Two Patients with Schizophrenia Treated with Clozapine Developed Neutropenia After Receiving a COVID-19 Vaccine.

BACKGROUND: We observed two cases of patients with schizophrenia who were treated with clozapine (250mg/day and 275mg/day, respectively) and showed neutropenia after receiving a COVID-19 vaccine (BNT162b2). CASE PRESENTATION: Case 1 is a twenty-two year old woman with a diagnosis of schizophrenia. She enrolled in Clozaril® Patient Monitoring Service in 2017 and had been taking clozapine for 4 years. She received two doses of a COVID-19 vaccine and developed neutropenia (1850/mm3 (37.9% of white blood cell 4880/mm3)) 6 days after the second vaccination, but her neutropenia self-resolved naturally. Case 2 is a twenty year old woman with a diagnosis of schizophrenia. She enrolled in Clozaril® Patient Monitoring Service in 2020 and had been taking clozapine for 10 months. She received two doses of a COVID-19 vaccine and white blood cell and neutrocyte counts were below (3730/mm3 and 1440/mm3 (38.6%), respectively) the lower limits 3 days after the second vaccination. She had to discontinue clozapine according to the withdrawal definition (her neutrocyte count was <1500/mm3), and her neutropenia self-resolved naturally. CONCLUSION: Physicians need to have a strict follow-up protocol in place for patients after vaccination for COVID-19.

Secondary oxalosis induced by xylitol concurrent with lithium-induced nephrogenic diabetes insipidus: a case report.

BACKGROUND: Xylitol is an approved food additive that is widely used as a sweetener in many manufactured products. It is also used in pharmaceuticals. Secondary oxalosis resulting from high dietary oxalate has been reported. However, reported cases of oxalosis following xylitol infusion are rare. CASE PRESENTATION: A 39-year-old man with a 16-year history of organic psychiatric disorder was hospitalized for a laparoscopic cholecystectomy because of cholecystolithiasis. He had been treated with several antipsychotics and mood stabilizers, including lithium. The patient had polyuria (> 4000 mL/day) and his serum sodium levels ranged from 150 to 160 mmol/L. Urine osmolality was 141 mOsm/L, while serum arginine vasopressin level was 6.4 pg/mL. The patient was diagnosed with nephrogenic diabetes insipidus (NDI), and lithium was gradually discontinued. Postoperative urine volumes increased further to a maximum of 10,000 mL/day, and up to 10,000 mL/day of 5% xylitol was administered. The patient's consciousness level declined and serum creatinine increased to 4.74 mg/dL. This was followed by coma and metabolic acidosis. After continuous venous hemodiafiltration, serum sodium improved to the upper 140 mmol/L range and serum creatinine decreased to 1.25 mg/dL at discharge. However, polyuria and polydipsia of approximately 4000 mL/day persisted. Renal biopsy showed oxalate crystals and decreased expression of aquaporin-2 (AQP2) in the renal tubules. Urinary AQP2 was undetected. The patient was discharged on day 82 after admission. CONCLUSIONS: Our patient was diagnosed with lithium-induced NDI and secondary oxalosis induced by excess xylitol infusion. NDI became apparent perioperatively because of fasting, and an overdose of xylitol infusion led to cerebrorenal oxalosis. Our patient received a maximum xylitol dose of 500 g/day and a total dose of 2925 g. Patients receiving lithium therapy must be closely monitored during the perioperative period, and rehydration therapy using xylitol infusion should be avoided in such cases.

Sex Differences In Psychoeducation For Patients With Depression: A Comparison Of Frequency And Efficacy Of Psychoeducation.

