Associations among plasma markers for N-methyl-d-aspartate receptor hypofunction, redox dysregulation, and insufficient myelination in patients with schizophrenia.

Background: Several hypotheses regarding the pathomechanisms of schizophrenia have been proposed. If schizophrenia is a unitary disease, then these pathological processes must be linked; however, if such links do not exist, schizophrenia may best be considered a group of disorders. Only a few studies have examined the relationships among these pathomechanisms. Herein, we examined the relationships among deficient myelination, NMDA receptor hypofunction, and metabolic dysregulation by measuring various plasma markers and examining their correlations. Methods: Plasma samples were collected from 90 patients with schizophrenia and 68 healthy controls. Concentrations of nardilysin (N-arginine dibasic convertase, NRDC), a positive regulator of myelination, the NMDA receptor co-agonist d-serine and glycine, various additional amino acids related to NMDA receptor transmission (glutamate, glutamine, and l-serine), and homocysteine (Hcy), were measured. Concentrations were compared using independent samples t-test or logistic regression, and associations were evaluated using Pearson's correlation coefficients. Results: Plasma glycine (t = 2.05, p = 0.042), l-serine (t = 2.25, p = 0.027), and homocysteine (t = 3.71, p < 0.001) concentrations were significantly higher in patients with schizophrenia compared to those in healthy controls. Logistic regression models using age, sex, smoking status, glutamine, glutamate, glycine, l-serine, d-serine, homocysteine, and NRDC as independent variables revealed significantly lower plasma d-serine (p = 0.024) and NRDC (p = 0.028), but significantly higher l-serine (p = 0.024) and homocysteine (p = 0.001) in patients with schizophrenia. Several unique correlations were found between NMDA receptor-related amino acids and NRDC in patients with schizophrenia compared to those in healthy controls, while no correlations were found between plasma homocysteine and other markers. No associations were found between plasma marker concentrations and disease status or cognitive function in patients with schizophrenia, except for a significant correlation between plasma glycine and full intelligence quotient. Conclusion: Reduced myelination and NMDA receptor hypofunction may be related to pathological mechanisms in schizophrenia, while homocysteine dysregulation appears to be an independent pathological process. These results suggest that schizophrenia may be a group of disorders with unique or partially overlapping etiologies.

Management of Pregnant Women with Mental Disorders Requires Attention to Gestational Diabetes Mellitus.

Background: Psychiatric interventions may be required during pregnancy. In the aspect of the management of psychiatric symptoms and the consideration of the need for pharmacotherapy, possibly to manage the effects on the fetus, pregnant women with mental disorders are considered high risk as other physical illnesses. Objective: We investigated the characteristics of pregnant women with psychiatric disorders compared with high-risk pregnant women with physical illnesses at our university hospital and the effects of psychotropic drug use on pregnant women with mental disorders and their children. Materials and Methods: In a multivariate analysis of 1282 pregnant women, excluding those with multiple pregnancies who gave birth at our hospital between January 2017 and the end of December 2019, we evaluated the effects of mental disorders and the use of psychotropic drugs throughout at least the third trimester up to the day of delivery on obstetric complications and infants. All data were collected retrospectively. Results: Ninety-nine pregnant women had mental disorders and 62 took psychotropic drugs. Among multiple factors, pregnant women with mental disorders were associated with significantly higher rates of smoking and gestational diabetes mellitus (GDM) and significantly lower child abnormalities. The cause or effect was difficult to determine; however, the use of antipsychotics or antidepressants was also significantly associated with GDM, while psychotropic use was not related to any of the other factors investigated in this study. Conclusions: Attention to GDM might be important in the management of pregnant women with mental disorders.

Case report: Impact of hyperthyroidism on psychotic symptoms in schizophrenia comorbid with Graves' disease.

