Alterations of mental defeat and cognitive flexibility during cognitive behavioral therapy in patients with major depressive disorder: a single-arm pilot study.

OBJECTIVE: Mental defeat affects the occurrence and chronicity of depression and cognitive flexibility. This study aimed to examine changes in mental defeat and cognitive flexibility scores after cognitive behavioral therapy including IR. In the intervention group, patients with depression (n = 18, mean age = 37.89 years) received 15 cognitive behavioral therapy sessions. Patients completed the Beck Depression Inventory-II; Mental Defeat Scale; Cognitive Flexibility Scale; EuroQol five dimensions questionnaire; Patient Health Questionnaire-9 and seven-item Generalized Anxiety Disorder Scale before the intervention, after six sessions, and post-intervention. The healthy control group (n = 33, mean age = 37.91) completed all scales once and did not receive treatment. RESULTS: Post-cognitive behavioral therapy, a significant decrease was observed in Beck Depression Inventory-II, Mental Defeat Scale, Cognitive Flexibility Scale, and Patient Health Questionnaire-9 scores. Although mental defeat and cognitive flexibility did not reach the level of the healthy control group, they demonstrated improvement. Therefore, when treating depression, mental defeat and cognitive flexibility should be measured in addition to depressive symptoms. Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 25, 2016 (registration ID: UMIN000023320).

Does cognitive behavioral therapy alter mental defeat and cognitive flexibility in patients with panic disorder?

OBJECTIVE: Mental defeat and cognitive flexibility have been studied as explanatory factors for depression and posttraumatic stress disorder. This study examined mental defeat and cognitive flexibility scores in patients with panic disorder (PD) before and after cognitive behavioral therapy (CBT), and compared them to those of a gender- and age-matched healthy control group. RESULTS: Patients with PD (n = 15) received 16 weekly individual CBT sessions, and the control group (n = 35) received no treatment. Patients completed the Mental Defeat Scale and the Cognitive Flexibility Scale before the intervention, following eight CBT sessions, and following 16 CBT sessions, while the control group did so only prior to receiving CBT (baseline). The patients' pre-CBT Mental Defeat and Cognitive Flexibility Scale scores were significantly higher on the Mental Defeat Scale and lower on the Cognitive Flexibility Scale than those of the control group participants were. In addition, the average Mental Defeat Scale scores of the patients decreased significantly, from 22.2 to 12.4, while their average Cognitive Flexibility Scale scores increased significantly, from 42.8 to 49.5. These results suggest that CBT can reduce mental defeat and increase cognitive flexibility in patients with PD Trial registration The study was registered retrospectively in the national UMIN Clinical Trials Registry on June 10, 2016 (registration ID: UMIN000022693).

Exploratory study of imagery rescripting without focusing on early traumatic memories for major depressive disorder.

BACKGROUND: Mental imagery has a more powerful impact on our emotions than thinking in words about the same material. Treating intrusive images with imagery rescripting (IR) has been reported for various disorders, including post-traumatic stress disorder, social anxiety disorder, and bipolar disorder. There has been less research about IR as a major depressive disorder (MDD). AIMS: We examined whether IR without focusing on early traumatic memories is effective in MDD. METHODS: We enrolled 19 participants with MDD, who received 15 weekly sessions of full CBT, including two sessions for IR of intrusive images and, separately, for memory rescripting. Before and after the IR intervention, participants were asked to rate the intrusive images they experienced against, an intrusion index that included difficulty (interference with daily life), uncontrollability, distress caused by the negative image, and vividness. We recorded the contents of each participant's negative and positive imagery to classify these. RESULTS: The intrusion index scores decreased after the IR sessions. Negative images experienced by the participants while in a depressive mood were categorized into three different types: blame, social exclusion, and loneliness. The rescripted positive images were categorized into good relations and worthy self (competent self). CONCLUSIONS: These results suggest that IR of intrusive images without focusing on early traumatic memories may usefully be incorporated into routine CBT sessions for MDD.

A feasibility study of the clinical effectiveness and cost-effectiveness of individual cognitive behavioral therapy for panic disorder in a Japanese clinical setting: an uncontrolled pilot study.

