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Jin Narumoto

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Geraldine McMahon

Udoka Okpalauwaekwe

University of Saskatchewan

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Università Degli Studi Di Verona

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Papers by Jin Narumoto

Over Half of Falls Were Associated with Psychotropic Medication Use in Four Nursing Homes in Japan: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health, 2022

Medication use can increase the risk of falls and injuries in nursing homes, creating a significa... more Medication use can increase the risk of falls and injuries in nursing homes, creating a significant risk for residents. We performed a retrospective cohort study over one year to identify the incidence of drug-related falls with and without injury among four Japanese nursing homes with 280 beds. We evaluated the relationship between potential risk factors for falls and fall-related injuries while considering well-known risks such as ADLs and chronic comorbidities. By collaboratively reviewing care records, we enrolled 459 residents (mean age, 87) and identified 645 falls, including 146 injurious falls and 16 severe injurious falls requiring inpatient care, incidence: 19.5, 4.4, 0.5 per 100 resident-months, respectively. Medication influenced around three-quarters of all falls, >80% of which were psychotropic drugs. Regularly taking ≥5 medications was a risk factor for the initial falls (HR 1.33: CI 1.00–1.77, p = 0.0048) and injuries after falls (OR 2.41: CI 1.30–4.50, p = 0.006)...

Diffusion Tensor Imagingを用いた精神疾患の研究

Duration of untreated illness of patients with obsessive–compulsive disorder in Japan

Early Intervention in Psychiatry, 2020

Obsessive–compulsive disorder (OCD) is a common and severe disease; however, the duration of untr... more Obsessive–compulsive disorder (OCD) is a common and severe disease; however, the duration of untreated illness (DUI) of OCD is approximately 7 years, which is longer than that of other psychiatric disorders. Differences in medical environments have been reported to affect the DUI. Therefore, we surveyed the DUI of OCD in Japan and the reason for delayed treatment.

Pineal volume reduction in patients with mild cognitive impairment who converted to Alzheimer's disease

Psychiatry and Clinical Neurosciences, 2020

This is the author manuscript accepted for publication and has undergone full peer review but has... more

Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic

Journal of Alzheimer's Disease, 2019

Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and f... more Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and for some, an early manifestation of dementia. Objective: We examined the prevalence of MBI in the psychiatric outpatient clinic, and compared the incidence of dementia in MBI with that in other psychiatric diseases. Methods: Retrospective chart review was conducted in 2,853 consecutive outpatients over the age of 50. MBI was diagnosed according to the International Society to Advance Alzheimer's Research and Treatment research diagnostic criteria. The incidence rate of dementia was examined in the patients who were followed up for at least 1 month. Kaplan-Meier survival analyses and Cox proportional hazards regression models were performed to compare the time to onset of dementia between MBI and other psychiatric diseases. Results: The prevalence of MBI was 3.5% and the incidence of dementia was 30.7 cases per 1000 person-years. The hazard ratio (HR) for dementia was higher for MBI than other psychiatric diseases (HR: 8.07, 95% confidence interval: 4.34-15.03, p < 0.001). In MCI patients, the cumulative survival in MCI with affective dysregulation tended to be lower than that in MCI without (p = 0.090). Conclusions: Psychiatric outpatients often meet MBI criteria. MBI, especially the affective dysregulation domain, increases the risk of dementia in this psychiatric outpatient population. Since late-onset psychiatric and behavioral symptoms may be prodromal symptoms of dementia in some, careful observation is needed, and psychiatric clinicians should keep prodromal dementia on their differential diagnosis when assessing those with new onset psychiatric symptomatology in older adults.

Effectiveness of parent training in improving stress-coping capability, anxiety, and depression in mothers raising children with autism spectrum disorder

