The effect of lemborexant on insomnia in patients with psychiatric disorders: Detailed evaluation using the Athens Insomnia Scale.

Aim: Chronic insomnia disorder is common and associated with reduced quality of life. Benzodiazepine hypnotics are commonly prescribed for insomnia, but have potential side effects such as concentration impairment, somnolence, and dependence. Lemborexant (LEM) is an orexin receptor antagonist considered to have fewer side effects than benzodiazepine hypnotics. This study evaluated the effect of LEM on sleep in detail and examined whether benzodiazepine hypnotics can be gradually tapered by adding LEM. Methods: We retrospectively examined the effectiveness of LEM in 28 outpatients with insomnia. Insomnia symptoms were assessed using the Athens Insomnia Scale (AIS) before and after LEM administration. We also attempted to taper benzodiazepine hypnotics and assessed benzodiazepine dose using diazepam equivalents for some patients taking benzodiazepine hypnotics. Wilcoxon's signed-rank test was used for statistical analysis. Results: The mean AIS score was significantly improved after LEM treatment (8.7 ± 5.2 vs. 3.8 ± 3.3; P < 0.01). Among the AIS subitems, significant improvement was observed for six items: sleep induction, awakenings during the night, sleep quality, well-being, functioning capacity, and sleepiness during the day. The mean benzodiazepine dose was significantly lower after LEM treatment (4.6 ± 5.0 mg vs. 2.1 ± 3.3 mg; P < 0.01). Conclusions: This study indicated the potential of LEM for improving insomnia and reducing benzodiazepine dose.

Current research of idiopathic normal pressure hydrocephalus: Pathogenesis, diagnosis and treatment.

Idiopathic normal pressure hydrocephalus (iNPH) is caused by impaired cerebrospinal fluid absorption in the elderly; it is a surgically treatable form of dementia. Gait disturbance, dementia, and urinary incontinence are the triad of signs for iNPH. In addition to these clinical findings, imaging studies show characteristic ventricular enlargement. High Evans Index and 'disproportionately enlarged subarachnoid hydrocephalus' are other well-known imaging findings of iNPH. If the tap test shows improved symptoms, shunt surgery is performed. The disease was first described by Hakim and Adams in 1965, followed by the publication of the first, second, and third editions of the guidelines in 2004, 2012, and 2020, respectively. Recent studies signal the glymphatic system and classical cerebrospinal fluid (CSF) absorption from the dural lymphatics as aetiological mechanisms of CSF retention. Research is also underway on imaging test and biomarker developments for more precise diagnosis, shunting technique options with fewer sequelae and complications, and the influence of genetics. Particularly, the newly introduced 'suspected iNPH' in the third edition of the guidelines may be useful for earlier diagnosis. However, less well-studied areas remain, such as pharmacotherapy in non-operative indications and neurological findings other than the triadic signs. This review briefly presents previous research on these and future issues.

Pneumonia and seizures due to hypereosinophilic syndrome-organ damage and eosinophilia without synchronisation: A case report.

BACKGROUND: Hypereosinophilic syndrome (HES) is a condition characterized by increased eosinophil proliferation in the bone marrow, as well as tissue eosinophilia, often causing organ damage. The cause of the disease is unknown. Initial symptoms include fatigue, cough, shortness of breath, myalgia, angioedema, fever, and pneumonia. In addition to the respiratory symptoms, damage to the central nervous system can lead to severe seizures. Here, we report a case with pneumonia and complex partial seizures secondary to HES. CASE SUMMARY: A 94-year-old woman was admitted to our hospital for heart failure and bloody stools. After admission, she also showed symptoms of pneumonia. Non-contrast computed tomography of the chest showed pleural effusion and infiltrative shadows. Lower gastrointestinal endoscopy showed multiple ulcers in the sigmoid colon. Blood analyses showed marked eosinophilia (eosinophils 1760/mm3, total leukocytes 6850/mm3). Initial treatment with furosemide 20 mg/d and prednisolone 25 mg/d relieved these symptoms. However, the patient subsequently experienced localised epileptic seizures characterized by bilateral eyelid twitching and eyes rolling upwards, without generalized convulsions, and respiratory arrest occurred. Electroencephalography showed spikes and waves. Non-contrast magnetic resonance imaging of the brain showed extensive periventricular hyperintensity. With administration of levetiracetam 1000 mg/d the epileptic seizures disappeared. However, the patient's consciousness remained impaired, and her pneumonia worsened again. Two weeks later, she died of pneumonia. CONCLUSION: HES symptoms are variable and atypical, and the level and timing of eosinophilia and organ damage are often discordant.

