論文 - 高江洲　義和

Improvements in the Degree of Understanding the Treatment Guidelines for Schizophrenia and Major Depressive Disorder in a Nationwide Dissemination and Implementation Study

Shusuke Numata, Masahito Nakataki, Naomi Hasegawa, Yoshikazu Takaesu, Masahiro Takeshima, Toshiaki Onitsuka, Toshinori Nakamura, Reon Edagawa, Hiroaki Edo, Kenichiro Miura, Junya Matsumoto, Norio Yasui-Furukori, Taishiro Kishimoto, Hikaru Hori, Takashi Tsuboi, Yuka Yasuda, Ryuji Furihata, Hiroyuki Muraoka, Shinichiro Ochi, Tatsuya Nagasawa, Toshitaka Kyou, Atsunobu Murata, Eiichi Katsumoto, Kazutaka Ohi, Akitoyo Hishimoto, Ken Inada, Koichiro Watanabe, Ryota Hashimoto

■■■ ( Research Square )    2020年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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<title>Abstract</title> <bold>Background</bold>: To implement clinical practice guidelines (CPGs), it is necessary for psychiatrists to deepen their understanding of the CPGs. The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide dissemination and implementation study of two sets of CPGs for schizophrenia and major depressive disorder (MDD).<bold>Methods</bold>: A total of 413 psychiatrists (n=212 in 2016; n=201 in 2017) learned the two CPGs in the education program of the EGUIDE project over two days, and clinical knowledge of the two CPGs was evaluated by two 37-item questionnaires at baseline and after the EGUIDE programs. To improve the correct answer rate for clinical knowledge after the EGUIDE programs, we revised the lecture materials associated with items that had a low correct answer rate in 2016 and used the revised lecture materials with the CPGs in 2017. The rates of correct answers after the EGUIDE programs for each item between the 2016 and 2017 groups were compared.<bold>Results</bold>: The total clinical knowledge scores after the EGUIDE program significantly increased in both the 2016 groups and the 2017 groups. We revised lecture materials related to two items in the schizophrenia CPG and five items in the MDD CPG that had low correct answer rates after the EGUIDE programs. The correct answer rate of one item on the schizophrenia CPG and one item on the MDD CPG tended to be improved (S-D5, p=0.038; D-C6, p=0.033) and that of one on the MDD CPG was significantly improved (D-D3, p=0.00080) in the 2017 group compared to those in the 2016 group. The other four items were not significantly improved.<bold>Conclusions</bold>: We reported improvements in clinical knowledge of CPGs after the EGUIDE program in the 2017 group following revision of the lecture materials based on results from the 2016 group. These attempts to improve the degree of understanding of CPGs may facilitate the successful dissemination and implementation of psychiatric guidelines in everyday practice.Trial registration: Effectiveness of Guideline for Dissemination and Education in Psychiatric Treatment, UMIN000022645, Registered 15 June 2016, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&amp;action=brows&amp;recptno=R000026044&amp;type=summary&amp;language=J

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Response to 'Efficacy and safety of bright light therapy for bipolar depression'.

Masahiro Takeshima, Tomohiro Utsumi, Yumi Aoki, Zhe Wang, Masahiro Suzuki, Isa Okajima, Norio Watanabe, Koichiro Watanabe, Yoshikazu Takaesu

Psychiatry and clinical neurosciences   74 ( 7 ) 410 - 411   2020年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Efficacy and safety of bright light therapy for manic and depressive symptoms in patients with bipolar disorder: A systematic review and meta-analysis.

Masahiro Takeshima, Tomohiro Utsumi, Yumi Aoki, Zhe Wang, Masahiro Suzuki, Isa Okajima, Norio Watanabe, Koichiro Watanabe, Yoshikazu Takaesu

