Reliability of the Two-dimensional Mood Scale for self-reported mood assessment by older adults with dementia.

The purpose of this study was to evaluate the reliability of the Two-dimensional Mood Scale (TDMS) for mood assessment among older adults with dementia. The study included 100 elderly patients with dementia admitted to two hospitals. For each mood state measured by the TDMS, the intraclass correlation coefficient of agreement (ICCagreement) was calculated to evaluate test-retest reliability. Scores corresponding to the minimal detectable change (MDC) in each mood state at the individual level (MDCind) was also calculated to evaluate measurement error, while McDonald's omega was calculated to evaluate internal consistency. The TDMS ICC was 0.54 for vitality, 0.74 for stability, 0.70 for pleasure, and 0.55 for arousal. The MDCind was 6.89 for vitality, 5.88 for stability, 9.96 for pleasure, and 4.11 for arousal. McDonald's omega ranged from 0.60 to 0.84. The TDMS has generally acceptable reliability for the self-assessment of mood states by older adults with dementia.

Effects of rhythmic auditory stimulation on gait speed in older adult inpatients in a convalescent rehabilitation ward: a pilot randomized controlled trial.

PURPOSE: To assess the impact of gait training with rhythmic auditory stimulation (RAS) on enhancing gait speed in older people admitted to a convalescent rehabilitation ward (CRW), compared to conventional gait training methods. METHODS: The study was designed as a single-center, open-label, pilot, randomized, parallel-group study. Thirty older people admitted to CRW were divided into two groups: the experimental group, which received gait training with RAS (n = 15, females = 53.3%, mean age = 83.9, SD = 6.5), and the control group, which underwent usual gait training (n = 15, females = 60.0%, mean age = 81.3, SD = 8.4). Regardless of their assigned group, all participants underwent 30 min training sessions, five times a week, for 3 weeks. The primary outcome was the 10 m walk test (10mWT), and the secondary outcomes included the Medical Outcome Study 8-Item Short-Form Health Survey and the Japanese version of the modified Gait Efficacy Scale. All measurements were taken at baseline and again at week 3. RESULTS: Results indicated that older people in CRWs in the experimental group showed significant improvements in their 10mWT (effect size - 1.02) compared to the control group. None of the secondary outcomes were significant. CONCLUSIONS: This study suggests the preliminary effectiveness and feasibility of a gait practice intervention using RAS in a CRW. TRIAL REGISTRATION: The University Hospital Medical Information Network (UMIN) Registered 1 October 2022 (UMIN000049089).

Habituation of Brain Activity with Repetition in Color and Picture-Word Stroop Tests.

As a widely used mental task for functional near-infrared spectroscopy (fNIRS), the original color-word Stroop task has the advantage of being difficult to habituate, but also the disadvantage of being difficult to understand, especially for children. While the introduction of derived Stroop tasks offers highly promising countermeasures, changes in brain activity during these tests have not been well tested. We investigated the degree of habituation between the original and a derived Stroop task by measuring brain activity to obtain a better fNIRS task design. Fourteen healthy adults participated in the study, and a 10-channel fNIRS device was used. A picture-word Stroop task with lower linguistic conflict than the original was conducted. The original and derived Stroop tests were repeated four times in a 1-week interval. We found that the original Stroop test did not show any significant changes in brain activity with repeated measures; however, brain activity decreased during the derived test. The differences in habituation between the original and derived tests may be due to the differences in the strength of the linguistic conflict. Our findings also highlight the need to consider the effects of habituation when using derived Stroop tasks in repeated measures.

Immediate Effects of Mobile Phone App for Depressed Mood in Young Adults with Subthreshold Depression: A Pilot Randomized Controlled Trial.

