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1.
BMC Gastroenterol ; 23(1): 106, 2023 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-37020184

RESUMO

OBJECTIVE: Comorbid psychiatric disorders negatively affect the survival rate of patients with some physical disorders. In liver transplant recipients, various psychiatric disorders have been identified as worsening prognosis. However, little is known about how the presence of any comorbid (overall) disorders affect the survival rate of transplant recipients. In this study, we examined the effect of overall comorbid psychiatric disorders on survival rate in liver transplant recipients. METHODS: A total of 1006 recipients who underwent liver transplantation between September 1997 and July 2017 across eight transplant facilities with a psychiatric consultation-liaison team were identified consecutively. Recipients were categorized into those with comorbid psychiatric disorders and those without comorbid psychiatric disorders. In the comorbid psychiatric disorder group, psychiatric disorder diagnosis and time of diagnosis were investigated retrospectively. RESULTS: Of the 1006 recipients, 294 (29.2%) had comorbid psychiatric disorders. Comorbid psychiatric disorders in the 1006 recipients were insomnia (N = 107, 10.6%), delirium (N = 103, 10.2%), major depressive disorder (N = 41, 4.1%), adjustment disorder (N = 19, 1.9%), anxiety disorder (N = 17, 1.7%), intellectual disability (N = 11, 1.1%), autism spectrum disorder (N = 7, 0.7%), somatic symptom disorder (N = 4, 0.4%) schizophrenia (N = 4, 0.4%), substance use disorder (N = 24, 2.4%) and personality disorder (N = 2, 0.2%). The most common time of psychiatric disorder diagnosis was within the first 3 months after liver transplantation (51.6%). The final mortality in patients with comorbid psychiatric disorder diagnosis during the five periods (pretransplant, transplant to 3 months, months to 1 year, 1 to 3 years, and over 3 years posttransplant) was 16.2%, 18.8%, 39.1%, 28.6%, and 16.2% respectively, and there were no significant differences between the five periods (χ2 = 8.05, df = 4, p = 0.09). Overall comorbid psychiatric disorders were significantly associated with shorter survival time (log-rank test: p = 0.01, hazard ratio: 1.59 [95% confidence interval: 1.14-2.21], survival rate at the endpoint [%]: 62.0 vs. 83.3). However, after adjusting for confounding variables using Cox proportional hazards regression, there was no significant effect of overall comorbid psychiatric disorders on prognosis. CONCLUSION: Comorbid psychiatric disorders did not affect the survival rate of liver transplant recipients in this study.


Assuntos
Transtorno do Espectro Autista , Transtorno Depressivo Maior , Transplante de Fígado , Transtornos Mentais , Humanos , Estudos Retrospectivos , Encaminhamento e Consulta
2.
Clin Exp Nephrol ; 27(5): 473-479, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36840901

RESUMO

BACKGROUND: Patient survival and physical outcomes among children with end-stage kidney disease (ESKD) have significantly improved, and recent research has focused on long-term depression symptoms and health-related quality of life (HRQOL). However, no studies have been conducted among adolescents and young adults with childhood-onset ESKD in Japan. METHODS: This multicenter study included 45 adolescents and young adults aged 16-39 years who developed ESKD at age < 20 years. Depression symptoms were measured using the Beck Depression Inventory (BDI)-II. The Short Form-36 Health Survey (SF-36) was used to assess HRQOL. Factors associated with depression and HRQOL were analyzed. RESULTS: Depression (BDI-II score ≥ 14) was observed in 13 (29%) patients. Patient's SF-36 physical component summary (PCS) and mental component summary (MCS) scores were comparable with those for the general population. Lower estimated glomerular filtration rate, higher BDI-II scores, and lower body mass index were associated with lower PCS scores. BDI-II scores were negatively correlated with MCS scores. We observed a trend that unemployment was associated with lower MCS scores. CONCLUSIONS: Depression is frequently observed among adolescents and young adults with childhood-onset ESKD. Regular screening for psychosocial concerns, maintaining stable graft functions, and achieving optimal nutritional status may contribute to improved well-being among these patients.