Psychiatry and clinical neurosciences   74 ( 4 ) 247 - 256   2020年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIM: This systematic review and meta-analysis evaluated whether bright light therapy (BLT) is an effective and safe treatment for manic/depressive symptoms and a preventive measure for recurrent mood episodes in patients with bipolar disorder. METHODS: A literature search of major electronic databases was conducted in June 2019, including all published articles up to that date. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. RESULTS: Six randomized controlled trials (RCT) evaluated the efficacy of BLT for bipolar depression. A meta-analysis found no significant differences between BLT and placebo for the following outcomes: (i) rates of remission from depressive episodes (risk ratio [RR]: 1.81, 95% confidence interval [CI]: 0.43 to 7.64, P = 0.42); (ii) depressive symptom scores (standardized mean difference: -0.25, 95%CI: -0.74 to 0.23, P = 0.30); and (iii) rates of manic switching (RR: 1.00, 95%CI: 0.28 to 3.59, P = 0.26). The sensitivity analysis for studies with low overall indirectness did show a significant antidepressant effect for BLT (RR: 3.09, 95%CI: 1.62 to 5.90, P = 0.006). No RCT investigated the effect of BLT in preventing the recurrence of mood episodes in the euthymic state or in improving manic symptoms in the manic state. No severe adverse events were reported. CONCLUSION: While a meta-analysis was unable to demonstrate the efficacy of BLT for bipolar depression, a sensitivity analysis did show a significant effect. Further well-designed studies are needed to clarify the effectiveness of BLT, not only for the depressive state but also for other states, in the treatment of bipolar disorder.

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Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: A systematic review and meta-analysis.

Yoshikazu Takaesu, Tomohiro Utsumi, Isa Okajima, Akiyoshi Shimura, Nozomu Kotorii, Kenichi Kuriyama, Hidehisa Yamashita, Masahiro Suzuki, Norio Watanabe, Kazuo Mishima

Sleep medicine reviews   48   101214 - 101214   2019年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Long-term benzodiazepine (BZD) use is not recommended in the treatment of chronic insomnia, and psychosocial interventions, particularly cognitive behavioral therapy for insomnia (CBT-I), are a potential treatment option for discontinuing BZDs. This systematic review and meta-analysis aimed to clarify whether psychosocial interventions are effective for discontinuing BZD hypnotics in patients with chronic insomnia. A literature search of major electronic databases was conducted up to July 2018. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Eight randomized-controlled trials, all of which evaluated CBT-I, were included in this review, and meta-analyses were performed. The results indicated that short-term (≤3 mo) CBT-I plus gradual tapering was more effective than gradual tapering alone for discontinuing BZDs hypnotics (risk ratio: 1.68, 95% confidence interval [CI]: 1.19-2.39, p = 0.003) and for improving insomnia symptoms (g: -0.69, 95% CI: -1.09 - -0.28, p = 0.0009). However, the long-term (12 mo) efficacy of CBT-I for discontinuing BZDs was not significant (risk ratio: 1.67, 95% CI: 0.91-3.07, p = 0.10). Thus, CBT-I is effective for discontinuing BZD hypnotics for ≤3 mo. Further studies are needed to clarify the long-term efficacy of psychosocial interventions for discontinuing BZD hypnotics.

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Seven-day shared decision making for outpatients with first episode of mood disorders among university students: A randomized controlled trial.

Aoki Y, Takaesu Y, Inoue M, Furuno T, Kobayashi Y, Chiba H, Kakita Y, Hori M, Tachimori H, Watanabe K

Psychiatry research   281   112531 - 112531   2019年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Providing appropriate treatment to patients with a first episode of mood disorders is crucial for recovery from the disorders. Although shared decision making (SDM) has been proposed as a promising model in psychiatric practice, an appropriate SDM approach has not yet been established. The aim of the current study was to evaluate the effects of an originally developed seven-day SDM program for outpatients with a first episode of mood disorders among university students. University students with a first episode of mood disorders were randomly allocated into two arms: SDM and control. The participants in the SDM arm received the seven-day SDM program, which included option presentation consultation, external deliberation with a decision aid booklet, decision coaching by a nurse, and decision-making consultation. The control arm received usual care. The primary outcome was patient-perceived involvement. We enrolled 88 participants. Compared with usual care, the SDM program significantly improved patient-perceived involvement in treatment decision making without taking up clinicians' time. The program did not lead to worse symptoms of mood disorders. In conclusion, sharing treatment decision making with university students with a first episode of mood disorders is feasible.

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Improvement of psychiatrists' clinical knowledge of the treatment guidelines for schizophrenia and major depressive disorders using the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)' project: A nationwide dissemination, education, and evaluation study.

