The reliability and validity of a developed anxiety scale specific to primary focal hyperhidrosis symptoms.

BACKGROUND: Patients with primary focal hyperhidrosis (hyperhidrosis) are known to have higher levels of anxiety induced by sweating than those who do not. However, in hyperhidrosis, no scale has been developed to measure anxiety specific to hyperhidrosis symptoms. Therefore, this study aimed to develop an anxiety scale specific to hyperhidrosis symptoms (ASSHS) and to verify its reliability and validity. METHODS: Based on previous studies on hyperhidrosis and a preliminary survey conducted with 26 university students who met the diagnostic criteria for hyperhidrosis, 40 items that adequately reflected anxiety specific to hyperhidrosis symptoms were obtained. A survey was done to examine the internal consistency and validity of the our developed ASSHS. In total, 1,207 participants (680 male and 527 female; mean age ± standard deviation 18.7 ± 0.9 years) were included. A second survey (re-survey) was conducted three weeks later to verify the reliability. It included 201 participants (85 male and 116 female; mean age ± standard deviation 18.6 ± 0.7 years). The survey items included (1) the diagnostic criteria for hyperhidrosis, (2) our anxiety scale developed for primary focal hyperhidrosis symptoms (ASSHS), (3) Hyperhidrosis Disease Severity Scale (HDSS), (4) State-Trait Anxiety Inventory (STAI), (5) Hospital Anxiety and Depression Scale (HADS), (6) Dermatology Life Quality Index (DLQI), and (7) presence of anxiety induced by sweating. RESULTS: The results of the factor analysis revealed 10 items with one factor, "anxiety specific to hyperhidrosis symptoms." The alpha coefficient of the ASSHS was α = 0.94. The correlation coefficient between the scores at re-test was r = 0.75. A moderate positive correlation was found between the ASSHS, HDSS (r = 0.53), and anxiety induced by sweating (r = 0.47) (all p < 0.001). Additionally, participants with hyperhidrosis symptoms had significantly higher ASSHS scores than did those without hyperhidrosis symptoms (p < 0.001). Those with mild/moderate hyperhidrosis and those with severe hyperhidrosis had significantly higher the ASSHS scores than did those without hyperhidrosis (p < 0.001). CONCLUSIONS: This scale has sufficient reliability and validity as an instrument to measure anxiety specific to hyperhidrosis symptoms.

Association of primary focal hyperhidrosis with anxiety induced by sweating: A cross-sectional study of Japanese university students focusing on the severity of hyperhidrosis and site of sweating.

Hyperhidrosis significantly reduces patients' quality of life, with many reporting feeling highly anxious. However, the relationship between hyperhidrosis and anxiety induced by sweating has not been examined in detail. The current study examined the relationship between: (1) the presence of hyperhidrosis symptoms, (2) hyperhidrosis severity, and (3) the sites of the most sweating and anxiety induced by sweating. A cross-sectional web-based survey was conducted among university students, and 1080 consenting participants (600 males and 480 females; mean age, 18.8 years) were included in the analysis. The survey items were: (1) diagnostic criteria for hyperhidrosis, (2) Hyperhidrosis Disease Severity Scale, (3) presence of anxiety induced by sweating, and (4) site of the most sweating. The results of multiple logistic regression analysis adjusted for sex and age showed that the odds ratio (OR) for anxiety induced by sweating was significantly higher in participants who screened positive for hyperhidrosis than in those who screened negative (OR, 9.72 [95% CI, 5.80-16.27]). The OR of anxiety induced by sweating was 7.11 (95% CI, 3.99-12.65) for mild/moderate hyperhidrosis and 23.46 (95% CI, 7.15-76.93) for severe hyperhidrosis, compared with those who screened negative for hyperhidrosis. Compared with those who screened negative for hyperhidrosis, the OR for anxiety induced by sweating in those with the palmar, plantar, axillary, and head/face as the site of the most sweating was 7.74 (95% CI, 3.91-15.33), 14.86 (95% CI, 1.83-120.58), 16.92 (95% CI, 5.95-48.14), and 5.38 (95% CI, 1.39-20.74), respectively. Our findings suggest that participants who screened positive for hyperhidrosis, mild/moderate or severe, are at a higher risk of anxiety induced by sweating than participants who screened negative for hyperhidrosis.

Subjective achievement from psychiatry rotation in the Japanese postgraduate residency system: a longitudinal questionnaire study.

