Clarification of Psychiatric Nurses' Intentions and Analysis Contents in Observing Schizophrenia Patient.

The purpose of this study was to clarify what psychiatric nurses intended to observe when observing schizophrenia patient and what they analyzed from their observations. Twenty-one experienced nurses were included in the study. Data were collected through semi-structured interviews, and content analysis was conducted. The results were as follows:Nurses' intentions in observing patient were [Observation of psychiatric symptoms], [Observation of normality or abnormality], [Possibility of self-harm or harming others], [Side effects of antipsychotics], [Degree of communication disorder], [Degree of self-care], [Observation of nutritional status], [Effects of external stimuli on patient], and [Less importance of observing doctor]. Nurses' analysis contents were [Analysis of psychiatric symptoms], [No risk of self-harm or harming others], [Effects of antipsychotics], [Presence of communication disorder], [Lack of trust in doctor], [Problems in daily life], [Consideration of future nursing intervention], [Assessment of normality or abnormality], [Unhealthy physical state], and [Unnecessary analysis]. The results of this study revealed the nurses' observational process. J. Med. Invest. 71 : 54-61, February, 2024.

Examining Factors Associated with Dynapenia/Sarcopenia in Patients with Schizophrenia: A Pilot Case-Control Study.

Sedentary behavior in patients with schizophrenia causes muscle weakness, is associated with a higher risk of metabolic syndrome, and contributes to mortality risk. This pilot case-control study aims to examine the associated factors for dynapenia/sarcopenia in patients with schizophrenia. The participants were 30 healthy individuals (healthy group) and 30 patients with schizophrenia (patient group), who were matched for age and sex. Descriptive statistics, Welch's t-test, cross-tabulations, adjusted residuals, Fisher's exact probability test (extended), and/or odds ratios (ORs) were calculated. In this study, dynapenia was significantly more prevalent in patients with schizophrenia than in healthy individuals. Regarding body water, Pearson's chi-square value was 4.41 (p = 0.04), and significantly more patients with dynapenia were below the normal range. In particular, body water and dynapenia showed a significant association, with an OR = 3.42 and 95% confidence interval [1.06, 11.09]. Notably, compared with participants of the healthy group, patients with schizophrenia were overweight, had less body water, and were at a higher risk for dynapenia. The impedance method and the digital grip dynamometer used in this study were simple and useful tools for evaluating muscle quality. To improve health conditions for patients with schizophrenia, additional attention should be paid to muscle weakness, nutritional status, and physical rehabilitation.

Usefulness of 2D Video Analysis for Evaluation of Shoulder Range of Motion during Upper Limb Exercise in Patients with Psychiatric Disorders.

Aging and its associated problems related to movement impacts the care of people with psychiatric disorders. This study sought to clarify the usefulness of 2D video analysis for evaluating shoulder range of motion (ROM) during upper limb exercises in patients with psychiatric disorders. Subjects (N=54) were patients with psychiatric disorders categorized as the following:having either a high or low activities of daily living (ADL) score using the Barthel Index;experiencing shoulder ROM limitation, and whether or not compensatory movements were exhibited. Compensatory movement was also considered in patients with Parkinsonism, cerebrovascular disease, and cognitive dysfunction. Shoulder joint ROM was measured using a goniometer and active ROM was captured using ImageJ. No significant difference between passive ROM measured by a goniometer and active ROM measured by ImageJ considering disease groups, ADL level, and shoulder ROM limitation was found. Factoring in compensatory movements, however, significant differences were found between passive and active ROM:existence compensatory movement group, left side (z=-2.30, p=0.02);nonexistence compensatory movement group, right side (z=-2.63, p<0.001). Image-evaluating devices help assess ROM in patients with psychiatric disorders, enhancing the development of physical rehabilitation programs to regain critical ADL, sustaining self-care capabilities. J. Med. Invest. 69 : 70-79, February, 2022.