Assuntos
Falência Renal Crônica , Qualidade de Vida , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Depressão/epidemiologia , Japão/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/psicologia , Estado Nutricional , Inquéritos e Questionários
3.
BMC Cancer ; 22(1): 134, 2022 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-35109805

RESUMO

BACKGROUND: This study aimed to clarify predictors of depressive symptoms and anxiety symptoms after cancer diagnosis among Japanese cancer survivors (CSs). METHODS: As part of a Japanese cancer survivorship research project commissioned by the Ministry of Health, Labour and Welfare (MHLW) of Japan, we conducted a web-based nationwide survey of CSs in 2018. We analyzed the risk factors for depressive and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale Japanese version (HADS). RESULTS: Of 1,234 Japanese CSs, mean score of HADS-depression and HADS-anxiety were 4.08 and 4.78, respectively. At the time of the study, the number of CSs with symptoms of depression and anxiety were 111 (9.0%) and 269 (21.8%), respectively. After multivariable analysis, CSs ≥ 60 years old (reference: ≤ 39 years old, odds ratios (OR): 0.39, 95%CI: 0.17-0.90) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.55, 95%CI: 0.32-0.96) had lower odds for depressive symptoms. And CSs ≥ 60 years old (reference: ≤ 39 years old, OR: 0.27, 95%CI: 0.15-0.49) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.62, 95%CI: 0.42-0.90) also had lower odds for anxiety symptoms. CSs who received chemotherapy (OR: 1.56, 95%CI: 1.10-2.20) had higher odds for anxiety symptoms. CONCLUSIONS: Based on manifestation of symptoms, CSs who were younger, closer to the time of cancer diagnosis, had advanced-staged cancer, or received chemotherapy may be at higher risk for depressive or anxiety symptoms. Those CSs who have higher risk for depression and anxiety symptoms, should be followed-up more carefully for better cancer survivorship, by medical professionals, companies, and society.


Assuntos
Ansiedade/etiologia , Sobreviventes de Câncer/psicologia , Depressão/etiologia , Neoplasias/psicologia , Adulto , Antineoplásicos/uso terapêutico , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/tratamento farmacológico , Escalas de Graduação Psiquiátrica , Fatores de Risco , Inquéritos e Questionários
4.
J Pharmacol Sci ; 145(2): 198-201, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33451754

RESUMO

The orexinergic system plays a significant role in regulating proper sleep/wake maintenance. Dual orexin receptor antagonist (DORA) is widely prescribed for insomnia symptoms. The antagonist acts on orexin 1 and 2 receptors located in certain brain areas, including the locus coeruleus and dorsal raphe. Nevertheless, its effects on monoamine-related gene expression remain unclear. Here, we measured the expression levels of monoamine-related genes in DORA-treated mice. DORA treatment significantly affected overall levels of noradrenalin transporter/monoamine oxidases A mRNA expression in the hippocampus. Our findings suggest that DORA contributes to noradrenalin-related gene expression regulation in the central nervous system.


Assuntos
Azepinas/farmacologia , Benzimidazóis/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Expressão Gênica/efeitos dos fármacos , Hipocampo/metabolismo , Monoaminoxidase/genética , Monoaminoxidase/metabolismo , Proteínas da Membrana Plasmática de Transporte de Norepinefrina/genética , Proteínas da Membrana Plasmática de Transporte de Norepinefrina/metabolismo , Antagonistas dos Receptores de Orexina/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Animais , Masculino , Camundongos Endogâmicos C57BL
5.
BMC Public Health ; 21(1): 138, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446165