BACKGROUND: Psychiatry rotation has been mandatory in the Japanese postgraduate residency system since 2020. Some psychiatry-related competency items are stipulated as mandatory for residents. The current study aimed to clarify whether psychiatry rotation affected residents' subjective achievement of these competency items. METHODS: This longitudinal study was conducted among postgraduate residents who completed a rotation in the psychiatry department at Nagasaki University Hospital across two academic years (2020-2021). The survey was administered at the start and at the end of the psychiatry rotation. Residents evaluated their subjective understanding and confidence regarding initiating treatment for these competency items using a six-point Likert scale. The average scores for each item were compared between pre-rotation and post-rotation. RESULTS: In total, 99 residents (91.7%) responded to this survey. Residents had significantly higher scores at post-rotation compared with pre-rotation in all psychiatry-related competency items in both subjective understanding and confidence in initiating treatment. Additionally, strong effect sizes were found for many items. CONCLUSION: Residents improved learning about psychiatry-related competency items through psychiatry rotation. This finding suggests that it is reasonable for psychiatry rotation to be mandatory in the current Japanese postgraduate residency system. The importance of psychiatry is likely to increase in both undergraduate and postgraduate medical education in the future. It is necessary to continuously update educational strategies to meet changing social needs over time. As this study was conducted at a single institution, a multi-center study is needed to expand the current findings.

The effectiveness of lamotrigine for persistent depressive disorder: A case report.

AIM: Persistent depressive disorder (PDD) was first introduced in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), which encompasses numerous different conditions, including dysthymia, recurrent major depressive disorder, double depression, and chronic major depression. SSRIs are the first-line drugs for treatment of PDD; however, not all patients respond to SSRI treatment. CASE PRESENTATION: We describe a woman who was diagnosed with PDD. At the age of 38, the patient presented with anxiety, reduced energy, marked tiredness, and sleep disturbances. She was prescribed with three antidepressants (paroxetine, duloxetine, and mirtazapine), which were not effective in relieving her symptoms. She was also prescribed bromazepam, which was also not effective. Subsequently, she was switched to lamotrigine, which resulted in a marked improvement in symptoms. The antidepressants and bromazepam were gradually tapered and discontinued. CONCLUSION: This case demonstrates that lamotrigine may be effective for treating patients with antidepressant resistant PDD and suggests that it may be a promising alternative to combination therapy of antidepressants and benzodiazepines in the treatment of PDD.

Early rehabilitation in older patients hospitalized with acute decompensated heart failure: A retrospective cohort study.

Although hospitalized patients with acute decompensated heart failure (ADHF) have severe physical dysfunction, little data are available on the comparative effectiveness of early versus late rehabilitation. This study examined the relationship between early compared to late rehabilitation and physical function among older patients hospitalized for ADHF. METHODS: In a retrospective cohort study, independent patients aged ≥65 years at baseline who were hospitalized for ADHF from 2012 to 2014 and underwent inpatient rehabilitation were identified using Emergency Department visit data and electronic medical records at two hospitals. Patients were classified into those who underwent early rehabilitation (initiated within 72 hours of admission) and late rehabilitation (after 72 hours). Primary outcome was length of time from admission until the patient was able to walk independently. Multivariable competing-risk regression with death as the competing event was used to adjust for potential confounding factors, and multiple imputation (MI) analysis was performed. RESULTS: Of 259 individuals, 30 (11.6%) commenced rehabilitation within 72 hours after admission while 229 (88.4%) did so 72 hours after admission. Patients who received early rehabilitation had a higher rate of unassisted walking for at least 40 m by 30 days after admission (hazard ratio: 8.03; 95% confidence interval: 2.15 to 29.98; P = .002 in the multivariable adjusted model) than those who received late rehabilitation. Similar findings were observed on MI analysis. CONCLUSION: Early rehabilitation therapy commenced within 72 hours of admission was associated with a higher rate of recovery of an activity of daily living (independent walking on a level surface).

Characteristics of Anaphylactic Reactions: A Prospective Observational Study in Japan.

