Characteristics of patients with anxiety disorder without selective serotonin reuptake inhibitor prescription over a two-year period of pharmacotherapy.

INTRODUCTION: Pharmacotherapy such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors is recommended for the treatment of anxiety disorders. Although there are patients with persisted symptoms of anxiety disorders who are treated with monotherapy of benzodiazepine anxiolytics without SSRIs, the characteristics of these patients are unclear. In the present study, we investigated the characteristics of patients with persisted symptoms of anxiety disorder without SSRI prescription. METHODS: From a prescription dataset covering 2018 and 2020, the prescriptions of 243 patients with anxiety disorder were analyzed. Patients were classified into two groups: SSRI non-prescription and prescription groups. RESULTS: The SSRI non-prescription group had a higher ratio of females than did the SSRI prescription group (60.1% vs. 44.6%, respectively, p = 3.12 × 10-2 ), but statistically not significant after the Bonferroni correction. No significant differences in age, body mass index, or duration of outpatient visits were found between groups. Among the independent variables, sex (female) was the only variable identified that predicted SSRI non-prescription. CONCLUSION: The present study showed that among patients with anxiety disorders, sex (female) was the only variable that predicted SSRI non-prescription.

Association between functional recovery and medication adherence in schizophrenia.

AIM: Medication adherence is important for achieving functional recovery from schizophrenia and is commonly assessed using the Drug Attitude Inventory-30 (DAI-30). Subscales of the DAI-30, including "awareness of the need for medication," "awareness of the effects of psychiatric drugs," and "impression of medication," have been used to assess medication adherence. To determine which of these subscales are associated with the prognosis of schizophrenia, this study followed patients with schizophrenia to identify the prognosis and examine the subscales related to "recovery." METHODS: In total, 89 patients were recruited, 78 of whom were registered in the study. After assessing adherence using the DAI-30, Positive and Negative Syndrome Scale and Global Assessment of Functioning scores were assessed at 0 and 24 week to define the functional prognosis. RESULTS: At the end of the 24-week follow-up period, 36% of patients showed recovery from schizophrenia. A comparison of subscales revealed that the score for "impression of medication" was significantly higher in the recovery than in the non-recovery group. Logistic regression analysis identified only the "impression of medication" score as being predictive of recovery. CONCLUSION: The results indicated that among the three DAI-30 subscales, "impression of medication" was the most closely associated with recovery in patients with schizophrenia.

Comparison of the effects of cognitive-behavioral therapy for insomnia between patients with primary insomnia and comorbid insomnia.

Cognitive behavioral therapy for insomnia (CBT-I) is effective for not only primary insomnia (PI) but also comorbid insomnia (CI; insomnia associated with psychiatric/physical diseases or other types of sleep disorders). This study aimed to compare the outcomes of CBT-I implemented in the same manner between patients with PI and CI. In total, 41 adult patients who had completed CBT-I were enrolled in this retrospective analysis and divided into a PI group and a CI group. The authors then examined and compared the significance of changes after therapy between the two groups. The magnitude of improvement on the Japanese version of the Insomnia Severity Index (ISI-J) was analyzed as the primary endpoint. In the PI group (n = 24), both the ISI-J score and the dose of hypnotics decreased significantly following CBT-I. On the other hand, in the CI group (n = 17), only the dose of hypnotics decreased significantly; no statistically significant improvement was seen in the ISI-J score. Sleep onset latency and sleep quality rating in recorded sleep diaries were significantly correlated with improved ISI-J scores in the CI group only. CBT-I was shown to be effective for CI, but its efficacy for CI was inferior to that for PI in terms of impact on sleep and mental condition. These results suggest that in addition to the basic components of CBT-I, treatment for CI, especially when accompanied by severe insomnia symptoms, should include approaches targeting the comorbid disease.

Associations between parental bonding during childhood and functional recovery in patients with schizophrenia.

INTRODUCTION: Schizophrenia is believed to be etiologically associated with environmental factors. Poor parental bonding, especially arising from "low care" and "overprotection," may contribute to the prognosis in patients with psychosis. In the present study, we investigated the associations between the aforementioned two different parental bonding types and the prognosis, in terms of the functional recovery, of patients with schizophrenia. METHODS: A total of 89 patients with schizophrenia were recruited, and 79 patients were registered for the study. After the parental bonding types and representative childhood adverse events were assessed, specific items on the PANSS were assessed at 0 and 24 weeks of the study period to define the functional prognosis. RESULTS: At the end of the 24-week follow-up period, 36% of the patients were judged as showing recovery from schizophrenia. The score for "overprotective attitude," but not that for "low care," was found to be significantly higher in the non-recovery (defined below) group. Exploratory logistic regression analysis identified only "overprotective attitude" of the parents as being predictive of non-recovery. Moreover, a significant negative correlation was found between "low care" and "overprotective attitude" only in the non-recovery group. CONCLUSION: In the present study, we showed that an overprotective attitude of the parents was associated with non-recovery in patients with schizophrenia.

MERS associated with bacterial translocation in a pediatric patient with congenital portal vein hypoplasia: A case report.

A case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a female child who developed bacterial translocation from a congenital portal vein hypoplasia is reported. The patient was diagnosed as having portal hypertension after examinations and laboratory results showing splenomegaly and thrombocytopenia at the age of 1 year. The patient required three endoscopic variceal ligation (EVL) surgeries before the age of 9 due to development of multiple esophageal varices. After the second and third EVL procedures, she developed septicemia, possibly due to bacterial translocation associated with the administration of general anesthesia. The day after the third EVL, the patient presented with high fever and neurological disturbances (altered consciousness). Magnetic resonance imaging detected abnormal intensities in the corpus callosum ampulla and cerebral white matter, which suggested a diagnosis of MERS type 2. Considering this clinical course, the possible association between bacterial translocation and MERS in a patient with congenital portal vein hypoplasia and portal hypertension is discussed.

Efficacy and safety of cardioversion with continuous landiolol infusion for atrial tachyarrhythmia in an inflammatory state caused by volvulus in a child with TARP syndrome and postoperative tetralogy of Fallot.

A 2-year-old boy was diagnosed with TARP syndrome and underwent surgery for tetralogy of Fallot. He developed fever and had an acute abdomen. After 12 hours, atrial tachyarrhythmia (300 beats/min [bpm]) occurred. After nine administration of adenosine and two cardioversions, it relapsed promptly. Landiolol (10 µg/kg/min) was administered until the heart rate decreased to 270 bpm, and cardioversion was performed until sinus rhythm was normal. Exploratory laparotomy revealed small bowel volvulus. Systemic inflammation causing an acute abdomen may be associated with atrial tachyarrhythmia in postoperative tetralogy of Fallot. We speculated that landiolol lowered the defibrillation threshold of the atrium.