RESUMO

BACKGROUND: In Japan, 55.5% of breast cancer survivors (BCSs) are of working age, so various perspectives regarding return to work (RTW) after cancer diagnosis need to be considered. Therefore, this study aimed to clarify the risk factors for resignation and taking sick leave (SL) among BCSs in continued employment at the time of diagnosis. METHODS: A web-based retrospective cross-sectional survey was conducted on BCSs using data from a 2018 Japanese national research project (Endo-Han) commissioned by the Ministry of Health, Labour and Welfare of Japan. The subjects were women aged 18-69 years who had been diagnosed with breast cancer for the first time at least 1 year previously. The risk factors for resignation and taking SL after breast cancer diagnosis, including age at diagnosis, education level, cancer stage, surgery, chemotherapy, radiotherapy, employment status, and occupational type, were then analyzed using a logistic regression model. RESULTS: In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of the multivariable analysis indicated that lower education level (odds ratio [OR]: 3.802; 95% confidence interval [CI]: 1.233-11.729), taking SL (OR: 2.514; 95%CI: 1.202-5.261), and younger age at diagnosis (OR: 0.470; 95%CI: 0.221-0.998) were predictors of resignation. Of 229 patients who continued working, SL was taken by 72 (31.4%). In addition, undergoing surgery was found to be a predictor of taking SL (OR: 8.311; 95%CI: 1.007-68.621). CONCLUSIONS: In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of this study indicated that younger age, lower education level, and taking SL were predictors of resignation after breast cancer diagnosis.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Adolescente , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Licença Médica , Adulto Jovem
6.
J Pharmacol Sci ; 144(1): 57-59, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32624301

RESUMO

Some psychiatric diseases are associated with disruptions in the circadian clock system. Ziprasidone (ZIP), a second-generation antipsychotic, is widely used for psychiatry-related pharmacotherapy but its mechanism has not been clearly elucidated. We measured clock gene fluctuation patterns in the hippocampus and the amygdala in ZIP-treated mice. ZIP significantly increased Per1, Per2, and Bmal1 mRNA 2 h after the lights were turned off (ZT14) in the hippocampus, but not in the amygdala. These results suggest that ZIP might affect clock gene regulation, which could represent the pathway underlying symptom amelioration.


Assuntos
Fatores de Transcrição ARNTL/genética , Fatores de Transcrição ARNTL/metabolismo , Antipsicóticos/farmacologia , Relógios Biológicos/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/genética , Expressão Gênica/efeitos dos fármacos , Proteínas Circadianas Period/genética , Proteínas Circadianas Period/metabolismo , Piperazinas/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Tiazóis/farmacologia , Tonsila do Cerebelo/metabolismo , Animais , Hipocampo/metabolismo , Luz , Masculino , Camundongos Endogâmicos C57BL
7.
Hum Psychopharmacol ; 35(4): e2739, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32420645

RESUMO

OBJECTIVE: To determine the prevalence, background factors, and progression of and recovery from clozapine-induced agranulocytosis in Japan. METHODS: Data on treatment-resistant schizophrenia patients registered with the Clozaril Patient Monitoring Service (CPMS) between July 29, 2009 and January 20, 2016 were extracted. Patients with a neutrophil count <500/mm3 were defined as having agranulocytosis, and those with a leukocyte count <3,000/mm3 or a neutrophil count <1,500/mm3 but not meeting the criteria for agranulocytosis were defined as having leukopenia/neutropenia. RESULTS: Of 3,746 patients, agranulocytosis and leukopenia/neutropenia were observed in 38 (1.0%) and 182 (4.9%) patients, respectively. Age was significantly higher in the agranulocytosis group (p < .001). Decreased leukocyte counts 1 week prior to discontinuation were observed only in the agranulocytosis group. The median number of days to recovery from agranulocytosis and leukopenia/neutropenia was 10 and 4, respectively, with more variation in the latter. CONCLUSIONS: Although some patients with leukopenia/neutropenia might carry less pathologic significance, the results of this study reconfirmed the importance of regular blood monitoring for preventing agranulocytosis.


