Severe fibromyalgia alleviated by the unique muscle relaxation method of applying low force: A case report.

RATIONALE: Fibromyalgia (FM) is characterized by idiopathic persistent chronic pain in the ligaments or musculoskeletal system, and more than half of the patients with FM might have migraine headaches. Direct musculoskeletal intervention could be a non-pharmacological management to relieve symptoms. However, patients with severe FM often have intense pain from only a soft touch, thereby rendering musculoskeletal intervention challenging. PATIENT CONCERNS: A 47-year-old man had progressing intense pain, and this affected his everyday life. There were no abnormal physical findings on laboratory examination such as levels of complement, antinuclear antibodies, and C-reactive protein, which were within normal limits. Magnetic resonance imaging did not indicate abnormalities. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: The patient satisfied the American College of Rheumatology criteria. Finally, we made a final diagnosis of fibromyalgia. The therapeutic intervention of Kanshoho, the unique muscle relaxation technique with low force, relieved his pain. LESSONS: If Kanshoho is carefully applied in a state of hospitalization under surveillance by an experienced physician, it could be a promising muscle relaxation method. Relaxing the trapezius muscle and reducing its intramuscular pressure might be key in treating patients with severe FM. However, it needs elucidation of its mechanism.

Macrocytic anemia induced by selenium deficiency in the course of anorexia nervosa: A case report.

RATIONALE: Anorexia nervosa is characterized by an extreme fear of weight gain. Clinicians often prescribe meal replacement shakes if patients are unable or unwilling to consume typical foods. However, these shakes sometimes lack essential micronutrients, such as selenium, which may lead to health risks. Moreover, selenium deficiency induces macrocytic anemia. Herein, we present a case of a patient with anorexia nervosa with macrocytic anemia due to selenium deficiency, which was alleviated by selenium supplementation. PATIENT CONCERNS: An 18-year-old female was admitted to our hospital. The patient was diagnosed with anorexia nervosa. Ultimately, she was unable to walk independently because of fatigue and electrolyte disturbances. CLINICAL FINDINGS: On admission, the height, weight, and body mass index of the patient were 158.5 cm, 27.1 kg, and 10.8, respectively. Our treatment for anorexia nervosa showed relative effectiveness, and the patient's body weight recovered to 29.2 kg by day 60. However, the mean corpuscular volume increased from day 20, suggesting macrocytic anemia. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: Despite our vitamin B12 and folic acid supplementation interventions, the mean corpuscular volume continued to rise. On day 60, the patient was diagnosed with selenium deficiency, and selenium administration of 100 µg/day was initiated. OUTCOMES: The macrocytic anemia in the patient was alleviated, and treatment for anorexia nervosa was continued in our hospital. LESSONS: To the best of our knowledge, this is the first case of macrocytic anemia induced by selenium deficiency with anorexia nervosa comorbidity, underscoring the importance of selenium supplementation in patients with anorexia nervosa, especially in those with macrocytic anemia.

The effect of lavender aroma for anxiety disorder: a study protocol for a multicenter, double-masked, randomized, placebo-controlled clinical trial.

BACKGROUND: Anxiety disorder is the most prevalent psychiatric disorder. Benzodiazepines, which are often used for anxiety in patients with anxiety disorder, have various side effects. Lavender, one of the most commonly used essential oils in aromatherapy, has the potential to reduce benzodiazepine use for anxiety disorders. METHODS: This study is a multicenter, double-masked, randomized, placebo-controlled clinical trial. The study will recruit patients aged 20-59 years old with generalized anxiety disorder and panic disorder among anxiety disorders. The bottle containing the test solution (lavender aroma essential oil or distilled water) will be given to the patients. Patients will carry the bottles with them in their daily life and use the drops on tissue paper when anxious. The primary endpoint is the number of times anxiolytics used in 28 days. DISCUSSION: If the use of benzodiazepines could be reduced by sniffing lavender aroma, which is inexpensive and safe, it would contribute not only to the risks associated with benzodiazepine use but also to the health care economy and could even be added as a standard treatment. TRIAL REGISTRATION: University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000034422 Registered 17 January 2019.

Correlation between trait emotional intelligence and prefrontal activation during a verbal fluency task: A functional near-infrared spectroscopy study.