BACKGROUND: Anaphylaxis is a systemic, life-threating, allergic reaction in which the clinical features may vary in different populations or due to the allergic triggers. Moreover, the timing and characteristics of biphasic anaphylactic reactions remain unclear. OBJECTIVES: The purpose of this study was to investigate the clinical characteristics of anaphylaxis cases assessed and treated in Japanese hospitals. METHODS: This was a prospective observational study of anaphylactic reactions treated in the Emergency Department (ED) of two medical centers from June 2016 to May 2019. All patients diagnosed with anaphylaxis were enrolled in this study. Data collected included patient demographics, symptoms and signs, treatment, clinical course, and suspected triggers. Descriptive statistics and univariate methods were used in the analyses. RESULTS: We enrolled 302 patients. The median age was 32 years (interquartile range 13-37) and the sample included 182 (60.3%) women. Of the 302 patients, 179 (59.3%) had a history of allergic reactions. The dermatologic, respiratory, gastrointestinal, and cardiac systems were involved in 297 (98.3%), 248 (82.1%), 150 (49.7%), and 55 (18.2%), respectively. Nineteen patients (6.3%) experienced biphasic anaphylactic reactions. Epinephrine use was associated with a lower incidence of biphasic anaphylactic reaction (odds ratio 0.3, 95% confidence interval 0.1-0.9). Time to recurrence of symptoms ranged from 2 to 48 h (median: 10 h). CONCLUSIONS: In this prospective ED study, foods were the most common triggers of anaphylaxis, and epinephrine administration was associated with a decreased occurrence of biphasic anaphylactic reactions. Over half of patients experiencing biphasic anaphylactic reactions developed symptoms more than 10 h after presentation.

Persistence of positive severe acute respiratory syndrome coronavirus-2 reverse transcription-polymerase chain reaction test result for 24 days in a hospitalized asymptomatic carrier.

BACKGROUND: Several countries have imposed a mandatory 14-day period of quarantine on individuals arriving from countries considered high-risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, it is not clear how long asymptomatic patients infected with SARS-CoV-2 can be an asymptomatic carrier. CASE PRESENTATION: We experienced a case of an asymptomatic female patient infected with SARS-CoV-2 with abnormal chest computed tomography findings. She did not develop a fever during hospitalized isolation. She remained reverse transcription-polymerase chain reaction-positive for 24 days. CONCLUSION: An asymptomatic patient diagnosed with SARS-CoV-2 infection remained reverse transcription-polymerase chain reaction-positive for 24 days, although she was quarantined in an isolation hospital. This finding suggests that an asymptomatic patient diagnosed with SARS-CoV-2 infection with abnormal chest computed tomography findings can be an asymptomatic carrier for more than 3 weeks.

Recent trends in mental illness and omega-3 fatty acids.

Although it is clear that nutrition affects physical and metabolic functions in humans, the importance of nutrition in mental illness has often been overlooked. Following a report by Hibbeln (Lancet 351:1213, 1998) published in The Lancet, which suggested that depression rates and fish consumption were inversely correlated, the relationships between a variety of nutritional/epidemiological treatments and neuropsychiatric disorders have received increased attention. In particular, many studies have been conducted on the omega-3 fatty acid mechanism of action in pathophysiological aspects of various neuropsychiatric disorders. Furthermore, many clinical studies have also been conducted on the effects of omega-3 replacement therapy. Therefore, this article reports recent trends in, and perspectives on, the use of omega-3 fatty acids to treat the five psychiatric disorders: schizophrenia (a delusion of the psychotic zone), depression and other mood disorders, attention deficit hyperactivity disorder (a developmental disorder), post-traumatic stress disorder (psychological trauma after the disaster), and Alzheimer-type dementia.

Genetic and environmental factors of schizophrenia and autism spectrum disorder: insights from twin studies.

Twin studies of psychiatric disorders such as schizophrenia and autism spectrum disorder have employed epidemiological approaches that determine heritability by comparing the concordance rate between monozygotic twins (MZs) and dizygotic twins. The basis for these studies is that MZs share 100% of their genetic information. Recently, biological studies based on molecular methods are now being increasingly applied to examine the differences between MZs discordance for psychiatric disorders to unravel their possible causes. Although recent advances in next-generation sequencing have increased the accuracy of this line of research, there has been greater emphasis placed on epigenetic changes versus DNA sequence changes as the probable cause of discordant psychiatric disorders in MZs. Since the epigenetic status differs in each tissue type, in addition to the DNA from the peripheral blood, studies using DNA from nerve cells induced from postmortem brains or induced pluripotent stem cells are being carried out. Although it was originally thought that epigenetic changes occurred as a result of environmental factors, and thus were not transmittable, it is now known that such changes might possibly be transmitted between generations. Therefore, the potential possible effects of intestinal flora inside the body are currently being investigated as a cause of discordance in MZs. As a result, twin studies of psychiatric disorders are greatly contributing to the elucidation of genetic and environmental factors in the etiology of psychiatric conditions.

