Unraveling complex relationships among dysphoric disorder, localization-related epilepsy, and mood disorders.

BACKGROUND: Dysphoric disorder (DD), characterized by intermittent pleomorphic symptoms, has been believed to be specific to epilepsy. However, our previous study revealed that DD in patients with localization-related epilepsy was associated with a lifetime diagnosis of mood disorders. The present study was conducted to estimate the prevalence of DD in patients with mood disorders, but not epilepsy, and to identify the clinical similarities and differences of DD in patients with either epilepsy or mood disorders. METHODS: Subjects consisted of 104 patients with localization-related epilepsy (group E) and 101 patients with DSM-IV mood disorders, but not with epilepsy (group M). After a diagnostic investigation for DD and the euthymic state, defined as the absence of any mood episodes during the last 12months, we compared the clinical characteristics of DD in patients from groups E and M. RESULTS: Dysphoric disorder was apparently more common in group M (56.4%) than in group E (21.2%). However, 86.0% of patients in group M showed a temporal overlap between DD and the noneuthymic state, while 68.2% of patients in group E did not show this overlap. Moreover, the noneuthymic state was significantly associated with symptoms of DD, indicating that the diagnosis of DD was more likely to be overestimated when the subjects were in a noneuthymic state. The prevalence of DD, temporally independent of the noneuthymic state (pure DD), was estimated at 13.4% and 7.0% in groups E and M, respectively, and pure DD was 1.91 times more common in patients with epilepsy than in those with mood disorders. Diagnosis of pure DD was significantly associated with increased suicidality in group E, but not group M. CONCLUSION: The present results suggest that DD is more familiar to epilepsy than mood disorders, although DD is not specific to epilepsy. Moreover, suicidality is specifically associated with DD in patients with epilepsy.

Interictal dysphoric disorder in patients with localization-related epilepsy: Diagnostic relationships with DSM-IV psychiatric disorders and the impact of psychosocial burden.

BACKGROUND: Some patients with epilepsy develop intermittent and pleomorphic affective-somatoform symptoms, termed interictal dysphoric disorder (IDD). Other psychiatric disorders have been extensively investigated in patients with epilepsy, but there are few clinical studies investigating the comorbidity patterns of IDD and common psychiatric disorders (PDs). In particular, the impact of IDD on the psychosocial burden of patients remains unclear. METHODS: The participants were 128 adult Japanese outpatients with localization-related epilepsy (LRE). In order to determine the comorbidity patterns for IDD and PDs, we conducted a comprehensive diagnostic investigation for IDD and DSM-IV psychiatric disorders. Based on these analyses, participants were divided into groups according to the comorbidity patterns for IDD and PDs in order to compare both suicide risk and quality of life (QOL). RESULTS: The findings indicated that 19.5% of participants had IDD, and 55.5% had PDs. Younger age at epilepsy onset and refractory complex partial seizures were associated with IDD, but the duration and type of epilepsy were not. Patients with IDD were more likely to have comorbid PDs as follows: mood disorders (odds ratio, OR: 8.30; 95% confidence interval, CI: 3.15-21.83), anxiety disorders (OR: 8.81; 95% CI: 3.30-23.49), and psychotic disorders (OR: 7.72; 95% CI: 2.83-21.06). Group comparisons demonstrated that there were no patients with IDD but without PD. Furthermore, patients with IDD and with PDs had a significantly higher suicide risk and lower QOL compared to the other groups, even after adjusting for the influences of confounding factors. CONCLUSION: Interictal dysphoric disorder adds extreme psychosocial burden and is associated with multiple PDs in patients with LRE. The present study suggests that IDD has a specific prognostic significance. However, whether IDD is nosologically independent from conditions diagnosed using standardized psychiatric diagnostic systems such as DSM-IV must be further assessed by future research.

Electroconvulsive therapy-induced Wolff-Parkinson-White syndrome: a case report.

OBJECTIVE: Wolff-Parkinson-White (WPW) syndrome is characterized by premature ventricular excitation due to the presence of an abnormal accessory pathway. Electrocardiography (ECG) of patients with WPW syndrome portrays a short PR interval and a wide QRS interval with a delta wave. METHODS: Herein, we report the case of a patient with schizophrenia who developed a wide QRS interval with a delta wave immediately following electroconvulsive therapy (ECT). RESULTS: Initially, the delta wave disappeared within 2 days after ECT. However, the duration of the delta wave increased exponentially to 4 months when ECT was repeated. CONCLUSION: Although the patient's cardiocirculatory dynamics remained normal, we continued to monitor her ECG until the delta wave disappeared because WPW syndrome can lead to serious arrhythmia.

[Psychological trauma risks among disaster workers: perspectives on their mental health following the Great East Japan Earthquake].

