Intravenous pulse methylprednisolone and corticosteroid-induced psychiatric disorders: A retrospective study.

OBJECTIVE: Corticosteroids can cause psychiatric symptoms known as corticosteroid-induced psychiatric disorders (CIPDs). Little is known regarding the relationship between intravenous pulse methylprednisolone (IVMP) and CIPDs. Therefore, we aimed to examine the relationship between corticosteroid use and CIPDs in this retrospective study. METHODS: Patients who were prescribed corticosteroids during their hospitalization at a university hospital and referred to our consultation-liaison service were selected. Patients diagnosed with CIPDs according to the ICD-10 codes were included. The incidence rates were compared between patients receiving IVMP and those receiving any other corticosteroid treatment. The association between IVMP and CIPDs was examined by classifying patients with CIPD into three groups according to the use of IVMP and timing of CIPD onset. RESULTS: Of the 14,585 patients who received corticosteroids, 85 were diagnosed with CIPDs, with an incidence rate of 0.6%. Among the 523 patients who received IVMP, the incidence rate of CIPDs was 6.1% (n = 32), which was significantly higher than that in patients receiving any other corticosteroid treatment. Among the patients with CIPDs, 12 (14.1%) developed CIPDs during IVMP, 19 (22.4%) developed CIPDs after IVMP, and 49 (57.6%) developed CIPDs without IVMP. There was no significant difference in the doses at the time of CIPD improvement among the three groups when we excluded one patient whose CIPD improved during IVMP. CONCLUSION: Patients receiving IVMP were more likely to develop CIPDs than those who did not receive IVMP. Furthermore, corticosteroid doses at the time of improvement of CIPDs were constant, regardless of IVMP use.

Impact of the COVID-19 pandemic on patients with mental health problems and the differences among diagnostic categories.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a total upending of our daily lives. While anxiety and depression were frequently reported among the general population, the pandemic's impact on patients with mental health problems remains unknown. METHODS: A cross-sectional questionnaire survey involving 1,166 patients was conducted at one psychiatric hospital and one mental health clinic. RESULTS: Symptom deterioration was reported in 23% to 34% of the patients and 9% to 20% reported increase in drug dosage. No significant differences were reported in these items among diagnostic categories. Patients with F3 (mood disorders) reported more psychological stress during the pandemic's beginning and during the emergency. Patients with F2 (schizophrenia, schizotypal, and delusional disorders) did online shopping and meetings less frequently, and reported poorer adherence of 3C's, while mask management was stricter in patients with F4 (neurotic, stress-related, and somatoform disorders). Symptom deterioration was significantly associated with increase in drug dosage, new physical symptoms, anxiety unrelated to COVID-19, stress at the beginning of pandemic, stress during the 'state of emergency', poor adaptability to environmental change, daily life changes, decrease in sleeping time, and decrease in time spent outside. CONCLUSION: One third of patients reported symptom deterioration during the pandemic, which was associated with stress and daily life changes. Patients with good adaptability to environmental changes might resilient against symptom deterioration. Providing continuous support to help patients manage their daily life in this COVID-19 era may minimize the risk of symptom deterioration.

[Concepts and Treatment Strategies for Somatic Symptom Disorder and Relative Disorders].

Somatic Symptom Disorder is a specific disorder that is extensively defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Although the diagnostic criteria for somatic symptom disorder has archived breakaway from mind-body dualism and simplification for physicians, it remains vague and universally unapplicable. Moreover, despite the DSM-5 removing etiology in diagnosis, there is still a need to determine the etiology for individualized patient treatment. In particular, patients with somatic symptom disorder and relative disorders have psychological pathologies, such as somatization and anxiety about illness, all of which require psychiatric treatment. However, these patients initially visit physicians, not psychiatrists, since their symptoms are somatic, and they are anxious about the possibility of a physical disease. As such, supportive attitude and continuous treatment are important, as they can be performed even without a psychiatric consultation. Furthermore, while the effectiveness of pharmacotherapy is limited for these disorders, psychotherapy has the possibility to bring about a fundamental resolution. Particularly, cognitive behavior therapy or psychoanalytic psychotherapy has been found to be effective; however, they require high motivation and take up much time from the patients. Fortunately, the Morita therapy is especially effective for patients who pay excessive attention to somatic symptoms or are hypochondriacal, which is applicable for outpatients using a comparatively short interview that can even be performed in nonpsychiatric clinical settings.

Descending neural drives to ankle muscles during gait and their relationships with clinical functions in patients after stroke.

OBJECTIVE: The objective of this study was to investigate the descending neural drive to ankle muscles during gait in stroke patients using a coherence analysis of surface electromyographic (EMG) recordings and the relationships of the drive with clinical functions. METHODS: EMG recordings of the paired tibialis anterior (TA), medial and lateral gastrocnemius (MG and LG), and TA-LG muscles were used to calculate intramuscular, synergistic, and agonist-antagonist muscle coherence, respectively, in 11 stroke patients and 9 healthy controls. Paretic motor function, sensory function, spasticity, ankle muscle strength, and gait performance were evaluated. RESULTS: Paretic TA-TA and MG-LG beta band (15-30 Hz) coherences were significantly lower compared with the non-paretic side and controls. TA-LG beta band coherence was significantly higher on both sides compared with controls. Paretic TA-TA beta band coherence positively correlated with gait speed, and paretic TA-LG beta band coherence negatively correlated with paretic ankle plantar flexor muscle strength. CONCLUSIONS: The intramuscular and synergistic muscle neural drives were reduced during gait on the paretic side in stroke patients. The agonist-antagonist muscle neural drive was increased to compensate for paretic ankle muscle weakness. SIGNIFICANCE: Descending neural drive reorganization to agonist-antagonist muscles is important for patients with paretic ankle muscle weakness.