論文 - 高江洲　義和

Development and acceptability testing of a decision aid for considering whether to reduce antipsychotics in individuals with stable schizophrenia.

Aoki Y, Takaesu Y, Matsui K, Tokumasu T, Tani H, Takekita Y, Kanazawa T, Kishimoto T, Tarutani S, Hashimoto N, Takeuchi H, Mishima K, Inada K

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )    2023年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

AIM: Continued antipsychotic treatment is the key to preventing relapse. Maintenance antipsychotic monotherapy and optimal dose use are recommended for individuals with stable schizophrenia because of their undesirable effects. Decision aids (DAs) are clinical conversation tools that facilitate shared decision-making (SDM) between patients and health-care providers. This study aimed to describe the development process and results of acceptability testing of a DA for individuals with stable schizophrenia, considering (i) whether to continue high-dose antipsychotics or reduce to the standard dose and (ii) whether to continue two antipsychotics or shift to monotherapy. METHODS: A DA was developed according to the guidelines for the appropriate use of psychotropic medications and International Patient Decision Aid Standards (IPDAS). First, a DA prototype was developed based on a previous systematic review and meta-analysis conducted for identifying the effects of continuing or reducing antipsychotic treatment. Second, mixed-method survey was performed among individuals with schizophrenia and health-care providers to modify and finalize the DA. RESULTS: The DA consisted of an explanation of schizophrenia, options to continue high-dose antipsychotics or reduce to the standard dose, options to continue two antipsychotics or shift to monotherapy, pros and cons of each option, and a value-clarification worksheet for each option. The patients (n = 20) reported acceptable language use (75%), adequate information (75%), and well-balanced presentation (79%). Health-care providers (n = 20) also provided favorable overall feedback. The final DA covered six IPDAS qualifying criteria. CONCLUSION: A DA was successfully developed for schizophrenia, considering whether to reduce antipsychotics, which can be used in the SDM process.

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Combination Psychotropic Use for Schizophrenia With Long-Acting Injectable Antipsychotics and Oral Antipsychotics: A Nationwide Real-World Study in Japan.

Onitsuka T, Okada T, Hasegawa N, Tsuboi T, Iga JI, Yasui-Furukori N, Yamada N, Hori H, Muraoka H, Ohi K, Ogasawara K, Shinichiro O, Takeshima M, Ichihashi K, Fukumoto K, Iida H, Yamada H, Furihata R, Makinodan M, Takaesu Y, Numata S, Komatsu H, Hishimoto A, Kido M, Atake K, Yamagata H, Kikuchi S, Hashimoto N, Usami M, Katsumoto E, Asami T, Kubota C, Matsumoto J, Miura K, Hirano Y, Watanabe K, Inada K, Hashimoto R

Journal of clinical psychopharmacology     2023年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Effects of Japanese policies and novel hypnotics on long-term prescriptions of hypnotics.

Takeshima M, Yoshizawa K, Enomoto M, Ogasawara M, Kudo M, Itoh Y, Ayabe N, Takaesu Y, Mishima K

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  77 ( 5 ) 264 - 272   2023年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIM: This study aimed to examine the effect of Japanese policies for appropriate hypnotics use and novel hypnotics (e.g., melatonin receptor agonist [MRA] and orexin receptor antagonist [ORA]) on long-term prescriptions of hypnotics. METHODS: This retrospective study was conducted using a large-scale health insurance claims database. Among subscribers prescribed hypnotics at least once between April 2005 and March 2021, those prescribed hypnotics for the first time after being included in the database in three periods (period 1, April 2012-March 2013; period 2, April 2016-March 2017; and period 3, April 2018-March 2019) were eligible. These were set considering the timing of the 2014 and 2018 medical fee revisions (2014 for polypharmacy of three or more hypnotics, 2018 for long-term prescription of benzodiazepine receptor agonists for >12 months). The duration of consecutive prescriptions of hypnotics over 12 months was evaluated. Factors associated with short-term prescriptions of hypnotics were also investigated. RESULTS: In total, 186,535 participants were newly prescribed hypnotics. The mean duration of prescriptions was 2.9 months, and 9.3% of participants were prescribed hypnotics for 12 months. Prescription periods were not associated with short-term prescriptions of hypnotics. ORA use was associated with short-term prescriptions of hypnotics (adjusted hazard ratio, 1.077; 95% confidence interval, 1.035-1.120; p<0.001), but MRA use was not. CONCLUSION: Japanese policies had no statistically significant effect on long-term prescriptions of hypnotics. Although this study suggests initiating ORA for insomniacs as a candidate strategy to prevent long-term prescriptions of hypnotics, further research is necessary to draw conclusions. This article is protected by copyright. All rights reserved.

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A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan.

Aoki Y, Takeshima M, Tsuboi T, Katsumoto E, Udagawa K, Inada K, Watanabe K, Mishima K, Takaesu Y

International journal of environmental research and public health ( International Journal of Environmental Research and Public Health )  20 ( 7 ) 5373 - 5373   2023年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Although long-term use of benzodiazepines and z-drugs (BZDs) is not recommended, little is known about the stakeholders’ perceptions. This study aimed to assess and compare the perceptions of BZD use and decision making regarding its discontinuation between psychiatric outpatients and psychiatrists. Methods: A cross-sectional survey was conducted. Results: Of 104 outpatients, 92% were taking hypnotics and 96% were taking anxiolytics for ≥a year, while 49% were willing to taper hypnotic/anxiolytics within a year of starting. Most psychiatrists felt that “patient and psychiatrist make the decision together on an equal basis” compared to patients (p &lt; 0.001), while more patients felt that “the decision is (was) made considering the psychiatrists’ opinion” compared to psychiatrists (p &lt; 0.001). Of 543 psychiatrists, 79% reported “patients were not willing to discontinue hypnotic/anxiolytic” whereas a certain number of patients conveyed “psychiatrists did not explain in enough detail about hypnotic/anxiolytic discontinuation such as procedure (18.3%), timing (19.2%), and appropriate condition (14.4%)”. Conclusion: The results suggest that the majority of psychiatric outpatients were taking hypnotic/anxiolytics for a long time against their will. There might be a difference in perceptions toward hypnotic/anxiolytic use and decision making for its discontinuation between psychiatric outpatients and psychiatrists. Further research is necessary to fill this gap.

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Effect of discontinuation of lemborexant following long-term treatment of insomnia disorder: Secondary analysis of a randomized clinical trial

Takaesu Y.

Clinical and Translational Science ( Clinical and Translational Science )  16 ( 4 ) 581 - 592   2023年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Satisfaction with web-based courses on clinical practice guidelines for psychiatrists: Findings from the "Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)" project.

Iida H, Okada T, Nemoto K, Hasegawa N, Numata S, Ogasawara K, Miura K, Matsumoto J, Hori H, Iga JI, Ichihashi K, Hashimoto N, Yamada H, Ohi K, Yasui-Furukori N, Fukumoto K, Tsuboi T, Usami M, Furihata R, Takaesu Y, Hishimoto A, Muraoka H, Katsumoto E, Nagasawa T, Ochi S, Komatsu H, Kikuchi S, Takeshima M, Onitsuka T, Tamai S, Kubota C, Inada K, Watanabe K, Kawasaki H, Hashimoto R

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  43 ( 1 ) 23 - 32   2023年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Management of unspecified anxiety disorder: Expert consensus.

Sakurai H, Inada K, Aoki Y, Takeshima M, Ie K, Kise M, Yoshida E, Tsuboi T, Yamada H, Hori H, Inada Y, Shimizu E, Mishima K, Watanabe K, Takaesu Y

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )    2023年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIMS: Treatment guidelines with respect to unspecified anxiety disorder have not been published. The aim of this study was to develop a consensus among field experts on the management of unspecified anxiety disorder. METHODS: Experts were asked to evaluate treatment choices based on eight clinical questions concerning unspecified anxiety disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). According to the responses from 119 experts, the choices were categorized into first-, second-, and third-line recommendations. RESULTS: Benzodiazepine anxiolytic use was not categorized as a first-line recommendation for the primary treatment of unspecified anxiety disorder, whereas multiple nonpharmacological treatment strategies, including coping strategies (7.9 ± 1.4), psychoeducation for anxiety (7.9 ± 1.4), lifestyle changes (7.8 ± 1.5), and relaxation techniques (7.4 ± 1.8), were categorized as first-line recommendations. Various treatment strategies were categorized as first-line recommendations when a benzodiazepine anxiolytic drug did not improve anxiety symptoms, that is, differential diagnosis (8.2 ± 1.4), psychoeducation for anxiety (8.0 ± 1.5), coping strategies (7.8 ± 1.5), lifestyle changes (7.8 ± 1.5), relaxation techniques (7.2 ± 1.9), and switching to selective serotonin reuptake inhibitors (SSRIs) (7.0 ± 1.8). These strategies were also highly endorsed when tapering the dosage of or discontinuing benzodiazepine anxiolytic drugs. There was no first-line recommendation regarding excusable reasons for continuing benzodiazepine anxiolytics. CONCLUSIONS: The field experts recommend that benzodiazepine anxiolytics should not be used as a first-line option for patients with unspecified anxiety disorder. Instead, several nonpharmacological interventions and switching to SSRIs were endorsed for the primary treatment of unspecified anxiety disorder and as alternatives to benzodiazepine anxiolytics.

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Effects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score-matched analysis.

Tsuboi T, Takaesu Y, Hasegawa N, Ochi S, Fukumoto K, Ohi K, Muraoka H, Okada T, Kodaka F, Igarashi S, Iida H, Kashiwagi H, Hori H, Ichihashi K, Ogasawara K, Hashimoto N, Iga JI, Nakamura T, Usami M, Nagasawa T, Kido M, Komatsu H, Yamagata H, Atake K, Furihata R, Kikuchi S, Horai T, Takeshima M, Hirano Y, Makinodan M, Matsumoto J, Miura K, Hishimoto A, Numata S, Yamada H, Yasui-Furukori N, Inada K, Watanabe K, Hashimoto R

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  77 ( 1 ) 30 - 37   2023年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development and acceptability of a decision aid for anxiety disorder considering discontinuation of benzodiazepine anxiolytic.

Aoki Y, Takaesu Y, Inada K, Yamada H, Murao T, Kikuchi T, Takeshima M, Tani M, Mishima K, Otsubo T

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1083568   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Aim We aimed to develop a decision aid (DA) for individuals with anxiety disorders who consider tapering benzodiazepine (BZD) anxiolytics, and if tapering, tapering BZD anxiolytics with or without cognitive behavioral therapy (CBT) for anxiety. We also assessed its acceptability among stakeholders. Methods First, we conducted a literature review regarding anxiety disorders to determine treatment options. We cited the results of the systematic review and meta-analysis, which we conducted previously, to describe the related outcomes of two options: tapering BZD anxiolytics with CBT and tapering BZD anxiolytics without CBT. Second, we developed a DA prototype in accordance with the International Patient Decision Aid Standards. We carried out a mixed methods survey to assess the acceptability among stakeholders including those with anxiety disorders and healthcare providers. Results Our DA provided information such as explanation of anxiety disorders, options of tapering or not tapering BZD anxiolytics (if tapering, the options of tapering BZD anxiolytics with or without CBT) for anxiety disorder, benefits and risks of each option, and a worksheet for value clarification. For patients (n = 21), the DA appeared to be acceptable language (86%), adequate information (81%), and well-balanced presentation (86%). The developed DA was also acceptable for healthcare providers (n = 10). Conclusion We successfully created a DA for individuals with anxiety disorders who consider tapering BZD anxiolytics, which was acceptable for both patients and healthcare providers. Our DA was designed to assist patients and healthcare providers to involve decision-making about whether to taper BZD anxiolytics or not.

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Treatment strategy for insomnia disorder: Japanese expert consensus.

Takaesu Y, Sakurai H, Aoki Y, Takeshima M, Ie K, Matsui K, Utsumi T, Shimura A, Okajima I, Kotorii N, Yamashita H, Suzuki M, Kuriyama K, Shimizu E, Mishima K, Watanabe K, Inada K

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1168100   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Purpose: There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: 1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and 2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments. Methods: Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1=“disagree” to 9=“agree”). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations. Results: The primary pharmacological treatment, lemborexant (7.3±2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3±1.8) and suvorexant (6.8±1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4±1.1) and maintenance insomnia (8.1±1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6±2.3) and maintenance insomnia (5.7±2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5±1.8) and suvorexant (6.9±1.9) were categorized as first-line recommendations. Conclusion: Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.

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Physicians' attitudes toward hypnotics for insomnia: A questionnaire-based study.