CPR related thoracic injury: a comparison of CPR guidelines between 2005 and 2010.

Aim: The objective of this study was to investigate the incidence and characteristics of thoracic injuries associated with cardiopulmonary resuscitation (CPR) performed under the 2005 and the 2010 guidelines. Methods: We evaluated patients who had an out-of-hospital cardiac arrest in 2010 (2005 group) and 2012 (2010 group). We analyzed the incidence and characteristics of rib fractures and pneumothoraces received during CPR as determined by medical records and image studies. Results: Two hundred and ninety-two patients in the 2005 group and 243 in the 2010 group were enrolled. The number of patients with rib fractures was greater in the 2010 group than in the 2005 group (123 [42.1%] versus 167 [68.7%], P < 0.001), and the number of pneumothorax patients with rib fractures was also higher (8 [2.7%] versus 21 [8.6%], P = 0.004). Of the 21 patients, four had a tension pneumothorax. The anterior-posterior diameter of the chest (APD) was smaller in patients with a pneumothorax and rib fractures than those without the injuries (166.0 mm [standard deviation 22.8] versus 176.2 mm [standard deviation 21.0], P = 0.04), and the APD for patients of Japanese descent was smaller than that of patients of European descent by more than 50 mm. Conclusion: The number of rib fractures and pneumothoraces received during CPR increased significantly under the 2010 guidelines when compared with the 2005 guidelines. As the APD for patients of Japanese descent is smaller than that of patients of European descent, Japanese medical facilities need to be prepared for possible fatal adverse events associated with CPR under the current international guidelines.

Incidence and characteristics of biphasic and protracted anaphylaxis: evaluation of 114 inpatients.

AIM: Anaphylaxis is a systemic allergic reaction that potentially causes death. Most anaphylactic reactions are uniphasic, but some cases may be biphasic or protracted. However, these clinical epidemiology concepts are unfamiliar in Japan. Therefore, we have investigated the incidences and characteristics of patients with biphasic and protracted anaphylaxis. METHODS: We retrospectively evaluated patients with anaphylaxis in a single emergency medical center located in Yokohama, Japan from April 2009 to March 2012. We analyzed the incidences and characteristics of patients with biphasic and protracted anaphylaxis who needed to be admitted. RESULTS: A total of 253 patients were diagnosed with anaphylaxis and 114 patients needed to be admitted. Of the 114 patients, 103 (90.4%) were uniphasic, 7 (6.1%) were biphasic and 4 (3.5%) were protracted anaphylaxis. The most common antigens were foods and drugs. The median onset of a biphasic reaction was 8 h and dermatologic symptoms were mostly observed. Regarding severity, mild symptoms were seen in four cases, similar symptoms to the initial reaction were seen in two cases, and only one case was severe. The duration of protracted anaphylaxis varied from 2 to 8 days. CONCLUSION: The incidence of biphasic and protracted anaphylaxis in inpatients was 6.1% and 3.5%, respectively. The median onset of biphasic reaction was 8 h, and most symptoms were mild or similar to the initial reaction. We suggest that patients with anaphylaxis need an 8-h and ideally a 24-h observation period in order to monitor possible biphasic reactions. The duration of protracted anaphylaxis was up to 8 days.

[Epidemiology of schizophrenia].

Schizophrenia exhibits wide variation in epidemiological characteristics. Through the past few decades, we have learned much about schizophrenia epidemiology, providing important findings for etiological research, clinical care and public health. In this article, we provide overview of current research on incidence, prevalence, risk factors, mortality and outcome of schizophrenia. Contrary to traditional understanding, the incidence and prevalence of schizophrenia show prominent variation between locations. Risk factors for schizophrenia include urbanicity, migration, sex, season of birth and pregnancy and birth complications. Schizophrenia patients have an increased mortality risk compared with the general population. Recent studies about outcome show not so tragic, especially in regard to social functioning. Over the recent decades, circumstances have been changing around schizophrenia. As to treatment, for example, 'the second generation antipsychotics' have replaced conventional ones and 'early intervention' is developing. However, we have only limited evidences of current schizophrenia. Further epidemiological development is needed.