Stress is inevitable in humans and stress changes our physical and mental states. Stress has been studied epidemiologically, biologically, and psychologically. First defined in 1990, emotional intelligence (EI) affects psychological stress management. In contrast, the prefrontal cortex (PFC) is suggested to play a vital role in stress management. Human PFC activity can be inferred from the balance of oxygenated and deoxygenated hemoglobin in cerebral blood flow, which can be measured and calculated using functional near-infrared spectroscopy (fNIRS). An important cognitive activation task to activate the PFC is the verbal fluency task (VFT). Therefore, if the PFC is activated by the VFT and monitored by fNIRS, and the activity correlates with EI, fNIRS can be used to measure EI. In this study, Psychological tests using the self-rating depression scale, state-trait anxiety inventory (STAI), and trait emotional intelligence questionnaire-short form (TEIQue-SF) were conducted to evaluate the correlation with VFT performance. Relative oxygenated and deoxygenated hemoglobin concentrations were measured using an fNIRS device, and their correlation with VFT performance was tested. Spearman correlation coefficient was used to determine correlations. Results were as follows. Although VFT performance did not correlate with the oxygenated hemoglobin concentration ([Oxy-Hb]) changes, [Oxy-Hb] was elevated in all channels. VFT performance was significantly negatively correlated with the Zung self-rating depression scale (ρ = 0.063, P = .759), trait anxiety or anxiety level as a personal characteristic of STAI (ρ = 0.243, P = .232), and state anxiety or anxiety about an event of STAI (ρ = -0.138, P = .500), whereas no correlation was found with the TEIQue-SF (ρ = 0.303, P = .132). Healthy individuals PFC activity is not severely affected by their mental state and cognitive activation successfully activates the PFC, supporting the hypothesis that EI is correlated with frontal cortical activation during the VFT in a nonclinical population. EI may play a vital role in reducing stress associated with depression and anxiety in our social lives. Although we failed to show a statistical correlation between TEIQue-SF and [Oxy-Hb] due to a sample size shortage, our preliminary study was the first to attempt to show the PFC activity of EI through a hemodynamic response. Future research may elucidate the role of EI in reducing psychological stress in social life.

Unpredictable refeeding syndrome with severe hypophosphatemia in borderline personality disorder comorbidity: A case report.

RATIONALE: Refeeding syndrome (RS) is a fatal condition caused by rapid calorie intake during starvation. Self-neglected fasting in psychiatric disorders is associated with RS. However, overeating resulting from circumventing the clinician's instructions does not have a reportedly high risk of RS. PATIENT CONCERNS: A 47-year-old undernourished woman with borderline personality disorder was hospitalized for nausea, vomiting, and diarrhea. CLINICAL FINDINGS: She had not eaten much for 10 days and had lost weight (56.5-51.1 kg) over 3 weeks. No abnormalities were indicated on physical examination and imaging examinations. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: Infectious diseases and malignancies were excluded from the differential diagnosis. On the third day of admission, the patient's serum phosphorus level significantly decreased to 0.7 mg/dL, and additional sodium phosphate was administered intravenously. On the fourth day, despite our instructions, the patient was found to be eating nonhospital food from the first day of admission. In conjunction with her history, a final diagnosis of RS was made. After appropriate treatments, the patient was discharged on the 15th day of hospitalization. The patient's nausea, vomiting, and diarrhea were improved. LESSONS: When undernourished patients have psychiatric disorders, including borderline personality disorder or schizophrenia, the occurrence of RS should be considered based on the patients' poor adherence to physicians' instructions.

Esophageal achalasia, diagnosed through the repeated manometry, alleviated using benzodiazepine: A case report.

RATIONALE: Idiopathic achalasia is an esophageal peristaltic dysfunction of the lower esophageal sphincter (LES). The initial symptom is progressive dysphagia. However, due to its rarity, it is often misdiagnosed as an esophageal disorder. High LES pressure on esophageal manometry is an essential finding for the diagnosis. PATIENT CONCERNS: A 55-year-old man was hospitalized with saliva-like vomitus, stuck-in-throat feeling of dysphagia, and weight loss. CLINICAL FINDINGS: On initial admission, gastrointestinal endoscopy, esophageal manometry, laboratory tests, and physical examination results were within normal limits. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: Initially, the patient was diagnosed with globus sensation and recovered with medication. However, the symptoms recurred. He requested another examination on the second admission and was diagnosed with achalasia based on repeat esophageal manometry. The patient recovered after surgical treatment. LESSONS: When patients still suffer from these symptoms, there is a need to reconsider achalasia, even if it is initially excluded from the differential diagnosis. Medication is not a radical treatment; however, it sometimes ameliorates symptoms. Moreover, the psychosomatic approach can be useful in such cases.

Possible effect of natural light on emotion recognition and the prefrontal cortex: A scoping review of near-infrared (NIR) spectroscopy.