Takeshima M, Aoki Y, Ie K, Katsumoto E, Tsuru E, Tsuboi T, Inada K, Kise M, Watanabe K, Mishima K, Takaesu Y

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1071962 - 1071962   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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INTRODUCTION: Benzodiazepines and non-benzodiazepines are still widely prescribed despite safety concerns and the introduction of novel hypnotics (orexin receptor antagonists [ORA] and melatonin receptor agonists [MRA]), which may be influenced by physicians' attitudes toward hypnotics. METHODS: A questionnaire survey was administered to 962 physicians between October 2021 and February 2022, investigating frequently prescribed hypnotics and the reasons for their selection. RESULTS: ORA were the most frequently prescribed at 84.3%, followed by non-benzodiazepines (75.4%), MRA (57.1%), and benzodiazepines (54.3%). Compared to non-frequent prescribers of hypnotics, a logistic regression analysis showed that frequent ORA prescribers were more concerned with efficacy (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.01-2.54, p = 0.044) and safety (OR: 4.52, 95% CI: 2.99-6.84, p < 0.001), frequent MRA prescribers were more concerned with safety (OR: 2.48, 95% CI: 1.77-3.46, p < 0.001), frequent non-benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91-6.04, p < 0.001), and frequent benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91-6.04, p < 0.001) but less concerned with safety (OR: 0.25, 95% CI: 0.16-0.39, p < 0.001). DISCUSSION: This study suggested that physicians believed ORA to be an effective and safe hypnotic and were compelled to prescribe benzodiazepine and non-benzodiazepine frequently, choosing efficacy over safety.

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Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation.

Futenma K, Takaesu Y, Komada Y, Shimura A, Okajima I, Matsui K, Tanioka K, Inoue Y

Frontiers in psychiatry ( Frontiers in Psychiatry )  14   1174719   2023年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Comparison of the efficacy and safety of quetiapine and lithium for bipolar depression: A systematic review and meta-analysis of randomized controlled trials.

Ogasawara M, Takeshima M, Esaki Y, Kaneko Y, Utsumi T, Aoki Y, Watanabe N, Suzuki M, Takaesu Y

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 4 ) 410 - 420   2022年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development of individual fitness score for conformity of prescriptions to the "Guidelines For Pharmacological Therapy of Schizophrenia".

Inada K, Fukumoto K, Hasegawa N, Yasuda Y, Yamada H, Hori H, Ichihashi K, Iida H, Ohi K, Muraoka H, Kodaka F, Ide K, Hashimoto N, Iga JI, Ogasawara K, Atake K, Takaesu Y, Nagasawa T, Komatsu H, Okada T, Furihata R, Kido M, Kikuchi S, Kubota C, Makinodan M, Ochi S, Takeshima M, Yamagata H, Matsumoto J, Miura K, Usami M, Kishimoto T, Onitsuka T, Katsumoto E, Hishimoto A, Numata S, Yasui-Furukori N, Watanabe K, Hashimoto R

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 4 ) 502 - 509   2022年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Decision aid development and its acceptability among adults with attention‐deficit/hyperactivity disorders regarding treatment discontinuation after remission

Noa Tsujii, Takashi Okada, Masahide Usami, Hidenori Kuwabara, Junichi Fujita, Hideki Negoro, Junzo Iida, Yumi Aoki, Yoshikazu Takaesu, Takuya Saito

Psychiatry and Clinical Neurosciences Reports ( Wiley )  1 ( 4 )   2022年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Attitudes and Difficulties Associated with Benzodiazepine Discontinuation.

Takeshima M, Aoki Y, Ie K, Katsumoto E, Tsuru E, Tsuboi T, Inada K, Kise M, Watanabe K, Mishima K, Takaesu Y

International journal of environmental research and public health ( International Journal of Environmental Research and Public Health )  19 ( 23 )   2022年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Long-term use of benzodiazepine receptor agonists (BZDs) may depend on clinicians' BZD discontinuation strategies. We aimed to explore differences in strategies and difficulties with BZD discontinuation between psychiatrists and non-psychiatrists and to identify factors related to difficulties with BZD discontinuation. Japanese physicians affiliated with the Japan Primary Care Association, All Japan Hospital Association, and Japanese Association of Neuro-Psychiatric Clinics were surveyed on the following items: age group, specialty (psychiatric or otherwise), preferred time to start BZD reduction after improvement in symptoms, methods used to discontinue, difficulties regarding BZD discontinuation, and reasons for the difficulties. We obtained 962 responses from physicians (390 from non-psychiatrists and 572 from psychiatrists), of which 94.0% reported difficulty discontinuing BZDs. Non-psychiatrists had more difficulty with BZD discontinuation strategies, while psychiatrists had more difficulty with symptom recurrence/relapse and withdrawal symptoms. Psychiatrists used more candidate strategies in BZD reduction than non-psychiatrists but initiated BZD discontinuation after symptom improvement. Logistic regression analysis showed that psychosocial therapy was associated with less difficulty in BZD discontinuation (odds ratio, 0.438; 95% confidence interval, 0.204-0.942; p = 0.035). Educating physicians about psychosocial therapy may alleviate physicians' difficulty in discontinuing BZDs and reduce long-term BZD prescriptions.

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Shared decision-making interventions for people with mental health conditions.

Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG

The Cochrane database of systematic reviews ( Wiley )  11 ( 11 ) CD007297   2022年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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「半年の休職で気分は良くなったけど, 朝決まった時間に起きられない」気分障害に併存する睡眠・覚醒相後退障害

高江洲義和

精神科治療学   37   263 - 266   2022年10月

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Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study.

Ochi S, Tagata H, Hasegawa N, Yasui-Furukori N, Iga JI, Kashiwagi H, Kodaka F, Komatsu H, Tsuboi T, Tokutani A, Numata S, Ichihashi K, Onitsuka T, Muraoka H, Iida H, Ohi K, Atake K, Kishimoto T, Hori H, Takaesu Y, Takeshima M, Usami M, Makinodan M, Hashimoto N, Fujimoto M, Furihata R, Nagasawa T, Yamada H, Matsumoto J, Miura K, Kido M, Hishimoto A, Ueno SI, Watanabe K, Inada K, Hashimoto R

The international journal of neuropsychopharmacology ( International Journal of Neuropsychopharmacology )  25 ( 10 ) 818 - 826   2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Although antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. METHODS: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. RESULTS: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; p < 2.0 × 10 -16) and the ND-TRS without clozapine group (54.7%; p < 2.0 × 10 -16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; p = 1.1 × 10 -6) and the ND-TRS without clozapine group (17.0%; p = 5.9 × 10 -6). CONCLUSIONS: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.

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Efficacy and safety of adjunctive therapy to lamotrigine, lithium, or valproate monotherapy in bipolar depression: a systematic review and meta-analysis of randomized controlled trials.

Maruki T, Utsumi T, Takeshima M, Fujiwara Y, Matsui M, Aoki Y, Toda H, Watanabe N, Watanabe K, Takaesu Y

International journal of bipolar disorders ( International Journal of Bipolar Disorders )  10 ( 1 ) 24 - 24   2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND: The efficacy and safety of adjunctive therapy are unclear in bipolar depression. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of second-generation antipsychotic, lamotrigine, lithium, or valproate therapy used in adjunction with lamotrigine, lithium, or valproate monotherapy in bipolar depression. A literature search of major electronic databases was conducted in February 2021, and all articles published until then were eligible. Two researchers independently screened relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. RESULTS: Five studies met the inclusion criteria. The meta-analysis revealed significant differences in the following outcomes: (i) remission rates from depressive episodes (risk ratio [RR]: 1.23, 95% confidence interval [CI] 1.01-1.50, p = 0.04), (ii) improvement in depressive symptoms (standardized mean difference [SMD]: 0.21, 95% CI 0.09-0.34, p = 0.001), (iii) improvement in quality of life (SMD: 0.22, 95% CI 0.06-0.37, p = 0.005), and (iv) rate of adverse events during the study period (RR: 1.12, 95% CI 1.03-1.22, p = 0.008). There was no significant difference between adjunctive therapy and monotherapy in the emergence of suicide-related behaviors, dropout rate during the study period, or rate of manic switching. CONCLUSIONS: Our results suggest that adjunctive second-generation antipsychotics, lamotrigine, lithium, or valproate increase both the benefits and risks in patients with bipolar depression, although there is no significant difference in severe adverse events. Adjunctive therapy should be provided through shared decision-making while considering the patients' condition in clinical settings.

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「睡眠」に着目した向精神薬の作用再考　薬剤誘発性の睡眠時随伴症

普天間国博, 高江洲義和

臨床精神薬理   25 ( 10 ) 1121 - 1129   2022年10月

掲載種別: 研究論文（その他学術会議資料等）

Second-Generation Antipsychotic Monotherapy Contributes to the Discontinuation of Anticholinergic Drugs in Hospitalized Patients With Schizophrenia.

Tsuyoshi Okada, Hikaru Hori, Naomi Hasegawa, Atsunobu Murata, Yoshitaka Kyou, Fumitoshi Kodaka, Hitoshi Iida, Shinichiro Ochi, Yoshikazu Takaesu, Takashi Tsuboi, Jun-Ichi Iga, Kayo Ichihashi, Hiroyuki Muraoka, Ryuji Furihata, Norio Yasui-Furukori, Masahide Usami, Toshiaki Onitsuka, Kazuyoshi Ogasawara, Hiromi Tagata, Masahiro Takeshima, Kazutaka Ohi, Shusuke Numata, Naoki Hashimoto, Hiroki Yamada, Manabu Makinodan, Hiroshi Komatsu, Akitoyo Hishimoto, Hirotaka Yamagata, Mikio Kido, Chika Kubota, Kiyokazu Atake, Hisashi Yamada, Tatsuya Nagasawa, Junya Matsumoto, Kenichiro Miura, Ken Inada, Koichiro Watanabe, Shiro Suda, Ryota Hashimoto

Journal of clinical psychopharmacology     2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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オンラインによる睡眠診察-現状と課題を整理する　オンラインによる睡眠診療 睡眠障害(睡眠障害以外)

普天間国博, 高江洲義和

睡眠医療   16 ( 3 ) 255 - 259   2022年09月

掲載種別: 研究論文（学術雑誌）

Changes in psychotropic polypharmacy and high-potency prescription following policy change: Findings from a large scale Japanese claims database.

Takeshima M, Enomoto M, Ogasawara M, Kudo M, Itoh Y, Yoshizawa K, Fujiwara D, Takaesu Y, Mishima K

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  76 ( 9 ) 475 - 477   2022年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development and acceptability of a decision aid for major depressive disorder considering discontinuation of antidepressant treatment after remission.

Aoki Y, Takaesu Y, Baba H, Iga JI, Hori H, Inoue T, Mishima K, Tajika A, Kato M

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 3 ) 306 - 314   2022年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

AIM: While evidence-based antidepressant treatment is available for major depressive disorder, standard approaches for discontinuation of antidepressants after remission have not yet been established. Decision aids are structured clinical tools that facilitate shared decision-making between patients and healthcare providers. This study aimed to describe the development process and acceptability of decision aids for major depressive disorder following discontinuation of antidepressant treatment after remission. METHODS: We systematically developed a decision aids according to the International Patient Decision Aid Standards. First, a decision aids prototype was created using the results of a systematic review and meta-analysis previously conducted to identify the consequences of continuing and discontinuing antidepressant treatment. Second, a mixed-methods questionnaire (alpha acceptability testing) was administered to patients and healthcare providers to improve the decision aids prototype and develop it into a final version acceptable for clinical settings. RESULTS: Our decision aids consisted of a description of major depressive disorder, the option to continue or discontinue antidepressant treatment, the advantages and disadvantages of each option, the consequences of each option, and value clarification exercises for each option. The patients (n = 22) reported that the decision aids had acceptable language (91%), adequate information (91%), and a well-balanced presentation (95%). Healthcare providers (n = 20) provided favorable feedback. The final decision aids fulfilled all six International Patient Decision Aid Standards qualifying criteria. CONCLUSION: We successfully developed a decision aids for discontinuation of antidepressant treatment after remission, which could be used during the shared decision-making process. Further studies are needed to verify the effects of using the decision aids during the shared decision-making process.

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Effectiveness and Tolerability of Lurasidone for Bipolar Types I and II and Other Specified Bipolar Depression: A 12-Week Observational Study

Takaesu Y.

Journal of Clinical Psychopharmacology ( Journal of Clinical Psychopharmacology )  42 ( 5 ) 485 - 488   2022年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Characteristics of the treatments for each severity of major depressive disorder: A real-world multi-site study.

Muraoka H, Kodaka F, Hasegawa N, Yasui-Furukori N, Fukumoto K, Kashiwagi H, Tagata H, Hori H, Atake K, Iida H, Ichihashi K, Furihata R, Tsuboi T, Takeshima M, Komatsu H, Kubota C, Ochi S, Takaesu Y, Usami M, Nagasawa T, Makinodan M, Nakamura T, Kido M, Ueda I, Yamagata H, Onitsuka T, Asami T, Hishimoto A, Ogasawara K, Katsumoto E, Miura K, Matsumoto J, Ohi K, Yamada H, Watanabe K, Inada K, Nishimura K, Hashimoto R

Asian journal of psychiatry ( Asian Journal of Psychiatry )  74   103174 - 103174   2022年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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PURPOSE: In the treatment guidelines for major depressive disorder (MDD), the recommended treatment differs based on the severity. However, the type of treatment provided based on the severity of MDD in real-world clinical practice has not been investigated. In this study, we clarified the actual situation of MDD treatment in clinical practice and compared the treatment based on the severity of MDD. METHODS: We used data from 1484 patients with MDD at discharge from October 2016 to March 2020. RESULTS: The number of psychotropic prescriptions tended to be lower in those diagnosed with MDD in the severe group compared to in the non-severe group. There were significant differences among the three groups (mild, moderate/severe, and psychotic) in the percentage of patients who were not prescribed antipsychotics (p = 1.9 ×10-6), a combination of antipsychotics and antidepressants (p = 5.0 ×10-4), and the implementation rate of modified electroconvulsive therapy (m-ECT) (p = 3.4 ×10-9). The percentage of patients with a severe diagnosis who underwent m-ECT was higher, which corresponded to the severity. CONCLUSION: Our findings showed that the use of psychotropics decreased when the severity of MDD was diagnosed, and the rate of a combination of antipsychotics and antidepressants and the implementation rate of m-ECT increased with the severity. However, this study suggests that there is still an evidence-practice gap in the treatment of MDD in Japan, and guidelines are only partially adhered to in the treatment of depression.

