Papers by Toshiyuki Kobayashi
Psychogeriatrics, 2012
We report on rare side effects of paroxetine. A 67-year-old female patient who had been suffering... more We report on rare side effects of paroxetine. A 67-year-old female patient who had been suffering from prolonged depression for over a year but had not received appropriate treatment was administered 20-mg paroxetine daily. However, the patient required hospital admission after 16 days because of behavioural disturbances and delusions that she was being chased by evil persons from a religious group. The delusions were ultimately confirmed to be serial nightmares and an oneiroid state. The nightmares gradually disappeared following discontinuation of paroxetine. The Adverse Drug Reaction Probability Scale showed a score of 6 (probable). Reports on paroxetine-induced nightmares are rare, and there is a possibility that, in this case, parexetine caused the nightmares in association with depression and assumed underlying brain dysfunction due to ageing.
Internal Medicine, 1993
Intestinal pseudoobstruction and pneumatosis cystoides intestinalis are uncommon complications of... more Intestinal pseudoobstruction and pneumatosis cystoides intestinalis are uncommon complications of progressive systemic sclerosis. Wereport a 26-year-old womanwith this disorder who responded poorly to conventional treatment. Subcutaneous administration of octreotide, a longacting somatostatin analogue, at a dose of50 J^g/day for 3 weeks, relieved symptoms such as nausea and bloating. There was also a markeddecrease of intestinal gas accumulation, as documentedon X-ray films.
Journal of Psychology & Clinical Psychiatry, 2014
Endogenous juvenile-asthenic failure syndrome (EJ-AFS; Glatzel and Huber, 2 three core features o... more Endogenous juvenile-asthenic failure syndrome (EJ-AFS; Glatzel and Huber, 2 three core features of which are cenesthopathy, alienation, and thought disorder, develops at a young age and is considered to be the initial stage or an abortive form of schizophrenia. It is rarely been discussed in the English-language literature, however, a number of cases have been continuously reported in Japan. In this paper, a case study is presented of a patient who showed the psychopathology of EJ-AFS early on and progression to severe personality and social dysfunction 30years later. From the 21 reported cases in Japan, an overall trend was observed of the symptoms remaining unchanged or improving somewhat, but persisting, in most cases. Only 3 of the cases had been followed for more than 10years. The present case leads us to reexamining the concept of EJ-AFS and to consideration of long-term course of an attenuate form of schizophrenia.
自治医科大学紀要 Jichi Medical University Journal, 2013
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, Jan 18, 2016
Persistent complex bereavement disorder (PCBD) was proposed as a bereavement-related clinical cat... more Persistent complex bereavement disorder (PCBD) was proposed as a bereavement-related clinical category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, which included the disorder among conditions for further study. This is an independent clinical category in which intense yearning for the deceased continues for at least 12 months. However, the diagnostic features are still inconclusive. We suggest a variation of PCBD for making category from our clinical experiences. We presented two representative case studies in which grief caused by bereavement was observed as the root of the pathological condition. We examined the disorder's pathological conditions, diagnoses, and appropriate treatments based on the cases we experienced. Both cases involved elderly women who lost their spouse through illness and experienced prolonged grief for an extended period, resulting in hospital admission. Based on the two cases, we believe that PCBD can also include a psycho...
ombining retrospectively investigated duration of untreated psychosis (DUP) and data from the pre... more ombining retrospectively investigated duration of untreated psychosis (DUP) and data from the previously reported 13-year outcome study of first-admission schizophrenic patients treated in Jichi Medical University Hospital, relationship between DUP and 13-year outcome was examined. The mean DUP of 62 identified patients with schizophrenia was 8.7 months, and the median was one month. The 47 followed-up subjects were divided into two groups according to their rating on Eguma's Social Adjustment Scale: a favorable outcome group and an unfavorable outcome group. In addition, they were divided into other two groups according to length of DUP (cutoff point was two weeks): a brief DUP group and a long DUP group. However, no statistically significant relationship between both couple of groups was found, the long DUP patients tended to belong to the unfavorable group.
