN

Hemodynamic changes in the prefrontal cortex during mental works as measured by multi channel near-infrared spectroscopy (NIRS)

To investigate the brain activation in the prefrontal cortex (PFC) during mental works, we examined blood oxygenation changes of healthy subjects by using multi channel near infrared spectropcopy (NIRS). It was directly confirmed that the PFC was activated during mental tasks in vivo and it was suggested that distribution of the activation in the PFC is different among healthy individuals

統合失調症におけるSalience Network機能障害、抑うつ気分、および主観的QOLの因果関係を評価する構造方程式モデリングアプローチ : 独立成分分析による安静時ｆMRI研究

Purpose: Quality of life (QOL) is an important clinical outcome for patients with schizophrenia, and recent studies have focused on subjective QOL. We evaluated the causal relationship between psychosocial aspect of subjective QOL, symptoms, cognitive functions, and salience network (SN) dysfunction in schizophrenia using structural equation modeling (SEM). Patients and methods: We performed a cross-sectional study of 21 patients with symptomatically stabilized schizophrenia and 21 age-, sex-, and education level-matched healthy controls who underwent resting-state functional magnetic resonance imaging. We evaluated SN dysfunction in schizophrenia using independent component analysis (ICA). We rated participant psychopathology using the Positive and Negative Syndrome Scale (PANSS), the Brief Assessment of Cognition in Schizophrenia (BACS), and the Calgary Depression Scale for Schizophrenia (CDSS). We rated psychosocial aspect of subjective QOL using the Schizophrenia Quality of Life Scale (SQLS) psychosocial subscale. We applied SEM to examine the relationships between SN dysfunction, PANSS positive and negative scores, CDSS total scores, BACS composite scores, and SQLS psychosocial subscale scores. Results: In second-level analysis after group ICA, patient group had significant lower right pallidum functional connectivity (FC) within the SN than the controls did (Montreal Neurological Institute [MNI] [x y z] = [22 -2 -6]) (p = 0.027, family-wise error [FWE] corrected). In SEM, we obtained a good fit for an SEM model in which SN dysfunction causes depressed mood, which in turn determines psychosocial aspect of subjective QOL (chi-squared p = 0.9, root mean square error of approximation (RMSEA) < 0.001, comparative fit index [CFI] = 1.00, and standardized root mean square residual [SRMR]= 0.020). Conclusion: We found a continuous process by which SN dysfunction causes depressed moods that determine psychosocial aspect of subjective QOL in schizophrenia. This is the first report that offers a unified explanation of functional neuroimaging, symptoms, and outcomes. Future studies combining neuroimaging techniques and clinical assessments would elucidate schizophrenia’s pathogenesis

統合失調症患者において否定的、肯定的自己認知は主観的QOLを予測する

Purpose: Recently, cognitive variables such as negative and positive self-belief and thoughts have attracted much attention because they are associated with functional outcomes and quality of life (QOL). However, it is unclear how cognitive variables affect subjective and objective QOL. This study aimed to investigate the relationship of negative and positive self-belief and thoughts with subjective and objective QOL. Participants and methods: Thirty-six people with schizophrenia participated in this study. Subjective and objective QOL were assessed with the Schizophrenia Quality of Life Scale (SQLS) and Quality of Life Scale (QLS), respectively. Neurocognitive function was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Clinical symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia. Side effects were assessed with the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS). Negative and positive self-belief and thoughts were assessed with the Defeatist Performance Belief Scale and Automatic Thoughts Questionnaire-Revised. A generalized linear model was tested, with subjective and objective QOL as the response variable and symptoms, neurocognitive function, and cognitive variables that were significantly correlated with subjective and objective QOL as explanatory variables. Results: In the schizophrenia group, the common objects score on the QLS was predicted by the composite BACS score, and the total QLS score was predicted by the DIEPSS score. Motivation and Energy, Psychosocial, and Symptoms and Side effects scores on the SQLS were predicted by depression and by negative automatic thought (NAT) and positive automatic thought (PAT). Conclusion: Our results indicated that key targets for improving objective and subjective QOL in people with schizophrenia are side effects, neurocognitive function, depression, and NAT and PAT

