研究等業績 - 原著論文 - 三島 和夫
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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.
Neuropsychopharmacol Rep ( Wiley ) 2023年07月 [査読有り]
研究論文（学術雑誌） 国内共著
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Feasibility of a wrist-worn wearable device for estimating mental health status in patients with mental illness.
Kazuyuki Nakagome, Manabu Makinodan, Mitsuhiro Uratani, Masaki Kato, Norio Ozaki, Seiko Miyata, Kunihiro Iwamoto, Naoki Hashimoto, Atsuhito Toyomaki, Kazuo Mishima, Masaya Ogasawara, Masahiro Takeshima, Kazumichi Minato, Toshikazu Fukami, Mari Oba, Kazuyoshi Takeda, Hideki Oi
Frontiers in psychiatry 14 1189765 - 1189765 2023年07月 [査読有り]
研究論文（学術雑誌） 国内共著
OBJECT: Real-world data from wearable devices has the potential to understand mental health status in everyday life. We aimed to investigate the feasibility of estimating mental health status using a wrist-worn wearable device (Fitbit Sense) that measures movement using a 3D accelerometer and optical pulse photoplethysmography (PPG). METHODS: Participants were 110 patients with mental illnesses from different diagnostic groups. The study was undertaken between 1 October 2020 and 31 March 2021. Participants wore a Fitbit Sense on their wrist and also completed the State-Trait Anxiety Inventory (STAI), Positive and Negative Affect Schedule (PANAS), and EuroQol 5 dimensions 5-level (EQ-5D-5L) during the study period. To determine heart rate (HR) variability (HRV), we calculated the sdnn (standard deviation of the normal-to-normal interval), coefficient of variation of R-R intervals, and mean HR separately for each sleep stage and the daytime. The association between mental health status and HR and HRV was analyzed. RESULTS: The following significant correlations were found in the wake after sleep onset stage within 3 days of mental health status assessment: sdnn, HR and STAI scores, HR and PANAS scores, HR and EQ-5D-5L scores. The association between mental health status and HR and HRV was stronger the closer the temporal distance between mental health status assessment and HR measurement. CONCLUSION: A wrist-worn wearable device that measures PPG signals was feasible for use with patients with mental illness. Resting state HR and HRV could be used as an objective assessment of mental health status within a few days of measurement.
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Clinical practice for unspecified anxiety disorder in primary care
Sakurai, H. Takeshima, M. Inada, K. Aoki, Y. Ie, K. Kise, M. Yoshida, E. Tsuboi, T. Yamada, H. Hori, H. Inada, Y. Shimizu, E. Mishima, K. Watanabe, K. Takaesu, Y.
Psychiatry and Clinical Neurosciences Reports ( Wiley ) 2 ( 3 ) 2023年06月 [査読有り]
研究論文（学術雑誌） 国内共著
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Yumi Aoki, Yoshikazu Takaesu, Ken Inada, Hiroki Yamada, Tomohiko Murao, Toshiaki Kikuchi, Masahiro Takeshima, Masayuki Tani, Kazuo Mishima, Tempei Otsubo
Frontiers in Psychiatry ( Frontiers Media SA ) 14 2023年05月 [査読有り]
研究論文（学術雑誌） 国内共著
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. -
Yumi Aoki, Masahiro Takeshima, Takashi Tsuboi, Eiichi Katsumoto, Ken Udagawa, Ken Inada, Koichiro Watanabe, Kazuo Mishima, Yoshikazu Takaesu
International Journal of Environmental Research and Public Health ( MDPI AG ) 20 ( 7 ) 5373 - 5373 2023年04月 [査読有り]
研究論文（学術雑誌） 国内共著
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 < 0.001), while more patients felt that “the decision is (was) made considering the psychiatrists’ opinion” compared to psychiatrists (p < 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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Treatment Strategy for Insomnia Disorder: Japanese Expert Consensus
Yoshikazu Takaesu, Hitoshi Sakurai, Yumi Aoki, Masahiro Takeshima, Kenya Ie, Kentaro Matsui, Tomohiro Utsumi, Akiyoshi Shimura, Isa Okajima, Nozomu Kotorii, Hidehisa Yamashita, Masahiro Suzuki, Kenichi Kuriyama, Eiji Shimizu, Kazuo Mishima, Koichiro Watanabe, Ken Inada
Frontiers in Psychiatry 2023年04月 [査読有り]
研究論文（学術雑誌） 国内共著
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. -
Exploratory Validation of Sleep-Tracking Devices in Patients with Psychiatric Disorders.