Psychogeriatrics, 2004
Three elderly females with commentary hallucinations are presented. Here, the term 'commentary ha... more Three elderly females with commentary hallucinations are presented. Here, the term 'commentary hallucination' is used as a comprehensive term describing a condition where the subject hears voices that comment on, command, or describe the subject's actions or behavior. According to the DSM-IV, the three cases presented here met the criteria for a psychotic disorder not otherwise specified, a schizoaffective disorder, and schizophrenia, respectively. All three cases showed no evidence of abnormalities when examined using neuroimaging techniques but might have had some senile brain changes that were under the threshold of the neuroimaging studies. Although the commentary hallucinations in the three patients were not distinctively different from the hallucinations that are characteristic of schizophrenia, the subjects were able to keep some distance from the hallucinations; in other words, the hallucinations were not ego-invasive. The commentary hallucinations in the present patients might be explained as resulting from exhaustion caused by stressful life events, subtle senile organic brain changes, and a subsequent decline in psychological tension. These hallucinations may have originated from the pathological appearance of a background-inner speech accompanying the patients' behavior.
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Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2008
Psychiatric symptoms are often manifested in verbal expression. Generally, the contents of such e... more Psychiatric symptoms are often manifested in verbal expression. Generally, the contents of such expression are pathological. The formal abnormalities of speech are also observed in various mental disorders, as far as quantitative abnormalities are concerned. However, disturbance of intonation, namely disprosody, is more commonly observed in organic disorders of the brain. When the accent of words and the intonation of sentences changes from that of a native speaker, the speech sounds like the broken language of untrained foreigners. Such foreign accent syndrome is usually an issue of neuropsychology. In this paper, the authors report a case of foreign accent syndrome without organic brain syndrome. The patient was a 44-year-old woman, who developed panic disorder about year after her father's death. Then she developed aphonia. After aphonia was resolved, she began to speak haltingly as if a Chinese woman was trying to speak Japanese. Organic brain diseases were subsequently excl...
Psychiatry and clinical neurosciences, Jan 23, 2015
The aim of this study was to evaluate differences in vulnerability to traumatic stress and the 1-... more The aim of this study was to evaluate differences in vulnerability to traumatic stress and the 1-year course of post-traumatic stress symptoms among patients with pre-existing psychiatric disorders after the Great East Japan Earthquake. The Impact of Event Scale-Revised (IES-R) was used to assess post-traumatic stress symptoms in 612 patients with schizophrenic (ICD-10 F2; n = 163), mood (F3; n = 299), or neurotic disorders (F4; n = 150) at 1-4 months and again at 13-16 months after the disaster (retention rate: 68%). The mean IES-R total score for all diagnostic groups was 18.6 at index and 13.4 at follow up. The mean IES-R total score for patients with neurotic disorders (22.5) was significantly higher than that of patients with mood disorders (18.1) and schizophrenic disorders (15.9). At follow up, these scores decreased for all groups and inter-group differences were not observed. Vulnerability to traumatic stress after a disaster was most severe in patients with neurotic disord...
Case reports in psychiatry, 2014
Mental capacity is a central determinant of patients' ability to make autonomous decisions ab... more Mental capacity is a central determinant of patients' ability to make autonomous decisions about their care and deal with bad news. Physicians should be cognizant of this when giving patients bad news in efforts to help them to cope with the illness and to avoid a deterioration of their mental well-being. To show the importance of this concept, a case of suicide attempt with lung cancer is exemplified. A 76-year-old woman attempted suicide after receiving a diagnosis of lung cancer. Her recent life had been emotionally turbulent and she did not have sufficient mental capacity to accept and cope with this truth. She developed depression before attempting suicide.