Introduction: Auditory hallucinations are the most common type of hallucinations observed in schizophrenia; however, visual hallucinations are not uncommon. In Graves' disease, depression, hypomania, and psychosis can occur. While the association between Graves' disease and psychosis has been explored, understanding of the specific impact of thyroid dysfunction severity on psychiatric symptom severity is limited. Here, we present a case report of a patient with schizophrenia comorbid with Graves' disease whose psychotic symptoms were impacted by hyperthyroidism. Case: The patient was a 32-year-old Japanese woman who presented with auditory and visual hallucinations, agitation, and pressured speech. The patient was diagnosed with schizophrenia comorbid with Graves' disease and thyroid storm. The patient's psychotic symptoms were found to be associated with fluctuations in thyroid hormone levels, and visual hallucinations were observed only during thyroid storms. Treatment involved dexamethasone, potassium iodide, bisoprolol fumarate, and methimazole for thyrotoxicosis, and a blonanserin transdermal patch, paliperidone, and paliperidone palmitate for psychotic symptoms. The patient's auditory and visual hallucinations improved with antipsychotic treatment and decreased thyroid hormone levels. Conclusion: This case highlights the importance of monitoring thyroid function in patients with schizophrenia, particularly those with comorbid Graves' disease. The correlation between psychiatric symptoms and thyroid hormone levels was demonstrated on an individual level over time, with symptoms worsening as thyroid hormone levels increased. Additionally, our case suggests that abnormally high thyroid hormone levels may trigger visual hallucinations in individuals with schizophrenia. Further studies are needed to elucidate the underlying mechanisms and potential treatment implications of this association.

Effect of antipsychotic use by patients with schizophrenia on deceleration capacity and its relation to the corrected QT interval.

OBJECTIVE: Schizophrenia patients treated with antipsychotics are at higher risk of sudden cardiac death. Decreased deceleration capacity (DC) of the heart rate is an accurate predictor of cardiac mortality. We evaluated the risk of sudden cardiac death due to antipsychotic use by assessing DC and examining the association between DC and the corrected QT interval (QTc) in schizophrenia patients. METHODS: We measured the DC and QTc of 138 schizophrenia patients. We then compared the DC of 86 age- and sex-matched healthy controls with that of 86 schizophrenia patients. We investigated the correlation of DC of approximately 138 schizophrenia patients with prescribed doses of antipsychotics using linear regression analysis. We compared the DC of schizophrenia patients with and without prolonged QT intervals. RESULTS: We found DC significantly differed between schizophrenia patients on antipsychotic medication and healthy controls. Additionally, DC was negatively correlated with antipsychotic use, especially chlorpromazine, zotepine, olanzapine and clozapine, in a dose-dependent manner. There was no significant association between DC and the QTc. CONCLUSION: Assessing DC could facilitate monitoring and identification of increased risk of cardiac mortality in patients with schizophrenia that take antipsychotics. Assessing both DC and the QTc may enhance the accuracy of predicting sudden cardiac death.

Limited social support is associated with depression, anxiety, and insomnia in a Japanese working population.

Background: Lack of social support is associated with depression, anxiety, and insomnia. This study aimed to determine the source of support related to depression, anxiety, and insomnia among Japanese workers. Methods: As part of a cohort study, we conducted a questionnaire survey among city government employees in Koka City, Shiga Prefecture, Japan, from September 2021 to March 2022. We used the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI) to assess depressive symptoms, anxiety symptoms, and insomnia, respectively. We used the Brief Job Stress Questionnaire (BJSQ) to assess job stressors and social support (from supervisors, colleagues, and family). Results: A total of 1,852 Japanese employees (38.4% male, 45.9 ± 12.9 years) participated in the survey, with 15.5, 10.8, and 8.2% of the participants having depressive symptoms (PHQ-9 ≥ 10), anxiety symptoms (GAD-7 ≥ 10), and insomnia (ISI ≥ 15), respectively. The logistic regression analysis suggested that job stressors were associated with depressive symptoms (p < 0.001), anxiety symptoms (p < 0.001), and insomnia (p = 0.009). In contrast, support from co-workers (p = 0.016) and family members (p = 0.001) was associated with decreased depressive symptoms. Support from family members was associated with decreased insomnia (p = 0.005). Conclusion: Social support from co-workers and family may be associated with reduced depressive symptoms, and family support may be associated with reduced insomnia in the Japanese working population. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03276585.