Yoshikazu Takaesu, Koichiro Watanabe, Shusuke Numata, Masaaki Iwata, Noriko Kudo, Satoru Oishi, Takeya Takizawa, Kiyotaka Nemoto, Yuka Yasuda, Hiromi Tagata, Takashi Tsuboi, Naohisa Tsujino, Naoki Hashimoto, Yuki Matsui, Hikaru Hori, Hidenaga Yamamori, Nobuhiro Sugiyama, Taro Suwa, Taishiro Kishimoto, Akitoyo Hishimoto, Masahide Usami, Ryuji Furihata, Kunihiro Iwamoto, Hiroshige Fujishiro, Toshinori Nakamura, Kentaro Mizuno, Takahiko Inagaki, Eiichi Katsumoto, Hiroaki Tomita, Kazutaka Ohi, Hiroyuki Muraoka, Kiyokazu Atake, Hitoshi Iida, Tatsuya Nagasawa, Junichi Fujita, Satoshi Yamamura, Toshiaki Onitsuka, Atsunobu Murata, Yoichiro Takayanagi, Hokuto Noda, Yukiko Matsumura, Kenji Takezawa, Jun-Ichi Iga, Kayo Ichihashi, Kazuyoshi Ogasawara, Hisashi Yamada, Ken Inada, Ryota Hashimoto

Psychiatry and clinical neurosciences   73 ( 10 ) 642 - 648   2019年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIM: Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)' integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs. METHODS: Four hundred thirteen out of 461 psychiatrists attended two 1-day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants' clinical knowledge of the treatment guidelines using self-completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants' demographics and their clinical knowledge scores. RESULTS: The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder. CONCLUSION: Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants' clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.

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A randomized controlled trial: tailored sleep hygiene intervention reduced high school studentś sleep disturbance, absenteeism, presenteeism, and dropout

Shimura, A, Takaesu, Y, Ito, J, Katayose, Y, Nieda, K, Kawashima, K, Hashimoto, M, Kunoki, K, Toumei, K, Inoue, T

Sleep Medicine ( Elsevier )  64   S348 - S349   2019年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial.

Azuma K, Takaesu Y, Soeda H, Iguchi A, Uchida K, Ohta S, Mishima S, Inoue T, Inoue Y, Oda J

Acute medicine & surgery   5 ( 4 ) 362 - 368   2018年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Aim: There are no effective, tolerable, and established medications for preventing delirium in critically ill patients admitted to the intensive care unit (ICU). We investigated whether suvorexant was effective in preventing ICU delirium. Methods: This randomized controlled study evaluated 70 adult patients (age ≥20 years) admitted to the mixed medical ICU of the Tokyo Medical University Hospital (Tokyo, Japan) between May 2015 and February 2017. Patients were randomized using a sealed envelope method to receive either suvorexant (n = 34; 15 mg for elderly patients and 20 mg for younger adults) or conventional treatment (n = 36) for a 7-day period. The primary outcome was delirium incidence based on the definition in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Results: No significant between-group differences were observed in the demographic or clinical characteristics. Kaplan-Meier estimates revealed that time to delirium onset was significantly longer in the suvorexant group than in the conventional group (P < 0.05). Conclusion: Suvorexant might be effective in preventing delirium in ICU patients.

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Circadian rhythm in bipolar disorder: A review of the literature.

Takaesu Y

Psychiatry and clinical neurosciences   72 ( 9 ) 673 - 682   2018年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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一般就労者における生活習慣が睡眠の問題に与える影響の包括的分析

志村 哲祥, 高江洲 義和, 大野 浩太郎, 林田 泰斗, 岬 昇平, 杉浦 航, 井上 猛

日本睡眠学会定期学術集会プログラム・抄録集 ( (一社)日本睡眠学会 )  43回   230 - 230   2018年07月

掲載種別: 研究論文（その他学術会議資料等）

食習慣が睡眠とプレゼンティーイズムへ与える影響

石橋 由基, 志村 哲祥, 高江洲 義和, 古井 祐司, 杉浦 航

産業衛生学雑誌 ( (公社)日本産業衛生学会 )  60 ( 臨増 ) 271 - 271   2018年05月

掲載種別: 研究論文（学術雑誌）

夜型のクロノタイプを持つ者の早すぎる起床時刻はプレゼンティーイズムを招く

志村 哲祥, 高江洲 義和, 林田 泰斗, 大野 浩太郎, 杉浦 航, 岬 昇平, 古井 祐司, 井上 猛, 医療法人東京桜十字産業保健チーム

産業衛生学雑誌 ( (公社)日本産業衛生学会 )  60 ( 臨増 ) 273 - 273   2018年05月

掲載種別: 研究論文（その他学術会議資料等）

Comprehensive assessment of the impact of life habits on sleep disturbance, chronotype, and daytime sleepiness among high-school students

Akiyoshi Shimura, Sakai Hideo, Yoshikazu Takaesu, Ryota Nomura, Yoko Komada, Takeshi Inoue

Sleep Medicine ( Elsevier B.V. )  44   12 - 18   2018年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Objective: Sleep affects adolescents in various ways. However, the effects of multiple factors on sleep hygiene remain unclear. A comprehensive assessment of the effects of life habits on sleep in high-school students was conducted. Methods: A cross-sectional survey of 344 high school students (age range 15–17 171 boys, 173 girls) in Tokyo, Japan was conducted in 2015. Complete responses were provided by 294 students. Demographic variables, Pittsburgh Sleep Quality Index (PSQI), diurnal type scale, Pediatric Daytime Sleepiness Scale (PDSS), and life habits such as dinnertime, viewing electronic displays, caffeine intake, sunlight in the morning, and the brightness of the room in the night were asked. Results: The mean scores were PSQI: 5.9 (±2.3), PDSS: 19.0 (±5.8), and the diurnal type scale: 16.7 (±3.4). Using an electronic display in bed (OR = 3.01 (95%CI) 1.24–7.30), caffeine intake at night always (OR = 2.22 1.01–4.90), and waking up before dawn (OR = 3.25 1.34–7.88) were significantly associated with sleep disturbance. Irregular timing of the evening meal (OR = 2.06 1.10–3.84) and display viewing within 2 h before bedtime (OR = 2.50 1.01–6.18) or in bed (OR = 3.60 1.41–9.21) were significantly associated with excessive daytime sleepiness. Using an electronic display within 2 h before bedtime (OR = 2.64 1.10–6.38) or in bed (OR = 3.50 1.40–8.76) and a living room which is bright at night (OR = 1.89 1.06–3.36) were significantly associated with eveningness. Conclusion: Each type of sleep-related problem had its own associated life habit factors.

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Circadian rhythm sleep-wake disorders predict shorter time to relapse of mood episodes in euthymic patients with bipolar disorder: A prospective 48-week study

Yoshikazu Takaesu, Yuichi Inoue, Kotaro Ono, Akiko Murakoshi, Kunihiro Futenma, Yoko Komada, Takeshi Inoue

Journal of Clinical Psychiatry ( Physicians Postgraduate Press Inc. )  79 ( 1 )   2018年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Objective: Circadian rhythm dysfunction has been considered to be common in bipolar disorder (BD) and plays an important role in mood dysregulation in this disorder. However, no study has investigated whether circadian rhythm dysfunction would affect the clinical course of BD. The aim of this study was to test the hypothesis that circadian rhythm dysfunction could be a predictor of relapse in euthymic BD patients. Methods: One hundred four euthymic outpatients with BD diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), participated in this prospective follow-up study from August 2014 to April 2015. At baseline, data on demographic variables and clinical descriptive variables of bipolar disorder were ascertained via clinical interviews. The diagnoses of circadian rhythm sleepwake disorders (CRSWDs) were made based on participants' sleep logs for 4 weeks and according to the International Classification of Sleep Disorders, Third Edition (ICSD-3). The BD symptoms of the subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores every 4 weeks throughout the 48-week study period. Relapse of BD was defined as scores higher than the cutoff points (MADRS score = 13 and YMRS score = 7). The primary outcome was time to relapse of mood episodes. Results: Thirty-four subjects met criteria for CRSWD at baseline, most frequently delayed sleep-wake phase disorder (n = 27). Of the total 104 subjects, 51 (49.0%) experienced relapse during the 48-week follow-up period. Multivariate Cox hazard regression analyses revealed that 2 or more previous mood episodes within the past year and comorbidity of CRSWD were significantly associated with the time to relapse of mood episodes (P &lt .001). Conclusions: Comorbid CRSWD, mainly delayed sleep-wake phase disorder, could be a significant predictor of relapse in BD patients.