Background: Preventive interventions for subthreshold depression (StD) are essential to reduce the incidence of major depressive disorder. Our smartphone application presenting positive word stimulation in video (ie, Subliminal Priming with Supraliminal Reward Stimulation, SPSRS) was suggested to improve depressive symptoms in people with StD, although it is unclear whether it can immediately improve depressed mood. This pilot randomized controlled trial (RCT) aimed to investigate the preliminary efficacy of SPSRS application intervention on depressive mood in people with StD. Methods: Thirty-two participants with StD were randomly assigned to the experimental (n = 16) or control group (n = 16). The experimental group received SPSRS application intervention (10-minute video with positive word stimulation) and the control group received YouTube application intervention (10-minute video without positive word stimulation). Both groups used identical iPhones managed by the research team. The primary outcome was the change from baseline in depression-dejection on the Profile of Mood States 2nd Edition-Adult Short (POMS 2-A Short) after the intervention. Results: No participants dropped out of the study. The experimental group showed a small improvement in depression-dejection on the POMS 2-A Short score (adjusted Hedges's g = -0.32) compared to the control group. Post-hoc power analyses estimated a sample size of 56 per group (112 total) to evaluate depression-dejection on the POMS 2-A Short in a future full-scale RCT. Conclusion: SPSRS application intervention may be effective in immediately improving depressive mood in people with StD. A future full-scale RCT based on a formally calculated sample size should be conducted to replicate these findings.

Assessing the Smallest Detectable Change of the Kessler Psychological Distress Scale Score in an Adult Population in Japan.

Background: Psychological distress is prevalent worldwide and can lead to the development of mental conditions such as major depression and anxiety disorders. It is essential to assess the severity of patient-reported outcomes to provide effective treatment for psychological distress. The Kessler Psychological Distress Scale (K6) is one of the most widely used psychological distress scales. However, the smallest detectable change (SDC) of the K6 score has not been elucidated. Therefore, the current study aimed to determine the SDC of the K6 score in a Japanese adult population. Methods: Participants aged 20-59 years who are native Japanese speakers were recruited from the panel list of a web research firm. The K6 score was assessed at baseline (T1) and at 2-week follow-up (T2). SDCs were calculated at the individual (SDCind) and group (SDCgroup) levels. Intraclass correlation coefficient agreement (ICCagreement) was calculated to assess test-retest reliability and Cronbach's alpha to evaluate internal consistency. Results: A total of 3254 (1627 [50%] female) responded at T1 and T2. The mean (standard deviation) K6 scores were 5.71 (5.84) at T1 and 5.65 (5.83) at T2. The SDCind and SDCgroup of the K6 score were 8.47 (35.31%) and 0.15 (0.63%), respectively. The ICCagreement was 0.73, and the Cronbach's alpha was 0.94. Conclusion: Our study provided evidence on the reliability and interpretation of the K6 score. Calculating the SDC of the K6 score can help identify the significance of changes in psychological distress over time and can determine the efficacy of interventions for psychological distress.

Effect of gait training using rhythmic auditory stimulation on gait speed in older adults admitted to convalescent rehabilitation wards: A study protocol for a pilot randomized controlled clinical trial.

Background: Decreased walking speed in older patients admitted to convalescent rehabilitation wards (CRWs) is one of the factors that inhibit home discharge. Therefore, interventions to improve gait speed in older patients admitted to CRWs are important, and rhythmic auditory stimulation (RAS) may be an effective intervention strategy. However, the effect of RAS on gait speed in older patients admitted to CRWs is not well known. Therefore, this study protocol aims to determine the feasibility of the RAS-based gait practice for older patients admitted to the CRW. Methods: The study is designed as a single-center, open-label, pilot, randomized, parallel-group study. Participants will be 30 patients aged ≥65 years admitted to the CRW and randomly assigned to the experimental group (RAS-based gait practice; n = 15) or the control group (normal gait practice; n = 15). In both groups, interventions will be conducted for 30 min per session, 5 times per week for 3 weeks. The primary outcome is the change in the 10-m walk test 3 weeks after the baseline assessment. Secondary outcome is the change in the score of the Medical Outcome Study 8-Item Short-Form Health Survey and the Japanese version of the modified Gait Efficacy Scale from baseline assessment to 3 weeks later. Discussion: This exploratory RCT was developed using strict scientific standards and is based on defined protocols. Thus, this study will be used to assess the viability of a larger investigation into RAS-based gait practice. If our theory is accurate, this study could serve as a foundation for establishing RAS-based gait practice in CRWs as a common rehabilitation strategy. Trial registration: This study was registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan (UMIN000049089).