BACKGROUND: In Japan, cognitive behavioral therapy (CBT) for panic disorder (PD) is not well established. Therefore, a feasibility study of the clinical effectiveness and cost-effectiveness of CBT for PD in a Japanese clinical setting is urgently required. This was a pilot uncontrolled trial and the intervention consisted of a 16-week CBT program. The primary outcome was Panic Disorder Severity Scale (PDSS) scores. Quality of life was assessed using the EuroQol's EQ-5D questionnaire. Assessments were conducted at baseline, 8 weeks, and at the end of the study. Fifteen subjects completed outcome measures at all assessment points. RESULTS: At post-CBT, the mean reduction in PDSS scores from baseline was -6.6 (95 % CI 3.80 to -9.40, p < 0.001) with a Cohen's d = 1.77 (95 % CI 0.88-2.55). Ten (66.7 %) participants achieved a 40 % or greater reduction in PDSS. By calculating areas under the curve for EQ-5D index changes, we estimated that patients gained a minimum of 0.102 QALYs per 1 year due to the CBT. CONCLUSIONS: This study demonstrated that individual CBT for PD may be useful in Japanese clinical settings but further randomized control trials are needed. TRIAL REGISTRATION: UMIN-CTR UMIN000022693 (retrospectively registered).

Onset Pattern and Long-Term Prognosis in Schizophrenia: 10-Year Longitudinal Follow-Up Study.

BACKGROUND: Although the duration of untreated psychosis (DUP) plays an important role in the short-term prognosis of patients with schizophrenia, their long-term prognosis generally is not determined by DUP alone. It is important to explore how other clinical factors in the early stage are related to DUP and consequent disease courses. METHODS: A total of 664 patients with untreated psychosis were surveyed for this study. At the first examination, we divided them into the severe positive symptoms cases (SC) or the less severe cases (NonSC) and compared the prognosis among the two groups after a 10-year follow-up. In all, 113 patients in the SC group and 43 patients in the NonSC group were follow-up completers. RESULTS: Whereas DUP was not different between the two groups, patients with nonacute onset in both groups had significantly longer DUP than those in patients with acute onset. For all clinical measures, there was no difference in prognosis between the two groups or among the four groups classified by mode of onset (MoO) and initial severity of positive symptoms. However, the degree of improvement of global assessment of functioning (GAF) was significantly smaller in the NonSC-nonacute group than in the SC-acute and SC-nonacute groups. CONCLUSIONS: These results suggest that neither DUP nor MoO alone necessarily affects the initial severity of positive symptoms. Moreover, it is possible that patients with low impetus of positive symptoms onset within long DUP experience profound pathologic processes. Therefore, the current study results indicated that long DUP and nonacute onset were related to poor long-term prognosis, regardless of initial positive symptoms.

Prism-coupled Cherenkov phase-matched terahertz wave generation using a DAST crystal.

Terahertz (THz) wave generation based on nonlinear frequency conversion is a promising method for realizing a tunable monochromatic high-power THz-wave source. Unfortunately, many nonlinear crystals have strong absorption in the THz frequency region. This limits efficient and widely tunable THz-wave generation. The Cherenkov phase-matching method is one of the most promising techniques for overcoming these problems. Here, we propose a prism-coupled Cherenkov phase-matching (PCC-PM) method, in which a prism with a suitable refractive index at THz frequencies is coupled to a nonlinear crystal. This has the following advantages. Many crystals can be used as THz-wave emitters; the phase-matching condition inside the crystal does not have to be observed; the absorption of the crystal does not prevent efficient generation of radiation; and pump sources with arbitrary wavelengths can be employed. Here we demonstrate PCC-PM THz-wave generation using the organic crystal 4-dimethylamino-N-metyl-4-stilbazolium tosylate (DAST) and a Si prism coupler. We obtain THz-wave radiation with tunability of approximately 0.1 to 10 THz and with no deep absorption features resulting from the absorption spectrum of the crystal. The obtained spectra did not depend on the pump wavelength in the range 1300 to 1450 nm. This simple technique shows promise for generating THz radiation using a wide variety of nonlinear crystals.

Tunability enhancement of a terahertz-wave parametric generator pumped by a microchip Nd:YAG laser.

We have enhanced the tunability of a terahertz-wave parametric generator using MgO:LiNbO3 pumped by a subnanosecond, passively Q-switched, microchip Nd:YAG laser. This pump source allows high-intensity pumping without damage to the nonlinear crystal and generates a narrow linewidth and tunable terahertz wave with injection seeding by an external cavity diode laser for the idler wave. The high-intensity pumping causes a gain curve broadening of the terahertz-wave parametric generation, especially in the high-frequency region. We obtained an output terahertz wave with a tuning range of 0.9-3 THz (100-330 microm), a peak power of 100 mW, and a linewidth of less than 10 GHz. This room temperature operated, palm-sized source promises to be a widely tunable terahertz-wave source that is suited to a variety of applications.