BACKGROUND: We aimed to reveal sex differences in depression comprehension by reanalyzing data from a previous study of patients who were administered antidepressants. METHODS: A total of 424 outpatients were enrolled in the study. Participants were provided an original self-administered questionnaire that comprised eight items: depressive symptoms, course of depression, cause of depression, treatment plan, duration of antidepressant use, how to discontinue antidepressants, side effects of antidepressants, and psychotherapy. Each item consisted of the following two questions: "Have you received an explanation from the doctor in charge?" and "How much do you understand about your treatment?" The level of patients' comprehension of these questions was rated on a scale of 0-10 (11 anchor points). Symptoms were evaluated using the Quick Inventory for Depressive Symptomatology, Japanese version, and other scales. Patients were divided on the basis of sex, regardless of whether they were in remission. RESULTS: Compared with male patients, female patients with depression exhibited lower levels of depression and did not receive adequate psychoeducation from their physicians. While depression comprehension of female patients might not necessarily be associated with remission, male patients in remission received more explanations about depression and understood more compared with female patients. CONCLUSION: Depression comprehension of male patients might be associated with remission, and psychoeducation should be sex-oriented to improve treatment responses.

Insulinoma resembling a rapid eye movement sleep behavior disorder: a case report.

Some patients with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed with psychiatric disease. We present the case of a 72-year-old Japanese female who exhibited violent behavior while asleep and received a diagnosis of suspected rapid eye movement sleep behavior disorder (RBD). She was admitted to the psychiatry ward after receiving levomepromazine 25 mg intramuscularly. The patient's blood glucose level was 27 mg/dL at the time of hospitalization, and a biochemical examination revealed that her insulin level was 9.1 µU/mL and C-peptide level was 2.16 ng/mL. A contrast-enhanced computed tomography revealed a mass 8 mm in diameter in the pancreatic head. The diagnosis was changed from RBD to insulinoma. The sleep behavior disorder disappeared after continuous glucose administration. After enucleation of the insulinoma, the administration of glucose was discontinued, and her blood glucose levels recovered. This case suggests that insulinoma should be considered by physicians and psychiatrists in the differential diagnosis of patients with symptoms presenting as RBD.

Effects of personality on the association between paroxetine plasma concentration and response.

BACKGROUND: We studied the differences between groups that were divided according to personality characteristics with respect to the relationship between drug concentration and symptom improvement. METHODS: A total of 120 patients with major depressive disorder were treated with paroxetine for 6 weeks, and 89 patients completed the protocol. The Montgomery-Åsberg Depression Rating Scale (MADRS) was used to evaluate the patients. Patients' paroxetine plasma concentrations at week 6 were measured. Their personalities were evaluated by the Temperament and Character Inventory (TCI) at the first visit. We divided the patients into two groups according to the median of each TCI dimension. We compared the responder rate between "high" and "low" groups in each TCI dimension and analyzed Pearson's correlation coefficients of paroxetine plasma concentration and MADRS-improvement rate. RESULTS: A total of 62 patients completed the TCI. Low-novelty-seeking, high-harm-avoidance, low-reward-dependence, and low-self-directedness groups exhibited significant negative correlations between paroxetine plasma concentration and MADRS improvement. Among the groups with combined personality traits, the high-harm-avoidance and low-self-directedness groups showed a markedly significant negative correlation. CONCLUSION: Patients with depression exhibiting specific personality traits, especially those with high harm-avoidance and low self-directedness scores, exhibited a significant negative association between paroxetine plasma concentration and MADRS-improvement rate. Therefore, a lower dose might be suitable for patients with specific personality traits.

The characteristics of understanding of depression among older patients treated with antidepressants: a comparison between older and younger patients.