Neuropsychiatric Disease and Treatment, 2018

Raising a child with autism spectrum disorder (ASD) can be a stressor, and mothers of ASD childre... more Raising a child with autism spectrum disorder (ASD) can be a stressor, and mothers of ASD children often present with high levels of stress and depression. Interventional steps to enhance parental coping skills and resiliency are more important for parental mental health and the family-centered care of children with ASD than merely reducing parental stress. Although the importance of stress-coping skills is well established, only a few studies have investigated interventional steps to improve parental coping or resiliency. Parent training (PT) is known to improve a mother's mental health. Here, we aimed to assess the effectiveness of PT in improving the stress-coping style of mothers raising children with ASD. Patients and methods: Thirty mothers of children with ASD aged 4-11 years participated in this study. The mothers underwent PT based on the Hizen Parenting Skills Training in Japan, which comprised seven sessions. Each session included education on behavior therapy, individual consultation, and workshops in small groups. Sixteen mothers completed psychological assessment, including the Stress Coping Inventory, the Beck Depression Inventory Second Edition, the State-Trait Anxiety Inventory, and the Child Behavior Checklist conducted before and after 2 months of PT. Results: The outcomes before and after the PT program were compared using the paired t-test and Pearson's correlation. After the PT program, the mothers' stress-coping strategy "positive appraisal" significantly increased (P,0.01) and "escape/avoidance" significantly decreased (P,0.01). The Beck Depression Inventory Second Edition (P,0.05) and the trait anxiety scores (P,0.01) also significantly decreased. The change in the stress-coping strategy "distancing" had a significantly negative correlation with the change in the externalizing Child Behavior Checklist T-scores of children with ASD (Pearson r=-0.518, P,0.05). Conclusion: PT may be effective for mothers of children with ASD to improve their stresscoping style and to decrease their depression and trait anxiety.

Attention to emotion modulates fMRI activity in human right superior temporal sulcus

Cognitive Brain Research, 2001

A parallel neural network has been proposed for processing various types of information conveyed ... more A parallel neural network has been proposed for processing various types of information conveyed by faces including emotion. Using functional magnetic resonance imaging (fMRI), we tested the effect of the explicit attention to the emotional expression of the faces on the neuronal activity of the face-responsive regions. Delayed match to sample procedure was adopted. Subjects were required to match the visually presented pictures with regard to the contour of the face pictures, facial identity, and emotional expressions by valence (happy and fearful expressions) and arousal (fearful and sad expressions). Contour matching of the non-face scrambled pictures was used as a control condition. The face-responsive regions that responded more to faces than to non-face stimuli were the bilateral lateral fusiform gyrus (LFG), the right superior temporal sulcus (STS), and the bilateral intraparietal sulcus (IPS). In these regions, general attention to the face enhanced the activities of the bilateral LFG, the right STS, and the left IPS compared with attention to the contour of the facial image. Selective attention to facial emotion specifically enhanced the activity of the right STS compared with attention to the face per se. The results suggest that the right STS region plays a special role in facial emotion recognition within distributed face-processing systems. This finding may support the notion that the STS is involved in social perception.

[Diagnosis, assessment, and treatment of alcohol withdrawal syndrome]

Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence, 2006

Alcohol withdrawal syndrome is the one of the most critical status among alcohol related disorder... more Alcohol withdrawal syndrome is the one of the most critical status among alcohol related disorders. Early detection, diagnosis, and appropriate treatment of alcohol withdrawal syndrome are keys to a successful outcome. This article describes the concrete method of diagnosis, assessment, and treatment of alcohol withdrawal syndrome.

Effect of institutional smoking prohibition on Japanese inpatients with chronic schizophrenia

Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence, 2006

A higher prevalence of smoking among schizophrenic patients has been well documented in Japan and... more A higher prevalence of smoking among schizophrenic patients has been well documented in Japan and other countries. Smoking reduction or cessation is desirable to reduce various physical complications in schizophrenic patients, but the effect of smoking reduction on psychiatric status and BMI remains ambiguous. The aim of this study was to determine the effect of an institutional smoking prohibition on smoking status, psychiatric status and BMI in Japanese inpatients with schizophrenia. Smoking status, psychiatric status (Clinical Global Impression (CGI) scores: global severity score and global change score) and BMI were investigated in 256 chronic schizophrenic inpatients before and 3 months after prohibition of smoking in a Japanese psychiatric hospital building. Following prohibition, the smoking rate decreased from 36.3% to 22.2%. A weak positive correlation was found between decreased cigarette consumption and the CGI global change score (r=0.140, p=0.025), but the mean global c...

Anosognosia in Alzheimer's disease: Association with patient characteristics, psychiatric symptoms and cognitive deficits