Differences in Center for Epidemiologic Studies Depression Scale, Generalized Anxiety Disorder-7 and Kessler Screening Scale for Psychological Distress Scores between Smartphone Version versus Paper Version Administration: Evidence of Equivalence.

The use of electronic patient-reported outcomes has increased recently, and smartphones offer distinct advantages over other devices. However, previous systematic reviews have not investigated the reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Kessler Screening Scale for Psychological Distress (K6) when used with smartphones, and this has not been fully explored. This study aimed to evaluate the equivalence of the paper and smartphone versions of the CES-D, GAD-7, and K6, which were compared following a randomized crossover design method in 100 adults in Gunma, Japan. Participants responded to the paper and smartphone versions at 1-week intervals. The equivalence of paper and smartphone versions was evaluated using the intraclass correlation coefficient (ICCagreement). The mean participant age was 19.86 years (SD = 1.08, 23% male). The ICCagreements for the paper and smartphone versions of the CES-D, GAD-7, and K6 were 0.76 (95% confidence interval [CI] 0.66-0.83), 0.68 (95% CI 0.59-0.77), and 0.83 (95% CI 0.75-0.88), respectively. Thus, the CES-D and K6 scales are appropriate for use in a smartphone version, which could be applied to clinical and research settings in which the paper or smartphone versions could be used as needed.

Hemodynamic changes in the right ventrolateral prefrontal cortex relate to the psychological mood profile.

Previous reports indicate that the right ventrolateral prefrontal cortex (VLPFC) is involved in emotional regulation. However, most such studies were performed under unphysiological conditions, like the administration of transcranial direct current or repetitive transcranial magnetic stimulation. We have shown that the right VLPFC is stimulated by an acute bout of daily activity, such as cleaning. Here, we investigated the relationship between the right VLPFC and mood changes using this system. Fourteen young adults vacuumed a floor as a cleaning task and kept a standing position as a control task on separate days. The oxyhemoglobin (oxy-Hb) and deoxy-hemoglobin (deoxy-Hb) signals of the prefrontal cortex were measured during the tasks. The mood scale scores of Profile of Mood States 2nd edition (POMS) and Two-Dimensional Mood Scale (TDMS) were measured before and after both tasks. The differences in subscale scores between pre- and post-tasks in both scales were calculated as ΔPOMS and ΔTDMS. The cleaning task significantly increased the oxy-Hb signal in the bilateral VLPFC and right frontopolar, but did not affect the deoxy-Hb signals. The control task significantly decreased the oxy-Hb signal in some brain regions. The Confusion-Bewilderment score in POMS changed after the cleaning task. Importantly, the oxy-Hb signal in the right VLPFC was negatively correlated with the ΔPOMS Confusion-Bewilderment score. The activity of the right VLPFC stimulated by the cleaning task might have a correlation with the Confusion-Bewilderment mood state.