Assuntos
Agranulocitose/induzido quimicamente , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Esquizofrenia/tratamento farmacológico , Adulto , Agranulocitose/epidemiologia , Antipsicóticos/administração & dosagem , Clozapina/administração & dosagem , Progressão da Doença , Feminino , Humanos , Japão , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Prevalência
8.
J Oncol Pharm Pract ; 26(5): 1041-1051, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31635550

RESUMO

BACKGROUND: Corticosteroid-induced psychiatric disorders (CIPDs) represent an adverse effect that can cause severe emotional and behavioral problems. The aim of the present study was to assess the incidence and risk factors of CIPDs. METHODS: A retrospective analysis of 92 pediatric and young adult patients with hematologic malignancies was conducted. RESULTS: The incidence of CIPDs in patients receiving a treatment regimen with prednisolone or dexamethasone was 64.9% and 77.5%, respectively, both of which were significantly higher than that in patients not receiving corticosteroids. Independent risk factors and adjusted odds ratios (95% confidence intervals) related to severe CIPD were 2.15 (1.11-4.18) for dexamethasone (using prednisolone as the reference) and 0.81 (0.75-0.87) for age, suggesting that the odds increase with decreasing age. Frequently observed symptoms, respectively in terms of behavioral and emotional problems were defiance, crying, psychomotor excitement, dysphoria, irritability, and depression. To our knowledge, this is the first report to mention the risk factors and characteristics for clinical symptoms of CIPDs during the developmental process. CONCLUSIONS: Healthcare professionals should predict and prepare for psychiatric adverse events prior to chemotherapy in the clinical settings, especially in patients in younger age and receiving a treatment regimen with dexamethasone.


Assuntos
Glucocorticoides/efeitos adversos , Neoplasias Hematológicas/tratamento farmacológico , Transtornos Mentais/induzido quimicamente , Adolescente , Adulto , Criança , Pré-Escolar , Quimioterapia de Consolidação , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lactente , Masculino , Prednisolona/administração & dosagem , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Tohoku J Exp Med ; 252(2): 177-183, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33055431

RESUMO

Clozapine (CLZ), an antipsychotic with a unique mechanism of action, is known to be superior to any other antipsychotic for schizophrenia. However, CLZ is also known to be associated with the development of lethal side effects, which include agranulocytosis and glucose intolerance (GI). Regular measurement and registration of blood test results have been mandatory for all CLZ users; however, these risks may still prevent therapists from prescribing CLZ. While CLZ-induced agranulocytosis has been well documented, CLZ-induced GI in the real world has not been fully investigated. Therefore, in this study, we used data registered in monitoring systems to investigate background factors associated with new-onset GI after CLZ administration and changes in HbA1c levels during CLZ treatment. Data of all patients with schizophrenia who were using CLZ from July 29, 2009 to January 20, 2016 were used for the analysis. Of the 3,746 patients enrolled in the study, 92 (2.5%) had GI at baseline; of the remaining 3,654 patients, 428 (11.7%) developed new-onset GI. Multivariate logistic regression analysis revealed that the development of new-onset GI was significantly associated with older age, higher baseline HbA1c levels, and longer treatment duration. In patients with GI at baseline, HbA1c levels were maintained or improved over 18 months, while in the other patients, CLZ administration gradually elevated HbA1c levels. The findings of this study suggest that, although adequate monitoring and intervention is required, CLZ induction and maintenance therapy may be safe, even for patients with impaired glucose tolerance.


Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Intolerância à Glucose/induzido quimicamente , Teste de Tolerância a Glucose , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Feminino , Hemoglobinas Glicadas/biossíntese , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Risco , Esquizofrenia/complicações
10.
Psychol Health Med ; 25(1): 91-101, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31144516

RESUMO

Nonadherence to immunosuppressive medications after kidney transplantation is a major risk factor for allograft rejection and graft loss. Transplant recipients tend to conceal nonadherence in clinical settings. We conducted an internet-based cross-sectional survey aimed to clarify the prevalence and risk factors of patient nonadherence after kidney transplantation in Japan. The Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©) was used to detect nonadherence. In this survey, patients were asked about their relationship with medical staff and their self-efficacy for taking medication, along with other questions. A total of 219 kidney transplant recipients were included in the analysis. Ninety-four demonstrated nonadherence (42.7%). The following factors were associated with nonadherence: short dialysis period prior to transplantation; undergoing transplantation at least twice; male sex; lack of satisfaction with the explanation of immunosuppressive medication; and absence of medical staff to consult upon forgetting to take drugs. The nonadherence group reported low self-efficacy for medication in many settings. This anonymous survey provides valuable insight into the actual nonadherence rate, factors associated with nonadherence, and life situations that may complicate medication-taking.


Assuntos
Imunossupressores/administração & dosagem , Transplante de Rim/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Autoeficácia , Transplantados/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Internet , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
BMC Health Serv Res ; 19(1): 755, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655578

RESUMO

BACKGROUND: No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. METHODS: Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors' sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients' clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors' perceptions of the donation results and transplant procedure were assessed using measures that we developed. RESULTS: The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079-0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045-1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250-1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. CONCLUSIONS: Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.


Assuntos
Transplante de Rim , Doadores Vivos/psicologia , Satisfação Pessoal , Idoso , Feminino , Humanos , Japão , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
J Stroke Cerebrovasc Dis ; 28(4): e17-e21, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30638936

RESUMO

BACKGROUND: Cases of obsessive-compulsive disorder (OCD) following cerebrovascular accident (CVA) have rarely been reported. METHODS: Case report and literature review. RESULTS: We describe the case of a 58-year-old, right-handed man developed OCD 17 months after stroke resulting from lesion of the right middle cerebral artery infarction. The patient was successfully treated with sertraline up to 50 mg per day. His OCD behaviors largely reduced in 6 weeks, and the Yale-Brown Obsessive Compulsive Scale score was reduced from 29 to 12 in 1 year. A literature review revealed 21 previous cases of OCD following CVA. Among these, consistent with our case, the basal ganglia was the most common site of the lesion responsible for the development of this rare disorder. We discuss the patient's treatment and outcomes. CONCLUSIONS: Our present case and a literature review suggest that OCD can manifest following CVA, although further studies are necessary. Selective serotonin reuptake inhibitors appear to be effective in treating this rare disorder.


Assuntos
Infarto da Artéria Cerebral Média/complicações , Transtorno Obsessivo-Compulsivo/etiologia , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Procedimentos Endovasculares/instrumentação , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/terapia , Angiografia por Ressonância Magnética , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/psicologia , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Sertralina/administração & dosagem , Stents , Terapia Trombolítica , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
13.
J Clin Psychopharmacol ; 38(4): 302-306, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29912802

RESUMO

OBJECTIVE: The aim of this study was to investigate clozapine use and its associated adverse effects in patients in Japan. METHODS: We analyzed data recorded from July 2009 to January 2016 (N = 3780 patients) in the Clozaril Patient Monitoring Service, which was established in Japan in 2009 and includes all Japanese patients who have been prescribed clozapine. RESULTS: The treatment discontinuation rate was 23.9% (869/3780 cases). The average ± SD treatment duration was 234.9 ± 306.9 days (median, 115 days), and the average ± SD dosage was 186.41 ± 151.6 mg/d. The estimated treatment continuation rates resulting from all-cause discontinuation were 78.2 after 1 year and 72.9% after 2 years of treatment. The incidence of neutropenia/leucopenia was 5.4% (206/3780 cases). The average ± SD dose before discontinuation was 233.36 ± 168.15 mg (median, 200 mg; range, 4-600 mg). The incidence of glucose intolerance was 15.4% (583/3780 cases). Of 3780 patients, 98 (2.67%) developed glucose intolerance before and after taking clozapine administration, whereas 485 patients (12.8%) developed glucose intolerance after taking clozapine. The average ± SD time from treatment initiation to new onset of glucose intolerance was 382.2 ± 420.2 days (median, 216 days; range, 4-2053 days). CONCLUSIONS: The data obtained in this study, particularly regarding the incidence of clozapine-induced adverse events, will enable the optimal and safe use of clozapine in Japanese patients with treatment-resistant schizophrenia.


Assuntos
Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Criança , Clozapina/administração & dosagem , Clozapina/efeitos adversos , Feminino , Intolerância à Glucose/induzido quimicamente , Intolerância à Glucose/epidemiologia , Humanos , Japão/epidemiologia , Leucopenia/induzido quimicamente , Leucopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Neutropenia/epidemiologia , Adulto Jovem
14.
Health Qual Life Outcomes ; 16(1): 14, 2018 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-29338728

RESUMO

BACKGROUND: Although a score of less than 7 for the 17-item Hamilton Depression Rating Scale (HAM-D17) has been widely adopted to define remission of depression, a full recovery from depression is closely related to the patient's quality of life as well. Accordingly, we re-evaluated this definition of remission using HAM-D17 in comparison with the corresponding score for health-related quality of life (HRQOL) measured by the SF-36. METHODS: Using the data for depressive patients reported by GlaxoSmithKline K.K. (Study No. BRL29060A/863) in a post-marketing observational study of paroxetine, with a sample size of n = 722, multivariate logistic regression was performed with the HAM-D17 score as a dependent variable and with each of the eight domain scores of HRQOL (from the SF-36) transformed into a binominal form according to the national standard value for Japan. Then, area under curve of receiver operating characteristic analyses were conducted. Based on the obtained results, a multivariate analysis was performed using the HAM-D17 score in a binomial form with HAM-D17 as a dependent variable and with each of the eight HRQOL domain scores (SF-36) as binominalized independent variables. RESULTS: A cutoff value for the HAM-D17 score of 5 provided the maximum ROC-AUC at "0.864." The significantly associated scores of the eight HRQOL domains (SF-36) were identified for the HAM-D17 cutoff values of ≥5 and ≤4. The scores for physical functioning (odds ratio, 0.473), bodily pain (0.557), vitality (0.379), social functioning (0.540), role-emotion (0.265), and mental health (0.467) had a significant negative association with the HAM-D17 score (p < 0.05), and HRQOL domain scores for HAM-D17 ≥ 5 were significantly lower compared with those for HAM-D17 ≤ 4. CONCLUSIONS: A cutoff value for HAM-D17 of less than or equal to 4 was the best candidate for indicating remission of depression when the recovery of HRQOL is considered. Restoration of social function and performance should be considered equally important in assessing the adequacy of treatment for patients with depression.


Assuntos
Transtorno Depressivo/tratamento farmacológico , Paroxetina/administração & dosagem , Qualidade de Vida , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Área Sob a Curva , Transtorno Depressivo/psicologia , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Vigilância de Produtos Comercializados , Escalas de Graduação Psiquiátrica/normas , Índice de Gravidade de Doença
15.
Palliat Support Care ; 16(1): 41-49, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28464966

RESUMO

OBJECTIVE: Our objective was to examine the accuracy of non-psychiatrist assessments of psychiatric problems in cancer patients. METHOD: We conducted a retrospective chart review of cancer patients who were admitted and referred to the consultation-liaison (C-L) team between January of 2011 and December of 2012. The agreement between non-psychiatrist assessments and final diagnoses by attending C-L psychiatrists was estimated for every category of referral assessment using codes from the International Classification of Mental and Behavioral Disorders (10th revision). The data were obtained from the consultation records of 240 cancer inpatients who were referred to the C-L service at a tertiary care center in Tokyo. RESULTS: The agreement ratio between referring oncologists and psychiatrists differed according to the evaluation categories. The degrees of agreement for the categories of "delirious," "depressive," "dyssomnia," "anxious," "demented," "psychotic," and "other" were 0.87, 0.43, 0.51, 0.50, 0.27, 0.55, and 0.57, respectively. The agreement for all patients was 0.65. Significant differences were observed among seven categories (chi-squared value = 42.454 at p < 0.001 and df = 6). The analysis of means for proportions showed that the degree of agreement for the "delirious" category was significantly higher and that that for the "depressive" category was lower than that for all patients, while for the "demented" category it was close to the lower decision limit but barely significant. One half of the 20 cases who were referred as depressive were diagnosed with delirium, with one quarter of those having continuously impaired consciousness. Some 7 of the 11 cases who were referred as demented were diagnosed as having delirium. SIGNIFICANCE OF RESULTS: The accuracy of non-psychiatrist assessments for psychiatric problems in cancer patients differs by presumed diagnosis. Oncologists should consider unrecognized delirium in cancer inpatients who appear depressed or demented.


Assuntos
Competência Clínica/normas , Transtornos Mentais/diagnóstico , Oncologistas/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Tardio/tendências , Feminino , Hospitalização , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Circ J ; 80(12): 2482-2488, 2016 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-27818463

RESUMO

BACKGROUND: The aim of this study was to determine the prevalence of depression assessed by the 9-item test from the Patient Health Questionnaire (PHQ-9) and the effect of depression on adverse cardiovascular outcomes in Japanese outpatients with cardiovascular disease (CVD).Methods and Results:This prospective observational study enrolled 1,453 outpatients with CVD (mean age 67±13 years; 31.3% female; 32.6% ischemic heart disease). Depression was defined as a PHQ-9 score ≥10. The main composite outcome was the time to death from any cause or a cardiovascular event. 81 patients (5.6%) were diagnosed with depression (PHQ-9 ≥10). NYHA class III, living alone, and unemployment were independently associated with depression. During an average follow-up of 584±80 days, the main outcome occurred in 85 patients (5.8%). There was a higher incidence of the main outcome in patients with depression than in those without depression (P<0.001). Depression was an independent predictor of the primary outcome (hazard ratio 4.64, 95% confidence interval 2.24-9.09, P<0.001). CONCLUSIONS: Depression assessed by the PHQ-9 was found in 5.6% of Japanese outpatients with CVD and was an important risk factor for adverse outcomes. (UMIN-CTR No. UMIN 000023514) (Circ J 2016; 80: 2482-2488).


Assuntos
Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Doenças Cardiovasculares/complicações , Depressão/etiologia , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco
18.
Liver Transpl ; 20(3): 298-310, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24470014

RESUMO

Alcoholic liver cirrhosis (ALC) is an established indication for liver transplantation (LT). Most LT procedures in Japan are living donor liver transplantation (LDLT) because of an extreme shortage of deceased donors. Social circumstances enabling LDLT could be favorable for preventing relapse. The aims of this retrospective study were to analyze the outcomes of LDLT for ALC and to evaluate risk factors for relapse in this cohort. One hundred ninety-five subjects underwent LT [LDLT (n = 187), deceased donor LT (n = 5), or domino LT (n = 3)] for ALC in Japan from November 1997 to December 2011. Risk factors for alcohol relapse and the impact of relapse on outcomes were analyzed for 140 patients after the exclusion of 26 patients who died in the hospital and 29 patients without information about alcohol relapse. The incidence of alcohol consumption after LT was 22.9%. The risk factors for patient survival were a donor age ≥ 50 years (P < 0.01) and a Model for End-Stage Liver Disease score ≥ 19 (P = 0.03). The 10-year patient survival rates were 21.9% and 73.8% for patients who had relapsed and patients who had not relapsed 18 months after LT, respectively (P = 0.01). The relapse rates were 50.0%, 34.5%, 13.3%, 19.7%, and 14.3% for patients who had received livers from parents, siblings, spouses, sons/daughters, and deceased or domino donors, respectively. A history of treatment for psychological diseases other than alcoholism before LT was a significant indicator for the risk of recidivism (P = 0.02), and noncompliance with clinic visits after LT and smoking after transplantation were promising indicators for the risk of recidivism (P = 0.06, and P = 0.05, respectively). Preoperative alcohol consumption was not a risk factor. In conclusion, rather than selecting patients on the basis of preoperative alcohol use, we should provide sociomedical support to improve adherence after LT for ALC in Japan.


Assuntos
Alcoolismo/diagnóstico , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas , Humanos , Japão , Cirrose Hepática Alcoólica/mortalidade , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
20.
Int J Geriatr Psychiatry ; 29(3): 253-62, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23801358

RESUMO

OBJECTIVE: Attention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting. METHODS: A prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events. RESULTS: Among 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global Impressions-Improvement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1 week in more than half of the patients (54%). CONCLUSIONS: In the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk.


Assuntos
Antipsicóticos/efeitos adversos , Delírio/tratamento farmacológico , Hospitais Gerais/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Feminino , Humanos , Masculino , Pneumonia Aspirativa/induzido quimicamente , Estudos Prospectivos , Tromboembolia Venosa/induzido quimicamente , Ferimentos e Lesões/induzido quimicamente
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