BACKGROUND: To reveal characteristics of understanding of depression among older patients, we reanalyzed the data from a previous study of patients who were administered antidepressants. METHODS: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire consisting of eight items: depressive symptoms, the course of depression, the cause of depression, the treatment plan, the duration of antidepressant use, how to discontinue antidepressants, the side effects of antidepressants, and psychotherapy. Each item consisted of the following two questions: "Have you received an explanation from the doctor in charge?" and "How much do you understand about your treatment?". The level of understanding was rated on a scale of 0-10 (11 anchor points). Subjects were divided into two groups: younger patients who were <65 years of age and older patients who were ≥65 years of age. RESULTS: Older patients with depression showed lower levels of understanding of depression and did not receive sufficient psychoeducation from their physicians, but their understanding of depression might not be associated with their remission. In the younger group, the scores of understanding of the course of depression, the treatment plan, how to discontinue antidepressants, and psychotherapy items, and the total understanding score of remitters, were significantly higher than those of non-remitters. In contrast, there were no significant differences in the items score or total score between remitters and non-remitters in the older group. CONCLUSION: Older patients showed lower levels of understanding of depression and did not appear to receive sufficient psychoeducation, but their understanding of depression might not be associated with their remission.

Timing of psychoeducation for patients with depression who were treated with antidepressants: when should patients receive psychoeducation.

BACKGROUND: We analyzed data on the understanding of depression among patients who were prescribed antidepressants to determine when psychoeducation should be provided. PATIENTS AND METHODS: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire consisting of eight categories: (A) depressive symptoms, (B) the course of depression, (C) causes of depression, (D) the treatment plan, (E) the duration of antidepressant use, (F) discontinuation of antidepressants, (G) the side effects of antidepressants, and (H) psychotherapy. Each category was assessed with the following two questions: "Have you received an explanation of this topic from the doctor in charge?" and "How much do you understand about your treatment?" The level of understanding of patients was rated on a scale from 0 to 10 (no understanding to full understanding; 11 anchor points). Symptoms were evaluated using the Quick Inventory for Depressive Symptomatology, Japanese version (QIDS-J) and other scales. Participants were divided into two groups: patients receiving psychoeducation at their first visit vs patients receiving psychoeducation after their first visit. RESULTS: Of the patients who had received an explanation of each psychoeducation item, a greater proportion were in the first visit group than in the after first visit group for nearly all items. Compared with the after first visit group, the first visit group showed a better understanding of each psychoeducation item and significantly lower QIDS scores for those receiving explanations of Items A and C. There was no significant difference between the two groups in remittance rates. CONCLUSION: Psychoeducation on depression, especially regarding the symptoms and causes of depression, should be provided at patients' first visit.

The Association Between the Severity and Level of Understanding of Depression Among Patients Treated With Antidepressants: A Survey of 424 Outpatients in Japan.

OBJECTIVES: The present study investigated the association between the severity and knowledge of depression and attempted to reveal the specific aspects of understanding associated with severity. METHODS: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire: (a) the symptoms of depression, (b) the course of depression, (c) the cause of depression, (d) the treatment plan, (e) the duration of antidepressant use, (f) how to discontinue antidepressant use, (g) the adverse effects of antidepressants, and (h) psychotherapy. Each category consisted of the following questions: "How much do you understand about your treatment?" The level of understanding was rated on an 11-point scale ranging from 0 to 10. The following scales were administered: the Quick Inventory of Depressive Symptomatology, Japanese version (QIDS-J); the Global Assessment of Functioning; and the Clinical Global Impression, Severity scale. Subjects were divided in 5 groups according to severity of QIDS-J. Clinical characteristics were also investigated. RESULTS: Based on an analysis of variance, significant differences were found among the 5 groups with regard to age at onset, duration of disease, and duration of antidepressant use. A multiple regression analysis revealed that item B significantly and negatively predicted the QIDS-J scores, whereas item C significantly and positively predicted these scores. Some multiple logistic regression models seeking to distinguish severity found that all but items E to H were significantly associated with severity. CONCLUSIONS: Items B and C were significantly negatively and positively associated with depression severity, respectively. Sufficient and suitable psychoeducation in and knowledge of depression might improve the treatment responses in patients with depression.

Attitudes toward placebo-controlled clinical trials among depressed patients in Japan.