A case report of an alcoholic with delirium tremens diagnosed with hypopharyngeal cancer: Psychiatrists played important roles in the smooth diagnosis and treatments.

Background: Alcohol use increases the risk of developing several types of cancer. Of these, hypopharyngeal cancer has one of the worst prognoses. Moreover, treating an alcoholic patient with hypopharyngeal cancer is often difficult. There are various treatments for hypopharyngeal cancer, including surgery, chemotherapy, and radiotherapy, depending on the state of the cancer and the patient's quality of life. Patients need physical, psychological, and social support in decision-making and post-treatment follow-up. This is especially true for alcoholic patients. Case Presentation: A 59-year-old man was admitted to our hospital with complaints of fatigue, loss of appetite, and tremor of the upper limbs. He was single, alcoholic, and had no family. After treatment for delirium tremens, he complained of throat pain. After endoscopy, magnetic resonance imaging, and examination with 18F-fluorodeoxyglucose positron emission tomography/computed tomography, he was diagnosed with Stage 4 A (T2 N2c M0) hypopharyngeal cancer. The psychiatrist and otolaryngologist discussed the patient's decision-making capacity and the various risks associated with treatment. Shared decision-making with the patient was considered most important in determining the treatment strategy. As a result, the patient decided to receive endoscopic laryngopharyngeal surgery in combination with lymphadenectomy, a challenging surgical treatment. The operation was successful, and the patient is now ready for a new life after discharge. Conclusion: Psychiatrists have a significant role to play in the oncological treatment of patients with alcoholism and other psychiatric disorders.

A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a common form of dementia that causes gait disturbance, cognitive impairment, and urinary incontinence. iNPH is a "treatable dementia" that can be treated with shunt surgery, but this can be ineffective in some cases and can be accompanied by complications. As a result, many patients with iNPH do not undergo surgery. However, there is insufficient evidence on effective treatments other than surgical therapy. Case Presentation: A 75-year-old woman presented to our hospital with a chief complaint of cognitive decline. She showed reduced motivation and inactivity. Brain magnetic resonance imaging showed a high score on the Evans Index (maximum width between bilateral lateral ventricular anterior horns/maximum intracranial cavity in the same slice). The subarachnoid space was enlarged at and below the Sylvian fissure, and narrowed at the higher arcuate region. She was diagnosed with iNPH. However, no shunt surgery was performed; 11 months later, she had a generalized convulsive seizure with loss of consciousness. An electroencephalogram showed generalized epileptic discharges. The possibility of surgery for her iNPH was ruled out. Levetiracetam prevented seizure recurrence and cognitive functions such as spontaneity and motivation were improved. Conclusion: It is often assumed that surgery is the only effective treatment for patients with iNPH. However, as in the present case, symptomatic epileptic seizures may be a factor in dementia. Even in the absence of surgical treatment, we should examine the cause of dementia in patients with iNPH and consider pharmacological treatment, including antiepileptic drugs.

Determination of Cloud-top Height through Three-dimensional Cloud Reconstruction using DIWATA-1 Data.

Cloud-top height is a useful parameter with which to elucidate cloud vertical growth, which often indicates severe weather such as torrential rainfall and thunderstorms; it is widely used in meteorological research. However, general cloud-top height estimation methods are hindered by observational and analytical constraints. This study used data from DIWATA-1, the Philippines' first microsatellite, to overcome these limitations and successfully produce sophisticated three-dimensional cloud models via stereo-photogrammetry. High-temporal snapshot 200-ms-interval imaging of clouds over Iloilo, Philippines, is performed. Two types of telescopes were used to capture 30 stereoscopic cloud images at ~60- and ~3-m ground sampling resolutions; these were used to construct three-dimensional cloud models with 40- and 2-m vertical resolutions, respectively. The imaged clouds have heights of 2.0 to 4.8 km, which is below freezing level for the Philippines and typical of stratocumulus and cumulus clouds. The results are validated using cloud-edge heights determined by measuring the distance from the clouds to their ground shadows. An RMSE of 0.32 km and a maximum difference of 0.03 km are found for the low- and high-resolution telescopes, respectively. For further validation, the results are compared with cloud-top heights estimated from HIMAWARI-8 images captured on the same day, yielding an average vertical difference of 0.15 km and a maximum difference of 1.7 km.