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, 2014
The length of hospital stay (LOHS) for elderly patients tends to be long. We aimed to identify fa... more The length of hospital stay (LOHS) for elderly patients tends to be long. We aimed to identify factors related to long hospitalization periods for elderly Japanese patients with late-onset depression. We retrospectively examined 133 patients with late-onset depression. Univariate and multivariate analyses were performed to confirm the relationship between each clinical feature and the duration of hospital stay. The mean LOHS was 83.9 ± 55.6 days. On the basis of univariate analysis, we found that living as a housewife, death of a close relative or friend, recurrent depression, melancholic features, and treatment with electroconvulsive therapy, tricyclic or tetracyclic antidepressants or mood stabilizer were associated with a longer LOHS. Multivariate analysis showed that treatment with tricyclic or tetracyclic antidepressants, atypical antipsychotics were associated with prolonged LOHS. These results suggest that job status, changes in household circumstances and the failure of init...
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2013
We report the case of a woman in her late twenties with anorexia nervosa who was difficult to tre... more We report the case of a woman in her late twenties with anorexia nervosa who was difficult to treat both psychologically and physically because she resisted being treated despite presenting with various and severe physical complications, such as a refractory tracheoesophageal fistula. On admission, she weighed 24.8 kg and her body mass index was 9.6 kg/m2. Treatment on a medical ward was not possible due to her resistance to being fed and repeated secretive and deviant behaviors. Therefore, she was treated mainly on a psychiatric ward, with a psychiatrist as the attending doctor. After hospitalization for more than 3 years, she had sufficiently recovered to leave the hospital. She was discharged weighing 37.7 kg and her body mass index was 14.5 kg/m2. As physical complications, the patient manifested with a tracheoesophageal fistula, duodenal bulb perforation, and tension pneumothorax, which were considered to reflect the vulnerability of the intrapleural and intraperitoneal soft ti...
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2013
The Great East Japan Earthquake and subsequent tsunami of March 11, 2011 severely damaged a wides... more The Great East Japan Earthquake and subsequent tsunami of March 11, 2011 severely damaged a widespread region of northeastern Japan. Consequently, the Fukushima Nuclear Power Plant experienced a level seven 3 reactors melted down, which released a large amount of radioactive materials into the air. Due to the structural damage and radiation leaks, the victims are facing prolonged psychological distress. Eighty-two subjects with mental disorders who made their initial visit during the first 4 months after the earthquake and one hundred and ninety-four subjects with mental disorders who had been admitted during the first one year after the earthquake to the Jichi Medical University Hospital, which is located at the edge of the disaster-stricken region, were recruited for this study. Enrolled participants were assessed according to ICD-10. A questionnaire survey was employed to evaluate the severity of psychological distress and total amount of damage. The conditions of 22% of the outp...
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2011
We report the case of an adolescent male who presented with mutism, immobility, catalepsy, and ma... more We report the case of an adolescent male who presented with mutism, immobility, catalepsy, and mannerisms. The patient was admitted to our hospital with suspected catatonic schizophrenia; however, he was subsequently diagnosed with catatonia due to Asperger's disorder. The patient was a 16-year-old male. More than six months before presentation, his grandfather displayed bizarre and violent behavior. Subsequently, he began to experience catatonia, which eventually led to hospitalization. Treatment with diazepam improved his condition and, as no causal disorders other than Asperger's disorder were identified, he was diagnosed with catatonia. The patient had experienced persistent abuse by his mother during childhood; therefore, it is important to consider reactive attachment disorder (DSM-IV-TR) as a differential diagnosis. Among child and adolescent psychiatrists, catatonia is considered to occur at a high frequency among patients with autistic spectrum disorders. In contras...
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, 2010
The Japanese herbal medicine, yokukansan, has been reported to improve behavioral and psychologic... more The Japanese herbal medicine, yokukansan, has been reported to improve behavioral and psychological symptoms of dementia and activities of daily living in patients with dementia. In the present case report, the authors report the effectiveness of yokukansan in treating psychiatric symptoms after traumatic brain injury. An 85-year-old man, who underwent surgery for hepatic portal cholangiocarcinoma, sustained traumatic brain injury after falling from bed as the result of postoperative delirium. He subsequently presented with psychiatric symptoms, showing markedly impulsive and aggressive behavior. Neuroleptics did not alleviate the symptoms. Ultimately, we succeeded in controlling the symptoms, without adverse effects, by giving the patient yokukansan. Yokukansan shows the potential for reducing aggressive and impulsive behavior in dementia as well as in other psychiatric diseases.