BACKGROUND: Placebo-controlled clinical trials are the standard in the design of clinical studies for the licensing of new drugs. Medical and ethical concerns regarding placebo use still exist in clinical trials of depressed patients. The aim of this study was to investigate the attitudes toward placebo-controlled clinical trials and to assess factors related to the willingness to participate in such trials among depressed patients in Japan. METHODS: A total of 206 depressed patients aged 49.5 ± 15.7 years (mean ± SD) who were admitted to three psychiatric hospitals were recruited for a cross-sectional study from June 2015 to March 2016. After a thorough explanation of the placebo, the study participants completed a brief 14-item questionnaire developed to evaluate patients' attitudes regarding possible participation in placebo-controlled clinical trials. The Quick Inventory of Depressive Symptomatology was also administered to assess depressive symptoms. RESULTS: The results indicated that 47% of the patients would be willing to participate in a placebo-controlled clinical trial. Expectations for the improvement of disease, desire to receive more medical care, encouragement by family or friends, and desire to support the development of new drugs were associated with the willingness to participate in such trials, whereas a belief that additional time would be required for medical examinations and fear of exacerbation of symptoms due to placebo use were associated with non-participation. LIMITATIONS: Patients were asked about possible participation in placebo-controlled clinical trials. CONCLUSIONS: Less than half of the respondents were willing to participate in placebo-controlled clinical trials. Attitudes toward participation in a placebo-controlled clinical trial need to be considered when deciding whether to conduct such a trial.

Work-family conflict as a mediator between occupational stress and psychological health among mental health nurses in Japan.

BACKGROUND: Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work-family conflict (WFC) in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan. METHODS: In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work-Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis. RESULTS: The relationship between emotional exhaustion and occupational factors, including quantitative workload and the variance in workload, disappeared with the addition of WFC (each work interference with family [WIF] or family interference with work [FIW]). The relationship between emotional exhaustion and mental demands disappeared only with the addition of WIF. The relationship between depressive symptoms and variance in workload disappeared with the addition of WFC (each WIF or FIW). CONCLUSION: Our findings may encourage hospital administrators to consider the risks of medical staff WFC. Furthermore, longitudinal investigations into the factors associated with WFC are required for administrative and psychological interventions.

Prevalence of major depressive disorder among hemodialysis patients compared with healthy people in Japan using the Structured Clinical Interview for DSM-IV.

BACKGROUND: We investigated the prevalence of depression in hemodialysis (HD) patients using the Center for Epidemiologic Studies for Depression (CES-D) scale and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) and compared the rates with those of community dwelling people in Japan. PATIENTS AND METHODS: A total of 99 patients undergoing HD were recruited. Blood sampling was performed no later than 2 weeks prior to assessment. As a reference group for SCID and CES-D evaluation, 404 age- and sex-matched healthy controls who had participated in the Iwaki Health Promotion Project were included in this study. The SCID and the CES-D scale were administered to all participants to diagnose their depression. Participants who met the criteria of a major depressive episode according to the SCID were classified as SCID depression and the participants whose CES-D score was 16 or higher were classified as CES-D depression. RESULTS: Ninety-nine HD patients completed the evaluation and data collection. There were no significant differences in age, sex, or CES-D scores between HD patients and controls. There were 12 cases of SCID depression in HD patients and four cases in controls. There was a significant difference between HD patients and controls in the prevalence of SCID depression. There were no significant differences between the two groups with regard to demographic or clinical data. There were 19 HD patients and 24 controls who showed CES-D depression. There was no significant difference between HD patients and controls in the prevalence of CES-D depression. There was a significant difference in potassium level between the two groups, but there were no significant differences in any of the other items. CONCLUSION: There were significantly more HD patients showing SCID depression than controls in the present study. In clinical settings, the SCID might be useful in surveying cases of depression detected by screening tools among HD patients.

Insomnia in patients on hemodialysis for a short versus long duration.