地域在住自立高齢者を対象にした体力測定会への参加希望者における閉じこもりリスクと孤独感との関連

　Purpose：This study was conducted for the purpose of examining the risk of becoming homebound and the correlation of loneliness in the community-dwelling older adults volunteering to participate in a physical f itness measurement program．　Method：The subjects of this study consisted of 638 older adults dwelling in Kameoka City who volunteered to participate in a physical fitness measurement program in 2012 and desired also to participate in a similar program held roughly one year and a half years later．A survey was conducted in the form of a questionnaire survey that was mailed to the subjects．The contents of the survey consisted of questions relating to gender，age，household composition，frequency of meetings with separately dwelling family members，number of neighbors they can rely on，tasks within the home，presence of a hobby，participation in group activities，subjective view of health，subjective physical strength，risk of depression，risk of becoming homebound，assessment using the Japanese language version of the UCLA loneliness scale（ 3rd edition）（ to be simply referred to as ""loneliness""） and assessment using the Life Satisfaction Index K（ to be abbreviated as LSIK）．Analyses consisted of an intergroup comparison of loneliness scores for each parameter．This was followed by an analysis of covariance using those parameters for which there was a correlation with loneliness as covariates in order to examine the correlation between risk of becoming homebound and loneliness．　Results：539 of the subjects submitted valid responses to the survey （response rate：84.5%）．The analysis of the risk of becoming homebound indicated that 20 subjects were homebound（ 3.7%），90 subjects were at risk of becoming homebound （16.7%） and 429 subjects were not homebound （79.6%）． According to the results of an intergroup comparison of loneliness scores for each survey parameter，signif icant differences（ p ＜0.001） were observed for gender，number of neighbors the subjects can rely on，subjective view of health，subjective physical strength，risk of depression， tasks within the home，presence of a hobby，participation in group activities and LSIK score． The average loneliness scores of each risk of becoming homebound were 36.2 ± 8.9 in the nonhomebound group，41.9 ± 9.8 in the group at risk of becoming homebound，and 45.8 ± 8.7 in the homebound group，with scores becoming higher as the tendency to become homebound worsened． The correlation between the two was such that significant differences （ p =0.007） were observed when the above parameters were used as covariates，and loneliness was greater in the group at risk of becoming homebound than in the non-homebound group（ p =0.047）．　Discussion：This study demonstrated that persons at risk of becoming homebound are present even among relatively healthy older adults expressing a strong desire to continue to participate in physical f itness measurement programs like the subjects of this study，and that there is already a strong sense of loneliness among subjects of the group at risk of becoming homebound． Efforts to eliminate this sense of loneliness targeted at older adults at risk of becoming homebound who are already demonstrating a decrease in frequency of leaving their homes are expected to lead to effective countermeasures for preventing these persons from becoming homebound．　目　的：地域在住自立高齢者を対象とした体力測定会への参加希望者における閉じこもりリスクの程度と孤独感との関連を明らかにすることを目的とした。　方　法：亀岡市在住高齢者で2012 年の体力測定会に参加し，その約1 年半後の体力測定会に参加を希望した638 名を対象とした。調査は郵送法による質問紙調査を行った。質問項目は性別，年齢，世帯構成，別居家族と会う頻度，近所に頼れる人の人数，家庭内の仕事，趣味の有無，グループ活動への参加，主観的健康感，主観的体力，うつのリスク，閉じこもりリスク，日本語版UCLA 孤独感尺度（第3 版）（以下，孤独感），生活満足度尺度K（以下，LSIK）である。分析は各調査項目において孤独感得点の群間比較を行った。次に，孤独感と関連のあった項目を共変量とした共変量分散分析を行い，閉じこもりリスクと孤独感の関連を明らかにした。　結　果：有効回答者539 名（有効回答率84.5%）であった。閉じこもりリスクの分布は，閉じこもり群20 名（3.7%），閉じこもり予備群90 名（16.7%），非閉じこもり群429 名（79.6%）であった。調査項目ごとの孤独感得点の群間比較では性別，近所に頼れる人の人数，主観的健康感，主観的体力，うつのリスク，家庭内の仕事，趣味の有無，グループ活動への参加，LSIK に有意差が認められた（ p ＜ 0.001）。閉じこもりリスク別の孤独感得点の平均は，非閉じこもり群36.2 ± 8.9 点，閉じこもり予備群41.9 ± 9.8点，閉じこもり群45.8 ± 8.7 点と閉じこもり傾向に伴い高まった。両者の関連では先の項目を共変量としても有意差があり（ p =0.007），閉じこもり予備群の孤独感が非閉じこもり群に比べて有意に高かった（ p =0.047）。　考　察：体力測定会に継続参加可能な意欲の高い比較的健康な高齢者においても，閉じこもりリスク保有者が存在し閉じこもり予備群で孤独感が高いことが示された。閉じこもり予備群のうちから，孤独感を解消させるような働きかけを行うことが閉じこもり予防対策につながると期待される。原