Cherenkov phase matched THz-wave generation with surfing configuration for bulk lithium nobate crystal.

We demonstrated a Cherenkov phase matched THz-wave generation with surfing configuration for bulk lithium niobate crystal. THz-wave output was enhanced about 50 times by suppressing phase mismatching for THz-wave propagation direction. The suppression was achieved by combining two pumping waves with dual wavelength with finite angle, and THz-frequency was controllable by changing the angle within 2.5 degrees range. Higher frequency THz-wave generation at around 4.0 THz was successfully obtained by the method.

Extremely frequency-widened terahertz wave generation using Cherenkov-type radiation.

Terahertz (THz) wave generation based on nonlinear frequency conversion is promising way for realizing a tunable monochromatic bright THz-wave source. Such a development of efficient and wide tunable THz-wave source depends on discovery of novel brilliant nonlinear crystal. Important factors of a nonlinear crystal for THz-wave generation are, 1. High nonlinearity and 2. Good transparency at THz frequency region. Unfortunately, many nonlinear crystals have strong absorption at THz frequency region. The fact limits efficient and wide tunable THz-wave generation. Here, we show that Cherenkov radiation with waveguide structure is an effective strategy for achieving efficient and extremely wide tunable THz-wave source. We fabricated MgO-doped lithium niobate slab waveguide with 3.8 microm of thickness and demonstrated difference frequency generation of THz-wave generation with Cherenkov phase matching. Extremely frequency-widened THz-wave generation, from 0.1 to 7.2 THz, without no structural dips successfully obtained. The tuning frequency range of waveguided Cherenkov radiation source was extremely widened compare to that of injection seeded-Terahertz Parametric Generator. The tuning range obtained in this work for THz-wave generation using lithium niobate crystal was the widest value in our knowledge. The highest THz-wave energy obtained was about 3.2 pJ, and the energy conversion efficiency was about 10(-5) %. The method can be easily applied for many conventional nonlinear crystals, results in realizing simple, reasonable, compact, high efficient and ultra broad band THz-wave sources.

Does hypofrontality expand to global brain area in progression of schizophrenia?: a cross-sectional study between first-episode and chronic schizophrenia.

Although to date there have been no conclusive pathophysiological findings in support of the degenerative theory of the etiology of schizophrenia, the results of neuroimaging studies have suggested that progressive changes in the brain do occur during the clinical course of schizophrenia. However, there has been no report on alterations in regional cerebral blood flow (rCBF) under resting condition, which was compared between the first-episode and the chronic patients of schizophrenia and healthy controls. Therefore, in this study, we applied three-dimensional stereotactic surface projection analysis of resting SPECT (3D-SSP SPECT) in patients with first-episode (n=18) and chronic schizophrenia (n=23) and age-/sex-matched healthy controls (n=40). The rCBFs in the middle/inferior/medial frontal gyrus and the anterior cingulate gyrus were significantly decreased in both patient groups, relative to the respective controls (Z>3.0, P<0.001, uncorrected). The chronic group showed significant hypoperfused region in the left inferior parietal lobule and middle/inferior temporal gyrus. Furthermore, within-cases comparison between the first-episode and chronic schizophrenia, revealed that the significant hypoperfused regions in the chronic group, compared to the first-episode group, were not only the lateral and medial prefrontal cortex, but also the inferior parietal cortex, posterior part of the temporal lobe, and the cuneus. The present study suggested that the reduction in rCBF occurs in the posterior brain area in addition to the frontal lobe across all clinical stages of schizophrenia.

Cherenkov phase-matched monochromatic THzwave generation using difference frequency generation with a lithium niobate crystal.

We demonstrated a Cherenkov phase-matching method for monochromatic THz-wave generation using the difference frequency generation process with a lithium niobate crystal, which resulted in high conversion efficiency and wide tunability. We successfully generated monochromatic THz waves across the range 0.2-3.0 THz. We obtained efficient energy conversion in the low frequency region below 0.5 THz, and achieved a flat tuning spectrum by varying the pumping wavelength during THz-wave tuning.