Relationship between quality of life and clinical factors in inpatients with schizophrenia.

OBJECTIVE: The purpose of this study was to clarify the relationship between quality of life (QOL) and clinical factors in inpatients with schizophrenia. METHODS: Subjects were 50 hospitalized patients with schizophrenia. Their mean age was 56.48 (Standard Deviation=11.93) years. Japanese version of the schizophrenia Quality of Life Scale (JSQLS) and Subjective Well-being under Neuroleptic drug Treatment Short form, Japanese version (SWNS-J) were used to assess subjective QOL, and Mini Mental State Examination-Japanese was used to evaluate cognitive function. Japanese version of the Calgary Depression Scale for Schizophrenia (JCDSS), Brief Psychiatric Rating Scale, and Drug-Induced Extrapyramidal Symptoms Scale were used to assess depression severity, psychotic symptoms, and drug-induced extrapyramidal symptoms, respectively. Stepwise regression analyses were conducted to find factors influencing JSQLS and SWNS-J. RESULTS: JCDSS was a predictor of two scales of JSQLS, and JCDSS also predicted SWNS-J Total and it's two subscales. However, other clinical factors were not related to JSQLS and SWNS-J. CONCLUSION: The results indicate that treating depressive symptoms may lead to improvement of subjective QOL in inpatients with schizophrenia. J. Med. Invest. 69 : 80-85, February, 2022.

Characteristics of psychiatric nurses' observation techniques for psychopathological symptoms.

The purpose of this study was to clarify characteristics of psychiatric nurses' observation techniques for psychopathological symptoms. The subjects were 21 psychiatric nurses and 20 nursing students who had finished their practicum in psychiatric nursing. Using a non-contact eye-tracking analysis system, we compared quantitatively their radial motion while they were observing psychopathological symptoms of a schizophrenia simulation patient. The radial motion of them was recorded while they were observing a video of a simulated patient presenting psychopathological symptoms, and the recording was analyzed by the eye-tracking system. The investigator set the important observation areas and determined the sum of the fixation time and the number of fixations in the areas. Differences between psychiatric nurses and nursing students were tested using the Mann-Whitney U-test. The results revealed a significant difference in observation of the upper limbs area with a median of 7147.90 msec for nurses group and a median of 2447.54 msec for students group (U = 98.00, p = 0.01). The finding suggests that nurses tend to pay more attention to patient's upper limbs to be cautious about possible violence and to find agitation caused by psychopathological symptoms, extrapyramidal adverse effects, and scars caused by self-mutilation. J. Med. Invest. 68 : 271-275, August, 2021.

Predictors of life skills in people with schizophrenia.

Objective : The purpose of the present study is to examine clinical factors related to life skills in people with schizophrenia. Method : The participants were 51 stabilized outpatients with schizophrenia. Their mean age was 38.91 (SD = 10.73) years. Life skills were assessed using the Life skills profile (LSP). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). Results : Cognitive function was not correlated with the LSP scores at all. Among clinical symptoms, scores of the PANSS positive and negative syndrome scales, the CDSS, and the DIEPSS had negative correlations with the LSP total score and the subscales. Stepwise regression analyses showed that the CDSS and PANSS negative syndrome scale scores were independent predictors of the LSP total score and two of the subscales. Conclusions : These results indicate that cognitive function is not associated with life skills but clinical symptoms such as depressive and negative symptoms have considerable impacts on life skills in people with schizophrenia. J. Med. Invest. 67 : 75-82, February, 2020.

Differences in male climacteric symptoms with aging among rotating night shift workers.