Masaya Ogasawara, Masahiro Takeshima, Shumpei Kosaka, Aya Imanishi, Yu Itoh, Dai Fujiwara, Kazuhisa Yoshizawa, Norio Ozaki, Kazuyuki Nakagome, Kazuo Mishima
Nature and science of sleep 15 301 - 312 2023年04月 [査読有り]
研究論文（学術雑誌） 国内共著
PURPOSE: Sleep-tracking devices have performed well in recent studies that evaluated their use in healthy adults by comparing them with the gold standard sleep assessment technique, polysomnography (PSG). These devices have not been validated for use in patients with psychiatric disorders. Therefore, we tested the performance of three sleep-tracking devices against PSG in patients with psychiatric disorders. PATIENTS AND METHODS: In total, 52 patients (32 women; 48.1 ± 17.2 years, mean ± SD; 18 patients diagnosed with schizophrenia, 19 with depressive disorder, 3 with bipolar disorder, and 12 with sleep disorder cases) were tested in a sleep laboratory with PSG, along with portable electroencephalography (EEG) device (Sleepgraph), actigraphy (MTN-220/221) and consumer sleep-tracking device (Fitbit Sense). RESULTS: Epoch-by-epoch sensitivity (for sleep) and specificity (for wake), respectively, were as follows: Sleepgraph (0.95, 0.76), Fitbit Sense (0.95, 0.45) and MTN-220/221 (0.93, 0.40). Portable EEG (Sleepgraph) had the best sleep stage-tracking performance. Sleep-wake summary metrics demonstrated lower performance on poor sleep (ice, shorter total sleep time, lower sleep efficiency, longer sleep latency, longer wake after sleep onset). CONCLUSION: Devices demonstrated similar sleep-wake detecting performance as compared with previous studies that evaluated sleep in healthy adults. Consumer sleep device may exhibit poor sleep stage-tracking performance in patients with psychiatric disorders due to factors that affect the sleep determination algorithm, such as changes in autonomic nervous system activity. However, Sleepgraph, a portable EEG device, demonstrated higher performance in mental disorders than the Fitbit Sense and actigraphy.
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Management of unspecified anxiety disorder: Expert consensus.
Hitoshi Sakurai, Ken Inada, Yumi Aoki, Masahiro Takeshima, Kenya Ie, Morito Kise, Eriko Yoshida, Takashi Tsuboi, Hisashi Yamada, Hikaru Hori, Yasushi Inada, Eiji Shimizu, Kazuo Mishima, Koichiro Watanabe, Yoshikazu Takaesu
Neuropsychopharmacology reports 2023年02月 [査読有り]
研究論文（学術雑誌） 国内共著
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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Physicians' attitudes toward hypnotics for insomnia;a questionnaire-based study
Masahiro Takeshima, Yoshikazu Takaesu, Yumi Aoki, Kenya Ie,Eiichi, Katsumoto, Eichi Tsuru, Takashi Tsuboi, Ken Inada, Morito Kise, Koichiro Watanabe, Kazuo Mishima
Frontiers in Psychiatry 14 1071962 - 1071962 2023年01月 [査読有り]
研究論文（学術雑誌） 国内共著
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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Effects of Japanese policies and novel hypnotics on long-term prescriptions of hypnotics.
Masahiro Takeshima, Kazuhisa Yoshizawa, Minori Enomoto, Masaya Ogasawara, Mizuki Kudo, Yu Itoh, Naoko Ayabe, Yoshikazu Takaesu, Kazuo Mishima
Psychiatry and clinical neurosciences 77 ( 5 ) 264 - 272 2022年12月 [査読有り]
研究論文（学術雑誌） 国内共著
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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Preterm toddlers have low nighttime sleep quality and high daytime activity.
Yoko Asaka, Yusuke Mitani, Hidenobu Ohta, Takayo Nakazawa, Rika Fukutomi, Kyoko Kobayashi, Mayuko Kumagai, Hitomi Shinohara, Michiko Yoshida, Akiko Ando, Yuko Yoshimura, Machiko Nakagawa, Yoshihisa Oishi, Masato Mizushima, Hiroyuki Adachi, Yosuke Kaneshi, Keita Morioka, Yoshitaka Seto, Rinshu Shimabukuro, Michio Hirata, Takashi Ikeda, Miwa Ozawa, Masahiro Takeshima, Atsushi Manabe, Tsutomu Takahashi, Kazuo Mishima, Mitsuru Kikuchi, Hitoshi Yoda, Isao Kusakawa, Kazutoshi Cho
Scientific reports 12 ( 1 ) 20032 - 20032 2022年11月 [査読有り]
研究論文（学術雑誌） 国内共著
A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers' waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development.