Patient with bipolar I disorder who presented with low blood lithium levels after receiving crushed tablets via a nasogastric tube: A case report.

In clinical psychiatric cases, the placement of a nasogastric tube is occasionally considered. If a patient who presents with mania or other psychiatric conditions refuses to take drugs, they are administered via the nasogastric tube. The tablet is crushed, suspended, passed via the nasogastric line, and reaches the stomach directly. However, the effects of these processes on blood drug concentrations remain unclear. Herein, we report a patient with bipolar I disorder who presented with low blood lithium carbonate (Li) concentrations after receiving the drug via the nasogastric tube. Case: A 26-year-old woman developed manic symptoms with grandeur delusion. She was admitted to a psychiatric hospital three times after diagnosis. Her manic symptoms with delusion improved with Li and aripiprazole (ARP). Her condition stabilized with Li 800 mg/day and ARP 9 mg/day. After the Li dose was reduced to 600 mg/day, she maintained remission, with the blood level range of Li being 0.31 ∼ 0.42 mEq/L. After 1 year, she was admitted to our hospital due to a jaw deformity. During the perioperative period, treatment with oral Li was discontinued by the surgeons, and her manic symptoms recurred. During therapy with olanzapine 20 mg and Li 800 mg, her blood Li concentration was 0.67 mEq/L. The symptoms remained. Hence, the Li dose increased to 1,000 mg/day. However, she refused to take the medication. Thus, a nasogastric tube was used to administer medicines. Thereafter, the blood Li concentration decreased to 0.43 mEq/L, which was lesser than 800 mg/day. Each blood sample was collected approximately 18 h after the administration. Her symptoms remained. Thereafter, she agreed to take the medication, and the Li concentration reached 0.78 mEq/L. Then, the symptoms partly improved. Conclusion: After the administration of Li via the nasogastric tube, the Li concentration decreased, which was lower than expected. This phenomenon could be attributed to the fact that the medication was crushed, suspended, and administered via the nasogastric tube. Therefore, pulverizing and administering Li tablets via the nasogastric tube can be applied for the management of mania, however, caution should be observed because of the risk of fluctuations in blood Li levels, as in this case.

The prevalence of depression in isolated/idiopathic rapid eye movement sleep behavior disorder: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to investigate depression prevalence and depression-related symptoms among patients with isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD). We systematically searched online databases (PubMed and Scopus), performed meta-analyses of psychiatric symptoms prevalence using a random-effects model, and calculated 95% prediction intervals (PIs) and I2 values to evaluate the degree of heterogeneity. We conducted a meta-regression analysis to assess the relationship between psychiatric symptom severity, age at diagnosis, and disease duration from onset of iRBD. We analyzed 31 studies which included 3,576 patients (2,871 men, 80.3%; mean age, 66.6 ± 8.6 years). The pooled depression prevalence was 28.8% (95% CI 23.1-35.2, 95% PI 8.1-65.1, and I2 = 83.9%). We found a significantly negative correlation between depression-scale scores and disease duration in iRBD (p = 0.012, ß = -0.36, R2 analog = 0.33). Pooled prevalence of apathy and anxiety was 38.4% (95% CI 27.7-50.4, 95% PI 0.02-99.9, and I2 = 57.8%) and 21.3% (95% CI 15.5-28.5, 95% PI 4.2-62.6, and I2 = 47.1%), respectively. Few articles on alexithymia were available for meta-analysis. This study confirmed high prevalence of depression, apathy, and anxiety in patients with iRBD.

Toe grip force of the dominant foot is associated with fall risk in community-dwelling older adults: a cross-sectional study.