Near-infrared (NIR) spectroscopy, also known as functional NIR spectroscopy (fNIRS), is a tool for measuring the hemodynamic response of the prefrontal cortex (PFC) by using NIR light, enabling a noninvasive indirect neural activity assessment. The application of fNIRS in emotion recognition or the differential diagnosis of psychiatric disorders of depressive patients, including major depressive disorder, bipolar disorder and schizophrenia, has previously been reported. Although the use of fNIRS has gradually expanded in cognitive neuroscience studies, few researchers have focused on the effects of light exposure in fNIRS studies. In addition, to the best of our knowledge, there are no scoping reviews of fNIRS studies on light exposure. Because light is an important topic in cognitive neuroscience and psychiatry, we evaluated fNIRS studies on light exposure in humans. We reviewed 10 papers in their entirety. Bright light (BR) modulates fear, and the color differences showed no significance in 1 study, whereas other studies delved extensively into the effects of colored light, finding some individual hemodynamic responses. In our study, we highlighted that the effects of natural light have not been studied using fNIRS. Light is becoming a critical topic in cognitive neuroscience and psychiatry, and fNIRS is critical for improving public health and managing psychiatric disorders.

Aversive emotion rapidly activates orexin neurons and increases heart rate in freely moving mice.

The perifornical area of the hypothalamus has been known as the center for the defense response, or fight-or-flight response, which is characterized by a concomitant rise in arterial blood pressure, heart rate, and respiratory frequency. It is well established that orexin neurons, which are located in this region, play a critical role in this response. In this study, we further examined this role by recording orexin neuronal activity and heart rate in freely moving mice using an original dual-channel fiber photometry system in vivo. Analysis of orexin neuron activity in relation to autonomic responses to aversive stimuli revealed a rapid increase in neuronal activity just prior to changes in heart rate. In addition, we examined whether orexin neurons would be activated by a conditioned neutral sound that was previously associated with aversive stimulus. We show that the memory of the aversive stimulus activated orexin neurons and increased heart rate. Our data suggest that orexin neurons are a key component linking aversive emotions to autonomic defense response. Our data also suggest that targeting orexin neurons may enable treatment of psychiatric disorders associated with chronic stress and traumatic memories.

Acute nociceptive stimuli rapidly induce the activity of serotonin and noradrenalin neurons in the brain stem of awake mice.

Nociception is an important type of perception that has major influence on daily human life. There are some descending pathways related to pain management and modulation, which are collectively known as the descending antinociceptive system (DAS). Noradrenalin (NA) in the locus coeruleus (LC) and serotonin (5-HT) in the rostral ventromedial medulla (RVM) are components of the DAS. Most 5-HT neurons in the dorsal raphe (DR) have ascending projections rather than descending projections, and they project to the thalamus that modulates nociception. Both the DAS and the DR are believed to be involved in pain-emotion symptoms. In this study, we utilized a fiber photometry system to specifically examine the activity of LC NA neurons and RVM/DR 5-HT neurons using mice carrying tetracycline-controlled transactivator transgene (tTA) under the control of either a dopamine ß-hydroxylase promoter or a tryptophan hydroxylase-2 promoter and site-specific infection of an adeno-associated virus carrying a TetO G-CaMP6 gene. After confirmation of specific expression of G-CaMP6 in the target populations, changes in green fluorescent signal intensity were recorded in awake mice upon exposure to acute nociceptive stimulation consisting of a pinch and application of heat (55 °C) to the tail. Both stimuli resulted in rapid and transient (<15 s) increases in the activity of LC NA neurons and RVM/DR 5-HT neurons while the control stimuli did not induce any changes. The present results clearly indicate that acute nociceptive stimuli increase the activity of LC NA neurons and RVM/DR 5 H T neurons and suggest a possible therapeutic target for pain treatment.

Acute Aversive Stimuli Rapidly Increase the Activity of Ventral Tegmental Area Dopamine Neurons in Awake Mice.

The ventral tegmental area (VTA) is one of the origins of the brain dopaminergic system and is involved in regulating various physiological functions such as pain processing and motivation. In this study, we utilized a fiber photometry system to specifically investigate the activity of dopamine neurons in the VTA using dopamine transporter promoter-driven Cre recombinase-expressing mice and site-specific infection of adeno-associated virus carrying the FLEX G-CaMP6 gene. As expected, expression of G-CaMP6 was restricted to VTA dopamine neurons. We recorded G-CaMP6 green fluorescent signal, which reflected dopaminergic neuronal activity, in awake mice exposed to tail pinch, ultrasonic sound, predator odor, and a male intruder mouse. These stimuli resulted in a rapid and short-lasting increase in the activity of VTA dopamine neurons while the control stimuli of a gentle tail touch and appearance of empty box did not induce any changes. In addition, fluorescence intensity was not changed by any of these stimuli in the control animals expressing hrGFP instead of G-CaMP6 in VTA dopamine neurons. Our data clearly show that acute aversive stimuli rapidly increase the activity of VTA dopamine neurons and thus suggest a salience-processing role.