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Development of a 20-item questionnaire for drinking behavior pattern (DBP-20) toward personalized behavioral approaches for alcohol use disorder.

Kurihara K, Shinzato H, Koda M, Enoki H, Otsuru T, Takaesu Y, Kondo T

Alcohol (Fayetteville, N.Y.) ( Alcohol )  101   9 - 16   2022年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Although screening tools are available for alcohol use disorders (AUD), such as the Alcohol Use Disorders Identification Test (AUDIT), these tools do not directly characterize individual drinking behavior for patients with AUD. Therefore, the aim of this study was to develop a new self-report questionnaire to identify the characteristics of drinking behavior patterns in patients with AUD.The study team developed a self-administered 20-item questionnaire for drinking behavior pattern (DBP-20) based on semi-structured interviews of patients with AUD. The DBP-20 and AUDIT were administered to 232 patients with AUD and 222 normal drinkers (1 ≤ AUDIT <20) as controls. Exploratory factor analysis of the DBP-20 was conducted for patients with AUD, followed by comparisons of its item and subscale scores between patients with AUD and controls. Correlations of AUDIT with total and subscale scores of the DBP-20 were also analyzed. Receiver operating characteristic (ROC) analyses for the DBP-20 and its subscales were performed to distinguish patients with AUD from controls.Exploratory factor analysis revealed a multidimensional 4-factor model of the DBP-20: coping with negative affect, automaticity, enhancement, and social use. Significant differences in DBP-20 total and subscale scores were observed for patients with AUD versus controls for all factors, except the social use subscale. Both the coping with negative affect and automaticity subscale scores as well as total DBP-20 scores were highly correlated with AUDIT scores. Total DBP-20 scores showed the greatest sensitivity, negative predictive value, and area under the ROC curve to distinguish patients with AUD from normal drinkers.Drinking as a means of coping with negative affect and automaticity may be specific for patients with AUD. DBP-20 may help patients with AUD to be aware of their own targeted problematic drinking behaviors and to seek their personalized behavioral approaches in a collaborative relationship with therapists.

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Subjective assessment of participants in education programs on clinical practice guidelines in the field of psychiatry.

Ogasawara K, Numata S, Hasegawa N, Nakataki M, Makinodan M, Ohi K, Takeshima M, Tsuboi T, Hashimoto N, Onitsuka T, Muraoka H, Hori H, Ichihashi K, Inagaki T, Yasui-Furukori N, Hishimoto A, Sugiyama N, Fukumoto K, Nagasawa T, Matsumoto J, Takaesu Y, Furihata R, Nemoto K, Nakamura T, Usami M, Miura K, Fujimoto M, Tagata H, Yamada H, Komatsu H, Ochi S, Atake K, Katsumoto E, Kido M, Kishimoto T, Suwa T, Yamamura S, Iga JI, Iida H, Inada K, Watanabe K, Hashimoto R

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 2 ) 221 - 225   2022年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

The Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE) project, which is a nationwide dissemination and implementation program for clinical practice guidelines (CPGs) in the field of psychiatry, is currently ongoing. In the current study, a subjective assessment of the participants in the EGUIDE programs was assessed using a questionnaire. Then, the relationships between the subjective assessment, the characteristics of the participants, and the clinical knowledge of the CPGs were evaluated. More than 90% of the participants gave a high rating for the components of content, recommendation, knowledge, skill, and adherence, but not for the component of confidence. A positive correlation was found between years of professional experience and the score of confidence. These results suggest that it may be necessary to apply the knowledge and skills of CPGs obtained in the education programs into practice to increase confidence in the proper use of psychiatric therapies based on CPGs.

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Metabolic-Syndrome-Related Comorbidities in Narcolepsy Spectrum Disorders: A Preliminary Cross-Sectional Study in Japan.

Futenma K, Takaesu Y, Nakamura M, Hayashida K, Takeuchi N, Inoue Y

International journal of environmental research and public health ( International Journal of Environmental Research and Public Health )  19 ( 10 )   2022年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Narcolepsy types 1 (NT1) and 2 (NT2) and idiopathic hypersomnia (IH) are thought to be a disease continuum known as narcolepsy spectrum disorders (NSDs). This study aimed to assess the prevalence of and factors associated with metabolic-syndrome-related disorders (MRDs) among patients with NSD. Japanese patients with NSD (NT1, n = 94; NT2, n = 83; and IH, n = 57) aged ≥35 years were enrolled in this cross-sectional study. MRD was defined as having at least one of the following conditions: hypertension, diabetes, or dyslipidemia. Demographic variables and MRD incidence were compared among patients in the respective NSD categories. Multivariate logistic regression analysis was used to investigate the factors associated with MRDs. Patients with NT1 had a higher body mass index (BMI) and incidence of MRD than that had by those with NT2 or IH. Age, BMI, and the presence of OSA were significantly associated with the incidence of MRD in NSDs. Age and BMI in NT1, BMI and human leukocyte antigen (HLA)-DQB1*06:02 positivity in NT2, and only age in IH were factors associated with the incidence of MRD. Obesity should be carefully monitored in narcolepsy; however, NT2 with HLA-DQB1*06:02 positive should be followed up for the development of MRD even without obesity.

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増大号特集 精神科診療のピットフォール 疾患各論 双極性障害 双極性障害(維持期)

友利 陽子, 高江洲 義和

精神医学 ( 株式会社医学書院 )  64 ( 5 ) 638 - 642   2022年05月

掲載種別: 研究論文（学術雑誌）

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抑うつ状態を呈する起床困難患者に対する評価と介入

高江洲義和

日本精神神経学会総会プログラム・抄録集 (日本精神神経学会総会抄録集)     2022年04月

掲載種別: 研究論文（その他学術会議資料等）

A dissemination and education programme to improve the clinical behaviours of psychiatrists in accordance with treatment guidelines for schizophrenia and major depressive disorders: the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project.

Yamada H, Motoyama M, Hasegawa N, Miura K, Matsumoto J, Ohi K, Yasui-Furukori N, Numata S, Takeshima M, Sugiyama N, Nagasawa T, Kubota C, Atake K, Tsuboi T, Ichihashi K, Hashimoto N, Inagaki T, Takaesu Y, Iga JI, Hori H, Onitsuka T, Komatsu H, Hishimoto A, Fukumoto K, Fujimoto M, Nakamura T, Nemoto K, Furihata R, Yamamura S, Yamagata H, Ogasawara K, Katsumoto E, Murata A, Iida H, Ochi S, Makinodan M, Kido M, Kishimoto T, Yasuda Y, Usami M, Suwa T, Inada K, Watanabe K, Hashimoto R

BJPsych open ( BJPsych Open )  8 ( 3 ) e83   2022年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

BACKGROUND: Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists. AIMS: The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes. METHOD: A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme. RESULTS: All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending. CONCLUSIONS: All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists.

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入院うつ病患者におけるECT後の炭酸リチウムの処方実態について

五十嵐 俊, 坪井 貴嗣, 長谷川 尚美, 古郡 規雄, 越智 紳一郎, 飯田 仁志, 村岡 寛之, 高江洲 義和, 岡田 剛史, 柏木 宏子, 小高 文聰, 福本 健太郎, 三浦 健一郎, 松本 純弥, 稲田 健, 渡邊 衡一郎, 橋本 亮太

精神神経学雑誌 ( (公社)日本精神神経学会 )  124 ( 4付録 ) S - 519   2022年04月

掲載種別: 研究論文（学術雑誌）

Association between the examination rate of treatment-resistant schizophrenia and the clozapine prescription rate in a nationwide dissemination and implementation study.

Yasui-Furukori N, Muraoka H, Hasegawa N, Ochi S, Numata S, Hori H, Hishimoto A, Onitsuka T, Ohi K, Hashimoto N, Nagasawa T, Takaesu Y, Inagaki T, Tagata H, Tsuboi T, Kubota C, Furihata R, Iga JI, Iida H, Miura K, Matsumoto J, Yamada H, Watanabe K, Inada K, Shimoda K, Hashimoto R

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 1 ) 3 - 9   2022年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

BACKGROUND: The decision to initiate clozapine treatment should be made on an individual basis and may be closely related to the early detection of treatment-resistant schizophrenia (TRS), although there is evidence that the early use of clozapine results in a better response to treatment. Therefore, we investigated the relationship between the examination rate of TRS and the prescription rate of clozapine. METHODS: After attending a 1-day educational program on schizophrenia based on the "Guidelines for the Pharmacological Treatment of Schizophrenia," we asked the participating facilities to submit records of whether or not TRS was evaluated for each patient. We calculated the clozapine prescription rate from the schizophrenic patients prescribed clozapine and all of the schizophrenic patients. Forty-nine facilities in 2017 were included in the study. RESULTS: There were dichotomous distributions in the examination rate of TRS and a non-normal distribution in the prescription rate of clozapine. There was a significant correlation between the prescription rate of clozapine and the examination rate of TRS (r s  = 0.531, P = 1.032 × 10-4 ). A significant difference was found in the prescription rate of clozapine between the three groups of facilities according to the examination rate of TRS. CONCLUSION: As a preliminary problem for the use of clozapine, in Japan, the examination rate of TRS varies, and there are many facilities that typically do not consider the possibility of TRS; this trend leads to a low rate of clozapine use. Clearly, further clinician training is needed for the early detection and appropriate management of TRS that includes an explanation of TRS and how to introduce clozapine therapy to patients and their families.

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The characteristics of patients receiving psychotropic pro re nata medication at discharge for the treatment of schizophrenia and major depressive disorder: A nationwide survey from the EGUIDE project.

Ichihashi K, Kyou Y, Hasegawa N, Yasui-Furukori N, Shimizu Y, Hori H, Hashimoto N, Ide K, Imamura Y, Yamada H, Ochi S, Iga JI, Takaesu Y, Ohi K, Tsuboi T, Iida H, Yamagata H, Hishimoto A, Horai T, Usami M, Makinodan M, Nagasawa T, Komatsu H, Kido M, Muraoka H, Atake K, Takeshima M, Kubota C, Inagaki T, Tamai S, Kishimoto T, Furihata R, Matsumoto J, Miura K, Inada K, Watanabe K, Kasai K, Hashimoto R

Asian journal of psychiatry ( Asian Journal of Psychiatry )  69   103007 - 103007   2022年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Development and acceptability of a decision aid for chronic insomnia considering discontinuation of benzodiazepine hypnotics.

Aoki Y, Takaesu Y, Suzuki M, Okajima I, Takeshima M, Shimura A, Utsumi T, Kotorii N, Yamashita H, Kuriyama K, Watanabe N, Mishima K

Neuropsychopharmacology reports ( Neuropsychopharmacology Reports )  42 ( 1 ) 10 - 20   2022年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIM: To describe the development and acceptability of a decision aid (DA) for chronic insomnia considering discontinuation of benzodiazepine (BZD) and benzodiazepine receptor agonist (BZRA) hypnotics, and if discontinuing, tapering with or without cognitive behavioral therapy for insomnia (CBT-I). METHODS: We reviewed relevant literature describing chronic insomnia to identify options. We used the results of the systematic review and meta-analysis conducted previously to determine the related outcomes of two options: discontinuation of BZD/BZRA hypnotics by gradual tapering alone and discontinuation of BZD/BZRA hypnotics by gradual tapering with CBT-I. We then developed a prototype of DA following the International Patient Decision Aid Standards. A mixed methods survey was conducted to assess the acceptability among patients and healthcare providers. RESULTS: The prototype consisted of a description of insomnia, options of continuing or discontinuing BZD/BRZA hypnotics (if discontinuing, the options of tapering hypnotics with or without CBT-I), pros and cons of each option, and a value clarification exercise. Patients (n = 24) reported that the DA had acceptable language (79%), adequate information (71%), and well-balanced presentation (91%). Healthcare providers (n = 20) also provided favorable feedback. CONCLUSION: We developed a DA for chronic insomnia considering discontinuation of BZD/BRZA hypnotics, which was acceptable for stakeholders. The developed DA was designed to support patients and healthcare providers to make a decision about whether to discontinue BZD/BRZA hypnotics.

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Three cases of parasomnias similar to sleep terrors occurring during sleep-wake transitions from REM sleep.