Psychiatry and Clinical Neurosciences, 2005

Anosognosia is one of the major problems in the treatment and care of Alzheimer&amp;amp;amp;a... more Anosognosia is one of the major problems in the treatment and care of Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) patients. The aim of the study was to determine the patient characteristics, psychiatric symptoms, and cognitive deficits associated with anosognosia, because these are currently poorly understood. Eighty-four patients who met the National Institute of Neurological and Communicative Disease and Stroke-Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disease and Related Disorders Association criteria for probable AD were examined for anosognosia based on the difference between questionnaire scores of the patient and their caregiver. The relationship of anosognosia with patient characteristics (age, age at onset, duration of illness, education, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Hyogo Activities of Daily Living Scale (HADLS)), psychiatric symptoms (Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS)), and cognitive function (Digit Span, Word Fluency Test, Trail Making Test, Stroop Test, Raven&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Coloured Progressive Matrices Test) were studied. Anosognosia showed positive correlations with age, age at onset, duration of illness, CDR, HADLS, and NPI disinhibition, and negative correlations with MMSE and GDS. Regarding cognitive function, only Part III of the Stroop Test was a predictor of anosognosia. The severity of anosognosia increased with disease progression and with a later age at onset. Subjective complaints of depression requiring self-monitoring of mood tended to decrease and, in contrast, inhibition of socially unsuitable behavior became more difficult as anosognosia worsened. Regarding cognitive function, anosognosia appeared to be associated with response inhibition impairment. Both disinhibition, as a psychiatric symptom, and response inhibition impairment are known to be correlated with disturbance of orbitofrontal function, which therefore may be associated with anosognosia.

Neurodegenerative disorders in schizophrenia

Psychiatry and Clinical Neurosciences, 2007

Frontotemporal dementia complicated with schizophrenia

Psychiatry and Clinical Neurosciences, 2005

Dementia is known to occur in schizophrenia in elderly patients. De Vries et al . 1 have suggeste... more Dementia is known to occur in schizophrenia in elderly patients. De Vries et al . 1 have suggested that the neuropsychological profile of dementia in schizophrenia is similar to that of frontotemporal dementia (FTD) 2 but found no structural imaging abnormalities, except for frontotemporal hypoperfusion. Arnold et al . 3 and Harrison 4 also concluded that neurodegeneration and neural injury are absent in schizophrenia in the elderly. We report the case of an elderly patient with schizophrenia who showed characteristic language disorder and remarkable functional and structural imaging abnormalities suggesting FTD.

Relationships among burnout, coping style and personality: Study of Japanese professional caregivers for elderly

Psychiatry and Clinical Neurosciences, 2008

To investigate relationships among burnout, coping style and personality. Methods: Seventy-two pr... more To investigate relationships among burnout, coping style and personality. Methods: Seventy-two professional caregivers working at nursing homes in Japan were assessed using the Maslach Burnout Inventory (MBI), NEO Five-Factor Inventory (NEO-FFI), 30-item General Health Questionnaire (GHQ) and Coping Inventory for Stressful Situation (CISS). Results: GHQ (b = 0.34, P < 0.01) and emotionoriented coping (CISS-E; b= 0.31, P < 0.05) were the predictors of emotional exhaustion (MBI-EE), and neuroticism (NEO-N; b= 0.45, P < 0.001) and age (b =-0.23, P < 0.05) were the predictors of depersonalization (MBI-DP). Structural equation modeling showed that NEON affected the burnout scores through CISS-E, and that age and GHQ affected the burnout scores independently. Conclusion: Personality affects burnout through coping style in professional caregivers.

Progressive isolated amnesia: A 9-year neuropsychological study with magnetic resonance imaging and single photon emission computed tomography data

Psychiatry and Clinical Neurosciences, 2010

C HOLINESTERASE INHIBITORS (CHEI) are recommended for cognitive decline and behavioral and psycho... more C HOLINESTERASE INHIBITORS (CHEI) are recommended for cognitive decline and behavioral and psychological symptoms of dementia in patients with dementia with Lewy bodies (DLB). 1 We present a case relating the efficacy of low-dose donepezil for DLB. The patient was a 74-year-old Japanese woman who showed cognitive decline, visual hallucinations, and delusions over one year. She was previously treated with 1.5 mg/day of haloperidol, 1 mg/day of risperidone and 3-5 mg/day of donepezil. However, she developed parkinsonism with these drugs and the regime was stopped. Subsequently, the visual hallucinations and delusions disappeared without any psychotropic medication. Four months thereafter, visual hallucinations of small animals and delusions of persecution recurred and she was admitted to our medical center. She demonstrated no specific neurological findings including parkinsonism and her score for the mini-mental state examination was 24/30. Initially, she was suspected as having Alzheimer's disease (AD) and was administered 0.5 mg/day of risperidone and low-dose haloperidol (0.50-0.75 mg/day) for the visual hallucinations and delusions, but she developed significant parkinsonism including arm rigidity and stooped posture. Because she revealed fluctuating cognitive decline and severe neuroleptic sensitivity as well as visual hallucinations, her diagnosis was changed to probable DLB according to the clinical criteria for the diagnosis of DLB. 1 Instead of these drugs, 3 mg/day of donepezil was effective for the visual hallucinations, but parkinsonism appeared. Next, the dose was decreased to 1.5 mg/day and parkinsonism disappeared without recurrence of the visual hallucinations. However, the delusions and fluctuating cognitive decline continued. Therefore, donepezil was stopped temporarily to determine whether the visual hallucinations actually improved due to the low-dose donepezil. Subsequently, the visual hallucinations reappeared, however they disappeared again with the re-administration of 1.5 mg/day of donepezil. Therefore, the efficacy of low-dose donepezil was confirmed. No randomized controlled trials have been carried out concerning the efficacy and dosage of donepezil for DLB patients, so the sensitivity of donepezil for its efficacy remains unclear. However, according to a previous report, adverse events due to donepezil occur more often in DLB patients than AD patients. 2 The guidelines indicated that a dose-dependent exacerbation of extrapyramidal symptom (EPS) may occur with the administration of CHEI. 1 The EPS of a DLB patient worsens with the therapeutic dose of rivastigmine (7.5 mg/ day), which could be reversed by a dose reduction to 6 mg/ day. 3 In the current case, a dose-reduction of donepezil to 1.5 mg/day reversed the EPS. Therefore, titration to a low-dose treatment of donepezil might be useful in some DLB patients who show hypersensitivity to the standard dose of donepezil.

