The Present State of Existential Interventions Within Palliative Care.

Existential psychotherapy is rooted in the European tradition of existential philosophy. Existential philosophers include Husserl and Heidegger, who were German, and Camus, Sartre, de Beauvoir, and Merleau-Ponty, who were French. Their works contain existentially ultimate themes such as death, freedom, meaninglessness, and isolation. Based on their knowledge of existential philosophy, Binswanger, Frankl, and Boss developed the earlier existential psychotherapies such as Dasein-analysis and Logotherapy, while May, Laing, Yalom, May, and Wong started later existential psychotherapies in the British and American culture. Focusing on patients with advanced cancer and/or terminal care, we found nine types of existential psychotherapies which were investigated using randomized controlled trials (RCTs): Meaning-Centered Group Psychotherapy (MCGP), Individual Meaning-Centered Psychotherapy (IMCP), Meaning-Making intervention (MMi), Meaning of Life Intervention, Managing Cancer and Living Meaningfully (CALM), Hope Intervention, Cognitive and Existential Intervention, Dignity Therapy, and Life-Review Interviews, from 19 relevant RCTs. All deal with death, meaninglessness, isolation, and freedom. Particularly, MCGP, IMCP, MMi, Meaning of Life intervention, and CALM emphasize finding and/or making meaning in the individual's life. The effects on existential or spiritual well-being were confirmed in MCGP, IMCP, Meaning of Life intervention, and Life-Review intervention although the number of studies were very few. In the other interventions, there were heterogenous findings and again the number of studies was very small. Further studies are required to investigate the effects of existential psychotherapy on patients with advanced cancer.

Is lithium potentially a trace element?

Lithium, a naturally occurring element, is widely used in clinical settings for psychiatric treatment. Several studies showed that micro-dose lithium (e.g., lithium in drinking water) could have anti-aging and anti-dementia effects in addition to an anti-suicidal effect, although anti-mania and psychosis or anti-cancer effects are yet to be determined. Although these studies do not provide conclusive evidence, further studies are warranted to investigate whether lithium is trace element. If so, future studies would need to determine what levels are required to maintain mental health.

Early computed tomography signs as early predictors of hemorrhagic transformation under heparinization in patients with cardiogenic embolism.

AIM: Early computed tomography (CT) signs are crucial to predict the onset of hemorrhagic transformation (HT) and are preventive to avoid a fatal hematoma after thrombolysis. In the present study, we retrospectively reviewed the clinical records of patients receiving heparinization to investigate the correlation between early CT signs and the frequency of HT. METHODS: We reviewed 96 patients with cardiogenic cerebral embolism. These patients were admitted within 24 h of the onset and were subsequently given 5000-15,000 units of heparin per day for 3 days. Owing to CT on admission, early CT changes were evaluated. Patient characteristics were also estimated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease and history of smoking. The probability of hemorrhagic transformation, or good outcome and independence was assessed by backward stepwise logistic regression analysis based on the maximum likelihood ratio. RESULTS: Higher baseline National Institutes of Health Stroke Scale (NIHSS) score, early CT signs and absence of hyperlipidemia diversely correlated with the occurrence of HT. Also, the presence or absence of early CT signs was significantly related to HT classification (χ(2)-test; P < 0.05). It was statistically significant that a higher baseline NIHSS score (OR 8.51; 95% CI 3.11-27.75) affected the outcome without showing a significant relationship to early CT signs. CONCLUSIONS: Presence of early CT signs correlated more strongly with HT than with the interval from symptom onset to hospital arrival. We might extend the therapeutic time for thrombolytic therapy, only if the early CT sign does not appear.

Bipolar temperaments and light.

BACKGROUND: Converging lines of evidence have established a relationship between exposure to ambient light and both mood state and mood disorders. In view of the association between mood disorder and affective disposition, in this study, the relationship between temperament (depressive, cyclothymic, hyperthymic, irritable and anxious) and daily light exposure was closely examined. METHODS: Fifty-six subjects completed the Japanese standardized version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire version (TEMPS-A) and illuminance of daytime using actigraphy. RESULTS: Cyclothymic temperament scores were significantly and negatively associated with illuminance of daytime whereas hyperthymic temperament scores were significantly and positively associated with illuminance of daytime. LIMITATIONS: Sample size was relatively small and they were only healthy subjects and no patients. CONCLUSIONS: The findings suggest that illuminance of daytime may be related to both cyclothymic and hyperthymic temperaments but that the associations lie in opposite directions. If this is the case, it seems important to consider individual patients' temperaments when light therapy is used to treat their depressive episode. Further studies are required to determine why and how these temperaments are associated with illuminance.

International consensus statement on major depressive disorder.