Futenma K, Inoue Y, Saso A, Takaesu Y, Yamashiro Y, Matsuura M

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine ( Journal of Clinical Sleep Medicine )  18 ( 2 ) 669 - 675   2022年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Sleep terrors are a non-rapid eye movement (NREM) sleep-related parasomnia characterized by abrupt terror with a frightening scream. However, it remains unknown whether sleep terrors occur only from NREM sleep. We evaluated 3 cases of a sleep terrors-like parasomnia that occurred exclusively during arousals from rapid eye movement (REM) sleep. These parasomnia events occurred at REM sleep-wake transitions, manifesting with screaming or crying, similar to sleep terrors, without alertness or clear orientation. The patients were all young-adult females without notable medical conditions. REM sleep behavior disorder and nocturnal frontal lobe epilepsy were not detected based on their video-polysomnographic findings. These 3 cases should be provisionally diagnosed as "Parasomnia, Unspecified" according to the International Classification of Sleep Disorders, third edition; however, the phenomenological diagnosis is proposed to be "Disorders of Arousal from REM Sleep." Our reported cases indicate that sleep terrors may also arise from REM sleep. CITATION: Futenma K, Inoue Y, Saso A, Takaesu Y, Yamashiro Y, Matsuura M. Three cases of parasomnias similar to sleep terrors occurring during sleep-wake transitions from REM sleep. J Clin Sleep Med. 2022;18(2):669-675.

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Development and field testing of a decision aid to facilitate shared decision making for adults newly diagnosed with attention-deficit hyperactivity disorder.

Aoki Y, Tsuboi T, Takaesu Y, Watanabe K, Nakayama K, Kinoshita Y, Kayama M

Health expectations : an international journal of public participation in health care and health policy ( Health Expectations )  25 ( 1 ) 366 - 373   2022年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

BACKGROUND: The number of individuals who are diagnosed with attention-deficit hyperactivity disorder (ADHD) during adulthood has increased in recent years. However, there is still no decision aid (DA) to help adults newly diagnosed with ADHD make decisions regarding further treatments. OBJECTIVE: This study aimed to describe the development process of a DA for adults newly diagnosed with ADHD and its field testing during the shared decision-making (SDM) process in a clinical setting. METHODS: The development process involved the creation of a DA prototype using the International Patient Decision Aid Standards criteria and revision of the prototype through the stakeholders' reviews. The field testing of the DA compared scores before and after the SDM process on the service users' knowledge scale, decisional conflict scale and the Conners Adult ADHD Rating Scales. RESULTS: The developed DA contained options of watchful waiting with own coping skills and pharmacological treatment, which consisted of several kinds of drug options. Fifteen adults newly diagnosed with ADHD participated in the field testing. The participant decision-making quality outcomes such as their knowledge and decisional conflict improved after the SDM process. ADHD severity did not change. CONCLUSION: A DA for adults with ADHD was systematically developed following the international criteria. Field testing indicated that the DA could serve as a tool to facilitate the SDM process. Further research on this DA is necessary before its routine implementation. PATIENT OR PUBLIC CONTRIBUTION: During the development process of the DA, the service users who had already been diagnosed with ADHD reviewed the DA prototype and provided feedback, which improved the final version of the DA.

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Hypnotic medication use among inpatients with schizophrenia and major depressive disorder: results of a nationwide study.

Furihata R, Otsuki R, Hasegawa N, Tsuboi T, Numata S, Yasui-Furukori N, Kashiwagi H, Hori H, Ochi S, Muraoka H, Onitsuka T, Komatsu H, Takeshima M, Hishimoto A, Nagasawa T, Takaesu Y, Nakamura T, Asami T, Miura K, Matsumoto J, Ohi K, Yasuda Y, Iida H, Ogasawara K, Hashimoto N, Ichihashi K, Yamada H, Watanabe K, Inada K, Hashimoto R

Sleep medicine ( Sleep Medicine )  89   23 - 30   2022年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

STUDY OBJECTIVES: To investigate the proportion of inpatients with schizophrenia and major depressive disorder prescribed hypnotic medication, and the association between such medication and the use of other antipsychotic agents. METHODS: This was a nationwide cross-sectional study performed as part of the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment' (EGUIDE) project. Data from 2146 inpatients with schizophrenia and 1031 inpatients with major depressive disorder were analyzed. All types and dosages of psychotropic drugs were recorded and the data at the time of discharge were analyzed. Associations between the use of hypnotic medication and other antipsychotic agents were evaluated using multivariate logistic regression analyses. RESULTS: The proportions of schizophrenia patients who were prescribed any and two or more hypnotic agents were 55.7% and 17.6%, respectively, and the corresponding proportions for patients with major depressive disorder were 63.6% and 22.6%, respectively. In schizophrenia patients, multivariate logistic regression analyses showed that two or more antipsychotics, anticholinergic drugs, anxiolytics, and mood stabilizers/antiepileptic drugs were positively associated with the use of any hypnotic agent. In patients with major depressive disorder, multivariate logistic regression analyses revealed that two or more antidepressants, two or more antipsychotics, anxiolytics, and mood stabilizers/antiepileptic drugs were positively associated with the use of any hypnotic agent. CONCLUSIONS: Prescription of hypnotic agents was found to be highly frequent among inpatients with psychiatric disorders. Prescription of two or more main antipsychotic agents was commonly associated with the use of hypnotic medication for both schizophrenia and major depressive disorder.

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不眠症の薬物療法

普天間国博, 高江洲義和

精神科Resident 3(3):179-181, 2022.   3 ( 3 ) 179 - 181   2022年

掲載種別: 研究論文（学術雑誌）

神経発達症に併存する概日リズム障害

高江洲義和

日本児童青年精神医学会総会抄録集     2022年

掲載種別: 研究論文（その他学術会議資料等）

抑うつ症状を伴う起床困難への対応

高江洲義和

日本睡眠学会定期学術集会プログラム抄録集   47   2022年

掲載種別: 研究論文（その他学術会議資料等）

児童・思春期の不眠症患者に対する評価とその対応

高江洲義和

日本睡眠学会定期学術集会プログラム抄録集   47   2022年

掲載種別: 研究論文（その他学術会議資料等）

不眠症治療の新展開～睡眠薬出口戦略のそのさきを目指して～

高江洲義和

日本睡眠学会定期学術集会プログラム抄録集   47   2022年

掲載種別: 研究論文（その他学術会議資料等）

不眠症治療薬レンボレキサント長期投与後の中止の影響について

高江洲義和, 鈴木正泰, Moline Margaret, Pinner Kate, 井鍋佳菜子, 西友理恵, 栗山健一

日本睡眠学会定期学術集会プログラム抄録集   47   2022年

掲載種別: 研究論文（その他学術会議資料等）

睡眠薬・抗不安薬出口戦略のエキスパートコンセンサス作成から考える一般医に向けた教育・啓発

高江洲義和

日本不安症学会学術大会プログラム抄録集     2022年

掲載種別: 研究論文（その他学術会議資料等）

双極性障害診療におけるSDMの実践

高江洲義和

日本うつ病学会総会プログラム抄録集     2022年

掲載種別: 研究論文（その他学術会議資料等）

気分障害の適切なゴールとは

高江洲義和

日本うつ病学会総会プログラム抄録集     2022年

掲載種別: 研究論文（その他学術会議資料等）

うつ病に対する維持ECT患者に併用する薬物療法の実態

岡田剛史, 福本健太郎, 坪井貴嗣, 長谷川尚美, 村岡寛之, 柏木宏子, 越智紳一郎, 五十嵐俊, 飯田仁志, 小高文聰, 大井一高, 高江洲義和, 古郡規雄, 三浦健一郎, 松本純弥, 須田史朗, 稲田健, 渡邉衡一郎, 橋本亮太

日本うつ病学会総会プログラム抄録集     2022年

掲載種別: 研究論文（その他学術会議資料等）

大うつ病エピソード患者における希死念慮に関連する要因の検討

大田一木, 高江洲義和, 座間味優, 大塚直亮, 栗原雄大, 新里輔鷹, 近藤毅

日本うつ病学会総会プログラム抄録集     2022年

掲載種別: 研究論文（その他学術会議資料等）

睡眠薬の中止の可能性

高江洲 義和

日本臨床薬理学会学術総会抄録集 ( 一般社団法人 日本臨床薬理学会 )  43 ( 0 ) 1-C-S07-4   2022年

掲載種別: 研究論文（その他学術会議資料等）

　概要を見る

<p>これまでわが国では不眠症の治療薬としてベンゾジアゼピン受容体作動薬が診療科を問わず汎用されており、諸外国と比較してもその処方量が多いことが知られている。近年は、ベンゾジアゼピン受容体作動薬の長期・多剤服用により、認知機能の悪化、転倒による骨折のリスクの増大、依存形成など、様々な問題点が指摘されている。2014年に睡眠薬の適正使用・休薬ガイドラインが公表され、睡眠薬を内服中で症状が安定している患者は、睡眠薬の休薬を目指していくことが望ましいとする「出口戦略」が提唱されるようになった。しかしながら現状では臨床現場において、睡眠薬の出口戦略が広く実装化されているとは言い難い状況である。</p><p>不眠症診療においてベンゾジアゼピン受容体作動薬の代替治療法は徐々に普及しており、メラトニン受容体作動薬やオレキシン受容体拮抗薬などの新たな作用機序を有する薬剤が登場しており、不眠に対する認知行動療法の有用性が広く知られるようになっている。しかしながら、近年のレセプトデータベース研究結果からも、未だベンゾジアゼピン受容体作動薬の多剤・長期処方の問題は解決していないことが明らかになっている。また、我が国における不眠に対する認知行動療法は保険収載もされておらず、十分に普及していないため、多くの診療現場からのアクセスは容易ではない現状がある。</p><p>このような状況から、我が国における睡眠薬治療の適正化や出口戦略の実装化のために、さらに踏み込んで実臨床で実装可能な明確な指針の作成が求められている。そのため我々は、厚生労働科学研究費事業としてベンゾジアゼピン受容体作動薬の適正使用ならびに出口戦略の指針を示す取り組みを行っている。本シンポジウムにおいては不眠症診療における睡眠薬の適正使用や出口戦略の実装化の取り組みを紹介して、今後我々が目指すべき不眠症治療について議論したい。</p>

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Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics.

Hori H, Yasui-Furukori N, Hasegawa N, Iga JI, Ochi S, Ichihashi K, Furihata R, Kyo Y, Takaesu Y, Tsuboi T, Kodaka F, Onitsuka T, Okada T, Murata A, Kashiwagi H, Iida H, Hashimoto N, Ohi K, Yamada H, Ogasawara K, Yasuda Y, Muraoka H, Usami M, Numata S, Takeshima M, Yamagata H, Nagasawa T, Tagata H, Makinodan M, Kido M, Katsumoto E, Komatsu H, Matsumoto J, Kubota C, Miura K, Hishimoto A, Watanabe K, Inada K, Kawasaki H, Hashimoto R

Frontiers in psychiatry ( Frontiers in Psychiatry )  13   823826   2022年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups—low rate group (LG), medium rate group (MG), and high rate group (HG)—according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.

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Implementation of a shared decision-making training program for clinicians based on the major depressive disorder guidelines in Japan: A multi-center cluster randomized trial.

Takaesu Y, Aoki Y, Tomo Y, Tsuboi T, Ishii M, Imamura Y, Tachimori H, Watanabe K

Frontiers in psychiatry ( Frontiers in Psychiatry )  13   967750 - 967750   2022年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Background: Although shared treatment decision-making with patients requires attention, it is not widely implemented, particularly in the field of psychiatry. The aim of this study was to assess whether a shared decision-making (SDM) training program for clinicians based on the major depressive disorder (MDD) guidelines improved the perceived involvement of the decision process for patients with MDD. Methods: A multi-center cluster-randomized controlled intervention of a clinician training program based on the Japanese MDD guidelines using related decision aids compared to usual care was conducted among 56 clinicians from 23 institutions. A total of 124 patients with MDD were enrolled in this study. The primary outcomes were the scores of the Shared Decision Making-Questionnaire-9 (SDM-Q-9) and Decision Conflict Scale (DCS) after the first visit to the outpatient clinics. The secondary outcomes were patients' satisfaction, quality of life, trust in clinicians, and depressive symptoms. Additionally, we evaluated all the observed outcomes at the first and third months of follow-up. Results: The scores of the SDM-Q-9 in the SDM training program group were significantly higher than those in the control group at the first visit. However, no significant difference in the DCS scores was found between the two groups. There was no intervention effect for secondary outcomes and the outcomes at the first- and third-month follow-up visits. Conclusion: The clinician training program based on the Japanese MDD guidelines can be useful for implementation of SDM. Additional research is needed to confirm the efficacy of this SDM training program. Clinical trial registration: [https://www.umin.ac.jp/], identifier [UMIN000034397].

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Delayed sleep-wake rhythm is associated with cognitive dysfunction, social dysfunction, and deteriorated quality of life in patients with major depressive disorder.

Takaesu Y, Kanda Y, Nagahama Y, Shiroma A, Ishii M, Hashimoto T, Watanabe K

Frontiers in psychiatry ( Frontiers in Psychiatry )  13   1022144   2022年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Background The delayed sleep-wake phase is commonly observed in major depressive disorder (MDD) and thought to be associated with functional impairments. This study aimed to evaluate the relationship between the delayed sleep-wake phase, cognitive dysfunction, social dysfunction, and quality of life in patients with MDD. Methods This cross-sectional design included 33 outpatients with MDD. Objective sleep-wake rhythm was assessed by actigraphy. Functional impairments were evaluated by the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), World Health Organization Disability Assessment Schedule (WHO-DAS), and Euro QOL 5 dimensions (EQ5D). Results Actigraphic assessment of the delayed sleep-wake phase (midpoint of sleep) was significantly correlated with the composite score of the BACS-J (r = –0.489, p = 0.010), WHO-DAS score (r = 0.466, p = 0.014), and EQ5D score (r = 0.472, p = 0.013). No significant correlation was found between the other actigraphic sleep parameters (sleep latency, total sleep time, and sleep efficiency) and functional impairments. Conclusion Our study’s results suggested that the delayed sleep-wake phase is associated with cognitive dysfunction, social dysfunction, and deteriorated quality of life in patients with MDD. Clinicians should pay attention to the sleep-wake rhythm in patients with MDD in clinical settings.