BACKGROUND: Many studies have investigated insomnia and the factors associated with this condition in hemodialysis (HD) patients, although the influence of HD duration has not been thoroughly investigated. In the present study, we investigated the factors, especially the duration of HD, associated with insomnia in HD patients. PATIENTS AND METHODS: A total of 138 patients undergoing HD were recruited, and the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess the quality of sleep. Subjects with a total PSQI score up to 4 and those with a score of at least 5 were identified as normal subjects and subjects with insomnia, respectively. Additionally, we assessed restless legs syndrome, depression using the Center for Epidemiologic Studies Depression Scale, and health-related quality of life (QOL) using the Short Form 8 Health Survey. We divided the subjects into two groups according to the median HD duration. RESULTS: The prevalence rate of insomnia was 54.3% among all the subjects. Twenty-one subjects (15.2%) had depression, 26 (18.8%) had restless legs syndrome, and 75 (54.3%) had insomnia. The median HD duration was 4 years. The scores of components 1 and 4 of the PSQI, subjective sleep quality and habitual sleep efficiency, did not show a significant difference between the normal and insomnia groups. The score of component 7, daytime dysfunction, showed a significant difference between the short and long HD duration groups. In multiple regression analysis, the score of the Short Form 8 Health Survey showed a significant association with the PSQI score in the long HD duration group, but no variable showed a significant association in the short HD duration group. CONCLUSION: Patients with a longer duration of HD indicated that insomnia has an influence on their daily activities, with a significant association between insomnia and QOL. Greater attention should be paid to poor QOL and troubles in daily activities caused by insomnia in patients with a longer HD duration.

An attempt to construct a 7-item short version of the temperament and character inventory to predict the treatment response of patients with depression; a validation study.

BACKGROUND: The Temperament and Character Inventory (TCI) is a psychological test that is frequently used to assess personality traits. Many studies have shown the potential of the inventory to predict the treatment response of patients with major depressive disorder (MDD). Previously, we showed the association between 10 items of the TCI and the treatment response. In the present study, we reanalyzed the 10 items and aimed to provide cut-off values. METHODS: This work is a secondary analysis of previously published work. Seventy-three patients were enrolled in the previously done study. Participants were treated with 10-40 mg/day of paroxetine for six weeks, and then the participants completed the TCI. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression. The participants were divided into two groups (responders and non-responders). Using chi-squared tests, we reanalyzed the 10 items that had the strongest association with the treatment response in the previous study. We rated the answers to each item associated with the treatment response as a "1", and the answers associated with a non-response were rated as a "0". We calculated predictive scores using 10 models. Each model consisted of 1-10 scores of the best 1-10 items. We defined cut-off values for predicting treatment responses using a receiver operating characteristic (ROC) curve analysis. RESULTS: Ranked by the strength of the association with the treatment response, items 174, 137, 70, 237, 106, 191, 34, 232, 161, and 215 of the TCI significantly predicted treatment responses. All predictive scores from models 1 to 10 significantly predicted treatment responses. The predictive score threshold of model 7 was 3/4, with an area under the curve of 0.825, and this model showed the highest odds and likelihood ratios (19.3 and 8.86, respectively). CONCLUSIONS: We might predict the treatment response of patients with MDD using TCI predictive scoring, including items 174, 137, 70, 237, 106, 191, and 34 and a cut-off value of 3/4.

Items of the Montgomery-Åsberg Depression Rating Scale Associated With Response to Paroxetine Treatment in Patients With Major Depressive Disorder.

OBJECTIVES: In the present study, we investigated the association between the severity of each symptom evaluated by the Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline and responsiveness to treatment in patients with major depressive disorder (MDD) to identify the items that predict treatment response. METHODS: The patients received a diagnosis of MDD if they had a score greater than 20 points on the MADRS. Following admission, 120 patients were enrolled in the study, and 89 patients completed the study. For the first week, a 20-mg/d dose of paroxetine was administered; thereafter, the dose was increased to 40 mg/d. The MADRS was applied at baseline and after 1, 2, 4, and 6 weeks. We defined responders as patients with improvements in their MADRS scores of more than 50% after 6 weeks of treatment. A multiple regression analysis of MADRS scores at 6 weeks was performed to identify patients who responded to treatment. RESULTS: There was a significant difference between responders and nonresponders in the reported sadness (RS) score for all MADRS items. In the multiple logistic regression analysis, only the RS and concentration difficulties (C) scores showed a significant association with treatment response. Based on the results of χ tests, RS score cutoff values of 2/3 and 3/4 revealed significant differences in the responder rate. None of the cutoff values for the C score revealed significant differences. CONCLUSIONS: The RS score was significantly associated with responsiveness to paroxetine treatment for MDD, with higher RS scores predicting poor responses to treatment.