Effects of Smartphone-Delivered Positive-Word Stimulation on Depressed Mood in People with Subthreshold Depression: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Major depressive disorder (MDD) is an important public health problem. Thus, preventive interventions against subthreshold depression (StD), which is one of the key risk factors for the development of MDD, are important. The study developed a smartphone application (SPSRS) that improves depressive symptoms in people with StD by automatically presenting positive word stimuli during videos. The SPSRS application has the potential to improve depressive symptoms in people with StDs. However, whether it can immediately improve depressed moods in people with StD is unclear. The study presents a protocol for investigating the immediate effects of the SPSRS application intervention on depressed mood in people with StD. METHODS: The study is designed as an open-label, parallel-group, and pilot randomized controlled trial (RCT). Thirty-two people who meet the criteria for StD (Beck Depression Inventory-II score of 10 points or more and fails to meet the diagnostic criteria for MDD) will be recruited and studied. It compares the immediate effects of the SPSRS application intervention (with positive word stimulus in a 10-minute video; n = 16) and YouTube application intervention (without positive word stimulus in 10-minute video; n = 16). The primary outcome is the change in the score for the Profile of Mood States 2nd Edition-Adult Short after 10 minutes of intervention. The secondary outcome is the change in the State-Trait Anxiety Inventory State after 10 min of intervention. DISCUSSION: The pilot RCT is the first to evaluate the immediate effects of the SPSRS application intervention on depressed mood in people with StD. The results are expected to provide a preliminary outcome of the immediate effect of the SPSRS application on the depressed mood of people with StD and aid in planning a full-scale trial. TRIAL REGISTRATION: ClinicalTrials.gov; Identifier: NCT03864484.

Night duty and decreased brain activity of medical residents: a wearable optical topography study.

BACKGROUND: Overwork, fatigue, and sleep deprivation due to night duty are likely to be detrimental to the performance of medical residents and can consequently affect patient safety. OBJECTIVE: The aim of this study was to determine the possibility of deterioration of cerebral function of sleep-deprived, fatigued residents using neuroimaging techniques. DESIGN: Six medical residents were instructed to draw blood from artificial vessels installed on the arm of a normal cooperator. Blood was drawn at a similar time of the day, before and after night duty. To assess sleep conditions during night duty, the participants wore actigraphy units throughout the period of night duty. Changes in cerebral hemodynamics, during the course of drawing blood, were measured using a wearable optical topography system. RESULTS: The visual analogue scale scores after night duty correlated negatively with sleep efficiency during the night duty (ρ = -0.812, p = 0.050). The right prefrontal cortex activity was significantly decreased in the second trial after night duty compared with the first (p = 0.028). The extent of [oxy-Hb] decrease, indicating decreased activity, in the right dorsolateral prefrontal cortex correlated negatively with the Epworth sleepiness score after night duty (ρ = -0.841, p = 0.036). CONCLUSIONS: Sleep deprivation and fatigue after night duty, caused a decrease in the activity of the right dorsolateral prefrontal cortex of the residents, even with a relatively easy routine. This result implies that the brain activity of medical residents exposed to stress on night duty, although not substantially sleep-deprived, was impaired after the night duty, even though they apparently performed a simple medical technique appropriately. Reconsideration of the shift assignments of medical residents is strongly advised. ABBREVIATIONS: DLPFC: Dorsolateral prefrontal cortex; ESS: Epworth sleepiness scale; PSQI: Pittsburgh sleep quality index; ROI: Regions of interest; VAS: Visual analogue scale; WOT: Wearable optical topography.

Persistent complex bereavement disorder: clinical utility and classification of the category proposed for Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

AIM: 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. METHOD: 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. RESULTS: 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 psychotic type with hallucinations as a major symptom. While studying PCBD, we took into account specific cultural characteristics of Japanese people and their present day social environment. CONCLUSIONS: Such cases would be suggestive when determining the PCBD clinical category in the future. PCBD is considered to be clinically very useful, especially in an extremely aged society as seen in developed countries, including Japan.

Actigraphy in Patients With Major Depressive Disorder Undergoing Repetitive Transcranial Magnetic Stimulation: An Open Label Pilot Study.