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Re-analysis of the association of temperature or sunshine with hyperthymic temperament using lithium levels of drinking water

Hideki Matsuzaki, Takeshi Terao, Takeshi Inoue, Yoshikazu Takaesu, Nobuyoshi Ishii, Kentaro Kohno, Minoru Takeshima, Hajime Baba, Hiroshi Honma

JOURNAL OF AFFECTIVE DISORDERS ( ELSEVIER SCIENCE BV )  223   126 - 129   2017年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background The Japanese archipelago stretches over 4000 km from north to south and has four large islands: Hokkaido, Honshu, Shikoku, and Kyushu. Previously, using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire version (TEMPS-A), we compared the hyperthymic scores of residents in Sapporo, Obihiro, Takaoka, Koshigaya, and Oita cities (which are located at latitudes of 43 degrees N, 42 degrees N, 36 degrees N, 36 degrees N and 33 degrees N with various combinations of ambient temperament and sunshine in Japan, respectively). We found that latitude predicted significant variance in hyperthymic temperament, and that ambient temperature, but not sunshine, significantly affected hyperthymic temperament scores. However, the analysis failed to consider the effects of naturally occurring low-dose lithium on temperament. Methods: In addition to the TEMPS-A data previously collected, we measured lithium levels of the five cities. The effect of temperature, sunshine, and lithium levels on hyperthymic temperament was analyzed for the five cities. Results: A stepwise multiple regression analysis revealed that lithium levels as well as latitude, but not temperature or sunshine, predicted significant variance in hyperthymic temperament scores. Hyperthymic temperament scores were significantly and positively associated with lithium levels whereas they were significantly and negatively associated with latitude. Limitations: The light, temperature, lithium exposure that residents actually received was not measured. The number of regions studied was limited. The findings might not be generalized to residents across Japan or other countries. Conclusions: The present findings suggest that lithium in drinking water may positively maintain hyperthymic temperament, and that latitude may negatively maintain it.

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Interpersonal sensitivity mediates the effects of child abuse and affective temperaments on depressive symptoms in the general adult population

Ayano Otsuka, Yoshikazu Takaesu, Mitsuhiko Sato, Jiro Masuya, Masahiko Ichiki, Ichiro Kusumi, Takeshi Inoue

Neuropsychiatric Disease and Treatment ( Dove Medical Press Ltd. )  13   2559 - 2568   2017年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Recent studies have suggested that multiple factors interact with the onset and prognosis of major depressive disorders. In this study, we investigated how child abuse, affective temperaments, and interpersonal sensitivity are interrelated, and how they affect depressive symptoms in the general adult population. Subjects and methods: A total of 415 volunteers from the general adult population completed the Patient Health Questionnaire-9, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire version, theChild Abuse and Trauma Scale, and the Interpersonal Sensitivity Measure, which are all self-administered questionnaires. Data were subjected to structural equation modeling (Mplus), and single and multiple regression analyses. Results: The effect of child abuse on depressive symptoms was mediated by interpersonal sensitivity and 4 affective temperaments, including depressive, cyclothymic, anxious, and irritable temperaments. In addition, the effect of these temperaments on depressive symptoms was mediated by interpersonal sensitivity, indicating the indirect enhancement of depressive symptoms. In contrast to these 4 temperaments, the hyperthymic temperament did not mediate the effect of child abuse on depressive symptoms its effect was not mediated by interpersonal sensitivity. However, a greater hyperthymic temperament predicted decreased depressive symptoms and interpersonal sensitivity, independent of any mediation effect. Limitations: Because this is a cross-sectional study, long-term prospective studies are necessary to confirm itsfindings. Therefore, recall bias should be considered when interpreting the results. As the subjects were adultsfrom the general population, the results may not be generalizable towards all patients with major depression. Conclusion: This study suggests that child abuse and affective temperaments affect depressive symptoms partly through interpersonal sensitivity. Interpersonal sensitivity may have amajor role in forming the link between abuse, affective temperament, and depression.