Insight and quality of life in long-term hospitalized Japanese patients with chronic schizophrenia

Psychiatry and Clinical Neurosciences, 2010

The aim of the study was to investigate the relationship between insight and quality of life (QOL... more The aim of the study was to investigate the relationship between insight and quality of life (QOL) and the respective predictive factors in long-term hospitalized patients with chronic schizophrenia. Methods: The present subjects were 47 Japanese patients with chronic schizophrenia who were hospitalized for >1 year (mean hospitalization period, 9.8 years). Assessments were made using the Scale of Unawareness of Mental Disorder (SUMD) and the EuroQoL-5 Dimensions (EQ-5D) scale. Sociodemographic details and illness-related variables were also evaluated, including use of the Positive and Negative Syndrome Scale. Results: There was no association between SUMD and EQ-5D scores. Hallucinatory behavior was a predictor of good insight. Poor rapport was a predictor of bad insight. Poor attention was a predictor of bad QOL. Conclusion: The relationship between insight and QOL and the respective predictive factors might be different between acute and chronic stages. Further studies are needed to investigate how these changes occur.

Effect of traditional Japanese herbal medicine toki-shakuyaku-san for mild cognitive impairment: SPECT study

Psychiatry and Clinical Neurosciences, 2007

Body Mass Index among Japanese Inpatients with Schizophrenia

The International Journal of Psychiatry in Medicine, 2006

Background: Many studies have emphasized the high frequency of obesity in schizophrenic patients.... more Background: Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population. Methods: The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey. Results: The mean patient BMI was 23.0 ± 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most ...

4．医療現場で直面している意思決定の課題について

Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics, 2013

Attitude toward dementia and preferences for diagnosis in Japanese health service consumers

BMC Health Services Research, 2021

Background Being diagnosed with dementia is a confronting experience for any individual and their... more Background Being diagnosed with dementia is a confronting experience for any individual and their caregiver. However, a diagnosis provides opportunity for future preparation for management of the condition. This study investigated attitudes toward dementia and preferences for diagnosis among a sample of health service consumers in Japan. Methods Participants were patients or accompanying support persons (n = 217) who visited the specialty outpatient clinic of four hospital departments. The survey was conducted using an iPad with answers sent automatically to a secure server. The survey included items about the participants’ most feared diseases and the reasons behind those fears, estimates of dementia prevalence in Japan, and preferences regarding a diagnosis of dementia and the reasons for their preference. Results The most feared disease was cancer (43.8 %), followed by dementia (18 %). Those selecting dementia most commonly reported practical, emotional and social impacts as the ...

The Economic Burden of Dementia: Evidence from a Survey of Households of People with Dementia and Their Caregivers

International Journal of Environmental Research and Public Health, 2021

Although a cognitive impairment such as dementia causes serious economic problems among older peo... more Although a cognitive impairment such as dementia causes serious economic problems among older people, its impact on economic activities is unclear. This study investigated the actual conditions of economic activities and the current status of the financial support systems among people with dementia and caregivers. One hundred and five dyads participated in the survey. Each dyad consisted of an older person with Alzheimer’s disease and their caregiver. The Mini-Mental State Examination (MMSE) and Functional Assessment Staging (FAST) were used to evaluate the cognitive functions of people with dementia. The caregivers were asked questions concerning the financial status of the household and their utilization of the financial support systems available to people with dementia. Average monthly care costs significantly increased according to the severity of dementia, while household income and spending incurred no significant changes. People with dementia experienced financial problems (i...