BACKGROUND: The effects of repetitive transcranial magnetic stimulation (rTMS) on physical activity and sleep patterns in individuals with major depressive disorder (MDD) remain unclear. METHOD: We examined the effects of rTMS treatment on the rest-activity cycle and sleep disturbances in MDD. In this open-label pilot study, 14 patients with medication-resistant MDD underwent 10 rTMS sessions over the bilateral dorsolateral prefrontal cortex. In addition to Hamilton Depression Rating Scale and Pittsburgh Sleep Quality Index scores, waist actigraphy was used to evaluate alterations in the rest-activity cycle over the course of rTMS treatments. Actigraphic data were evaluated at baseline and in the first (rTMS sessions 1-3), second (rTMS sessions 4-7), and third (rTMS sessions 8-10) sections. RESULTS: Although Hamilton Depression Rating Scale and Pittsburgh Sleep Quality Index scores were significantly improved by rTMS, sleep variables assessed by actigraphy did not show significant changes. However, post hoc tests indicated a significant increase in mean steps per day between the baseline and first section time points (P = 0.014; t13 = -2.316). CONCLUSIONS: Our data indicated that a daytime physical activity response to rTMS occurred in early sessions, whereas subjective symptom improvements were consistent across all sessions. Future double-blind placebo-controlled studies assessing the effects of rTMS on the rest-activity cycle and sleep disturbances in MDD are warranted.

Sleep complaints are associated with reduced left prefrontal activation during a verbal fluency task in patients with major depression: A multi-channel near-infrared spectroscopy study.

BACKGROUND: Recent studies have indicated the potential clinical use of near-infrared spectroscopy (NIRS) as a tool for assisting in the diagnosis of major depressive disorder (MDD). Although sleep complaints are often manifested in MDD, no study has elucidated the possible association between the objective evaluation of sleep and NIRS signals in MDD. METHODS: Fourteen patients with MDD and 15 healthy controls wore waist actigraphy equipment before the NIRS scan to investigate sleep parameters. We performed a 52-channel NIRS scan and measured changes in oxygenated hemoglobin ([oxy-Hb]) during a verbal fluency task. RESULTS: In patients with MDD, a significant negative correlation was observed between the 17-item Hamilton Depressive Rating Scale score and cerebral reactivity of the right temporal region (ps:=-0.804 to -0.762; FDR-corrected; p=0.008-0.012). The Pittsburgh Sleep Questionnaire Index, which enables assessment of continuous sleep quality and disturbances, was negatively correlated with [oxy-Hb] changes in the left prefrontal cortex (ps=-0.630 to -0.551; FDR-corrected; p=0.043-0.048). Actigraphic sleep variables prior to the NIRS measurement showed no significant correlation with [oxy-Hb] changes. LIMITATIONS: The limitations were small sample size with the low severity of depression and the use of actigraphy for only one night. CONCLUSION: Self-rated sleep disturbance were associated with decreased left prefrontal reactivity during a verbal fluency task in patients with MDD. Our result indicates that the reactivity of the prefrontal region is susceptible to sleep complaints, providing further evidence to support potential clinical application of NIRS.

Jogging Therapy for Hikikomori Social Withdrawal and Increased Cerebral Hemodynamics: A Case Report.

Severe social withdrawal, called hikikomori, has drawn increased public attention. However, an optimal clinical approach and strategy of treatment has not been well established. Here, we report a case of hikikomori for which an exercise intervention using jogging therapy was effective, showing cerebral hemodynamic improvement. The patient was a 20 year old Japanese male who was hospitalized in order to evaluate and treat severe social withdrawal. Although depressive and anxiety symptoms partially subsided with sertraline alone, social withdrawal persisted due to a lack of self confidence. With his consent, we implemented exercise therapy with 30 minutes of jogging three times a week for three months. We did not change the pharmacotherapy, and his social withdrawal remarkably improved with continuous jogging exercise. Using near infrared spectroscopy to evaluate hemodynamic alteration, bilateral temporal hemodynamics considerably increased after the three-month jogging therapy. Regarding exercise therapy for mental illness, numerous studies have reported the effectiveness of exercise therapy for major depression. This case implied, however, that the applicability of exercise therapy is not limited to major depressive disorder. Jogging therapy may contribute to reinforcing self confidence associated with "resilience" in conjunction with neurophysiological modulation of neural networks.

[Effects of psychological distress due to the Great East Japan Earthquake, tsunami, Fukushima Nuclear Power Plant disasters on psychiatric symptoms in patients with mental disorders: observational studies in Tochigi].