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睡眠・覚醒リズム障害に着目した双極性障害の診断と治療

高江洲 義和

九州神経精神医学 ( 九州精神神経学会 )  67 ( 1 ) 3 - 8   2021年12月

掲載種別: 研究論文（学術雑誌）

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A Cross-Sectional Study of Evening Hyperphagia and Nocturnal Ingestion: Core Constituents of Night Eating Syndrome with Different Background Factors.

Matsui K, Komada Y, Okajima I, Takaesu Y, Kuriyama K, Inoue Y

Nutrients ( Nutrients )  13 ( 11 )   2021年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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This web-based cross-sectional survey aimed to elucidate the differences between the two core symptoms of night eating syndrome (NES): evening hyperphagia and nocturnal ingestion in the general Japanese population aged 16-79 years. Participants who consumed at least 25% of daily calories after dinner were defined as having evening hyperphagia. Those who consumed food after sleep initiation at least twice a week were determined to have nocturnal ingestion. Of the 8348 participants, 119 (1.5%) were categorized in the evening hyperphagia group, 208 (2.6%) in the nocturnal ingestion group, and 8024 in the non-NES group. Participants with evening hyperphagia and nocturnal ingestion had significantly higher anxiety scores (p < 0.05 and p < 0.001, respectively) and depression (p < 0.001 for both) than those without NES. Multiple logistic regression analysis revealed that evening hyperphagia was significantly and independently associated with higher body mass index, shorter sleep duration, later sleep-wake schedule, and higher insomnia score, while nocturnal ingestion was significantly and independently associated with younger age, smoking habit, living alone, earlier sleep-wake schedule, and higher insomnia score. Sleep duration and sleep-wake schedule characteristics in the two groups were opposite, suggesting differences in the sleep pathophysiology mechanisms.

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特集 「実感と納得」に向けた病気と治療の伝え方 不眠症

高江洲 義和

精神医学 ( 株式会社医学書院 )  63 ( 11 ) 1721 - 1727   2021年11月

掲載種別: 研究論文（学術雑誌）

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Effects of transdiagnostic group treatment for sleep disturbances in adult attention-deficit/hyperactivity disorders and autistic spectrum disorder: a pilot study

Ishii M.

Sleep and Biological Rhythms ( Sleep and Biological Rhythms )  20 ( 2 ) 173 - 180   2021年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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<title>Abstract</title>Although adult patients with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often have sleep problems, few studies have verified the effect of a psychological approach specific to sleep–wake rhythms on these sleep disturbances. Therefore, the aim of this pilot study was to develop a trans-diagnostic approach with sleep scheduling and regularity of sleep duration as core modules, and to examine the effect of the intervention in adult ADHD and/or ASD subjects with sleep disturbances. This was a within-group pilot study. Ten patients with adult ADHD and/or ASD with sleep disturbances (10 males, age: 27.4 ± 5.6 years) took part in a 90-min weekly group intervention for 5 weeks. All participants were assessed on scales for sleep complaints, anxiety, depression, and symptoms of ADHD and ASD before and after the intervention, and at 3-month follow-up. The results showed that the intervention significantly improved sleep disturbances at post-intervention (<italic>p</italic> = 0.003, <italic>d</italic> = 1.30, 95% CI 0.31–2.28) and at the 3-month follow-up (<italic>p</italic> = 0.035, <italic>d</italic> = 0.41, 95% CI − 0.48 to 1.30). In addition, attention switching for ASD symptoms was significantly reduced post-intervention (<italic>p</italic> = 0.031, <italic>d</italic> = 1.16, 95% CI 0.19–2.13). This is the first pilot study of a trans-diagnostic group approach for adult ADHD and/or ASD with sleep disturbances. The intervention primarily led to an improvement of sleep disturbances, followed by improvement of disease-specific symptoms in adult subjects with ADHD and ASD.

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特集 産業精神保健の現状と課題 COVID-19流行下におけるライフスタイルと体内時計の変化

高江洲 義和

精神医学 ( 株式会社医学書院 )  63 ( 9 ) 1383 - 1390   2021年09月

掲載種別: 研究論文（学術雑誌）

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Characteristics of discharge prescriptions for patients with schizophrenia or major depressive disorder: Real-world evidence from the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project.

Hashimoto N, Yasui-Furukori N, Hasegawa N, Ishikawa S, Numata S, Hori H, Iida H, Ichihashi K, Furihata R, Murata A, Tsuboi T, Takeshima M, Kyou Y, Komatsu H, Kubota C, Ochi S, Takaesu Y, Usami M, Nagasawa T, Hishimoto A, Miura K, Matsumoto J, Ohi K, Yamada H, Inada K, Watanabe K, Shimoda K, Hashimoto R

Asian journal of psychiatry ( Asian Journal of Psychiatry )  63   102744 - 102744   2021年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND: Monopharmacy with antipsychotics and antidepressants is the first-line treatment for schizophrenia and major depressive disorder (MDD) in most clinical guidelines, while polypharmacy with psychotropic agents in the treatment of schizophrenia is common in clinical practice. There are no detailed data on the prescription patterns for inpatients with mental illness with reliable diagnoses made by treating psychiatrists. METHODS: We gathered prescription data at discharge from 2177 patients with schizophrenia and 1238 patients with MDD from October 2016 to March 2018. RESULTS: The patients with schizophrenia aged between 60 and 79 were prescribed lower doses of antipsychotics and hypnotics/anxiolytics than those aged between 40 and 59. There were significant differences between the prescription rate of antipsychotics in the patients with schizophrenia and that of antidepressants in the patients with MDD. The frequency of concomitant drugs such as anti-Parkinson drugs, anxiolytics/hypnotics and mood stabilizers in the subjects with schizophrenia prescribed antipsychotic polypharmacy was significantly higher than that with monotherapy. For the patients with schizophrenia, olanzapine, risperidone, aripiprazole, quetiapine, and blonanserin were the five most prescribed antipsychotics. For the patients with MDD, mirtazapine, duloxetine, escitalopram, trazodone and sertraline were the five most prescribed antidepressants. CONCLUSIONS: Our results showed the use of high doses of antipsychotics, high percentages of antipsychotic polypharmacy and concurrent use of hypnotics/anxiolytics in patients with schizophrenia. Notably, these data were collected before intensive instruction regarding the guidelines; therefore, we need to assess the change in the prescription pattern post guideline instruction.

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Association of sleep duration on workdays or free days and social jetlag with job stress.

Takaesu Y, Shimura A, Komada Y, Futenma K, Ishii M, Sugiura K, Watanabe K, Inoue Y

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  75 ( 8 ) 244 - 249   2021年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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AIM: The aim of this study was to investigate the impact of sleep problems on job stress in office workers. METHODS: This study included 4645 office workers from 29 companies who completed the study questionnaires between April 2017 and April 2019 in Japan. Sleep duration was assessed based on the participants' subjective sleep schedule on workdays and free days. The midpoint of sleep on free days (sleep-corrected) and social jetlag were calculated in accordance with the Munich Chronotype Questionnaire. To assess job stress, we used the 57-item Brief Job Stress Questionnaire. RESULTS: Multivariate logistic regression analysis revealed that the following factors were significantly associated with high job stress in office workers: a sleep duration <6 h on workdays (OR = 1.77, 95% CI = 1.46-2.15, P < 0.001), a sleep duration <6 h on free days (OR = 1.40, 95% CI = 1.05-1.87, P = 0.022), a sleep duration of at least 8 h on free days (OR = 1.31, 95% CI = 1.06-1.60, P = 0.011), and more than 2 h of social jetlag (OR = 1.33, 95% CI = 1.04-1.70, P = 0.022). CONCLUSION: This study suggests that insufficient sleep, long sleep durations on free days, and social jetlag may be associated with high job stress in office workers.

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構造化された睡眠衛生指導は学生の出席を向上させ退学を予防する 多施設ランダム化比較試験

志村 哲祥, 高江洲 義和, 伊藤 潤, 片寄 ゆうや, 仁枝 幹太, 川嶋 香江, 橋本 真由, 久能木 共子, 當銘 貴世美, 井上 猛

日本社会精神医学会雑誌 ( (一社)日本社会精神医学会 )  30 ( 3 ) 287 - 287   2021年08月

掲載種別: 研究論文（学術雑誌）

電気けいれん療法における過換気手技の有用性の検討 系統的レビューとメタ解析

五十嵐 俊, 内海 智博, 青木 裕見, 竹島 正浩, 坪井 貴嗣, 小笠原 正弥, 渡邊 衡一郎, 高江洲 義和

日本うつ病学会総会・日本認知療法・認知行動療法学会プログラム・抄録集 ( 日本うつ病学会・日本認知療法・認知行動療法学会 )  18回・21回   383 - 383   2021年07月

掲載種別: 研究論文（その他学術会議資料等）

難治性うつ状態を呈する神経発達症の特性 作業療法による行動評価の活用

長島 泉, 早坂 友成, 高江洲 義和, 二田 未来, 野崎 和博, 片桐 建志, 今村 弥生, 神田 優太, 栗原 真理子, 大江 悠樹, 吉田 信子, 青鹿 由紀, 坪井 貴嗣, 渡邊 衡一郎

日本うつ病学会総会・日本認知療法・認知行動療法学会プログラム・抄録集 ( 日本うつ病学会・日本認知療法・認知行動療法学会 )  18回・21回   396 - 396   2021年07月

掲載種別: 研究論文（その他学術会議資料等）

難治性うつ状態にある患者を認知機能の側面から捉えなおす試み

大江 悠樹, 栗原 真理子, 坪井 貴嗣, 高江洲 義和, 片桐 建志, 野崎 和博, 今村 弥生, 早坂 友成, 二田 未来, 青鹿 由紀, 小野田 直子, 渡邊 衡一郎

日本うつ病学会総会・日本認知療法・認知行動療法学会プログラム・抄録集 ( 日本うつ病学会・日本認知療法・認知行動療法学会 )  18回・21回   396 - 396   2021年07月

掲載種別: 研究論文（その他学術会議資料等）

うつ病の寛解後,抗うつ薬の継続・中止を本人と一緒に決めるためのDecision Aidの開発

青木 裕見, 高江洲 義和, 堀 輝, 井上 猛, 伊賀 淳一, 馬場 元, 三島 和夫, 田近 亜蘭, 加藤 正樹

日本うつ病学会総会・日本認知療法・認知行動療法学会プログラム・抄録集 ( 日本うつ病学会・日本認知療法・認知行動療法学会 )  18回・21回   380 - 380   2021年07月

掲載種別: 研究論文（その他学術会議資料等）

ECTはうつ病入院患者の薬物療法をどのように変化させるか EGUIDEデータを用いて

坪井 貴嗣, 五十嵐 俊, 越智 紳一郎, 長谷川 尚美, 古郡 規雄, 飯田 仁志, 村岡 寛之, 高江洲 義和, 岡田 剛史, 柏木 宏子, 小高 文聰, 福本 健太郎, 稲田 健, 渡邊 衡一郎, 橋本 亮太

日本うつ病学会総会・日本認知療法・認知行動療法学会プログラム・抄録集 ( 日本うつ病学会・日本認知療法・認知行動療法学会 )  18回・21回   369 - 369   2021年07月

掲載種別: 研究論文（その他学術会議資料等）

The relationship between insomnia symptoms and work productivity among blue-collar and white-collar Japanese workers engaged in construction/civil engineering work: a cross-sectional study.

Kayaba M, Sasai-Sakuma T, Takaesu Y, Inoue Y

BMC public health ( BMC Public Health )  21 ( 1 ) 1244 - 1244   2021年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

BACKGROUND: The situation of work productivity loss due to sleep disorders/problems among workers in industrialized societies remains unclear. The purpose of this study was to clarify the prevalence of insomnia symptoms and actual situation of work productivity by job type (white-collars/blue-collars) among construction/civil engineering workers in Japan and evaluate the association between insomnia symptoms and work productivity adjusting for sleep duration and sociodemographic, work-related, and health-related variables. METHODS: This cross-sectional study included 17,828 construction/civil engineering workers (15,837 males and 1991 females) aged 40 to 74 years in Japan. The questionnaire consisted of socio-demographic characteristics, information on work productivity (work performance and absence), respective insomnia symptoms (difficulty initiating sleep; DIS, difficulty maintaining sleep; DMS, and early morning awakening; EMA), bedtime schedule, work-related factors (job type, working hours), and perceived health condition. To identify the associated factors of work productivity, the logistic regression analyses were conducted. RESULTS: The percentages of workers who reported to be experiencing DIS, DMS, and EMA were 7.9, 16.3, and 13.1%, respectively. Poor work performance was associated with every insomnia symptom in both the blue-collar and white-collar workers. Meanwhile, absence was associated with DIS in blue-collar workers and both DIS and DMS in white-collar workers; however, not with EMA in both the groups. In blue-collar workers, engagement in shift work was associated with poor work performance. CONCLUSIONS: The present study revealed the association between insomnia symptoms and work productivity, suggesting the necessity of early prevention of insomnia among both blue-collar and white-collar workers.