Over Half of Falls Were Associated with Psychotropic Medication Use in Four Nursing Homes in Japan: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health, 2022

Medication use can increase the risk of falls and injuries in nursing homes, creating a significa... more Medication use can increase the risk of falls and injuries in nursing homes, creating a significant risk for residents. We performed a retrospective cohort study over one year to identify the incidence of drug-related falls with and without injury among four Japanese nursing homes with 280 beds. We evaluated the relationship between potential risk factors for falls and fall-related injuries while considering well-known risks such as ADLs and chronic comorbidities. By collaboratively reviewing care records, we enrolled 459 residents (mean age, 87) and identified 645 falls, including 146 injurious falls and 16 severe injurious falls requiring inpatient care, incidence: 19.5, 4.4, 0.5 per 100 resident-months, respectively. Medication influenced around three-quarters of all falls, >80% of which were psychotropic drugs. Regularly taking ≥5 medications was a risk factor for the initial falls (HR 1.33: CI 1.00–1.77, p = 0.0048) and injuries after falls (OR 2.41: CI 1.30–4.50, p = 0.006)...

Diffusion Tensor Imagingを用いた精神疾患の研究

Duration of untreated illness of patients with obsessive–compulsive disorder in Japan

Early Intervention in Psychiatry, 2020

Obsessive–compulsive disorder (OCD) is a common and severe disease; however, the duration of untr... more Obsessive–compulsive disorder (OCD) is a common and severe disease; however, the duration of untreated illness (DUI) of OCD is approximately 7 years, which is longer than that of other psychiatric disorders. Differences in medical environments have been reported to affect the DUI. Therefore, we surveyed the DUI of OCD in Japan and the reason for delayed treatment.

Pineal volume reduction in patients with mild cognitive impairment who converted to Alzheimer's disease

Psychiatry and Clinical Neurosciences, 2020

This is the author manuscript accepted for publication and has undergone full peer review but has... more

Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic

Journal of Alzheimer's Disease, 2019

Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and f... more Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and for some, an early manifestation of dementia. Objective: We examined the prevalence of MBI in the psychiatric outpatient clinic, and compared the incidence of dementia in MBI with that in other psychiatric diseases. Methods: Retrospective chart review was conducted in 2,853 consecutive outpatients over the age of 50. MBI was diagnosed according to the International Society to Advance Alzheimer's Research and Treatment research diagnostic criteria. The incidence rate of dementia was examined in the patients who were followed up for at least 1 month. Kaplan-Meier survival analyses and Cox proportional hazards regression models were performed to compare the time to onset of dementia between MBI and other psychiatric diseases. Results: The prevalence of MBI was 3.5% and the incidence of dementia was 30.7 cases per 1000 person-years. The hazard ratio (HR) for dementia was higher for MBI than other psychiatric diseases (HR: 8.07, 95% confidence interval: 4.34-15.03, p < 0.001). In MCI patients, the cumulative survival in MCI with affective dysregulation tended to be lower than that in MCI without (p = 0.090). Conclusions: Psychiatric outpatients often meet MBI criteria. MBI, especially the affective dysregulation domain, increases the risk of dementia in this psychiatric outpatient population. Since late-onset psychiatric and behavioral symptoms may be prodromal symptoms of dementia in some, careful observation is needed, and psychiatric clinicians should keep prodromal dementia on their differential diagnosis when assessing those with new onset psychiatric symptomatology in older adults.

Effectiveness of parent training in improving stress-coping capability, anxiety, and depression in mothers raising children with autism spectrum disorder

Neuropsychiatric Disease and Treatment, 2018

Raising a child with autism spectrum disorder (ASD) can be a stressor, and mothers of ASD childre... more Raising a child with autism spectrum disorder (ASD) can be a stressor, and mothers of ASD children often present with high levels of stress and depression. Interventional steps to enhance parental coping skills and resiliency are more important for parental mental health and the family-centered care of children with ASD than merely reducing parental stress. Although the importance of stress-coping skills is well established, only a few studies have investigated interventional steps to improve parental coping or resiliency. Parent training (PT) is known to improve a mother's mental health. Here, we aimed to assess the effectiveness of PT in improving the stress-coping style of mothers raising children with ASD. Patients and methods: Thirty mothers of children with ASD aged 4-11 years participated in this study. The mothers underwent PT based on the Hizen Parenting Skills Training in Japan, which comprised seven sessions. Each session included education on behavior therapy, individual consultation, and workshops in small groups. Sixteen mothers completed psychological assessment, including the Stress Coping Inventory, the Beck Depression Inventory Second Edition, the State-Trait Anxiety Inventory, and the Child Behavior Checklist conducted before and after 2 months of PT. Results: The outcomes before and after the PT program were compared using the paired t-test and Pearson's correlation. After the PT program, the mothers' stress-coping strategy "positive appraisal" significantly increased (P,0.01) and "escape/avoidance" significantly decreased (P,0.01). The Beck Depression Inventory Second Edition (P,0.05) and the trait anxiety scores (P,0.01) also significantly decreased. The change in the stress-coping strategy "distancing" had a significantly negative correlation with the change in the externalizing Child Behavior Checklist T-scores of children with ASD (Pearson r=-0.518, P,0.05). Conclusion: PT may be effective for mothers of children with ASD to improve their stresscoping style and to decrease their depression and trait anxiety.

