Objective: We investigated oxyhemoglobin change in the prefrontal cortex (PFC) of patients with obsessive–compulsive disorder (OCD) who showed different responses to pharmacotherapy during neuropsychological tasks with near-infrared spectroscopy. Subjects and methods: A total of 42 patients with OCD (mean age: 35.6±9.6 years, 14 men, 28 women) and healthy control subjects (mean age: 35.4±9.7 years, 13 men, 29 women) were selected. Patients with OCD were divided into three groups (responders to selective serotonin-reuptake inhibitors (SSRIs), responders to SSRIs with antipsychotics, and nonresponders to SSRIs and SSRIs with antipsychotics) based on pharmacological response. We investigated oxyhemoglobin change in the PFC of subjects during Stroop tasks and a verbal fluency test with near-infrared spectroscopy. Results: Responders to SSRIs showed smaller activation compared to control subjects during the Stroop incongruent task and verbal fluency test, but not during the Stroop congruent task. In contrast, responders to SSRIs with antipsychotics showed smaller activation compared to control subjects during all three tasks. Conclusion: Our results suggest that activation of the PFC during Stroop tasks might predict responses to pharmacotherapy of patients with OCD. Keywords: obsessive–compulsive disorder, pharmacotherapy, near-infrared spectroscopy, Stroop task, verbal fluency test
Background Selective serotonin reuptake inhibitors (SSRI) are established first-line pharmacological treatments for obsessive-compulsive disorder (OCD), while antipsychotics are used as an augmentation strategy for SSRI in OCD patients who have either no response or a partial response to SSRI treatment. The goal of the present study was to identify genetic variants and pathways that are associated with the long-term clinical response of OCD patients to SSRI or SSRI with antipsychotics. Methods We first performed a genome-wide association study of 96 OCD patients to examine genetic variants contributing to the response to SSRI or SSRI with antipsychotics. Subsequently, we conducted pathway-based analyses by using Improved Gene Set Enrichment Analysis for Genome-wide Association Study (i-GSEA4GWAS) to examine the combined effects of genetic variants on the clinical response in OCD. Results While we failed to detect specific genetic variants associated with clinical responses to SSRI or to SSRI with an atypical antipsychotic at genome-wide levels of significance, we identified 8 enriched pathways for the SSRI treatment response and 5 enriched pathways for the treatment response to SSRI with an antipsychotic medication. Notably, the calcium signaling pathway was identified in both treatment responses. Conclusions Our results provide novel insight into the molecular mechanisms underlying the variability in clinical response to SSRI and SSRI with antipsychotics in OCD patients.
RESTLESS LEGS SYNDROME (RLS) is characterized principally by leg paresthesia and motor restlessness. Some patients, however, occasionally have the same sensations in the arm, face and trunk as well as the leg.1-3 The initial symptom of RLS could be arm restlessness.4 We report a case of RLS with chest and back restlessness as the initial symptom. A 55-year-old healthy man with neither past nor family history of RLS or psychiatric diseases started to feel uncomfortable sensations in his back and chest. On that day he visited a physician and was hospitalized on suspicion of a thoracic disease. Physical examination was all within normal limits. He did not take any medicine. These symptoms deteriorated at night. He had severe insomnia. On day 2 or 3 the uncomfortable sensations extended to the arms and the legs. On day 7 he was referred to a psychiatrist. He impatiently complained of the creeping and itchy sensations of arms, legs, chest and back. He kept walking around in the waiting room, because these symptoms became relieved when he moved. Neurological examination showed no abnormality. We diagnosed the patient with RLS and prescribed clonazepam, which is known to relieve the symptoms of RLS.5 After he took a single dose of 0.5 mg that night, the next day all his symptoms disappeared. Brain magnetic resonance imaging (MRI) taken several days later showed no abnormality. He has been taking clonazepam (0.5 mg/day) and has remained symptom free for 1 year. The diagnosis of RLS is based primarily on the following four essential criteria of the International Restless Legs Syndrome Study Group: (i) desire to move the extremities, often associated with paresthesias/dysesthesias; (ii) motor restlessness; (iii) worsening of symptoms at rest with at least temporary relief by activity; and (iv) worsening of symptoms in the evening or night.6 This case fulfilled the diagnostic criteria, although the initial and predominating symptom occurred not in the legs but the chest and back. As far as we know, this is the first case in which initial symptoms occurred in the chest and the back. Even when uncomfortable sensations occur in any parts of the body, we might think about RLS as a differential diagnosis.
This study investigated the relationship between subjective and objective quality of life and assessed predictors in people with schizophrenia. The study population consisted of 99 stabilized outpatients with schizophrenia (DSM-IV) who had been regularly receiving outpatient treatment at the Department of Psychiatry, The Tokushima University Hospital. Subjective and objective quality of life were estimated using the Schizophrenia Quality of Life Scale and the Quality of Life Scale, respectively. Psychiatric symptoms were also measured with the Brief Psychiatric Rating Scale and the Calgary Depression Scale for Schizophrenia. Scores on the Schizophrenia Quality of Life Scale Motivation and Energy scales significantly correlated with the Quality of Life Scale total scores –.40 ( p <.001), and with the scores on Interpersonal Relations subscale –.42 ( p <.001), Instrumental Role subscale –.28 ( p = .005), Intrapsychic Foundations subscale –.39 ( p <.001), and Common Objects and Activities subscale –.25 ( p = .014). The Schizophrenia Quality of Life Scale Psychosocial scale significantly correlated with only the Quality of Life Scale total score –.20 ( p = .05), and there was no significant correlation between the scores on the Schizophrenia Quality of Life Scale Symptoms and Side-effects scales and the Quality of Life Scale. Stepwise regression analyses showed that the Calgary Depression Scale for Schizophrenia score was the most important predictor of each scale of the Schizophrenia Quality of Life Scale, and the Brief Psychiatric Rating Scale Negative Symptoms score was the most important predictor of the Quality of Life Scale total score and each subscale. These results suggest that subjective and objective quality of life have different predictors and should be considered as separate and complementary outcome variables.
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. J. Med. Invest. 67 : 236-239, August, 2020
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