OBJECTIVE: The aim of this study was to clarify the actual status of male climacteric symptoms in rotating night shift workers and how to cope with the symptoms. METHODS: We planned a self-administered questionnaire survey in male rotating night shift workers. Male climacteric symptoms were evaluated by using the Aging Males' Symptoms (AMS) scale. RESULTS: Of 1891 questionnaires that were sent, 1561 were collected. There were significant differences in total AMS scores among the age groups. In all age groups, there were high proportions of men with increased need for sleep and often feeling tired (64.9%) and decrease in muscular strength (60.7%). There were significant differences in AMS scores for somatic symptoms between men in their 20 s and those in their 40 s or 50 s and between men in their 30 s and those in their 50 s and in AMS scores for sexual symptoms between men in their 20 s and those in their 30 s, 40 s, 50 s or 60 s, between men in their 30 s and those in their 40 s, 50 s or 60 s and between men in their 40 s and those in their 50 s or 60 s. CONCLUSION: Significant age-dependent differences are found in somatic symptoms and sexual symptoms in rotating night shift workers.

Clinical factors influencing resilience in patients with anorexia nervosa.

PURPOSE: This study was to elucidate clinical factors influencing resilience in anorexia nervosa (AN) patients. PATIENTS AND METHODS: Twenty female patients with AN (median age =30.0 years, quartile deviation =6.8) and 40 female healthy controls (HCs) (median age =30.0 years, quartile deviation =8.6) participated in the present study. Resilience was assessed with the Connor- Davidson resilience scale (CD-RISC). Clinical symptoms were evaluated with the structured interview guide for the Hamilton depression rating scale (SIGH-D) and the eating disorder inventory-2 (EDI-2). RESULTS: Scores of the CD-RISC in the AN group were lower than those in the HC group, and the SIGH-D score in the AN group was higher than that in the HC group. Scores of interoceptive confusion, interpersonal difficulty and negative self-image subscales of the EDI-2 negatively correlated with the CD-RISC score. Moreover, stepwise regression analysis showed that negative self-image score was an independent predictor of the CD-RISC score. CONCLUSION: These results suggest that among these clinical factors including psychopathologies, self-dissatisfaction and feeling of being rejected by others are the most important influencing factors on an AN patients' resilience.

Relationship between social and cognitive functions in people with schizophrenia.

PURPOSE: The purpose of the present study was to examine clinical factors related to social function in people with schizophrenia. PATIENTS AND METHODS: The participants were 55 stabilized outpatients with schizophrenia. Their mean age was 39.36 (SD =10.65) years. Social function was assessed using the Quality of Life Scale (QLS). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. RESULTS: Neither the MCCB cognitive domain score nor composite score was correlated with the QLS scores. However, of the 10 MCCB subtests, the Trail Making Test Part A and the Brief Assessment of Cognition in Schizophrenia-Symbol Coding (BACS-SC) scores were positively correlated with the QLS scores. Among clinical variables, especially the PANSS negative syndrome scale score had a strong negative correlation with the QLS scores. Stepwise regression analyses showed that the PANSS negative syndrome scale score was an independent predictor of the QLS scores, and although the BACS-SC score predicted the QLS common objects and activities subscale score, the association was not so strong compared to the PANSS negative syndrome scale score. CONCLUSION: These results indicate that speed of processing evaluated by BACS-SC could predict some aspect of social function but negative symptoms have a much stronger impact on global social function in people with schizophrenia.

Impaired central coherence in patients with anorexia nervosa.

The purpose of this study was to investigate the characteristics of central coherence in patients with anorexia nervosa (AN). 22 female patients with AN (median age = 31.50 (QD = 8.13) years) and 33 female healthy controls (HC) (median age = 28.00 (QD = 8.50) years) participated in the study. Their central coherence was assessed with the Rey Complex Figure Task (RCFT). Clinical symptoms were evaluated with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Form JYZ. The results showed that AN patients' Central Coherence Index and accuracy scores in copy, 3-min delayed recall and 30-min delayed recall tasks of the RCFT were significantly lower than those of HC. Moreover, the significant differences in Central Coherence Index score in copy task and accuracy scores in 3-min delayed recall and 30-min delayed recall tasks remained when the effects of depression, anxiety and starvation were eliminated statistically. These findings may explain some characteristics of AN patients such as focusing on local rather than global picture in their perception of body or life.