Attention to emotion modulates fMRI activity in human right superior temporal sulcus

Cognitive Brain Research, 2001

A parallel neural network has been proposed for processing various types of information conveyed ... more A parallel neural network has been proposed for processing various types of information conveyed by faces including emotion. Using functional magnetic resonance imaging (fMRI), we tested the effect of the explicit attention to the emotional expression of the faces on the neuronal activity of the face-responsive regions. Delayed match to sample procedure was adopted. Subjects were required to match the visually presented pictures with regard to the contour of the face pictures, facial identity, and emotional expressions by valence (happy and fearful expressions) and arousal (fearful and sad expressions). Contour matching of the non-face scrambled pictures was used as a control condition. The face-responsive regions that responded more to faces than to non-face stimuli were the bilateral lateral fusiform gyrus (LFG), the right superior temporal sulcus (STS), and the bilateral intraparietal sulcus (IPS). In these regions, general attention to the face enhanced the activities of the bilateral LFG, the right STS, and the left IPS compared with attention to the contour of the facial image. Selective attention to facial emotion specifically enhanced the activity of the right STS compared with attention to the face per se. The results suggest that the right STS region plays a special role in facial emotion recognition within distributed face-processing systems. This finding may support the notion that the STS is involved in social perception.

[Diagnosis, assessment, and treatment of alcohol withdrawal syndrome]

Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence, 2006

Alcohol withdrawal syndrome is the one of the most critical status among alcohol related disorder... more Alcohol withdrawal syndrome is the one of the most critical status among alcohol related disorders. Early detection, diagnosis, and appropriate treatment of alcohol withdrawal syndrome are keys to a successful outcome. This article describes the concrete method of diagnosis, assessment, and treatment of alcohol withdrawal syndrome.

Effect of institutional smoking prohibition on Japanese inpatients with chronic schizophrenia

Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence, 2006

A higher prevalence of smoking among schizophrenic patients has been well documented in Japan and... more A higher prevalence of smoking among schizophrenic patients has been well documented in Japan and other countries. Smoking reduction or cessation is desirable to reduce various physical complications in schizophrenic patients, but the effect of smoking reduction on psychiatric status and BMI remains ambiguous. The aim of this study was to determine the effect of an institutional smoking prohibition on smoking status, psychiatric status and BMI in Japanese inpatients with schizophrenia. Smoking status, psychiatric status (Clinical Global Impression (CGI) scores: global severity score and global change score) and BMI were investigated in 256 chronic schizophrenic inpatients before and 3 months after prohibition of smoking in a Japanese psychiatric hospital building. Following prohibition, the smoking rate decreased from 36.3% to 22.2%. A weak positive correlation was found between decreased cigarette consumption and the CGI global change score (r=0.140, p=0.025), but the mean global c...

Anosognosia in Alzheimer's disease: Association with patient characteristics, psychiatric symptoms and cognitive deficits

Psychiatry and Clinical Neurosciences, 2005

Anosognosia is one of the major problems in the treatment and care of Alzheimer&amp;amp;amp;a... more Anosognosia is one of the major problems in the treatment and care of Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) patients. The aim of the study was to determine the patient characteristics, psychiatric symptoms, and cognitive deficits associated with anosognosia, because these are currently poorly understood. Eighty-four patients who met the National Institute of Neurological and Communicative Disease and Stroke-Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disease and Related Disorders Association criteria for probable AD were examined for anosognosia based on the difference between questionnaire scores of the patient and their caregiver. The relationship of anosognosia with patient characteristics (age, age at onset, duration of illness, education, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Hyogo Activities of Daily Living Scale (HADLS)), psychiatric symptoms (Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS)), and cognitive function (Digit Span, Word Fluency Test, Trail Making Test, Stroop Test, Raven&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Coloured Progressive Matrices Test) were studied. Anosognosia showed positive correlations with age, age at onset, duration of illness, CDR, HADLS, and NPI disinhibition, and negative correlations with MMSE and GDS. Regarding cognitive function, only Part III of the Stroop Test was a predictor of anosognosia. The severity of anosognosia increased with disease progression and with a later age at onset. Subjective complaints of depression requiring self-monitoring of mood tended to decrease and, in contrast, inhibition of socially unsuitable behavior became more difficult as anosognosia worsened. Regarding cognitive function, anosognosia appeared to be associated with response inhibition impairment. Both disinhibition, as a psychiatric symptom, and response inhibition impairment are known to be correlated with disturbance of orbitofrontal function, which therefore may be associated with anosognosia.