BACKGROUND: It is unclear whether the toe grip force (TGF) of the dominant foot (DF) and the lower limb function asymmetry (LLFA) in older adults are associated with fall risk. Therefore, this study aimed to investigate the effect of lower limb properties (such as TGF, muscle strength, and plantar sensation) on the risk of falls in older adults, while considering the foot dominance and asymmetry of lower limb function. METHODS: This study was a cross-sectional study. We determined whether the lower limb function of the DF and non-dominant foot (non-DF) and LLFA had any effect on the fall risk in 54 older adults (mean ± standard deviation: 72.2 ± 6.0, range: 60-87 years). We examined the participants' fall history, Mini-Mental State Examination (MMSE) score, lower limb function, and LLFA. To determine fall risk factors, we performed logistic regression analysis, with presence or absence of falls as the dependent variable. RESULTS: The independent variables were age, sex, MMSE score, two-point discrimination of the heel (non-DF) as plantar sensation index, and the TGF of both feet. Only the TGF of the DF was identified as a risk factor for falls (p < 0.05). CONCLUSIONS: In older adults, clinicians should focus on the TGF of the DF as a risk factor for falls. TRIAL REGISTRATION: This study was retrospectively registered. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_up_rec_f1.cgi .

Prolonged Sleep Latency and Reduced REM Latency Are Associated with Depressive Symptoms in a Japanese Working Population.

BACKGROUND: Examining the relationship between sleep and depression may be important for understanding the aetiology of affective disorders. Most studies that use electroencephalography (EEG) to objectively assess sleep have been conducted using polysomnography in the laboratory. Impaired sleep continuity, including prolonged sleep latency and changes in rapid eye movement (REM) sleep, have been reported to be associated with depression in clinical settings. Here, we aimed to use home EEG to analyse the association between sleep and depressive symptoms. METHODS: We performed a cross-sectional epidemiological study in a large Japanese working population to identify the EEG parameters associated with depressive symptoms based on the results of a questionnaire survey and home EEG measurements using 1-channel (1-Ch) EEG. RESULTS: The study included 650 Japanese patients (41.2% male, 44.7 ± 11.5 years) who underwent home EEG monitoring along with the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms. Logistic regression analysis revealed that depressive symptoms (PHQ-9 ≥ 10) were associated with sleep latency (odds ratio (OR) 1.02; 95% confidence interval (CI): 1.00-1.04) and REM latency (OR, 0.99; 95% CI: 0.99-1.00). CONCLUSIONS: Our results suggest that depressive symptoms are associated with prolonged sleep latency and reduced REM latency in a Japanese working population. The 1-Ch EEG may be a useful tool to monitor sleep and screen depression/depressive symptoms in non-clinical settings.

Minor hallucinations in isolated rapid eye movement sleep behavior disorder indicative of early phenoconversion: A preliminary study.

OBJECTIVES: Minor hallucinations (MH) are psychotic symptoms that can occur anywhere between prodromal to early Parkinson's disease and after onset of motor problems. MH include visual illusions, presence hallucinations, and passage hallucinations. Isolated rapid eye movement sleep behavior disorder (RBD) is a harbinger of neurodegenerative diseases. We conducted a retrospective cohort study to investigate the clinical characteristics of isolated RBD with MH and the risk of phenoconversion. MATERIALS AND METHODS: We retrospectively analyzed the data of 36 patients with isolated RBD (four females; median age, 75.0 years). We defined cases reporting at least one minor hallucination as RBD with MH. Demographic data and cognitive function were compared between patients with and without MH, and Cox proportional hazards models estimated the risk of phenoconversion. RESULTS: We included 10 (27.8%) patients with MH and 26 (72.2%) without MH. Patients with MH were older, had less dopamine transporter accumulation, more severe autonomic dysfunction, more depressive symptoms, and lower verbal fluency and symbol coding test scores than patients without MH. After follow-up (median, 2.50 years), 13.9% (5/36) of all patients developed phenoconversion (Parkinson's disease, two patients; dementia with Lewy bodies, three patients). The rate of phenoconversion was significantly higher in patients with MH (40.0% vs. 3.8%, p = .005). The Cox proportional hazards model adjusted for age, sex, and disease duration revealed that MH was a significant risk factor for phenoconversion (hazard ratio, 14.72; 95% confidence interval, 1.35-160.5). CONCLUSIONS: Minor hallucinations may be utilized as early clinical markers for prodromal estimation of neurodegenerative diseases.

Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy: A retrospective cohort study.

BACKGROUND: Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD. AIM: To investigate the diagnostic factors and treatment strategies associated with depression relapse. METHODS: We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms. RESULTS: Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study. Compared with the MDD participants, more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission (65.6% vs 15.1%, P < 0.001; relative risk = 4.35, 95%CI: 2.19-8.63, P < 0.001). Twenty-nine patients experienced relapses during the three-year follow-up. In 21 (72.4%, 21/29) patients with relapse, the diagnosis was changed from MDD to BP. The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients (9.63 ± 10.4 mo vs 3.38 ± 3.77 mo, P = 0.022); for most patients, the interval was less than one month. The relative risk of depressive symptoms based on diagnostic changes was 4.35 (95% confidence interval: 2.19-8.63, P < 0.001), and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756 (95%CI: 0.562-0.895, P = 0.007). CONCLUSION: It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.

Explosive sound without external stimuli following electroencephalography kappa rhythm fluctuation: A case report.

BACKGROUND: The pathology underlying exploding head syndrome, a parasomnia causing a loud sound/sense of explosion, is not well understood. Kappa rhythm is a type of electroencephalogram alpha band activity with maximum potential between contralateral temporal electrodes We report a case of preceding kappa activity before exploding head syndrome attacks. CASE REPORT: A 57-year-old woman complained of explosive sounds for 2 months; a loud sound would transpire every day before sleep onset. She was diagnosed with exploding head syndrome. During polysomnography and the multiple sleep latency test, the exploding head syndrome attacks occurred six times. A kappa wave with activity disappearing a few seconds before most exploding head syndrome attacks was observed. The alpha band power in T3-T4 derivation gradually waxed followed by termination around the attacks. CONCLUSION: This case demonstrated that the dynamics of kappa activity precede exploding head syndrome attacks. Finding ways to modulate electroencephalogram oscillation could elucidate their causality and lead to therapeutic intervention.

Impact of a Psychiatric Nurse Specialist as a Liaison for Pregnant Women with Mental Disorders.

A number of scholarly reports have shown the importance of mental health care during pregnancy, especially for women with mental disorders. Nevertheless, the postpartum mortality rate due to mental disorders has been a serious issue in Japan. Therefore, since January 2015, our hospital has implemented a liaison system in which one psychiatric nurse specialist contributes to perinatal care. The aim of this study is to explore the impacts of a psychiatric nurse specialist as a liaison for pregnant women with mental disorders. More specifically, the investigation was retrospectively performed from January 2011 to December 2019 using medical records from a single university medical hospital in Japan. Participants comprised pregnant women with mental disorders. Of the 4,066 total deliveries completed during the study period, 152 women were detected as being exposed to the liaison system (2015-2019), while 92 were recognized as controls (2011-2014). We then conducted a comparative analysis between those who were exposed to the liaison system and the control group. Except for Apgar scores taken five minutes after birth, there were no intergroup differences in the patient characteristics or perinatal psychiatric outcomes. We found that the liaison system was associated with an increased rate of referral to the local public health center (p = 0.003). The system also significantly delayed the time at which patients first visited a psychiatrist because a psychiatric nurse could determine the urgency through interviews with the patients. Overall, our results suggest that the liaison system is helpful for pregnant women with mental disorders.

Effects of Antipsychotics on Arrhythmogenic Parameters in Schizophrenia Patients: Beyond Corrected QT Interval.

