Blonanserin Augmentation for Treatment-Resistant Somatic Symptom Disorder: A Case Series.

The augmentation of selective serotonin reuptake inhibitors with antipsychotics that have a high dopamine-receptor-D2 affinity may be effective in treatment-resistant obsessive-compulsive disorder and somatic symptom disorder, which is similar to illness anxiety disorder. Blonanserin, a novel antipsychotic developed in Japan, has a high affinity for the D2 receptor and weak or very little affinity for other receptors. This article presents two case studies that demonstrate the efficacy of blonanserin augmentation for treatment-resistant somatic symptom disorder. Two patients with treatment-resistant somatic symptom disorder were prescribed concomitant use of blonanserin. Augmentation with blonanserin resulted in the remarkable amelioration of all symptoms. Sedative adverse drug reactions produced by aripiprazole were improved after replacing it with blonanserin. Blonanserin is effective in treatment-resistant somatic symptom disorder. Furthermore, compared with aripiprazole, blonanserin is more likely to result in medication adherence in patients with somatic symptom disorder because it reduced adverse drug reactions.

[A case of Hashimoto's encephalopathy successfully treated with oral steroid therapy, resistant to high-dose methylprednisolone, plasma exchange and intravenous immunoglobulin].

A 30-year-old woman was admitted to the first institution with subacutely progressive aphasia and depression. Despite of lacking conclusive evidence on magnetic resonance imaging, cerebrospinal fluid examination, or electroencephalogram, we tentatively diagnosed her disease as limbic encephalopathy due to its acute progression. High-dose methylprednisolone was started on admission. However, symptoms did not improve. To make matters worse, psychiatric symptoms, such as hallucinations and emotional incontinence, appeared on the same day. Additional treatment with plasma exchange and intravenous immunoglobulin administration was also ineffective. Therefore, we could not manage the patient in a general ward due to severe psychiatric symptoms. The patient was transferred to a psychiatric ward in the second institution. She received both psychiatric treatment and steroid therapy, including a second course of intravenous high-dose methylprednisolone, followed by long-term oral prednisolone. Her symptoms gradually improved. A final diagnosis of Hashimoto's encephalopathy was made based on the patient's clinical course and positive results for both serum anti-thyroid antibody and anti-NAE antibody. In our case, long-term oral steroid therapy under psychiatric treatment was effective for good outcome.

Relationship between alexithymia and coping strategies in patients with somatoform disorder.

PURPOSE: A multidimensional intervention integrating alexithymia, negative affect, and type of coping strategy is needed for the effective treatment of somatoform disorder; however, few studies have applied this approach to the three different dimensions of alexithymia in patients with somatoform disorder. The purpose of this study was to determine the relationship between type of coping strategy and three different dimensions of alexithymia expressed in patients. PATIENTS AND METHODS: A total of 196 patients with somatoform disorder completed the 20-item Toronto Alexithymia Scale, the Zung Self-Rating Depression Scale, the Spielberger State-Trait Anxiety Inventory, the Somatosensory Amplification Scale, and the Lazarus Stress Coping Inventory. The relationships between alexithymia (Toronto Alexithymia Scale - 20 score and subscales), demographic variables, and psychological inventory scores were analyzed using Pearson's correlation coefficients and stepwise multiple regression analysis. RESULTS: The mean Toronto Alexithymia Scale - 20 total score (56.1±10.57) was positively correlated with the number of physical symptoms as well as with psychopathology scores (Self-Rating Depression Scale, State-Trait Anxiety Inventory trait, state, and Somatosensory Amplification Scale), but negatively correlated with planful problem solving, confrontive coping, seeking social support, and positive reappraisal coping scores. With respect to coping strategy, multiple regression analyses revealed that "difficulty in identifying feelings" was positively associated with an escape-avoidance strategy, "difficulty in describing feelings" was negatively associated with a seeking social support strategy, and "externally oriented thinking" was negatively associated with a confrontive coping strategy. CONCLUSION: Alexithymia was strongly associated with the number of somatic symptoms and negative affect. Patients with high "difficulty in describing feelings" tend to rely less on seeking social support, and patients with high "externally oriented thinking" tend to rely less on confrontive coping strategies. The coping skills intervention implemented should differ across individuals and should be based on the alexithymia dimension of each patient.

Predictors for exacerbation/improvement of postpartum depression--a focus on anxiety, the mothers' experiences of being cared for by their parents in childhood and borderline personality: a perspective study in Japan.

OBJECTIVE: To investigate the course and influencing factors of postpartum depression in women during the child rearing period. METHODS: Data were collected during 0-year-old baby check-ups and a follow-up investigation. 262 participants were included in the analysis. Both surveys employed the Zung Self-Rating Depression Scale (ZSDS). The first also comprised the State Trait Anxiety Inventory, Parental Bonding Instrument (PBI), and Borderline Scale Index, enabling sub-division of participating subjects into healthy/pathological groups. ZSDS group and survey scores were compared using the t-test. RESULTS: The average ages of the children and the ZSDS scores in both surveys were 7.0±3.2 and 21.8±2.4 months, 40.6±7.9 and 40.1±8.7, respectively, with no significant differences among depression scores. When subjects were divided according to individual scale scores, and survey scores compared, depression significantly improved in the high trait/state anxiety group, high PBI maternal care score group, nonborderline personality (BP) trait group, and breast feeding group, whereas depression was significantly exacerbated in the low PBI maternal care score group. DISCUSSION: Postpartum depression characterized by strong anxiety and a depressive state in mothers with favorable psychological backgrounds showed gradual improvement. We noted an exacerbation of depression during the separation period in mothers who had received poor maternal care. We assume that the feeling of abandonment induced by individuation of their children is a major factor. LIMITATIONS: There is concern that some depressive women may have dropped out due to a performance bias. CONCLUSIONS: Sharing our findings about exacerbation/improvement of depression among medical staff may be beneficial for postpartum mothers.