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Circadian rhythm sleep-wake disorders as predictors for bipolar disorder in patients with remitted mood disorders

Yoshikazu Takaesu, Yuichi Inoue, Kotaro Ono, Akiko Murakoshi, Kunihiro Futenma, Yoko Komada, Takeshi Inoue

JOURNAL OF AFFECTIVE DISORDERS ( ELSEVIER SCIENCE BV )  220   57 - 61   2017年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Circadian rhythm dysfunction is thought to play a key role in the pathogenesis of bipolar disorder (BD). We focused on circadian rhythm sleep-wake disorders (CRSWD) as possible predictors for bipolar disorder in patients with remitted mood disorders. Method: One hundred four BD (41 type I and 63 type II) outpatients and 73 age-and sex-matched major depressive disorder (MDD) outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of the disorder, and family history of psychiatric disorders. Severity of mood status was evaluated by the Montgomery-Asberg Depression Rating Scale and Young Mania Rating Scale. CRSWD was diagnosed by clinical interview and sleep logs based on the International Classification of Sleep Disorders, third edition. Results: The rate of CRSWD in BD subjects was significantly higher than that in MDD subjects (33.7% vs 9.6%; P &lt; 0.001). A multiple logistic regression analysis revealed that comorbid CRSWD (OR = 3.35, 95% CI = 1.24-9.07; P = 0.018), two or more previous mood episodes within the past year (OR = 3.57, 95% CI = 1.10-11.63; P = 0.035), and antidepressant-related switch to mania/hypomania (OR = 10.01, 95% CI = 1.20 - 83.52; P = 0.033) were significantly associated with BD in patients with remitted mood disorders. Conclusion: CRSWD, as well as other factors, could be diagnostic predictors for BD in patients with remitted mood disorders. Combinations of these factors might be useful for predicting a BD diagnosis among the mood disorders in a clinical setting.

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The influence of parental care and overprotection, neuroticism and adult stressful life events on depressive symptoms in the general adult population

Yasuyuki Ono, Yoshikazu Takaesu, Yukiei Nakai, Masahiko Ichiki, Jiro Masuya, Ichiro Kusumi, Takeshi Inoue

JOURNAL OF AFFECTIVE DISORDERS ( ELSEVIER SCIENCE BV )  217   66 - 72   2017年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: The quality of parenting, neuroticism, and adult stressful life events are reportedly associated with depressive symptoms. However, previous studies have not examined the complex interaction between these three factors. In this study, we hypothesized that the quality of parenting (care and overprotection) acts on depressive symptoms through 'neuroticism' and the appraisal of adult stressful life events, and this hypothesis was verified by structural equation modeling. Methods: Four hundred one participants from the general adult population were studied using the following self-administered questionnaire surveys: Patient Health Questionnaire-9 (PHQ-9), Parental Bonding Instrument (PBI), neuroticism subscale of the short version of the Eysenck Personality Questionnaire-revised (EPQ-R), and Life Experiences Survey (LES). The data were analyzed with single and multiple regression analyses and covariance structure analyses. Results: In the covariance structure analysis, neuroticism scores and negative change scores on the LES acted on the depressive symptoms (PHQ-9 scores) directly, but care or overprotection in childhood on the PBI did not act on them directly. Low care and high overprotection of the PBI increased depressive symptoms and negative change scores on the LES through enhanced neuroticism, which is regarded as a mediator in these effects. Limitations: The subjects of this study were nonclinical volunteers; the findings might not be generalizable to psychiatric patients. Conclusions: This research showed that low care and high overprotection of maternal and paternal parenting in childhood influence depressive symptoms indirectly through enhanced neuroticism in general adults. These findings suggest that neuroticism mediates the long-term effect of the quality of parenting on depression in adulthood.

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都内の通信制高校において睡眠の問題が欠席に与える影響

志村 哲祥, 伊藤 潤, 野村 亮太, 高江洲 義和, 井上 猛

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