RESUMO
Background: The severity of antipsychotic-induced cervical dystonia has traditionally been evaluated visually. However, recent advances in information technology made quantification possible in this field through the introduction of engineering methodologies like machine learning.Methods: This study was conducted from June 2021 to March 2023. Psychiatrists rated the severity of cervical dystonia into 4 levels (0: none, 1: minimal, 2: mild, and 3: moderate) for 101 videoclips, recorded from 87 psychiatric patients receiving antipsychotics. The Face Mesh function of the open-source framework MediaPipe was employed to calculate the tilt angles of anterocollis or retrocollis, laterocollis, and torticollis. These were calculated to examine the range of tilt angles for the 4 levels of severity of the different types of cervical dystonia.Results: The tilt angles calculated using Face Mesh for each level of dystonia were 0° ≤ θ < 6° for none, 6° ≤ θ < 11° for minimal, 11° ≤ θ < 25° for mild, and 25° ≤ θ for moderate laterocollis; 0° ≤ θ < 11° for none, 11° ≤ θ < 18° for minimal, 18° ≤ θ <25° for mild, and 25° ≤ θ for moderate anterocollis or retrocollis; and 0° ≤ θ < 9° for none, 9° ≤ θ < 17° for minimal, 17° ≤ θ < 32° for mild, and 32° ≤ θ for moderate torticollis.Conclusion: While further validation with new cases is needed, the range of tilt angles in this study could provide a standard for future artificial intelligence devices for cervical dystonia.
Assuntos
Antipsicóticos , Torcicolo , Humanos , Torcicolo/induzido quimicamente , Torcicolo/tratamento farmacológico , Antipsicóticos/efeitos adversos , Inteligência ArtificialRESUMO
The Inventory of Depressive Symptomatology, clinician version (IDSC), was developed by Rush et al. to evaluate the severity of major depressive episodes. The aim of the present study was to establish the interrater reliability of the Japanese version of the IDSC. A total of 16 subjects with DSMIV major depressive episode were evaluated. Two psychiatrists, who had completed a training session for evaluating the IDSC before starting this reliability study, attended systematic interview sessions with each subject to evaluate the IDSC independently, using the Japanese version of the structured interview guide for combined rating of the IDSC and the Hamilton Depression Rating Scale. The severity of the 30 IDSC items assessed by the two raters ranged from 0 to 4 for 27 items and from 0 to 3 for 3 items. The analysis of variance intraclass correlation interrater reliability values for the individual scale items ranged from 0.874 to 1.000. The present results suggest that the Japanese version of the IDSC is a potentially useful rating instrument with high interrater reliability for measuring the severity of depressive symptoms in the hands of psychiatrists with sufficient evaluation training.
Assuntos
Povo Asiático/etnologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etnologia , Escalas de Graduação Psiquiátrica/normas , Índice de Gravidade de Doença , Povo Asiático/psicologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos TestesRESUMO
AIMS: The aim of the present study was to develop a subscale of the Positive and Negative Syndrome Scale (PANSS) that would be brief and sensitive to changes in the clinical features of schizophrenia (i.e. the Brief PANSS, or bPANSS). METHODS: The PANSS before and after treatment, and the Clinical Global Impression-Change (CGI-C) was rated for 714 schizophrenia patients. Of these, Clinical Global Impression-Severity (CGI-S) was also evaluated in 30 of these patients. The bPANSS items were extracted from full PANSS items based on the following aims: (i) to develop a brief scale; (ii) to develop a scale sensitive to changes resulting from antipsychotic treatment; and (iii) to reflect the broad spectrum of schizophrenia symptoms. RESULTS: The following six items were extracted to serve as the bPANSS: delusion, suspiciousness, emotional withdrawal, passive/apathetic social withdrawal, tension, and unusual thought content. The coefficients of correlation between the bPANSS and full PANSS before and after treatment were 0.86 and 0.92, respectively (both P < 0.001). The coefficient of correlation between the degrees of change in the scores for the bPANSS and the full PANSS was 0.93 (P < 0.001), and that between delta bPANSS and CGI-C was 0.73 (P < 0.001). CONCLUSIONS: bPANSS is able to capture the overall clinical features of schizophrenia within a short assessment period.
Assuntos
Esquizofrenia/diagnóstico , Índice de Gravidade de Doença , Adulto , Antipsicóticos/uso terapêutico , Feminino , Humanos , Masculino , Esquizofrenia/tratamento farmacológico , Sensibilidade e Especificidade , Fatores de TempoRESUMO
AIMS: It clarifies a difference between early acute phase and late acute phase in medication. METHODS: The present report describes three patients with schizophrenia who presented with restlessness and excitement requiring hospitalization. RESULTS: Treatment with risperidone solution orally or parenteral haloperidol until the day after admission, followed by olanzapine, successfully improved the clinical condition of the patients. In the early stage of hospitalization, selection of fast-acting drugs that can be administered to uncooperative patients is considered preferable, focusing on rapid control of symptoms and behavioral disorders, whereas after this early stage, olanzapine is preferable for improving patient compliance in addition to stabilizing symptoms. CONCLUSIONS: Because the target symptoms differ between the early and late acute phases, the term 'acute phase' used in the broad sense should be divided into two units, each requiring a different therapeutic strategy, and independent clinical approaches should be considered in order to provide more suitable treatment.
Assuntos
Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Esquizofrenia Hebefrênica/tratamento farmacológico , Esquizofrenia Paranoide/tratamento farmacológico , Doença Aguda , Adulto , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Quimioterapia Combinada , Feminino , Seguimentos , Jogo de Azar/psicologia , Haloperidol/uso terapêutico , Humanos , Japão , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Olanzapina , Admissão do Paciente , Cooperação do Paciente/psicologia , Risperidona/uso terapêutico , Esquizofrenia Hebefrênica/diagnóstico , Esquizofrenia Hebefrênica/psicologia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Resultado do TratamentoAssuntos
Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Aumento de Peso/efeitos dos fármacos , Adulto , Animais , Antipsicóticos/antagonistas & inibidores , Antipsicóticos/uso terapêutico , Benzodiazepinas/antagonistas & inibidores , Benzodiazepinas/uso terapêutico , Composição Corporal , Feminino , Humanos , Camundongos , Olanzapina , Escalas de Graduação Psiquiátrica , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológicoRESUMO
Reported herein is a case of methamphetamine psychosis in which tardive dystonia was treated successfully with clonazepam. The patient was a 69-year-old man who had taken methamphetamine habitually for approximately 40 years. Auditory hallucinations had developed 25 years previously, for which haloperidol had been prescribed. Tardive dystonia had developed in December 2005. Haloperidol was withdrawn and risperidone or olanzapine alone had been administered, but neither had improved the dystonic posture. However, when clonazepam was added, a gradual improvement in the dystonic posture became evident. Tardive dystonia is currently treated on a trial-and-error basis. Accumulation of further cases similar to the present one is very important for establishing an effective treatment.