Because considerable variability exists between countries in the management of major depressive disorder, experts in psychiatry gathered for the International Consensus Group on Depression to outline a universal treatment algorithm for this illness. The experts decided to adapt the existing treatment algorithm developed in Japan and discuss strategies for clinical issues that have been problematic in some countries. Specific recommendations were made by the consensus group for screening for, diagnosing, and treating depression, which include periodically screening all patients for depression, completing a differential diagnosis of depression, referring to a psychiatric specialist if needed, establishing a therapeutic alliance with patients and their families, choosing and optimizing the dose of appropriate antidepressants based on individual patient's needs, and incorporating nonpharmacologic treatment strategies as necessary.

Mental effect of cholesterol in males: protective effect?

BACKGROUND: While the benefits of low cholesterol for physical health are not in doubt, a potential negative aspect of low cholesterol for mental health is suggested by several studies. To examine the association between cholesterol and mental health, the authors performed an observational study. METHOD: From April 1995 to March 2002, a series of questionnaires pertaining to physical activity, food consumption, alcohol, coffee, smoking, and mental health (12 item-version of General Health Questionnaire: GHQ-12) were administered to 1972 employees in Japan. Subjects with less than 150 mg/dL of total cholesterol (very low cholesterol cohort) and other subjects (control cohort) were followed up for one to six years, and their mental health compared using GHQ caseness (GHQ-12 scores more than 3). RESULTS: Kaplan-Meier survival curves revealed that the very low cholesterol cohort had significantly greater GHQ caseness than the control cohort. Notably, this finding applied to males but not to females. After adjustment for general health, Cox's proportional hazards regression model confirmed this association in males only. The survival curves of control cohort were significantly different between males and females whereas those of very low cholesterol cohort were not. LIMITATIONS: GHQ caseness was regarded as "death" in the survival analysis. As such, it is not possible to differentiate between transient and persistent mental dysfunction and therefore may lead to overestimation of GHQ caseness over observational years. CONCLUSION: The present findings suggest that very low cholesterol may be associated with worse mental health in males and conversely and interestingly indicate that moderate (but not very low) cholesterol levels may protect mental health in males.

The rarity of Charles Bonnet syndrome.

Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in otherwise psychologically normal people. Estimates of the prevalence of CBS in different samples vary from a small percentage (around 1%), to a relatively large percentage (about 10%). The purpose of the present study is to determine whether CBS is rare or not. One-thousand ophthalmologic and optometric outpatients at a university hospital were consecutively screened by a questionnaire to identify patients possibly experiencing visual hallucinations. The mean corrected visual acuity in the best eye was 1.1. Those who positively responded to the questionnaire were further investigated to determine whether their symptoms were consistent with CBS. As a result, the prevalence of CBS was 0.5% (5/1000). In subclass analyses, the prevalence was 3 of 372 (0.8%) in the low vision group, 2 of 346 (0.6%) in the elderly, and 1 of 120 (0.8%) in both conditions. These were not significantly different from each other or from the overall prevalence (0.5%). This low prevalence of CBS in our subjects may be due to their relatively good visual acuity because previous studies with high prevalence of CBS investigated patients with a visual acuity of less than 0.3. The prevalence of CBS may be low in patients with these particular characteristics, and this syndrome seems to be rare in even ophthalmologic and optometric patients if they do not have seriously low vision. Further studies are needed to investigate the prevalence of CBS in general population.

Chronic subdural hematoma following dural metastasis of gastric cancer: measurement of pre- and postoperative cerebral blood flow with N-isopropyl-p-[123I]iodoamphetamine--case report.

A 58-year-old female with gastric cancer presented with left chronic subdural hematoma (CSH) without history of head injury. Magnetic resonance imaging revealed left CSH with atypical findings such as abnormal dural enhancement and swelling of the left cerebral hemisphere. One month after gastrectomy, motor aphasia and right hemiparesis developed. Irrigation of the left CSH was performed. The hematoma was abnormally mucinous and became solid immediately after irrigation. Histological examination showed that adenocarcinoma cells had metastasized to the dura mater and the outer membrane of the hematoma. The preoperative cerebral blood flow (CBF) in the affected cerebral hemisphere, measured by single photon emission computed tomography using N-isopropyl-p-[123I]iodoamphetamine, was much higher than that in the opposite hemisphere, whereas the postoperative CBF was almost equal in both hemispheres. Subdural hematomas secondary to dural metastases of extraneuronal malignancies are rare, and are usually the chronic type. Measurement of the pre- and postoperative CBF in the present patient with CSH following dural metastasis of the malignant tumor showed that preoperative hyperemia in the affected hemisphere may result from dilation of the cerebral vessels caused by the effects of the CSH.