Neurodegenerative disorders in schizophrenia

Psychiatry and Clinical Neurosciences, 2007

Frontotemporal dementia complicated with schizophrenia

Psychiatry and Clinical Neurosciences, 2005

Dementia is known to occur in schizophrenia in elderly patients. De Vries et al . 1 have suggeste... more Dementia is known to occur in schizophrenia in elderly patients. De Vries et al . 1 have suggested that the neuropsychological profile of dementia in schizophrenia is similar to that of frontotemporal dementia (FTD) 2 but found no structural imaging abnormalities, except for frontotemporal hypoperfusion. Arnold et al . 3 and Harrison 4 also concluded that neurodegeneration and neural injury are absent in schizophrenia in the elderly. We report the case of an elderly patient with schizophrenia who showed characteristic language disorder and remarkable functional and structural imaging abnormalities suggesting FTD.

Relationships among burnout, coping style and personality: Study of Japanese professional caregivers for elderly

Psychiatry and Clinical Neurosciences, 2008

To investigate relationships among burnout, coping style and personality. Methods: Seventy-two pr... more To investigate relationships among burnout, coping style and personality. Methods: Seventy-two professional caregivers working at nursing homes in Japan were assessed using the Maslach Burnout Inventory (MBI), NEO Five-Factor Inventory (NEO-FFI), 30-item General Health Questionnaire (GHQ) and Coping Inventory for Stressful Situation (CISS). Results: GHQ (b = 0.34, P < 0.01) and emotionoriented coping (CISS-E; b= 0.31, P < 0.05) were the predictors of emotional exhaustion (MBI-EE), and neuroticism (NEO-N; b= 0.45, P < 0.001) and age (b =-0.23, P < 0.05) were the predictors of depersonalization (MBI-DP). Structural equation modeling showed that NEON affected the burnout scores through CISS-E, and that age and GHQ affected the burnout scores independently. Conclusion: Personality affects burnout through coping style in professional caregivers.

Progressive isolated amnesia: A 9-year neuropsychological study with magnetic resonance imaging and single photon emission computed tomography data

Psychiatry and Clinical Neurosciences, 2010

C HOLINESTERASE INHIBITORS (CHEI) are recommended for cognitive decline and behavioral and psycho... more C HOLINESTERASE INHIBITORS (CHEI) are recommended for cognitive decline and behavioral and psychological symptoms of dementia in patients with dementia with Lewy bodies (DLB). 1 We present a case relating the efficacy of low-dose donepezil for DLB. The patient was a 74-year-old Japanese woman who showed cognitive decline, visual hallucinations, and delusions over one year. She was previously treated with 1.5 mg/day of haloperidol, 1 mg/day of risperidone and 3-5 mg/day of donepezil. However, she developed parkinsonism with these drugs and the regime was stopped. Subsequently, the visual hallucinations and delusions disappeared without any psychotropic medication. Four months thereafter, visual hallucinations of small animals and delusions of persecution recurred and she was admitted to our medical center. She demonstrated no specific neurological findings including parkinsonism and her score for the mini-mental state examination was 24/30. Initially, she was suspected as having Alzheimer's disease (AD) and was administered 0.5 mg/day of risperidone and low-dose haloperidol (0.50-0.75 mg/day) for the visual hallucinations and delusions, but she developed significant parkinsonism including arm rigidity and stooped posture. Because she revealed fluctuating cognitive decline and severe neuroleptic sensitivity as well as visual hallucinations, her diagnosis was changed to probable DLB according to the clinical criteria for the diagnosis of DLB. 1 Instead of these drugs, 3 mg/day of donepezil was effective for the visual hallucinations, but parkinsonism appeared. Next, the dose was decreased to 1.5 mg/day and parkinsonism disappeared without recurrence of the visual hallucinations. However, the delusions and fluctuating cognitive decline continued. Therefore, donepezil was stopped temporarily to determine whether the visual hallucinations actually improved due to the low-dose donepezil. Subsequently, the visual hallucinations reappeared, however they disappeared again with the re-administration of 1.5 mg/day of donepezil. Therefore, the efficacy of low-dose donepezil was confirmed. No randomized controlled trials have been carried out concerning the efficacy and dosage of donepezil for DLB patients, so the sensitivity of donepezil for its efficacy remains unclear. However, according to a previous report, adverse events due to donepezil occur more often in DLB patients than AD patients. 2 The guidelines indicated that a dose-dependent exacerbation of extrapyramidal symptom (EPS) may occur with the administration of CHEI. 1 The EPS of a DLB patient worsens with the therapeutic dose of rivastigmine (7.5 mg/ day), which could be reversed by a dose reduction to 6 mg/ day. 3 In the current case, a dose-reduction of donepezil to 1.5 mg/day reversed the EPS. Therefore, titration to a low-dose treatment of donepezil might be useful in some DLB patients who show hypersensitivity to the standard dose of donepezil.