PURPOSE: Antipsychotic drugs have been implicated as risk factors for QT prolongation, which is a predictor of sudden cardiac death. However, the QT interval is considered an imperfect marker for proarrhythmic risk. Recently, improved methods, namely, QT dispersion (QTD), QTD ratio (QTDR), T wave peak-to-end interval (Tp-e), Tp-e/QT ratio and Tp-e/QTc ratio, have been regarded as proarrhythmic risk markers. We attempted to reevaluate the risk of sudden cardiac death due to antipsychotics use by measuring these improved evaluation methods. PATIENTS AND METHODS: We retrospectively evaluated QTc, QTD, QTDR, Tp-e, Tp-e/QT ratio and Tp-e/QTc ratio from the medical records of 410 patients with schizophrenia diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, or 5th Edition. Information on drugs administered was obtained from medical records. We investigated the correlation between each index on ECG and medication, such as antipsychotics, prescribed to participants with linear regression analysis. We also compared each index between 235 healthy controls and 235 patients matched for age and sex. RESULTS: Positive correlations between QTc and levomepromazine and brexpiprazole were identified. Levomepromazine and lithium were positively correlated with QTD. Levomepromazine, quetiapine, asenapine, clozapine and carbamazepine were positively correlated with QTDR. Levomepromazine, olanzapine, brexpiprazole and lithium were positively correlated with Tp-e. Olanzapine, brexpiprazole and lithium were positively correlated with the Tp-e/QT ratio. Olanzapine, brexpiprazole and lithium were positively correlated with Tp-e/QTc ratio. Significant differences in all indexes were noted between the patients and healthy controls. CONCLUSION: According to our results, the prediction of the risk of sudden cardiac death by each index was inconsistent. We should evaluate the predictive factor of ventricular arrhythmia according to various electrocardiogram indexes because QTc alone could not identify the risk of sudden cardiac death.

Contribution of Somatosensory and Parietal Association Areas in Improving Standing Postural Stability Through Standing Plantar Perception Training in Community-Dwelling Older Adults.

Although standing plantar perception training (SPPT) may improve standing postural stability, the underlying neural mechanisms remain unclear. The authors investigated the relationship between regional cortical responses to SPPT using a balance pad and training outcomes in 32 older participants (mean ± SD:72.2 ± 6.0, range:60-87). Regional cortical activity was measured in the bilateral supplementary motor area, primary sensorimotor area, and parietal association area using near-infrared spectroscopy. Postural sway changes were compared before and after SPPT. Changes in two-point plantar discrimination and regional cortical activity during SPPT, associated with standing postural stability improvements, were examined using multiple regression and indicated improved standing postural stability after SPPT (p < .0001). Changes in right parietal association area activity were associated with standing postural stability improvements while barefoot. Overall, the results suggest that right parietal association area activation during SPPT plays a crucial role in regulating standing postural stability and may help develop strategies to prevent older adults from falling.

Resting Heart Rate Variability Is Associated With Subsequent Orthostatic Hypotension: Comparison Between Healthy Older People and Patients With Rapid Eye Movement Sleep Behavior Disorder.