Characteristics of Escitalopram Discontinuation Syndrome: A Preliminary Study.

BACKGROUND: Antidepressant discontinuation syndrome (ADS) frequently occurs in patients who undergo an abrupt discontinuation of their antidepressant medication. METHODS: We evaluated 25 consecutive outpatients with depression who discontinued their use of escitalopram. The presence of ADS was evaluated according to the Antidepressants Discontinuation Syndrome checklist. RESULTS: Antidepressant discontinuation syndrome was observed in 14 of 25 patients. Frequent symptoms were dizziness (44%), muscle tension (44%), chills (44%), confusion or trouble concentrating (40%), amnesia (28%), and crying (28%). The treatment doses and plasma concentrations of escitalopram were significantly higher in patients with ADS than in patients without ADS. No group differences were observed regarding age, sex, or duration of escitalopram treatment before the discontinuation. CONCLUSIONS: These findings suggest that a higher dose and lower clearance of escitalopram lead to a higher risk of ADS. Very slow tapering is recommended for all patients.

Relationship between the lesion location of acute ischemic stroke and early depressive symptoms in Japanese patients.

BACKGROUND: Approximately one-third of stroke survivors suffer from post-stroke depression (PSD) in the acute or chronic stages. The presence of PSD in the acute stage after stroke is reportedly associated with poor patient prognosis; therefore, early recognition and treatment of PSD may alleviate these consequences. The aim of the current study was to examine the relationship between the lesion location and the presence of early depressive symptoms after acute ischemic stroke in Japanese patients. METHODS: Our study included 421 patients who suffered from acute ischemic stroke. On the day of admission, the lesion location was determined using magnetic resonance imaging (MRI). Stroke severity was measured on the seventh day of hospitalization withat the National Institutes of Health Stroke Scale (NIHSS). On the tenth day of hospitalization, depressive symptoms were measured and functional assessments were performed with the Japan Stroke Scale (Depression Scale) (JSS-D) and functional independence measure (FIM), respectively. RESULTS: A total of 71 subjects (16.9 %) were diagnosed with depression. According to the multiple logistic regression analysis, the infarcts located at frontal and temporal lobes were found to be a significant independent risk factor of early depressive symptoms in the acute stage of stroke. CONCLUSIONS: Patients suffering from acute ischemic stroke, particularly in the frontal and temporal lobes, should be carefully assessed to detect and treat early depressive symptoms; such treatment may improve patient outcomes.

Glutathione S-transferase K1 genotype and overweight status in schizophrenia patients: A pilot study.

Elevated oxidative stress in mitochondria and mitochondrial dysfunction are associated with weight gain in schizophrenia (SCZ) patients. Glutathione S-transferase kappa 1 (GSTK1) protects cells against exogenous and endogenous oxidative stress in the mitochondria. This exploratory study investigated the possible effects of a common GSTK1 polymorphism (rs1917760, G-1308T) on the risk for overweight status among 329 SCZ patients and 305 age- and gender-matched controls and on the GSTK1 mRNA level in peripheral blood mononuclear cells among 14 SCZ patients. The GSTK1 T/T genotype was associated with having a higher BMI value among SCZ male patients, whereas this genotype tended to be associated with a lower BMI value among female patients. Conversely, these associations were not observed among the controls. The GSTK1 T/T genotype was associated with decreased GSTK1 mRNA level among SCZ patients. The GSTK1 T/T genotype may be a novel risk factor for the prediction of overweight status in SCZ male patients, although the results of this pilot study should be verified by a larger study.