Influence of cognitive function on quality of life in anorexia nervosa patients.

AIM: The purpose of this study was to elucidate determinants of quality of life (QOL) in anorexia nervosa (AN) patients. METHODS: Twenty-one female patients with AN participated in the study. QOL was assessed with the 36-Item Short Form Health Survey (SF-36), and cognitive function was evaluated using the Wisconsin Card Sorting Test Keio version, the Rey Complex Figure Test, and the Social Cognition Screening Questionnaire. Clinical symptoms were evaluated with the Beck Depression Inventory-II, the State-Trait Anxiety Inventory-Form JYZ (STAI-JYZ), and the Maudsley Obsessive Compulsive Inventory. RESULTS: The Difficulty Maintaining Set score of the Wisconsin Card Sorting Test Keio version was negatively correlated to the SF-36 Physical Component Summary. Scores of the Beck Depression Inventory-II and the STAI-JYZ State and Trait were negatively correlated to the SF-36 Mental Component Summary (MCS), and the Central Coherence Index 30-min Delayed Recall score of the Rey Complex Figure Test was positively correlated with the MCS. Stepwise regression analysis showed that the Difficulty Maintaining Set score was an independent predictor of the Physical Component Summary and scores for Central Coherence Index 30-min Delayed Recall and the STAI-JYZ Trait-predicted MCS. CONCLUSION: These results suggest that not only trait anxiety but also poor central coherence and impaired ability to maintain new rule worsen AN patients' QOL.

Impaired social cognition in anorexia nervosa patients.

BACKGROUND: The purpose of this study was to investigate the characteristics of social cognition in patients with anorexia nervosa (AN). METHODS: Eighteen female patients with AN (mean age =35.4±8.6 years) and 18 female healthy controls (HC) (mean age =32.8±9.4 years) participated in the study. Their social cognition was assessed with the Social Cognition Screening Questionnaire (SCSQ). RESULTS: The results showed that total score of the SCSQ and scores of theory of mind and metacognition were significantly lower in AN group than those in HC group. Moreover, significant differences in theory of mind, metacognition, and total score of the SCSQ remained when the effects of depression, anxiety, and starvation were eliminated statistically. CONCLUSION: These results suggest that patients with AN may have difficulty inferring other people's intention and also monitoring and evaluating their own cognitive activities. Therefore, these features may explain some aspects of the pathology of AN.

Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa.

OBJECTIVE: Refeeding in patients with anorexia nervosa (AN) is associated with a risk of refeeding syndrome, which is a disruption in metabolism with a variety of features including hypophosphatemia. We evaluated the risk factors for refeeding hypophosphatemia (RH) during nutritional replenishment in Japanese patients with AN. METHODS: We retrospectively examined clinical data for 99 female inpatients (mean age 30.9 ± 10.7 years; range, 9 - 56 years). RESULTS: RH (phosphate < 2.3 mg/dL) occurred within 4.8 ± 3.7 days of hospital admission and was still observed at 28 days after admission in 21 of the 99 cases (21.2%). Oral or intravenous phosphate was given to some patients to treat or prevent RH. Patients with RH had a significantly lower body mass index, were older, and had higher blood urea nitrogen than those without RH. Severe complications associated with RH were recorded in only one patient who showed convulsions and disturbed consciousness at Day 3 when her serum phosphate level was 1.6 mg/dL. CONCLUSIONS: The significant risk factors for RH that we identified were lower body mass index, older age, and higher blood urea nitrogen at admission. No significant difference in total energy intake was seen between the RH and no RH groups, suggesting that RH may not be entirely correlated with energy intake. Precisely predicting and preventing RH is difficult, even in patients with AN who are given phosphate for prophylaxis. Thus, serum phosphate levels should be monitored for more than 5 days after admission.