Following the March 11, 2011 Great Japan East Earthquake and the Fukushima Daiichi Nuclear Power Plant accident, disaster workers have been working day and night for recovery efforts. A large part of disaster workers, i.e., Self-Defense Force, police, fire department, and coast guard personnel, were highly acknowledged by the Japanese public for searching nearly 19,000 dead or missing victims. This recognition will be beneficial for their psychological recovery. On the other hand, dentists and government employees also took a large role in these mortuary missions, but their work was hardly known to the people. Furthermore, local government employees became victims of public criticisms. Similar phenomenon has been seen among Fukushima nuclear plant workers. These workers have experienced a whole array of traumatic stress, including near-death work experiences, irradiation fear, loss of their properties and their loved ones. The electric company has been blamed by the public for their disaster responses, so the public portrays these employees as disaster perpetrators. However, this trend is leading to serious discriminations and harassments, and adversely affecting their mental health. We all hope the recovery efforts to complete as soon as possible. However, when people criticize these workers, their burden of psychological trauma will continue to grow, and their recovery process will be impeded. It is crucial for the society to recognize these hard-working people and to show appreciation and support for their dedications.

[Complexities of the stress experienced by employees of the Fukushima nuclear plants].

Fukushima Daiichi Nuclear Power Plants suffered serious damage by the Great East Japan Earthquake and Tsunami. The employees of the plant worked very hard to stabilize the nuclear reactor and to prevent any secondary accidents. They were in one of the most severe situations in this disaster, but they were the people who hesitated most to request help for themselves. We started visiting the Fukushima Daini Plant office that was used as the frontline base for Daiichi Plant workers since July, 2011. These visits were held once or twice a month and we offered mental health support to the employees. We have completed interview with the total number of 339 plant workers by April, 2012. We offered several ways of mental support including clinical treatment, continuous counseling, or one time advice, depending on mental condition of each interviewee. Complexity of huge disaster and individuality of suffering from it were discussed in this article. Like local residents, many plant workers also experienced death/missing of family, loss of housing, refuge life, and dispersion of family. Furthermore, they have been suffering from various kinds of criticism and slander against Tokyo Electric Power Company. Many workers, even though they were not in management positions, seemed to have guilty conscience and sense of responsibility that forced them to stay in the risky working site. We could find some struggling coexistence of sense of guilt (as a causer of disaster) and sense of victim in their mind. It was suggested that continuous effort to listen and pay attention to their talk is important in order to support their mission to stabilize the power plant and to prevent them from over-stress and burnout.

A case of seizures induced by abstract reasoning.

We describe a case of reflex seizures induced by abstract reasoning but not other cognitive processes. The patient, a 46-year-old man, experienced myoclonic seizures whenever he played shogi (Japanese chess). To identify the critical thought processes responsible for inducing his seizures, we monitored his clinical seizures and epileptiform discharges while he performed comprehensive neuropsychological tests, including the Wechsler Adult Intelligence Scale-Revised (WAIS-R), spatial working memory, mental rotation, and Wisconsin Card Sorting Test (WCST) tasks. A myoclonic seizure occurred only during the WCST. Generalized 3- to 5-Hz spike-and-slow-wave bursts occurred repeatedly during the Block Design subtest of the WAIS-R and the WCST, whereas no discharges occurred during other subtests of the WAIS-R including the calculation, spatial working memory, and mental rotation tasks. These results indicate that abstract reasoning, independent of other cognitive processes, could induce the patient's epileptiform discharges, suggesting that his reflex seizures might be a distinct subtype of nonverbal thinking-induced seizures.

Validation study of the Japanese version of the Obsessive-Compulsive Drinking Scale.

The Obsessive-Compulsive Drinking Scale (OCDS) is a self-rating questionnaire that measures cognitive and behavioral aspects of craving for alcohol. The OCDS consists of two subscales: the obsessive thoughts of drinking subscale (OS) and the compulsive drinking subscale (CS). This study aims to validate the Japanese version of the OCDS. First, internal consistency and discriminant validity were evaluated. Second, a prospective longitudinal 3-month outcome study of 67 patients with alcohol dependence who participated in a relapse prevention program was designed to assess the concurrent and predictive validity of the OCDS. The OCDS demonstrated high internal consistency. The OS had high discriminant validity, while the CS did not. Twenty-three patients (34.3%) dropped out of treatment. These patients had significantly higher OS scores than those who completed the program. At 3 months, the relapse group had significantly higher OCDS scores than the no relapse group. Also, the OCDS score was higher in subjects who had early-onset alcohol dependence than late-onset dependence. The OCDS is useful for evaluating cognitive aspect of craving and predicts dropout and relapse.