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Reliability and validity of the Japanese version of the Biological Rhythms Interview of assessment in neuropsychiatry-self report for delayed sleep-wake phase disorder.

Yuta Kanda, Yoshikazu Takaesu, Mina Kobayashi, Yoko Komada, Kunihiro Futenma, Isa Okajima, Koichiro Watanabe, Yuichi Inoue

Sleep medicine   81   288 - 293   2021年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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OBJECTIVE: The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) might be applicable for assessing delayed sleep-wake phase disorder (DSWPD). We aimed to investigate the reliability and validity of the Japanese version of the BRIAN self-report (J-BRIAN-SR) in DSWPD patients and determine a cutoff score to identify the presence of the disorder. METHODS: We enrolled 60 newly diagnosed DSWPD outpatients and 64 age-matched healthy controls. We used Cronbach's alpha for internal reliability to evaluate J-BRIAN-SR. We confirmed the reliability of the A test and re-test using Pearson's correlation coefficient in the controls. We used confirmatory factor analysis to evaluate the factor structure of J-BRIAN-SR and referenced the Morningness-Eveningness Questionnaire (MEQ) to check concurrent validity. We analyzed the receiver operating characteristic curve (ROC) to determine the J-BRIAN-SR cutoff point for the presence of DSWPD. RESULTS: The 18-component scores of the J-BRIAN-SR had an overall reliability coefficient (Cronbach's alpha) of 0.82. We confirmed a high test-retest reliability using an intraclass correlation coefficient (r = 0.84). The correlation between J-BRIAN-SR and MEQ was 0.38 (p = 0.003). The J-BRIAN-SR that we extracted by exploratory factor analysis consisted of three factors. A score of 40 points provided a sensitivity of 80.0% and a specificity of 75.6% for the positivity of DSWPD. CONCLUSIONS: The results of the present study revealed that J-BRIAN-SR is a valid and reliable instrument for screening and evaluating the severity of DSWPD. Our findings will be useful to physicians and patients in Japan and those in clinical settings.

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Improving Employment Through Interpersonal Psychotherapy: A Case Series of Patients With Treatment-Refractory Depression

Takeshi Katagiri, Yoshikazu Takaesu, Mariko Kurihara, Yuki Oe, Miho Ishii, Naoko Onoda, Tomonari Hayasaka, Yuta Kanda, Yayoi Imamura, Koichiro Watanabe

Frontiers in Psychiatry ( Frontiers Media SA )  12   2021年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Patients with treatment-refractory depression (TRD) have significantly great losses in work productivity and employment. Interpersonal psychotherapy (IPT) is considered an approach for the treatment of TRD. However, the effectiveness of IPT in patients with TRD remains unclear. In this study, we report cases of TRD patients who underwent IPT after a detailed evaluation, along with their employment status. Of 112 patients who experienced 1-week examination administration for TRD at Kyorin University Hospital, which aimed to determine appropriate diagnosis and treatment approaches for each patient, four patients who met the criteria for major depressive disorder according to DSM-IV-TR and were determined suitable for IPT were included in this report. Two patients had moderate, one had mild, and one had remission levels of depressive symptoms according to the Montgomery-Asberg Depression Rating Scale at the time of admission. All four patients completed the scheduled sessions of IPT (6–16 sessions) in the outpatient clinic and achieved remission. All four patients attained full-time employment within 6 months after receiving IPT. This study suggests that the appropriate selection of IPT might be effective for TRD patients, possibly leading to positive outcomes, including work productivity and employment status.

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Prevalence of and factors associated with acute withdrawal symptoms after 24 weeks of eszopiclone treatment in patients with chronic insomnia: a prospective, interventional study.

Inoue Y, Takaesu Y, Koebis M

BMC psychiatry ( BMC Psychiatry )  21 ( 1 ) 193   2021年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta-analysis.

Takeshima M, Otsubo T, Funada D, Murakami M, Usami T, Maeda Y, Yamamoto T, Matsumoto T, Shimane T, Aoki Y, Otowa T, Tani M, Yamanaka G, Sakai Y, Murao T, Inada K, Yamada H, Kikuchi T, Sasaki T, Watanabe N, Mishima K, Takaesu Y

Psychiatry and clinical neurosciences ( Psychiatry and Clinical Neurosciences )  75 ( 4 ) 119 - 127   2021年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Factors Associated With Time to Achieve Employment Through Occupational Support Programs in Patients With Mood Disorders: 1 Year Naturalistic Study

Tomonari Hayasaka, Yoshikazu Takaesu, Izumi Nagashima, Miku Futada, Kazuhiro Nozaki, Takeshi Katagiri, Yayoi Imamura, Mariko Kurihara, Yuki Oe, Takashi Tsuboi, Koichiro Watanabe

Frontiers in Psychiatry ( Frontiers Media SA )  12   2021年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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<bold>Objective:</bold> Mood disorders cause significant work performance disability in sufferers and often lead to adverse employment outcomes in working individuals. The aim of this study was to explore factors associated with time to achieve employment through the occupational support program (OSP) for patients with mood disorders. <bold>Methods:</bold> The participants were patients admitted to the Kyorin university hospital from April 2016 to April 2019. Patients who met the criteria for major depressive disorder and depressive episode of bipolar I or II disorder according to DSM-5 and participated in the occupational therapy-based OSP for at least three sessions (one course) were included in this study. We collected demographic and clinical variables at the baseline of this study through medical records and OSP records; the variables included age, gender, diagnosis, scores of Quick Inventory of Depressive Symptomatology and Global Assessment of Functioning, the number of times of participation in the OSP, word count of the transcription task in the OSP, typographical deficiency, fatigue status and mood status after the OSP. The primary outcome was set as the time to achieve the employment within 1 year after the discharge. <bold>Results:</bold> Of the 211 patients who participated in the OSP during the survey period, 49 participants met the criteria in this study. The results showed that 14 patients achieved and the other 35 patients did not achieve the employment within 1 year of discharge from the hospital. A multivariate cox regression analysis revealed that the word count of the transcription task in the OSP (HR = 1.03, 95% CI = 1.01–1.05, <italic>p</italic> = 0.016) and mood status after the OSP (HR = 2.77, 95% CI = 1.18–6.51, <italic>p</italic> = 0.019) were significantly associated with time to achieve the employment. <bold>Conclusion:</bold> In conclusion, this study suggested that work speed and mood response in the OSP could be significant predictors for achieving employment in patients with mood disorders.

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精神疾患合併妊娠の向精神薬使用状況と周産期精神症状との関連の検討

前田 優那, 高江洲 義和, 野崎 和博, 大久保 譲, 坪井 貴嗣, 片桐 健志, 稗貫 理恵, 谷垣 伸治, 渡邊 衡一郎

総合病院精神医学 ( (一社)日本総合病院精神医学会 )  32 ( Suppl. ) S - 176   2020年11月

掲載種別: 研究論文（その他学術会議資料等）

Unmet needs of patients with major depressive disorder – Findings from the ‘ E ffectiveness of G uidelines for D issemination and E ducation in P sychiatric T reatment ( EGUIDE )’ project: A nationwide dissemination, education, and evaluation study

Hitoshi Iida, Junichi Iga, Naomi Hasegawa, Yuka Yasuda, Tomoya Yamamoto, Kenichiro Miura, Junya Matsumoto, Atsunobu Murata, Kazuyoshi Ogasawara, Hisashi Yamada, Hikaru Hori, Kayo Ichihashi, Naoki Hashimoto, Kazutaka Ohi, Norio Yasui‐Furukori, Takashi Tsuboi, Toshinori Nakamura, Masahide Usami, Ryuji Furihata, Yoshikazu Takaesu, Kunihiro Iwamoto, Nobuhiro Sugiyama, Taishiro Kishimoto, Naohisa Tsujino, Hiroki Yamada, Akitoyo Hishimoto, Kiyotaka Nemoto, Kiyokazu Atake, Hiroyuki Muraoka, Eiichi Katsumoto, Satoru Oishi, Takahiko Inagaki, Fumiaki Ito, Yayoi Imamura, Mikio Kido, Tatsuya Nagasawa, Shusuke Numata, Shinichiro Ochi, Masaaki Iwata, Hidenaga Yamamori, Junichi Fujita, Toshiaki Onitsuka, Satoshi Yamamura, Manabu Makinodan, Michiko Fujimoto, Yoichiro Takayanagi, Kenji Takezawa, Hiroshi Komatsu, Kentaro Fukumoto, Shinichiro Tamai, Hirotaka Yamagata, Chika Kubota, Tadasu Horai, Ken Inada, Koichiro Watanabe, Hiroaki Kawasaki, Ryota Hashimoto

Psychiatry and Clinical Neurosciences ( Wiley )    2020年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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難治性うつ状態の診断・治療の適正化により社会復帰に至った一例

丸木 拓, 高江洲 義和, 坪井 貴嗣, 渡邊 衡一郎

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2020特別号 ) S292 - S292   2020年09月

掲載種別: 研究論文（学術雑誌）

難治性うつ状態を呈する患者の作業遂行特徴と精神疾患に関する研究

早坂 友成, 長島 泉, 高江洲 義和, 坪井 貴嗣, 渡邊 衡一郎

日本作業療法学会抄録集 ( (一社)日本作業療法士協会 )  54回   OH - 27   2020年09月

掲載種別: 研究論文（その他学術会議資料等）

難治性うつ状態を呈する患者の病態と行動の特徴

早坂 友成, 長島 泉, 高江洲 義和, 坪井 貴嗣, 野崎 和博, 今村 弥生, 片桐 建志, 栗原 真理子, 大江 悠樹, 二田 未来, 青鹿 由紀, 渡邊 衡一郎

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2020特別号 ) S428 - S428   2020年09月

掲載種別: 研究論文（学術雑誌）

Prescription patterns in patients with schizophrenia in Japan: First-quality indicator data from the survey of "Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)" project.

Ichihashi K, Hori H, Hasegawa N, Yasuda Y, Yamamoto T, Tsuboi T, Iwamoto K, Kishimoto T, Horai T, Yamada H, Sugiyama N, Nakamura T, Tsujino N, Nemoto K, Oishi S, Usami M, Katsumoto E, Yamamori H, Tomita H, Suwa T, Furihata R, Inagaki T, Fujita J, Onitsuka T, Miura K, Matsumoto J, Ohi K, Matsui Y, Takaesu Y, Hashimoto N, Iga J, Ogasawara K, Yamada H, Watanabe K, Inada K, Hashimoto R

Neuropsychopharmacol Rep   40 ( 3 ) 281 - 286   2020年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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EGUIDEプロジェクト統合失調症の初年度講習前QIについての報告。2016年にはじまったEGUIDEプロジェクトで、初年度の講習会に先立って、参加44施設における1164人の統合失調症患者さんへ の処方のパターンを医療の質指標QI(Quality Indicator)を用いて示した。参加施設全体の抗精神病薬の単剤処方率は 57%でしたが、抗うつ薬の併用は8%、気分安定薬の併用は37%、抗不安薬や睡眠薬の併用は68%であった。 毎年の講習の実施に伴い、今後これらの指標がより良い方向に変化していくことが期待される。

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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

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 )  42回   202 - 202   2017年06月

掲載種別: 研究論文（その他学術会議資料等）

ストレスチェックにおいて睡眠がストレス反応に及ぼす影響の分析

林田 泰斗, 志村 哲祥, 杉浦 航, 大野 浩太郎, 高江洲 義和, 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 )  42回   167 - 167   2017年06月

掲載種別: 研究論文（研究会，シンポジウム資料等）

通信制高校において、個別化した睡眠衛生指導は登校率を向上させた

志村 哲祥, 伊藤 潤, 野村 亮太, 高江洲 義和, 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 )  42回   202 - 202   2017年06月

掲載種別: 研究論文（その他学術会議資料等）

Childhood parental bonding affects adulthood trait anxiety through self-esteem

Akiyoshi Shimura, Yoshikazu. Takaesu, Yukiei Nakai, Akiko Murakoshi, Yasuyuki Ono, Yasunori Matsumoto, Ichiro Kusumi, Takeshi Inoue

COMPREHENSIVE PSYCHIATRY ( W B SAUNDERS CO-ELSEVIER INC )  74   15 - 20   2017年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Introduction: The association between trait anxiety and parental bonding has been suggested. However, the mechanism remains uncertain and there is no study focused on general adult population. We investigated the association and the mechanism between childhood parental bonding and adulthood trait anxiety in the general adult population. Material and methods: A cross-sectional retrospective survey was conducted in 2014 with 853 adult volunteers from the general population. The Parental Bonding Instrument, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory Form Y (STAI-Y) were self-administered. Structural equation modelling was used for the analysis. Results: Childhood parental bonding affected adulthood trait anxiety indirectly mediated by self-esteem. Trait anxiety was decreased by parental care and increased by parental overprotection through self-esteem. This model explained 51.1% of the variability in STAI-Y trait anxiety scores. Conclusions: This study suggests an important role of self-esteem as a mediator between childhood parental bonding and adulthood trait anxiety. (C) 2016 Published by Elsevier Inc.