Changes of levels of depression and quality of life after short-term cognitive behavioral educational program for adolescent students in health class.

AIMS: The purpose of the present study was to evaluate the changes of levels of depression and quality of life in adolescent students after receiving short-term cognitive behavioral educational program in health class for stress management. METHODS: Subjects were 176 middle school students aged 12 to 14 years. They completed the Depression Self-Rating Scale for Children (DSRS-C) and the Revised Children Quality of Life Questionnaire (Kiddo-KINDL(R)) before, after and 6-months after the program. The three-session program consisted of psychoeducation and learning skills of cognitive restructuring and problem solving. RESULTS: The total scores of the DSRS-C and the Kiddo-KINDL(R) in all subjects did not significantly change after the completion of program. However, as for the high risk group (score of the DSRS-C≥16), significant improvement in the two scales was found after the program. Especially, depression level in the high risk group significantly decreased and the improvement was maintained 6-months later. CONCLUSION: These results suggest that this type of approach may be effective for adolescents with high risk of depression in terms of improving not only depressive symptom but also quality of life.

Gender differences of the influential factors on the mental health condition of teachers in the A university.

The purpose of this research was to investigate the gender differences of the influential factors on the mental health condition among university teachers in the A university in Japan. A questionnaire survey was mailed to 924 university teachers in Japan, with a survey return rate of 43.8% (N=405). The General Health Questionnaire 28 (GHQ-28), Multidimensional Scale of Perceived Social Support (MSPSS), the Japanese version of the Brief Coping Orientation to Problems Experienced (COPE) and the Work Situation Questionnaire (WSQ) developed by the authors were administered to subjects. The GHQ-28 total score and all of sub-score of the woman was significantly higher than men. In the correlated factor of mental health, level of job satisfaction and job control, social support of significant others was observed in the both sexes. However, gender differences was observed in the coping style. Some copings including self-distraction and self-blame were related to the men, but the woman was related to the substance use. University teachers had some gender differences in the factors affecting their mental health condition. In order to improve university teacher's mental health condition, it is necessary to increase their level of job satisfaction and feeling of job control in the workplace. Especially, it was considered women's coping using substance use was important.

Meta-analyses of blood homocysteine levels for gender and genetic association studies of the MTHFR C677T polymorphism in schizophrenia.

Previous studies suggest that elevated blood homocysteine levels and the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism are risk factors for schizophrenia. However, the effects of gender and MTHFR C677T genotypes on blood homocysteine levels in schizophrenia have not been consistent. We first investigated whether plasma total homocysteine levels were higher in patients with schizophrenia than in controls with stratification by gender and by the MTHFR C677T genotypes in a large cohort (N = 1379). Second, we conducted a meta-analysis of association studies between blood homocysteine levels and schizophrenia separately by gender (N = 4714). Third, we performed a case-control association study between the MTHFR C677T polymorphism and schizophrenia (N = 4998) and conducted a meta-analysis of genetic association studies based on Japanese subjects (N = 10 378). Finally, we assessed the effect of plasma total homocysteine levels on schizophrenia by a mendelian randomization approach. The ANCOVA after adjustment for age demonstrated a significant effect of diagnosis on the plasma total homocysteine levels in all strata, and the subsequent meta-analysis for gender demonstrated elevated blood homocysteine levels in both male and female patients with schizophrenia although antipsychotic medication might influence the outcome. The meta-analysis of the Japanese genetic association studies demonstrated a significant association between the MTHFR C677T polymorphism and schizophrenia. The mendelian randomization analysis in the Japanese populations yielded an OR of 1.15 for schizophrenia per 1-SD increase in plasma total homocysteine. Our study suggests that increased plasma total homocysteine levels may be associated with an increased risk of schizophrenia.

Measuring quality of sleep and autonomic nervous function in healthy Japanese women.