BACKGROUND: 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. METHODS: 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. RESULTS: The conditions of 22% of the outpatients had been worsened by the psychological distress related to the earthquake. Seven percent of the patients who had been hospitalized showed marked exacerbations due to the psychological distress associated with the disaster. COMMENTS: It is of note that the exacerbation of psychiatric symptoms due to the disaster was evident among patients with mental disorders who lived even at the edge of the disaster area (i. e., subject to an earthquake intensity of 5 upper and 150 km from the Fukushima Nuclear Power Plant). The results suggest that the close follow-up of disaster victims with mental disorders is of critical importance.

Relation between parametric change of the workload and prefrontal cortex activity during a modified version of the 'rock, paper, scissors' task.

BACKGROUND/AIMS: Modified rock, paper, scissors (RPS) tasks have previously been used in neuroscience to investigate activity of the prefrontal cortex (PFC). In this study, we investigated hemodynamic changes in the PFC using near-infrared spectroscopy (NIRS) during a modified RPS task in which each subject's successful performance rate was equalized; the workload was increased parametrically in order to reveal the resulting pattern of PFC activation. METHODS: The subjects were 20 healthy adults. During RPS, the player uses hand gestures to represent rock, paper, and scissors. Rock beats scissors, paper beats rock, and scissors beats paper. In the modified RPS task, the player is instructed to lose intentionally against the computer hand; the computer goes first and the player follows. The interstimulus interval (ISI) level was adjusted with 11 steps. If the level rose, the ISI decreased and the workload increased parametrically. The maximal level (maxLv: the shortest ISI and the biggest workload) in which a subject could perform the task correctly was determined for every subject during rehearsal of the task prior to the experiment. Lowering the level from the maxLv made the task easier. Hemodynamic changes were measured by NIRS over 4 task levels (maxLv-3, maxLv-2, maxLv-1 and maxLv). RESULTS: The hemodynamic changes in the left lateral PFC and bilateral Brodmann area 6 rose significantly with the increase in workload and presented a linear trend. CONCLUSION: These results suggest that PFC activation may linearly increase with increased workload during a modified RPS task in which successful performance rates of subjects are equalized.

Cognitive and psychological reactions of the general population three months after the 2011 Tohoku earthquake and tsunami.

BACKGROUND: The largest earthquake on record in Japan (magnitude 9.0) occurred on March 11, 2011, and the subsequent tsunami devastated the Pacific coast of Northern Japan. These further triggered the Fukushima I nuclear power plant accidents. Such a hugely complex disaster inevitably has negative psychological effects on general populations as well as on the direct victims. While previous disaster studies enrolled descriptive approaches focusing on direct victims, the structure of the psychological adjustment process of people from the general population has remained uncertain. The current study attempted to establish a path model that sufficiently reflects the early psychological adaptation process of the general population to large-scale natural disasters. METHODS AND FINDINGS: Participants from the primary disaster area (n = 1083) and other areas (n = 2372) voluntarily participated in an online questionnaire study. By constructing path models using a structural equation model procedure (SEM), we examined the structural relationship among psychological constructs known related to disasters. As post-traumatic stress symptoms (PTS) were significantly more present in people in the primarily affected area than in those in secondary- or non-affected areas, the path models were constructed for the primary victims. The parsimoniously depicted model with the best fit was achieved for the psychological-adjustment centered model with quality of life (QoL) as a final outcome. CONCLUSION: The paths to QoL via negative routes (from negative cognitive appraisal, PTS, and general stress) were dominant, suggesting the importance of clinical intervention for reducing negative cognitive appraisal, and for caring for general stress and PTS to maintain QoL at an early stage of psychological adaptation to a disaster. The model also depicted the presence of a positive route where positive cognitive appraisal facilitates post-traumatic growth (PTG) to achieve a higher QoL, suggesting the potential importance of positive psychological preventive care for unexpected natural disasters.

[Two cases of schizophrenia presenting with 'solar experience': the 'polysolar experience' and its progression].