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Associations among depressive symptoms, childhood abuse, neuroticism, and adult stressful life events in the general adult population

Kotaro Ono, Yoshikazu Takaesu, Yukiei Nakai, Akiyoshi Shimura, Yasuyuki Ono, Akiko Murakoshi, Yasunori Matsumoto, Hajime Tanabe, Ichiro Kusumi, Takeshi Inoue

Neuropsychiatric Disease and Treatment ( Dove Medical Press Ltd. )  13   477 - 482   2017年02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 the interactions among several factors affect the onset, progression, and prognosis of major depressive disorder. This study investigated how childhood abuse, neuroticism, and adult stressful life events interact with one another and affect depressive symptoms in the general adult population. Subjects and methods: A total of 413 participants from the nonclinical general adult population completed the Patient Health Questionnaire-9, the Child Abuse and Trauma Scale, the neuroticism subscale of the shortened Eysenck Personality Questionnaire -Revised, and the Life Experiences Survey, which are self-report scales. Structural equation modeling (Mplus version 7.3) and single and multiple regressions were used to analyze the data. Results: Childhood abuse, neuroticism, and negative evaluation of life events increased the severity of the depressive symptoms directly. Childhood abuse also indirectly increased the negative appraisal of life events and the severity of the depressive symptoms through enhanced neuroticism in the structural equation modeling. Limitations: There was recall bias in this study. The causal relationship was not clear because this study was conducted using a cross-sectional design. Conclusion: This study suggested that neuroticism is the mediating factor for the two effects of childhood abuse on adulthood depressive symptoms and negative evaluation of life events. Childhood abuse directly and indirectly predicted the severity of depressive symptoms.

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A pilot study: a priority oriented tailored sleep hygiene intervention reduced sleep disturbance and absenteeism among correspondence high school students

Shimura A, Ito J, Takaesu Y

Sleep Medicine ( Elsevier )  40   e304 - e304   2017年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Lithium in drinking water may be associated with depressive and irritable temperaments in nonclinical population.

Ishii N, Terao T, Matsuzaki H, Inoue T, Takaesu Y, Kohno K, Takeshima M, Baba H, Honma H

Clin Neuropsychopharmacol Ther ( 日本臨床精神神経薬理学会 )  8   7 - 11   2017年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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<p>Purpose: Recently, we reported that lithium levels in drinking water were significantly and positively associated with hyperthymic temperament scores, whereas latitude was significantly and negatively associated with the scores, suggesting that lithium in drinking water may positively maintain hyperthymic temperament and that latitude may negatively maintain it. In the present study, from the viewpoint of psychopharmacology, we investigated the other 4 affective temperaments in reference to lithium in drinking water with adjustment for latitude, temperature, and sunshine. Methods: We re-examined our previous dataset consisting of temperament data of 609 residents in Sapporo, Obihiro, Takaoka, Koshigaya, and Oita cities, in addition to the lithium levels in drinking water and climatic data of the five cities. Multiple regression analyses via the forced entry method were performed, whereby the individual temperament scores were dependent factors, and age, gender, the other four affective temperaments, lithium in drinking water, latitude, temperature, and sunshine were independent factors. Results: The multiple regression analysis revealed that lithium levels in drinking water were significantly and negatively associated with depressive temperament scores. The other three temperaments (i.e. irritable, cyclothymic and anxious temperaments) were not significantly associated with lithium levels in drinking water. Discussion: In conclusion, the present findings suggest that lithium in drinking water may be negatively associated with depressive temperament.</p>

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Effect of aripiprazole on non-24-hour sleep-wake rhythm disorder comorbid with major depressive disorder: a case report

Kentaro Matsui, Yoshikazu Takaesu, Takeshi Inoue, Ken Inada, Katsuji Nishimura

NEUROPSYCHIATRIC DISEASE AND TREATMENT ( DOVE MEDICAL PRESS LTD )  13   1367 - 1371   2017年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Patients with non-24-hour sleep-wake rhythm disorder (N24SWD) exhibit a sleep pattern that is asynchronous with the external light-dark cycle, typically involving a cycling, relapsing-remitting pattern of sleep disturbances, including nighttime insomnia and daytime sleepiness. Here, we report the case of a patient with N24SWD comorbid with major depressive disorder, who was successfully treated with a low dose of aripiprazole. Case presentation: A 47-year-old female presented with an 8-year complaint of difficulty falling asleep and waking up in the morning. The patient was diagnosed with major depressive disorder at the age of 35 years and was treated with various antidepressants since that time. At the age of 40 years, the patient's sleep-wake cycle began to extend without exacerbation of depressive symptoms. The patient was diagnosed with N24SWD at the age of 43 years. Ramelteon 8 mg/d and then melatonin 1 mg/d were administered, but these did not provide effective treatment. In January 2016, after treatment with aripiprazole 3 mg/d in the morning for 4 weeks, the patient's sleep-wake cycle became markedly synchronized to the environmental light-dark cycle. Her sleep-wake cycle remained synchronized when the same dose of aripiprazole was administered for at least 6 months. Conclusion: Treatment-refractory asynchrony of the sleep-wake cycle in an N24SWD patient with depression was successfully treated with aripiprazole. Although the detailed mechanism of action is unclear, aripiprazole may be an appropriate treatment for patients with circadian rhythm sleep-wake disorders.

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Association between the high-dose use of benzodiazepines and rehospitalization in patients with schizophrenia: A 2-year naturalistic study

Yukika Takita, Yoshikazu Takaesu, Kotaro Ono, Kunihiro Futenma, Akiyoshi Shimura, Akiko Murakoshi, Yoko Komada, Yuichi Inoue, Takeshi Inoue

Neuropsychiatric Disease and Treatment ( Dove Medical Press Ltd. )  12   3243 - 3247   2016年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: High-dose use of benzodiazepines (BZPs) reportedly causes adverse effects on cognitive function and quality of life in patients with schizophrenia. However, effects of BZPs on the clinical course of schizophrenia have not been clarified. This study was set out to investigate the association between BZPs and rehospitalization of patients with schizophrenia. Methods: In this retrospective study, patients with schizophrenia who were discharged from Tokyo Medical University Hospital between January 2009 and February 2012 were eligible as subjects. One hundred and eight patients who continued treatment for &gt 2 years after hospital discharge were included in this study. Clinical characteristics, doses of prescribed medication such as BZPs and antipsychotics, and Global Assessment of Functioning scores at discharge were investigated. The primary outcome was rehospitalization of patients for any reason. Results: In a total of 108 subjects with schizophrenia, 44 subjects (40.7%) experienced rehospitalization during the 2-year study period. A multivariate analysis by the Cox proportional hazards model revealed that low educational history (hazard ratio =2.43, P=0.032), younger onset age of schizophrenia (hazard ratio =2.10, P=0.021), and higher diazepam-equivalent dose (hazard ratio =6.53, P=0.011) were significantly associated with the time to rehospitalization after hospital discharge. Conclusion: The results of this study suggest that high-dose use of BZPs at discharge in patients with schizophrenia might be associated with a shorter time to rehospitalization.

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Later sleep schedule and depressive symptoms are associated with usage of multiple kinds of hypnotics

Akiyoshi Shimura, Yoshikazu Takaesu, Sayaka Aritake, Kunihiro Futenma, Yoko Komada, Yuichi Inoue

SLEEP MEDICINE ( ELSEVIER SCIENCE BV )  25   56 - 62   2016年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Objective: Usage of high doses of hypnotics possibly causes various adverse events. However, the risk factors of using multiple kinds of hypnotics have been inconclusive. To clarify this, we conducted a web based cross-sectional questionnaire survey on the Japanese adult population. Methods: A cross-sectional Internet-linked survey was conducted on 10,016 individuals and 1030 participants (10.3%) having subjective insomnia proceeded to subsequent analyses. The analyzed subjects were categorized into non-users of hypnotics (n = 833; 80.9%), users of a single kind of hypnotic (n = 96; 9.3%), and users of multiple kinds of hypnotics (n =101; 9.8%). The descriptive variables including demographic data, scores of Center for Epidemiological Studies Depression Scale (CES-D), Short Form-8 Health Related Quality of Life [QOL (SF-8)], Pittsburgh Sleep Quality Index (PSQI), and other parameters were compared among the groups. Results: The users of multiple kinds of hypnotics had the highest mean score of CES-D, the lowest mental component summary of QOL (SF-8), and the latest sleep schedule among the three groups (p &lt; 0.001). Logistic regression analyses revealed that sex (female: OR= 2.38; p &lt;0.001) and age (&gt;= 43 years old: OR= 2.61; p &lt; 0.001) were independently associated with use of a single kind of hypnotic, while later sleep schedule (midpoint of sleep &gt;= 5:30 a.m.: OR = 2.26; p &lt; 0.001) and higher CES-D score 6 points: OR = 2.41; p &lt; 0.001) were independently associated with use of multiple kinds of hypnotics. Conclusions: Characteristics of users of multiple kinds of hypnotics were different from those of users of a single kind of hypnotic. (C) 2016 Elsevier B.V. All rights reserved.

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Prevalence of and Factors Associated With Sleep-Related Eating Disorder in Psychiatric Outpatients Taking Hypnotics

Yoshikazu Takaesu, Jun Ishikawa, Yoko Komada, Akiko Murakoshi, Kunihiro Futenma, Shingo Nishida, Yuichi Inoue

JOURNAL OF CLINICAL PSYCHIATRY ( PHYSICIANS POSTGRADUATE PRESS )  77 ( 7 ) E892 - E898   2016年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Objective: To clarify the prevalence and clinical features of sleep-related eating disorder (SRED) in psychiatric outpatients taking hypnotics as well as factors associated with the disorder. Methods: From February 1, 2012, to February 29, 2012, a cross-sectional study was undertaken. A questionnaire addressing demographics, the Japanese version of the Pittsburgh Sleep Quality Index (PSQI), presence of abnormal behavior during sleep focusing on SRED and sleepwalking, and duration of hypnotic medication and subjective side effects of the drug was distributed to psychiatric outpatients who were taking hypnotics at the time of the survey. Results: Of 1,318 patients taking hypnotics, 1,048 patients (79.5%) provided valid responses, and 88 of them (8.4%) had experienced SRED. The SRED group was significantly younger, had a significantly higher total PSQI score, and took higher bedtime diazepam-equivalent doses of hypnotics than the non-SRED group (P &lt; .01 for all comparisons). In the SRED group, subjective side effects due to hypnotics were present at significantly higher proportions than in the non-SRED group. Multiple logistic regression analysis showed that younger age (adjusted odds ratio [aOR] = 0.98, 95% CI = 0.96-0.99, P = .021), taking 2 or more kinds of antipsychotics (aOR = 3.41, 95% CI = 1.93-6.05, P &lt; .001), and the bedtime diazepam-equivalent dose of a hypnotic (aOR = 1.03, 95% CI = 1.01-1.05, P = .039) were significantly associated with the experience of SRED. Conclusion: The prevalence of SRED in psychiatric outpatients taking hypnotics is elevated, particularly in younger patients, and the hypnosedative effects of the drugs could be responsible for the occurrence of the disorder in this population. (C) Copyright 2016 Physicians Postgraduate Press, Inc.

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Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder

Yoshikazu Takaesu, Yuichi Inoue, Akiko Murakoshi, Yoko Komada, Ayano Otsuka, Kunihiro Futenma, Takeshi Inoue

PLOS ONE ( PUBLIC LIBRARY SCIENCE )  11 ( 7 ) e0159578   2016年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Recent studies have suggested that there are certain pathophysiological relationships between bipolar disorder (BD) and circadian rhythm dysfunction. However, apparently no studies have clarified the prevalence of circadian rhythm sleep-wake disorders (CRSWD) in patients with BD. This study was set out to investigate the prevalence of CRSWD and associated factors in patients with BD. One hundred four euthymic BD outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of BD, and family history of psychiatric disorders and suicide. Severity of BD was assessed by the Montgomery-sberg Depression Rating Scale and Young Mania Rating Sca. CRSWD was diagnosed by clinical interview, together with sleep logs, according to the International Classification of Sleep Disorders, third edition (ICSD-3). Thirty-five subjects (32.4%) met the criteria for CRSWD. The age at the time of investigation and that at the onset of BD were both lower in the CRSWD group than in the non-CRSWD group. The rates of family history of psychiatric disorders and suicide in the CRSWD group were higher than those in the non-CRSWD group. Multiple logistic regression analysis revealed that the presence of CRSWD was significantly associated with younger onset age of BD and family history of suicide. The prevalence of CRSWD could be quite high in BD patients. Younger onset age of BD and family history of suicide were associated with presence of CRSWD in BD patients.

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[Major depression and insomnia comorbid with diabetes].