Insight and quality of life in long-term hospitalized Japanese patients with chronic schizophrenia

Psychiatry and Clinical Neurosciences, 2010

The aim of the study was to investigate the relationship between insight and quality of life (QOL... more The aim of the study was to investigate the relationship between insight and quality of life (QOL) and the respective predictive factors in long-term hospitalized patients with chronic schizophrenia. Methods: The present subjects were 47 Japanese patients with chronic schizophrenia who were hospitalized for >1 year (mean hospitalization period, 9.8 years). Assessments were made using the Scale of Unawareness of Mental Disorder (SUMD) and the EuroQoL-5 Dimensions (EQ-5D) scale. Sociodemographic details and illness-related variables were also evaluated, including use of the Positive and Negative Syndrome Scale. Results: There was no association between SUMD and EQ-5D scores. Hallucinatory behavior was a predictor of good insight. Poor rapport was a predictor of bad insight. Poor attention was a predictor of bad QOL. Conclusion: The relationship between insight and QOL and the respective predictive factors might be different between acute and chronic stages. Further studies are needed to investigate how these changes occur.

Effect of traditional Japanese herbal medicine toki-shakuyaku-san for mild cognitive impairment: SPECT study

Psychiatry and Clinical Neurosciences, 2007

Body Mass Index among Japanese Inpatients with Schizophrenia

The International Journal of Psychiatry in Medicine, 2006

Background: Many studies have emphasized the high frequency of obesity in schizophrenic patients.... more Background: Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population. Methods: The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey. Results: The mean patient BMI was 23.0 ± 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most ...

4．医療現場で直面している意思決定の課題について

Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics, 2013

Attitude toward dementia and preferences for diagnosis in Japanese health service consumers

BMC Health Services Research, 2021

Background Being diagnosed with dementia is a confronting experience for any individual and their... more Background Being diagnosed with dementia is a confronting experience for any individual and their caregiver. However, a diagnosis provides opportunity for future preparation for management of the condition. This study investigated attitudes toward dementia and preferences for diagnosis among a sample of health service consumers in Japan. Methods Participants were patients or accompanying support persons (n = 217) who visited the specialty outpatient clinic of four hospital departments. The survey was conducted using an iPad with answers sent automatically to a secure server. The survey included items about the participants’ most feared diseases and the reasons behind those fears, estimates of dementia prevalence in Japan, and preferences regarding a diagnosis of dementia and the reasons for their preference. Results The most feared disease was cancer (43.8 %), followed by dementia (18 %). Those selecting dementia most commonly reported practical, emotional and social impacts as the ...

The Economic Burden of Dementia: Evidence from a Survey of Households of People with Dementia and Their Caregivers

International Journal of Environmental Research and Public Health, 2021

Although a cognitive impairment such as dementia causes serious economic problems among older peo... more Although a cognitive impairment such as dementia causes serious economic problems among older people, its impact on economic activities is unclear. This study investigated the actual conditions of economic activities and the current status of the financial support systems among people with dementia and caregivers. One hundred and five dyads participated in the survey. Each dyad consisted of an older person with Alzheimer’s disease and their caregiver. The Mini-Mental State Examination (MMSE) and Functional Assessment Staging (FAST) were used to evaluate the cognitive functions of people with dementia. The caregivers were asked questions concerning the financial status of the household and their utilization of the financial support systems available to people with dementia. Average monthly care costs significantly increased according to the severity of dementia, while household income and spending incurred no significant changes. People with dementia experienced financial problems (i...