Relationship between occupational stress and depression among psychiatric nurses in Japan.

Psychiatric nursing is a stressful area of nursing practice. The purpose of this study was to examine occupational stress among psychiatric nurses in Japan. In this cross-sectional study, 238 psychiatric nurses were recruited from 7 hospitals. Data regarding the Generic Job Stress Questionnaire (GJSQ), the Center for Epidemiologic Studies for Depression Scale (CES-D), and the Health Practice Index (HPI) were obtained via self-report questionnaires. After adjusting for all the variables, CES-D scores were associated with job stress, but social support reduced the effect of stress on depression among psychiatric nurses. However, the interpretation of these results was hampered by the lack of data concerning important occupational factors, such as working position, personal income, and working hours. Further longitudinal investigation into the factors associated with depression may yield useful information for administrative and psychological interventions.

The association between the subjective memory complaints scale and depressive state and cognitive impairment: a factor analysis.

BACKGROUND: We aimed to discriminate individuals with depressive state from individuals with cognitive impairment among community-dwelling people using the subjective memory complaints (SMC) scale. METHODS: The study group consisted of 289 volunteers (over 60 years old; 104 males and 185 females). Participants' SMCs were assessed using the SMC scale. The Japanese version of the Center for Epidemiologic Studies for Depression scale and the Mini-Mental State Examination were administered. Participants whose Center for Epidemiologic Studies for Depression scores were 16 or higher were defined as the depressive group and participants whose Mini-Mental State Examination scores were less than 24 were defined as the cognitive impairment group. Exploratory factor analysis was performed to identify the factor structure of the items of the SMC scale. A multiple logistic regression analysis of the association between depressive state and cognitive impairment and the score of each factor was performed. RESULTS: In the final factor analysis model, six items of the SMC scale remained, and a two-factor structure was adequate. Factor 1 included the items 8, 9, and 10 about thought or the ability to think; thus, Factor 1 was defined as "thought disturbance factor". Factor 2 included the items 1, 2, and 4 about memory or forgetfulness; thus, Factor 2 was defined as "memory disturbance factor". In the multiple logistic regression analysis, Factor 1 was significantly associated with depressive state and Factor 2 was significantly associated with cognitive impairment. CONCLUSION: For individuals with SMCs, we might be able to discriminate depressive state or depression from cognitive impairment or dementia through a detailed investigation using the SMC scale.

The low level of understanding of depression among patients treated with antidepressants: a survey of 424 outpatients in Japan.

BACKGROUND: We used self-administered questionnaires to investigate the level of understanding of depression among outpatients who were administered antidepressants. METHODS: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire that consisted of eight categories: (A) depressive symptoms, (B) the course of depression, (C) the cause of depression, (D) the treatment plan, (E) the duration of taking antidepressants, (F) how to discontinue antidepressants, (G) the side effects of the antidepressants, and (H) psychotherapy. Each category consisted of the following two questions: "Have you received an explanation from the doctor in charge?" and "How much do you understand about it?" The level of understanding was rated on a scale of 0-10 (11 anchor points). The Quick Inventory of Depressive Symptomatology Japanese version, Global Assessment of Functioning, and Clinical Global Impression - Severity scale were administered, and clinical characteristics were investigated. RESULTS: The percentages of participants who received explanations were as follows: 61.8% for (A), 49.2% for (B), 50.8% for (C), 57.2% for (D), 46.3% for (E), 28.5% for (F), 50.6% for (G), and 36.1% for (H). The level of understanding in participants who received explanations from their physicians was significantly higher compared with patients who did not receive explanations for all evaluated categories. Patient age, age at disease onset, and Global Assessment of Functioning scores were significantly associated with more items compared with the other variables. CONCLUSION: Psychoeducation is not sufficiently performed. According to the study results, it is possible for patients to receive better psychoeducation and improve their clinical outcomes.