The purpose of this study was to determine the relationship between quality of sleep and autonomic nervous functioning in healthy adult Japanese women using three measures, namely, the Pittsburgh Sleep Quality Index (PSQI) for subjective assessment of sleep quality, actigraphy for objective assessment of sleep, and heart rate variability using high frequency and low frequency domains. Participants were 31 healthy women in their 20s to 40s who met the selection criteria, including having normal monthly menstrual periods. Participants were categorized as good or poor sleepers according to their PSQI score. Median correlation coefficients of activity count and high frequency were -0.62 (range -0.43 to -0.84) for good sleepers and -0.45 (range 0.003 to -0.64) for poor sleepers. Good sleepers showed a significantly higher correlation of activity count and high frequency (Z=-2.11, P<0.05). Median correlation coefficients of activity count and low frequency/high frequency were 0.54 (range 0.29-0.73) for good sleepers and 0.41 (range 0.11-0.63) for poor sleepers. The PSQI, actigraphy data, and heart rate variability results showed positive correlations between sleep time as measured by PSQI and duration of inactivity as measured by actigraphy (r=0.446, P<0.05) and sleep time as measured by actigraphy (r=0.377, P<0.05), and a negative correlation between sleep time as measured by PSQI and the correlation coefficients of activity count and high frequency (r=-0.460, P<0.01). These results support the finding that sleep-wake rhythms can be monitored efficiently with actigraphy, providing accurate data that can support the diagnosis of sleeping disorders. Furthermore, actigraphy data were associated with heart rate variability and PSQI findings, but only in subjects who were poor sleepers. Actigraphy is an accurate, efficient, rapid, and inexpensive test for determining objective and subjective sleeping problems, and can also be used in clinical tests for sleep assessment.

Factors associated with discharge of long-term inpatients with schizophrenia in Japan: a retrospective study.

Deinstitutionalization for people with mental disorders has only begun to be implemented in Japan. The purpose of this retrospective study was to examine factors associated with discharge for long-term patients with schizophrenia. Seventy patients were judged capable of discharge with psychiatric rehabilitation (special staff service). As a result of rehabilitation efforts, 37 patients were discharged and 33 patients remained in the hospital. Significant differences were found in age, level of family agreement about patient's disability, and length of the special staff service. These factors might be important to predict patients' potential for discharge.

Clinical correlates associated with cognitive dysfunction in people with schizophrenia.

AIMS: The purpose of the present study was to investigate the correlation between cognitive function and clinical variables in people with schizophrenia. METHODS: The subjects were 61 stabilized outpatients with schizophrenia (DSM-IV). Their mean age was 40.1 (SD = 12.2) years. All subjects gave written informed consent to participate in the research. Cognitive function was evaluated using the Brief Assessment of Cognition in Schizophrenia. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. RESULTS: The Positive and Negative Syndrome Scale Negative syndrome score was significantly correlated with verbal memory score (r = -0.37, P < 0.01), working memory score (r = 0.38, P < 0.01), attention and speed of information processing score (r = -0.51, P < 0.01), verbal fluency score (r = -0.39, P < 0.01), and composite score (r = -0.54, P < 0.01). In addition, the Drug-Induced Extrapyramidal Symptoms Scale score was significantly correlated with attention and speed of information processing (r = -0.45, P < 0.01), and composite score (r = -0.41, P < 0. 01). Dose of antipsychotics and anti-Parkinson drugs was not significantly correlated with the Brief Assessment of Cognition in Schizophrenia scores. CONCLUSIONS: These results indicate that cognitive dysfunction of people with schizophrenia might be associated with negative and drug-induced extrapyramidal symptoms, suggesting that their minimization would be important for improving cognitive dysfunction.

Retrospective study of Japanese patients with schizophrenia treated with aripiprazole.

Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (P = 0.04), significant decrease in dosage of antipsychotics in 71% of patients (P = 0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (P = 0.07) and body mass index (BMI) (P = 0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (P = 0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL.