Reliability and validity of the Multidimensional Measure of Leader-Member Exchange Japanese version for staff nurses.

AIM: To verify the reliability and validity of Multidimensional Measure of Leader-Member Exchange Japanese version (LMX-MDM-J) for staff nurses. BACKGROUND: Staff nurses who have a high-quality relationship with nurse managers tend to have low turnover intention. However, the validity and reliability of LMX-MDM Japanese version have not been confirmed. METHODS: Staff nurses (n = 870) working in wards of four Japanese hospitals were surveyed using self-administered questionnaires. Reliability was tested by internal consistency. Validity was tested by the confirmatory factor analysis for construct validity and relationships with external criteria for criterion-related validity. RESULTS: There were 450 valid responses. Cronbach's α coefficients of the overall scale and each dimension were 0.97 and 0.86-0.95, respectively. The goodness-of-fit indices of the confirmatory factor analysis showed CFI = 0.981 and RMSEA = 0.076. Correlation coefficients with external criteria were 0.57 for job satisfaction, 0.80 for relationship satisfaction with the nurse manager and -0.36 for turnover intention (all p < .001). CONCLUSION: The reliability and validity of LMX-MDM-J were determined to be adequate for staff nurses. IMPLICATIONS FOR NURSING MANAGEMENT: LMX-MDM-J can accurately measure the quality of the dyadic relationship between nurse managers and staff nurses. This measurement indicates whether nurse managers are providing leadership.

Irritable bowel syndrome, its cognition, anxiety sensitivity, and anticipatory anxiety in panic disorder patients.

AIM: The present study examined the effect of irritable bowel syndrome (IBS), cognitive appraisal of IBS, and anxiety sensitivity on anticipatory anxiety (AA) and agoraphobia (AG) in patients with panic disorder (PD). METHODS: We examined 244 PD patients who completed a set of questionnaires that included the Rome II Modular Questionnaire to assess the presence of IBS, the Anxiety Sensitivity Index (ASI), the Cognitive Appraisal Rating Scale (CARS; assessing the cognitive appraisal of abdominal symptoms in four dimensions: commitment, appraisal of effect, appraisal of threat, and controllability), and items about the severity of AA and AG. The Mini International Neuropsychiatric Interview was used to diagnose AG and PD. RESULTS: After excluding individuals with possible organic gastrointestinal diseases by using 'red flag items,' valid data were obtained from 174 participants, including 110 PD patients without IBS (PD/IBS[-]) and 64 with IBS (PD/IBS[+]). The PD/IBS[+] group had higher AA and higher comorbidity with AG than the PD/IBS[-] group. In the PD/IBS[+] group, the controllability score of CARS was significantly correlated with AA and ASI. Multiple regression analysis showed a significant effect of ASI but not of controllability on AA in PD/IBS[+] subjects. CONCLUSION: This study suggested that the presence of IBS may be related to agoraphobia and anticipatory anxiety in PD patients. Cognitive appraisal could be partly related to anticipatory anxiety in PD patients with IBS with anxiety sensitivity mediating this correlation.

Psychological distress of the bereaved seeking medical counseling at a cancer center.

OBJECTIVE: The death of a loved one is one of the most stressful events in life and is related to the physical and psychological wellbeing of the bereaved. Some bereaved individuals seek medical counseling to alleviate their distress. However, no studies have focused on the bereaved who have lost a loved one to cancer and have asked for medical help at a cancer center as a result. The aim of this study was to investigate the distress of the bereaved who sought consultation, as basic information for considering support. METHODS: We conducted a survey of people consulting outpatient services for bereaved families between April 2007 and September 2009. Data were obtained from medical records at initial consultation and qualitatively analyzed by content analysis using all statements related to their distress. RESULTS: Their statements were classified into 11 categories, which were further classified into six themes. The main categories of bereavement-related distress were as follows: (i) regret; (ii) anger; (iii) memories; (iv) loneliness; (v) anxiety; and (vi) hopelessness. 'Regret' was frequently recognized in their distress and it includes some points related to the cancer trajectory. CONCLUSIONS: Psychological distresses of the bereaved who have lost a loved one and have asked for medical counseling are revealed. Their distresses are strongly related to the cancer trajectory of a family member. Some of these distresses are related to medical misunderstanding about the course of cancer. These findings might provide basic information for considering their appropriate treatment.

Relationship between cognitive factors and anxiety in individuals with irritable bowel syndrome.

BACKGROUND: Individuals with irritable bowel syndrome (IBS) have high anxiety. There is insufficient information about the relationships between concrete cognitive contents and anxiety in IBS. PURPOSE: The present study investigated the relationship between cognitive factors and anxiety in individuals with IBS. METHOD: The participants were 1,087 college students (male, 506; female, 576; unidentified, 5; age, 19.72 ± 1.76 years) who completed a set of questionnaires that included the Rome II Modular Questionnaire (based on diagnostic criteria for IBS), Anxiety Sensitivity Index (ASI), Cognitive Appraisal Rating Scale (CARS; subscales: commitment, appraisal of effect, appraisal of threat, and controllability) for measuring symptom-related cognition, an item about attention to abdominal symptoms, the Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and an item regarding the presence of avoidant behavior due to anxiety of IBS symptoms. RESULTS: The participants included 881 individuals without IBS and 206 individuals with IBS. Individuals with IBS had higher ASI and HADS-A scores than those of the individuals belonging to the control group (p < 0.001). Subscale scores of CARS (except those of controllability and attention to IBS symptoms) significantly correlated with the ASI and HADS-A scores (p < 0.01). Individuals with IBS and avoidant behavior had higher subscale scores of CARS (except those of controllability and attention to IBS symptoms) and higher HADS-A scores (p < 0.05). The hypothetical models containing ASI scores, subscale scores of CARS (except those of controllability), and HADS-A scores with and without attention to IBS symptoms exhibited a good fit. CONCLUSION: Severe anxiety sensitivity in individuals with IBS related to their symptom-related cognition, and the altered cognition increases anxiety, leading to the possible development of a disabling condition.

Software for non-parametric image registration of 2-photon imaging data.

Functional 2-photon microscopy is a key technology for imaging neuronal activity. The recorded image sequences, however, can contain non-rigid movement artifacts which requires high-accuracy movement correction. Variational optical flow (OF) estimation is a group of methods for motion analysis with established performance in many computer vision areas. However, it has yet to be adapted to the statistics of 2-photon neuroimaging data. In this work, we present the motion compensation method Flow-Registration that outperforms previous alignment tools and allows to align and reconstruct even low signal-to-noise ratio 2-photon imaging data and is able to compensate high-divergence displacements during local drug injections. The method is based on statistics of such data and integrates previous advances in variational OF estimation. Our method is available as an easy-to-use ImageJ/FIJI plugin as well as a MATLAB toolbox with modular, object oriented file IO, native multi-channel support and compatibility with existing 2-photon imaging suites.

Psychiatric disorders in patients who lost family members to cancer and asked for medical help: descriptive analysis of outpatient services for bereaved families at Japanese cancer center hospital.

OBJECTIVE: There have been no previous studies about consultation of the bereaved who have lost a loved one to cancer and ask for medical help. The aim of this study was to investigate their basic characteristics and their psychiatric disorders. METHODS: A retrospective study using clinical and background data obtained over 30 months (from April 2007 to September 2009) was conducted at outpatient services for bereaved families at the Department of Psycho-Oncology at Saitama Medical University International Medical Center, Japan. RESULTS: During the period of investigation, 51 patients underwent consultation. The patients were frequently female (P < 0.0001) and the spouse of the deceased. Regarding the psychiatric diagnoses, major depression was the most common (39%), followed by adjustment disorders (28%). CONCLUSIONS: This study revealed basic characteristics and psychiatric disorders of the bereaved who asked for medical help. Most of the patients were women (86.3%) and 86.3% of them received a psychiatric diagnosis. This information is important for both physicians and psychologists since the bereaved who have lost a loved one to cancer often ask for medical help in clinical settings.

Cynical hostility, anger expression style, and acute myocardial infarction in middle-aged Japanese men.

Studies using American and European populations have demonstrated that high levels of anger/ hostility are predictive of coronary heart disease (CHD) mortality. However, Japanese studies did not show consistent relationship between anger/hostility and CHD. This study examines the association of cynical hostility and anger expression style with acute myocardial infarction (AMI) in middle-aged Japanese men through a case-control study. The patients with acute myocardial infarction (N = 96, mean age = 50.8 years) and the healthy participants in a health check-up program (N = 77, mean age = 50.3 years) were studied. Both groups completed the Cynicism Questionnaire (CQ) and the State-Trait Anger Expression Inventory (STAXI). The patients exhibited higher scores on CQ than the healthy controls. Logistic regression analyses controlling for biological risk factors revealed that the CQ score was associated with increased risk of AMI (OR = 1.11 [95% CI 1.00-1.22]). In addition, the score of Anger-control, a subscale of STAXI, was associated with decreased risk of AMI (OR = 0.75 [95% CI 0.62-0.92]). These results indicated that higher levels of cynical hostility increased the risk of AMI and that anger-control strategies could have some benefit in reducing the risk of AMI in middle-aged Japanese men.

The cortisol awakening response and autonomic nervous system activity during nocturnal and early morning periods.

The current study focuses on autonomic nervous system activity during sleep as a physiological aspect of sleep quality, and investigated the associations between the cortisol awakening response (CAR) and autonomic activity during sleep and after awakening. Ambulatory electrocardiograms were obtained from 20 participants, who also provided saliva samples (at the time of awakening, and 30, 45, and 60 min after awakening) and rated the subjective quality of their sleep at home. Autonomic activity was assessed with the Lorenz plot indices, cardiac sympathetic index (CSI) and cardiac vagal index. Total salivary cortisol secretion after awakening was calculated as area under the curve with respect to ground (AUC(G)) and increase (AUC(I)). After controlling for confounding factors, including sleep duration and awakening time, cortisol AUC(G) and AUC(I) were both found to be negatively correlated with CSI during the 30 min before and after awakening: before (r = -0.526 and -0.601 respectively) and after (r = -0.540 and -0.493 respectively). Self-reported sleep quality was not associated with the CAR. These results suggest that the CAR is negatively affected by basal sympathetic activity immediately before and after awakening, but not affected by subjective sleep quality. Physiological arousals around the time of awakening might inhibit the CAR.

Bereavement dream? Successful antidepressant treatment for bereavement-related distressing dreams in patients with major depression.

OBJECTIVE: The death of a person is a stressful event. Such stress affects the physical and psychological well-being of the bereaved. As an associated mental disorder, major depressive disorder (MDD) is common. Some dream of the deceased, and these dreams are called bereavement dreams. Some MDD patients also experience dreams. These two types of dreams are sometimes difficult to differentiate. The dream of the bereaved might be only a bereavement-related dream, yet it might be a symptom of MDD. Herein, we report one patient who had distressing dreams after the death of her mother. METHODS: A 63-year-old woman was referred for psychiatric consultation because of generalized fatigue and insomnia. Questioning her about recent events, she said that her mother had died of colonic carcinoma 5 months previously. Two months after the death, she suddenly started dreaming of her mother, getting angry with her almost every night. Generalized fatigue, insomnia, and distressing dreams appeared simultaneously. The dream caused much distress, making her afraid to fall asleep. RESULTS: Her psychiatric features fulfilled the DSM-IV-TR criteria for MDD, single episode. The death of her mother was considered to be one of the causes of MDD. She was administered 25 mg/day of sertraline hydrochloride. After that, her symptoms gradually disappeared, and the frequency of distressing dreams was reduced. Five months later, physical and psychiatric symptoms of MDD were completely resolved. Subsequently, she has not suffered from any distressing dreams of her mother. SIGNIFICANCE OF RESULTS: This case indicates that dreams experienced after the death of a loved one should not be regarded simply as bereavement dreams. Some of the dreams may be symptoms of MDD. If the dreams are the symptoms of MDD, antidepressant treatment as well as psychotherapy may be useful. Therefore, we should avoid regarding symptoms of MDD as reactions to bereavement.

[Development of a self-efficacy scale for going out among community-dwelling elderly].

OBJECTIVES: Prevention and support for Tojikomori has been a focus of recent regional preventive efforts in reducing the need for nursing care in the elderly, requiring indicators for evaluating effects including psychological influences on the elderly. Behavior change theory suggests potential benefits of self-efficacy in outing to reduce Tojikomori elderly. However, evaluation scales for such psychological effects have hitherto been lacking. The purpose of this study was to develop a self-efficacy scale regarding going out among community-dwelling elderly (hereinafter referred to as the SEGE) and to assess its reliability and validity. METHODS: We collected survey items from 18 community-dwelling older people in A Ward, Tokyo. Based on these items, we developed a 13-item prototype scale through a preliminary survey among 258 community-dwelling elderly in O City, located in Japan. The main survey was conducted through the mail by randomly selecting 8,000 community-dwelling elderly in A Ward. The survey included the prototype scale' items and basic attributes, such as age and gender, and items from evaluation scales to be used to examine the validity of the prototype scale. RESULTS: A total of 2,627 elderly people (1,145 men and 1,482 women, average age 73.8 +/- 6.6 years) were analyzed. Of these people, 86.1% left home at least once a week. Principal component analysis revealed that the prototype scale created through the preliminary survey had a one-factor structure. Through a stepwise variable selection procedure in exploratory factor analysis, a six-item scale was developed. The alpha coefficient of internal consistency was 0.96 for these six items, confirming high reliability. Lower outing frequencies tended to be associated with lower scores of the SEGE, which correlated significantly with self-efficacy of ADL, self-rated health, and health-related quality of life (QOL), confirming criterion-related and construct validity. In addition, a confirmatory factor analysis showed that SEGE and self-efficacy of ADL, although highly correlated with each other, measured different concepts. CONCLUSIONS: A six-item and one-factor SEGE was developed with high reliability and validity confirmed. With this new indicator, we can measure the psychological effects of prevention and support approaches for Tojikomori. This scale is now expected to widely used in Japan.

[How do the cost bias and probability bias influence social anxiety symptoms?].

The cost and probability bias in social situations are considered to be a maintaining factor for social anxiety disorder (SAD) symptoms. However, the process by which the cost and probability bias influences other SAD symptoms, such as avoidance behavior, self-perception of autonomic responses, and anxiety in social situations has not been investigated. We developed a model of the cost and probability bias and investigated the process through which the cost and probability bias influences SAD symptoms. Undergraduate students (N=290) were administered self-report measures assessing each component of SAD symptoms. A path analysis was conducted using the cost and probability bias model, which indicated high validity for the model (goodness of fit index = .99, adjusted goodness of fit index = .92, root mean square error of approximation = .09). The results also indicated that the cost bias had a strong effect on each component of SAD symptoms, and that the probability bias mediated the relationship between fear of negative evaluation and the cost bias. These findings suggest that changing the cost and probability bias may improve SAD symptoms.

Combined Optogenetic Approaches Reveal Quantitative Dynamics of Endogenous Noradrenergic Transmission in the Brain.

Little is known about the real-time cellular dynamics triggered by endogenous catecholamine release despite their importance in brain functions. To address this issue, we expressed channelrhodopsin in locus coeruleus neurons and protein kinase-A activity biosensors in cortical pyramidal neurons and combined two-photon imaging of biosensors with photostimulation of locus coeruleus cortical axons, in acute slices and in vivo. Burst photostimulation of axons for 5-10 s elicited robust, minutes-lasting kinase-A activation in individual neurons, indicating that a single burst firing episode of synchronized locus coeruleus neurons has rapid and lasting effects on cortical network. Responses were mediated by ß1 adrenoceptors, dampened by co-activation of α2 adrenoceptors, and dramatically increased upon inhibition of noradrenaline reuptake transporter. Dopamine receptors were not involved, showing that kinase-A activation was due to noradrenaline release. Our study shows that noradrenergic transmission can be characterized with high spatiotemporal resolution in brain slices and in vivo using optogenetic tools.

[Effect of speech estimation on social anxiety].

This study investigates the effect of speech estimation on social anxiety to further understanding of this characteristic of Social Anxiety Disorder (SAD). In the first study, we developed the Speech Estimation Scale (SES) to assess negative estimation before giving a speech which has been reported to be the most fearful social situation in SAD. Undergraduate students (n = 306) completed a set of questionnaires, which consisted of the Short Fear of Negative Evaluation Scale (SFNE), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), and the SES. Exploratory factor analysis showed an adequate one-factor structure with eight items. Further analysis indicated that the SES had good reliability and validity. In the second study, undergraduate students (n = 315) completed the SFNE, SIAS, SPS, SES, and the Self-reported Depression Scale (SDS). The results of path analysis showed that fear of negative evaluation from others (FNE) predicted social anxiety, and speech estimation mediated the relationship between FNE and social anxiety. These results suggest that speech estimation might maintain SAD symptoms, and could be used as a specific target for cognitive intervention in SAD.

Relationship between subtypes of irritable bowel syndrome and severity of symptoms associated with panic disorder.

OBJECTIVE: To investigate the relationship between subtypes of irritable bowel syndrome (IBS) and severity of symptoms associated with panic disorder (PD). MATERIAL AND METHODS: The study comprised 178 consecutive new PD outpatients. Sixty-four patients met the Rome-II criteria for IBS (IBS[+]; 29 diarrhea-predominant IBS (IBSD), 14 constipation-predominant IBS (IBSC), 21 other types of IBS). RESULTS: IBSD patients with agoraphobia avoided a greater number of scenes owing to fear of panic attack than did PD patients without IBS (IBS[-]) and with agoraphobia. IBS[+] patients with avoidant behavior due to fear of IBS symptoms had significantly higher Beck Depression Inventory (BDI) scores and avoided a larger number of scenes owing to fear of panic attack than IBS[+] patients with agoraphobia and without avoidant behavior due to fear of IBS symptoms or IBS[-] patients with agoraphobia. CONCLUSIONS: The results suggest that the presence of IBSD or avoidant behavior because of fear of IBS symptoms may be associated with a more severe form of agoraphobia, and the latter may also be associated with depression.

Episodic stress associated with writing a graduation thesis and free cortisol secretion after awakening.

Cortisol secretion after awakening, an index of hypothalamus-pituitary-adrenal axis activity, appears to be related to psychosocial stressors, or to symptoms caused by psychosocial stressors. The relationship between the quality, duration, and magnitude of psychosocial factors and cortisol secretion is however, unclear. Therefore, the effect of episodic stress associated with writing a graduation thesis on cortisol secretion after awakening was investigated. Saliva samples were collected from 10 undergraduate students at awakening, and 30, 45, and 60 min after awakening 1 month, 2 weeks, and a few days before the thesis submission and 1 week after the submission. They also completed the Short form of Profile of Moods Scale (POMS-S) on the night before each sampling. Results indicated that cortisol levels were higher a few days before the thesis submission compared to 1 month before submission. Scores of "Fatigue" and "Tension-Anxiety" in POMS-S were also higher a few days before submission. These results suggest that episodic stress associated with writing a graduation thesis caused an increase in cortisol levels after awakening.

[Primary care for depression].

Depressive patients often visit a primary care physician due to various physical symptoms. Though it is necessary to differentiate organic diseases, it is also important to approach from a viewpoint of psychosocial background and psychiatric disorders. Especially, as mild depression is seen widely in general practice, early diagnosis and early treatment is essential for its good prognosis and medical economics. So, primary care physician is expected to understand its symptomatology and treat depressive patients appropriately. Finally, I want to say that the cooperation between primary physician and psychiatrist is important, because typical bipolar disorders and severe depressive patients should be refer to psychiatry clinic.

[Effect of hostility on salivary cortisol levels in university students].

The influence of hostility on cortisol levels in saliva was investigated in 47 university students (27 males and 20 females). The students were divided into high and low hostility groups by cluster analyses based on their scores on the Buss-Perry Aggression Questionnaire and the Müller Anger Coping Questionnaire. Their saliva was collected twice, in the morning immediately after awakening at a two week interval. On the day before saliva collection, they completed questionnaires about stressful events and their moods in the previous two weeks. The results of the ANOVA showed higher cortisol levels and higher frequencies of stressful events and negative moods in the high hostility group. The effect of hostility on cortisol levels was diminished by controlling for stressful events and negative moods, which suggests that stressful events and negative moods are mediators between hostility and cortisol. The results are discussed in relation to the association between hostility and coronary heart disease.

Clients' response modes and session outcome.

This study examined clients' response modes in one-session counseling interviews with two counselors and 32 volunteer college students as clients. Sessions which yielded clients' higher ratings of helpfulness and satisfaction were associated with low proportions of clients' recounting, which involves clients providing statements on factual information in a storytelling style and high proportions of clients' response modes, which indicate an exploration of feelings, thoughts, and behaviors, insight into problems, and a problem-solving attitude. Thereafter, clients' response modes were examined in conjunction with counselors' interventions in the previous speaking turn using a sequential analysis. This analysis indicated that the occurrences of clients' response modes were not random but rather seemed to be associated with antecedent interventions by a counselor.

Development and future perspectives of behavioral medicine in Japan.

Development and Future Perspectives of Behavioral Medicine in Japan The study of the "Type A behavior pattern and myocardial infarction" was one of the main themes in the early stage of Behavioral Medicine. After that, behavior modification came to be widely applied to the treatment of various kinds of chronic diseases, and a general concept of Behavioral Medicine was subsequently formed. The Japanese Society of Behavioral Medicine was established in 1992 and is comprised of researchers in the fields of clinical medicine, social medicine, and psycho-behavioral science. Recently, we devised a core curriculum for behavioral science and behavioral medicine and have published a Japanese version of the "Textbook of Behavioral Medicine" in conformity with it. It is a primer that includes all of the basics and clinical applications of Behavioral Medicine and is edited as a manual that can be utilized in clinical practice. We hope this book will contribute to the development of Behavioral Medicine in Japan, to a more healthy life for our people, and to the improvement of the QOL of our patients. In this paper, I discuss the future perspectives from my personal opinion while looking back on the history of Behavioral Medicine in Japan.

Seasonality in mood and behaviours of Japanese residents in high-latitude regions: transnational cross-sectional study.

BACKGROUND: Daylight hours in high-latitude regions tend to be longer than those in Japan in summer, and shorter than those in Japan in winter. For example, daylight hours in London in winter are one-third those of Tokyo. Therefore, this study investigated and compared seasonal changes in mood and behaviours of Japanese individuals living in and outside Japan. METHODS: Surveys were conducted with Japanese residents in summer and winter in the UK (n = 106), Nordic countries (n = 40), Southeast Asia (n = 50), and Japan (n = 96). First, summer and winter General Health Questionnaire-28 (GHQ28) scores of each regional group were analysed. Subsequently, month-wise differences in mood and behaviours were compared across the four geographical regions. RESULTS: Summer and winter GHQ28 scores of participants living in the UK and Nordic countries differed significantly, while no seasonal differences were observed for residents in Japan and Southeast Asia. Further, in the UK and Nordic countries, summer was associated with better mood and more activity, while winter was linked to lowered mood and reduced activity. CONCLUSION: The results indicate that Japanese living in the UK and Nordic countries (high-latitude regions) experience seasonal fluctuations in depressive symptoms that may be linked to drastic seasonal environmental changes. Observed over a 12-month period, their mood and behaviour declined in winter and improved in summer. Therefore, considering the prevalence of overseas stressors that differ from those in their home country, it is necessary to investigate the effectiveness of support systems that help migrants adapt to seasonal changes in high-latitude regions.