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2010
The 'solar experience' as an abnormal experience of schizophrenia in which patients direc... more The 'solar experience' as an abnormal experience of schizophrenia in which patients directly experience the sun itself was first described by Miyamoto in 1974. Patients have delusions of the sun dying, hallucinations of the sun, and even believe that they become the sun. The patient may draw pictures of the sun similar to Edvard Munch's famous painting "The Sun". Miyamoto explained the progression of the solar experience as follows: (1) in the early stage of schizophrenia, patients believe that the sun falls or dies; (2) in the midst of the illness, they occupy the position of the sun in their delusions; and (3) in the recovery stage, they see or draw the sun against a scenic background, indicating that they no longer perceive themselves to be at the center of the world. Because of the absolute centrality of the sun, Miyamoto noted that the patient never experiences multiple suns (a 'polysolar experience'). However, in his book Memoirs of My Nervous Ill...
Psychosomatics, 2015
ABSTRACT Objective To report a case of anorexia nervosa with an acquired tracheoesophageal fistul... more ABSTRACT Objective To report a case of anorexia nervosa with an acquired tracheoesophageal fistula due to intubated mechanical ventilation. Patients The patient was a 28-year-old female with anorexia nervosa who developed a perforated duodenal ulcer and thereafter required intensive care. A tracheoesophageal fistula induced by endotracheal cuff-related trauma developed after about 1 month’s intubation on mechanical ventilation. Results It took about three years to improve her general and nutritional status required for the mediastinal surgical procedure because the patient had a very poor nutritional status and was reluctant to gain weight. Finally, surgical repair of the tracheoesophageal fistula was performed with no complications. Conclusions Anorexia nervosa patients tend to have predisposing factors for acquired tracheoesophageal fistula and might have soft tissue vulnerability, which warrant special caution and attention when they are intubated on mechanical ventilation. Difficulties in improving the general and nutritional status of these patients may arise. Psychiatrists should facilitate the treatment of medical complications by assessing the patient both physically and psychologically and suggesting an appropriate treatment plan.
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2006
Some researchers in Europe, America and Oceania have recently reported that the incidence of schi... more Some researchers in Europe, America and Oceania have recently reported that the incidence of schizophrenia is declining. We investigated changes in the proportion of schizophrenic patients to the total number of patients in two Japanese hospitals during the last decade. The subjects were patients who first consulted the psychiatric clinic of Jichi Medical School or the psychiatric clinic of Kamitsuga General Hospital between December 1993 and November 1994 or between December 2003 and November 2004. Both clinics accepted new patients without prior appointments. Patients were classified using ICD-10 criteria (F0-F9, G40). The sex distribution of the patients and the mean age at first contact were compared for the two time periods. The proportion of schizophrenia (F2 in the ICD-10 criteria) to the total number of patients was compared for the two time periods after standardizing the populations with regard to age using the "1985 model population in Japan." A decade ago, 398 ...
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2005
Recently, selective serotonin reuptake inhibitors (SSRI) have been frequently used as the first c... more Recently, selective serotonin reuptake inhibitors (SSRI) have been frequently used as the first choice of antidepressants because of their safety in comparison with tricyclic antidepressive agents (TCA). On the other hand, when SSRIs are not effective, they are frequently replaced with another antidepressant. In that case, a small dose of a TCA is often added without cross tapering. We report two elderly patients with depression who exhibited markedly low blood pressure when a small dose of a TCA was added to a SSRI. The combination of a SSRI and a TCA can be hazardous because it can cause unexpected adverse effects especially in elderly patients.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2001
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Papers by Toshiyuki Kobayashi