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 Illness (original German title: Denkwürdigkeiten eines Nervenkranken), Daniel Paul Schreber described that he saw two suns. In this paper, the authors report two patients with schizophrenia who presented with a solar experience. Patient 1 was a man in his early forties. Fourteen years before his 'polysolar experience', he had attempted suicide, developed stupor, and was diagnosed with depression. However, he sometimes exhibited cenestopathy. Three years before the experience, he developed catatonic stupor and auditory hallucinations, and his diagnosis was changed to schizophrenia. After two months of hospitalization, the patient, in partial remission, was discharged. Ten months later, he saw two fragments tumble down from the sun, which he described as sons of the sun. Thereafter, his behavior became erratic, which led to a third hospitalization. In the recovery phase, the patient drew a picture of a large sun covering the entire piece of drawing paper and another of the sun set in scenery. Patient 2 was a married woman in her late thirties. She developed delusions of persecution during high school. She managed to cope with the delusions over the next several years, until she experienced an acute psychotic episode while studying in an Asian country. After returning to Japan, she began treatment for schizophrenia. Her first marriage failed, and she later experienced marital problems in her second marriage. She hoped that having a baby would solve these problems, but neuroleptic-induced hyperprolactinemia made her infertile. She stopped taking the neuroleptics and had delusions, including that she was loved by the Crown Prince of Japan and that they would be married, and that her husband was an imposter and assassin. During a 4-month period of hospitalization, she repeatedly drew pictures of multiple suns. In the recovery phase, she drew the sun set in scenery but assigned it a specific area set apart from the rest of the picture. The solar experience of Patient 1 follows a relatively typical course which Miyamoto schematized. The patient's experience of a fragmented sun is equivalent to the fall or death of the sun, and was thought to occur in the transition between the first and second stages of the progression of the solar experience. The polysolar drawings of Patient 2 were also produced in the period between the first and second stages, where the multiple suns might signify the patient's ideal partner among many imposters.

[Acupuncture treatment for a patient with prolonged consciousness disturbance after a brain tumor surgery].

Acupuncture has long been applied as a therapeutic technique in China, Japan, Korea and other countries. Recently, its application began to be extended to the treatment of neural disorders. We experienced a 13-year-old boy with prolonged consciousness disturbance after a pineal tumor surgery and muscle contracture of lower extremity by long-term recumbency. We applied him acupuncture treatment for 4 months which was effective to alleviate these symptoms. Repeated IMP SPECT showed improvement of the cerebral blood flow (CBF) during the course of acupuncture therapy. Acupuncture was effective to improve prolonged coma after a brain surgery and also muscle contracture by long-lasting recumbency. CBF showed a slight increase along with the recovery of consciousness suggesting a strong relevance between CBF and improvement of these symptoms.

Alterations in prefrontal cortical activity in the course of treatment for late-life depression as assessed on near-infrared spectroscopy.

AIM: To evaluate the severity of depression by measuring alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy. METHODS: Ten of 27 subjects hospitalized for late-life depression from May 2006 to June 2007, were examined. In these 10 subjects changes in hemoglobin concentration were measured on near-infrared spectroscopy during two types of the rock, paper, scissors game as the cognitive tasks affecting prefrontal cortical activity on 2 days, including 1 day on which depressive symptoms had slightly improved due to treatment, and then on another day >4 weeks later. Severity of depression and cognitive impairment were also simultaneously assessed. RESULTS: The change in oxygenated hemoglobin concentration during a difficult task (intentional loss task) was significantly larger than that during an easy task (try to win task) on the left side (left, P = 0.010; right, P = 0.059). On the left side there was a significant negative correlation between the ratio of oxygenated hemoglobin measurements on the second day to those on the first day, and the severity of depression on the second day (left, P = 0.012; right, P = 0.090). Thus, the more left prefrontal cortical activity tended to increase, the fewer depressive symptoms tended to be present on the second day of testing. CONCLUSIONS: Measuring of alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy, is feasible in subjects with depression.