Takaesu Y, Ichiki M, Inoue T

Nihon rinsho. Japanese journal of clinical medicine   74 Suppl 2   470 - 476   2016年04月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Affective temperaments play an important role in the relationship between childhood abuse and depressive symptoms in major depressive disorder

Hiroyuki Toda, Takeshi Inoue, Tomoya Tsunoda, Yukiei Nakai, Masaaki Tanichi, Teppei Tanaka, Naoki Hashimoto, Yoshikazu Takaesu, Shin Nakagawa, Yuji Kitaichi, Shuken Boku, Hajime Tanabe, Masashi Nibuya, Aihide Yoshino, Ichiro Kusumi

PSYCHIATRY RESEARCH ( ELSEVIER IRELAND LTD )  236   142 - 147   2016年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Previous studies have shown that various factors, such as genetic and environmental factors, contribute to the development of major depressive disorder (MDD). The aim of this study is to clarify how multiple factors, including affective temperaments, childhood abuse and adult life events, are involved in the severity of depressive symptoms in MDD. A total of 98 participants with MDD were studied using the following self-administered questionnaire surveys: Patient Health Questionnaire-9 measuring the severity of depressive symptoms; Life Experiences Survey (LES) measuring negative and positive adult life events; Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego auto-questionnaire (TEMPS A) measuring affective temperaments; and the Child Abuse and Trauma Scale (CATS) measuring childhood abuse. The data were analyzed using single and multiple regression analyses and structural equation modeling (SEM). The neglect score reported by CATS indirectly predicted the severity of depressive symptoms through affective temperaments measured by TEMPS-A in SEM. Four temperaments (depressive, cyclothymic, irritable, and anxious) directly predicted the severity of depressive symptoms. The negative change in the LES score also directly predicted severity. This study suggests that childhood abuse, especially neglect, indirectly increases the severity of depressive symptoms through increased scores of affective temperaments in MDD. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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Factors associated with discontinuation of aripiprazole treatment after switching from other antipsychotics in patients with chronic schizophrenia: A prospective observational study

Yoshikazu Takaesu, Taishiro Kishimoto, Akiko Murakoshi, Nobutada Takahashi, Yuichi Inoue

PSYCHIATRY RESEARCH ( ELSEVIER IRELAND LTD )  236   71 - 74   2016年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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The purpose of the study was to identify factors associated with discontinuation of aripiprazole after switching from other antipsychotics in patients with schizophrenia in real world clinical settings. From January 2011 to December 2012, a prospective, 48-week open-label study was undertaken. Thirty-eight subjects on antipsychotic monotherapy were switched to aripiprazole. Patients who discontinued aripiprazole were compared to those who continued with regards to demographic characteristics as well as treatment factors. Multiple regression analysis was conducted to identify predictors for aripiprazole discontinuation. Thirteen out of 38 patients (34.2%) discontinued aripiprazole during the follow up period. Nine patients (23.7%) discontinued aripiprazole due to worsening of psychotic symptoms. Multiple logistic regression analysis revealed that only the duration of previous antipsychotic treatment was associated with aripiprazole discontinuation after switching to aripiprazole. The receiver operating curve (ROC) analysis identified that the cut-off length for duration of illness to predict aripiprazole discontinuation was 10.5 years. Longer duration of illness was associated with aripiprazole discontinuation. Greater caution may be required when treating such patients with aripiprazole. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

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Comparison of clinical features between primary and drug-induced sleep-related eating disorder

Yoko Komada, Yoshikazu Takaesu, Kentaro Matsui, Masaki Nakamura, Shingo Nishida, Meri Kanno, Akira Usui, Yuichi Inoue

NEUROPSYCHIATRIC DISEASE AND TREATMENT ( DOVE MEDICAL PRESS LTD )  12   1275 - 1280   2016年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Purpose: The aim of this study was to ascertain the clinical characteristics of drug-induced sleep-related eating disorder (SRED).Patients and methods: We retrospectively reviewed the medical records of 30 patients with primary SRED (without any comorbid sleep disorders and who were not taking any possible causative medications), and ten patients with drug-induced SRED (occurrence of SRED episodes after starting nightly medication of sedative drugs, which completely resolved after dose reduction or discontinuation of the sedatives).Results: All patients with drug-induced SRED took multiple types of sedatives, such as benzodiazepines or benzodiazepine receptor agonists. Clinical features of drug-induced SRED compared with primary SRED were as follows: higher mean age of onset (40 years old in drug-induced SRED vs 26 years old in primary SRED), significantly higher rate of patients who had total amnesia during most of their SRED episodes (75.0% vs 31.8%), significantly lower rate of comorbidity of night eating syndrome (0% vs 63.3%), and significantly lower rate of history of sleepwalking (10.0% vs 46.7%). Increased doses of benzodiazepine receptor agonists may be responsible for drug-induced SRED.Conclusion: The clinical features of drug-induced SRED were different from those of primary SRED, possibly reflecting differences in the underlying mechanisms between these two categories of SREDs.

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The influence of childhood abuse, adult life events, and affective temperaments on the well-being of the general, nonclinical adult population

Yoshiaki Kanai, Yoshikazu Takaesu, Yukiei Nakai, Masahiko Ichiki, Mitsuhiko Sato, Yasunori Matsumoto, Jun Ishikawa, Yasuyuki Ono, Akiko Murakoshi, Hajime Tanabe, Ichiro Kusumi, Takeshi Inoue

NEUROPSYCHIATRIC DISEASE AND TREATMENT ( DOVE MEDICAL PRESS LTD )  12   823 - 832   2016年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Previous studies have shown the effects of childhood abuse, life events, and temperaments on well-being (positive affect) and ill-being (negative affect). We hypothesized that childhood abuse, affective temperaments, and adult life events interact with one another and influence positive and negative affects in the general adult population and tested this hypothesis using structural equation modeling. Methods: A total of 415 participants from the general, nonclinical adult population were studied using the following self-administered questionnaires: the Subjective Well-Being Inventory (SUBI); Life Experiences Survey (LES); Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A); and the Child Abuse and Trauma Scale (CATS). The data were analyzed with single and multiple regression analyses and structural equation modeling (Mplus). Results: Childhood abuse indirectly predicted the worsening of positive and negative affects through cyclothymic, anxious, and irritable temperaments as measured by the TEMPS-A in the structural equation model. The cyclothymic, anxious, and irritable temperaments directly worsened the positive and negative affects and the negative appraisal of life events that occurred during the past year, while the hyperthymic temperament had the opposite effects. Limitations: The subjects of this study were nonclinical volunteers. The findings might not be generalizable to psychiatric patients. Conclusion: This study demonstrated that childhood abuse, particularly neglect, indirectly worsened the well-being of individuals through cyclothymic, anxious, and irritable affective temperaments. An important "mediator" role of affective temperaments in the effect of childhood abuse on well-being was suggested.

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Mandibular Advancement Device as a Comparable Treatment to Nasal Continuous Positive Airway Pressure for Positional Obstructive Sleep Apnea

Yoshikazu Takaesu, Satoru Tsuiki, Mina Kobayashi, Yoko Komada, Hideaki Nakayama, Yuichi Inoue

JOURNAL OF CLINICAL SLEEP MEDICINE ( AMER ACAD SLEEP MEDICINE )  12 ( 8 ) 1113 - 1119   2016年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Study Objectives: Positional obstructive sleep apnea (P-OSA) is a clinically common phenotype of OSA, which can be treated effectively with mandibular advancement devices (MADs). We hypothesized that the efficacy of an MAD is comparable to that of nasal continuous positive airway pressure (nCPAP) in P-OSA patients. Methods: Among patients diagnosed with OSA at a single sleep center from January 2008 to May 2014, male subjects with moderate OSA were recruited and stringently categorized as having P-OSA when the ratio of their lateral apnea-hypopnea index (AHI) to supine AHI was &lt;= 0.5, their lateral sleep time was &gt; 60 minutes, and their lateral REM sleep time was longer than 10 minutes. Treatment efficacy was compared between P-OSA subjects with an MAD (n = 34) and those with nCPAP (n = 34) after matching for age, body-mass index, and baseline AHI. Results: There were no significant differences in baseline AHI (MAD: nCPAP = 20.6 +/- 3.9/h: 21.3 +/- 1.7/h, p = 0.35) or in follow-up AHI (MAD: nCPAP = 4.7 +/- 3.5/h: 3.4 +/- 3.7/h, p = 0.12) between the 2 treatment groups, and hence MADs lowered the AHI to the same extent as nCPAP. Conclusions: These findings suggest that an MAD is as efficacious as nCPAP for P-OSA patients. MAD treatment for this specific phenotype may be a promising patient-tailored and first-line approach to OSA. Commentary: A commentary on this article appears in this issue on page 1079.

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Prevalence and associated factors of hypnotics dependence among Japanese outpatients with psychiatric disorders

Akiko Murakoshi, Yoshikazu Takaesu, Yoko Komada, Jun Ishikawa, Yuichi Inoue

PSYCHIATRY RESEARCH ( ELSEVIER IRELAND LTD )  230 ( 3 ) 958 - 963   2015年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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This study aimed to investigate the prevalence of the dependence for benzodiazepine or their agonist (BZDs) hypnotics, as well as factors associated with this dependence among Japanese psychiatric outpatients. One thousand and forty-three patients in the psychiatric outpatient clinic of Tokyo Medical University Hospital receiving treatment with BZDs hypnotics were analyzed. The subjects answered questionnaires including demographic variables, subjective sleep difficulty assessed by the Pittsburg Sleep Quality Index (PSQI), duration of hypnotics medication, dose of diazepam equivalent BZDs hypnotics, the presence or absence of subjective side effects due to BZDs hypnotics (dizziness, fatigue, daytime sleepiness, amnesia, and headache), and dependency assessed by the Dependency 2-A (D 2-A) score. Subjects with a D 2-A score &gt;= 10 were considered as having BZDs hypnotics dependence, and the variables associated with the presence of dependence were examined using logistic regression analyses. Eighty-two out of the 1043 subjects (7.9%) were determined to have BZDs hypnotics dependence. Compared with the non-dependence group, the dependence group had a significantly higher proportion of positive respondents for all the side effects. Multiple logistic regression analyses showed that the dependence was significantly associated with younger age, higher total PSQI score, and higher daily dose of BZDs hypnotics. Younger age, higher total PSQI score, and higher dose may be associated with BZDs hypnotics dependence. The finding that patients with BZDs hypnotics dependence frequently suffered from subjective side effects and had greater sleep difficulty encourages the establishment of alternative treatments for patients with insomnia symptoms refractory to BZDs hypnotics treatment. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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A preliminary study on the relationships between diurnal melatonin secretion profile and sleep variables in patients emergently admitted to the coronary care unit

Yoshikazu Takaesu, Kunihiro Futenma, Mina Kobayashi, Yoko Komada, Nobuhiro Tanaka, Akira Yamashina, Yuichi Inoue

CHRONOBIOLOGY INTERNATIONAL ( TAYLOR & FRANCIS INC )  32 ( 6 ) 875 - 879   2015年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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To clarify the significance of melatonin secretion under intensive care conditions, we investigated melatonin secretion profiles and sleep parameters of 23 patients just after admission to the coronary care unit (CCU) and 19 age-matched controls. Sleep parameters were evaluated by actigraphy, and melatonin secretion was assessed by measuring the urinary 6-sulphatoxy melatonin (6-SMT). 6-SMT secretion was lower and nocturnal sleep parameters were less satisfactory in the subjects than those in the controls, and there were positive correlations between these variables, particularly in the subject patients. The lowered melatonin secretion might be involved in the mechanism of insomnia in CCU patients.

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精神科病棟入院患者における転倒リスク要因の検討

大野 浩太郎, 高江洲 義和, 志村 哲祥, 瀧田 千歌, 丸田 敏雅

精神神経学雑誌 ( (公社)日本精神神経学会 )  ( 2015特別 ) S757 - S757   2015年06月

掲載種別: 研究論文（学術雑誌）

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Impact of hypnotics use on daytime function and factors associated with usage by female shift work nurses

Kunihiro Futenma, Shoichi Asaoka, Yoshikazu Takaesu, Yoko Komada, Jun Ishikawa, Akiko Murakoshi, Shingo Nishida, Yuichi Inoue

SLEEP MEDICINE ( ELSEVIER SCIENCE BV )  16 ( 5 ) 604 - 611   2015年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Objective: We investigated quality of life (QOL) and work performance of hypnotics users, and explored the factors associated with multiple hypnotics usage in shift work nurses. Methods: We conducted a questionnaire-based, cross-sectional survey on nurses in university hospitals. We analyzed responses from 1202 nurses; 997 were female shift work nurses (82.9%), including 696 and 281 two-and three-shift workers, respectively. Results: The rate of hypnotics use was 10% (6.9% were single hypnotic users and 3.1% were multiple hypnotics users). The rate of insomnia did not differ between the single and multiple hypnotics users. However, multiple hypnotics users showed lower QOL, more severe depressive symptoms, and greater frequencies of work-related errors than those using a single hypnotic. A multiple logistic regression analysis revealed that age &gt;= 27 years, presence of depression, eveningness chronotype, and presence of insomnia symptoms were significantly associated with hypnotics use. On the other hand, only the existence of shift work disorder (SWD) was significantly associated with usage of multiple hypnotics. Conclusions: The present study suggested that usage of multiple hypnotics is not beneficial for relieving insomnia or for keeping better QOL in shift work nurses. It would be desirable to explore the causal relationship between SWD and multiple hypnotics use in a future longitudinal study. (C) 2014 Elsevier B.V. All rights reserved.

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