Background: Orthostatic hypotension (OH) caused by autonomic dysfunction is a common symptom in older people and patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). The orthostatic challenge test is a standard autonomic function test that measures a decrease of blood pressure during a postural change from supine to standing positions. Although previous studies have reported that changes in heart rate variability (HRV) are associated with autonomic dysfunction, no study has investigated the relationship between HRV before standing and the occurrence of OH in an orthostatic challenge test. This study aims to examine the connection between HRV in the supine position and the occurrence of OH in an orthostatic challenge test. Methods: We measured the electrocardiograms of patients with iRBD and healthy older people during an orthostatic challenge test, in which the supine and standing positions were held for 15 min, respectively. The subjects were divided into three groups: healthy controls (HC), OH-negative iRBD [OH (-) iRBD], and OH-positive iRBD [OH (+) iRBD]. HRV measured in the supine position during the test were calculated by time-domain analysis and Poincaré plots to evaluate the autonomic dysfunction. Results: Forty-two HC, 12 OH (-) iRBD, and nine OH (+) iRBD subjects were included. HRV indices in the OH (-) and the OH (+) iRBD groups were significantly smaller than those in the HC group. The multivariate logistic regression analysis for OH identification for the iRBD groups showed the model whose inputs were the HRV indices, i.e., standard deviation 2 (SD2) and the percentage of adjacent intervals that varied by more than 50 ms (pNN50), had a receiver operating characteristic curve with area under the curve of 0.840, the sensitivity to OH (+) of 1.000, and the specificity to OH (-) of 0.583 (p = 0.023). Conclusions: This study showed the possibility that short-term HRV indices in the supine position would predict subsequent OH in iRBD patients. Our results are of clinical importance in terms of showing the possibility that OH can be predicted using only HRV in the supine position without an orthostatic challenge test, which would improve the efficiency and safety of testing.

Predictive Utility of Body Mass Index for Metabolic Syndrome Among Patients with Schizophrenia in Japan.

BACKGROUND: Reliable and easy screening for metabolic syndrome (MetS) is important for patients with schizophrenia. The aim of this study was to assess the predictive utility of body mass index (BMI) for MetS among patients with schizophrenia in Japan. METHODS: In total, 8468 patients (4705 males, 3763 females) with schizophrenia or schizoaffective disorders based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), or the International Classification of Diseases, tenth revision (ICD-10), were assessed for MetS using the criteria of the National Cholesterol Education Program Adult Treatment Panel III (ATP III-A). We applied a stratum-specific likelihood ratio (SSLR) analysis, which is independent of the prevalence of the target disease. RESULTS: The mean (± standard deviation) age of these patients was 57.4 ± 13.5 years. The prevalence of MetS was 20.4%. Among males, the SSLRs predicting MetS were 0.03 (95% CI 0.02-0.06), 0.54 (95% CI 0.48-0.60), 2.77 (95% CI 2.44-3.14) and 8.75 (95% CI 7.40-10.36) for BMI <20 kg/m2, 20 kg/m2 ≤ BMI < 25 kg/m2, 25 kg/m2≤ BMI < 28 kg/m2, and 28 kg/m2≤BMI, respectively. For females, the SSLRs predicting MetS were 0.08 (95% CI 0.05-0.12), 0.73 (95% CI 0.66-0.82), 2.50 (95% CI 2.16-2.90) and 4.83 (95% CI 4.12-5.67) for the same BMI categories, respectively. CONCLUSION: The predictive utility of BMI is confirmed, and BMI has more predictive value in males than in females. Patients with a BMI of 28 kg/m2 or greater had a significantly higher SSLR than those with a BMI less than 28 kg/m2.

Lower Prolactin Levels in Patients Treated With Aripiprazole Regardless of Antipsychotic Monopharmacy or Polypharmacy.

BACKGROUND: Hyperprolactinemia is a troublesome adverse effect of antipsychotics. Aripiprazole (ARP), which is one of second-generation antipsychotics, has been reported to lower serum prolactin (PRL) levels. However, few studies have compared the effect of ARP on plasma PRL levels between monopharmacy and polypharmacy with antipsychotics. METHODS: We conducted a large-scale investigation of the physical risk for inpatients with schizophrenia using a questionnaire covering demographic data, the number, dose and type of antipsychotics, and serum PRL levels. RESULTS: Sufficient data to conduct an assessment of the effect on PRL levels between antipsychotic monopharmacy and polypharmacy were obtained from 316 of the inpatients. Serum PRL levels in ARP combination group were lower than non-ARP combination group, regardless of antipsychotic monopharmacy or polypharmacy. CONCLUSIONS: The present study suggests that ARP lowers serum PRL levels regardless of monopharamacy or polypharmacy with antipsychotics.