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Attitudes and Difficulties Associated with Benzodiazepine Discontinuation.
Masahiro Takeshima, Yumi Aoki, Kenya Ie, Eiichi Katsumoto, Eichi Tsuru, Takashi Tsuboi, Ken Inada, Morito Kise, Koichiro Watanabe, Kazuo Mishima, Yoshikazu Takaesu
International journal of environmental research and public health 19 ( 23 ) 2022年11月 [査読有り]
研究論文（学術雑誌） 国内共著
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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Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study.
Yuta Kawakita, Masahiro Takeshima, Tomonari Komatsu, Aya Imanishi, Dai Fujiwara, Yu Itoh, Kazuo Mishima
BMC psychiatry 22 ( 1 ) 653 - 653 2022年10月 [査読有り]
研究論文（学術雑誌） 国内共著
OBJECTIVE: Clozapine may cause serious side effects despite benefits in patients with schizophrenia. Thus, an accurate understanding of the side-effect profile of clozapine is extremely important in the management of its administration to patients with schizophrenia. Our aim was to validate the relationship between clozapine exposure and appendicitis onset in patients with schizophrenia. METHODS: In this study, we retrospectively compared the incidence and cumulative incidence of appendicitis in patients with schizophrenia with and without a history of clozapine exposure. Among the patients with schizophrenia who visited our hospital between June 2009 and August 2021, we extracted those with a history of clozapine treatment. Patients with a history of taking clozapine were defined as the clozapine exposure group, while the others were defined as the clozapine non-exposure group. Patients with a history of appendectomy before their initial visit to our hospital or with a history of clozapine use at other hospitals were excluded. RESULTS: There were 65 patients in the clozapine exposure group and 400 patients in the clozapine non-exposure group who met the inclusion criteria. The exposure group exhibited a remarkably higher incidence of appendicitis during the observation period than the non-exposure group (863 cases vs. 124 cases per 100,000 person-years). In particular, if limited to the period of clozapine exposure, the incidence of appendicitis is extremely high, at 2,086 cases per 100,000 person-years. Moreover, multivariable analysis showed that clozapine exposure was an independent factor contributing to the onset of appendicitis. CONCLUSIONS: Clozapine exposure is associated with appendicitis onset in patients with schizophrenia.
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Development and validation of the Japanese version of the Hyperarousal Scale.
Naoko Ayabe, Shun Nakajima, Isa Okajima, Ken Inada, Wataru Yamadera, Hidehisa Yamashita, Hisateru Tachimori, Yuichi Kamei, Masahiro Takeshima, Yuichi Inoue, Kazuo Mishima
BMC psychiatry 22 ( 1 ) 617 - 617 2022年09月 [査読有り]
研究論文（学術雑誌） 国内共著
BACKGROUND: The objectives of this study were to develop a Japanese version of the Hyperarousal Scale (HAS-J) and investigate its factor structure, reliability, and validity, as well as to calculate a cutoff score for the HAS-J and assess different levels of hyperarousal in insomnia patients and community dwellers. METHODS: We recruited 224 outpatients receiving insomnia treatment (56.3% women; mean age 51.7 ± 15.6 years) and 303 community dwellers aged 20 years or older (57.8% women; mean age 43.9 ± 15.2 years). Exploratory and confirmatory factor analysis was performed to examine the factor structure of the HAS-J. Cronbach's α and McDonald's ω were then used to test internal consistency. To examine the scale's validity, we determined correlations between the HAS-J and other indexes and compared HAS-J scores between insomnia patients and community dwellers. We also compared HAS-J scores between two community-dweller groups (normal and poor sleepers) and two insomnia patient groups (with and without alleviation after treatment). RESULTS: Following exploratory and confirmatory factor analysis, a 20-item measure emerged comprising three factors: "Introspectiveness and Reactivity," "Neuroticism," and "Insomnia." Confirmatory factor analysis showed a generally good fit for the model of the three-factor structure suggested by the exploratory factor analysis loadings (χ2 (163) = 327.423, (p < 0.001), CFI = 0.914, GFI = 0.872, AGFI = 0.835, RMSEA = 0.067). In insomnia patients, internal consistency indicated sufficient reliability of the HAS-J. Correlation analysis showed weak to moderate positive correlations of the HAS-J score with other indexes, indicating concurrent validity of the HAS-J. All HAS-J subscale scores were significantly higher in insomnia patients than in community dwellers. Additionally, the total score in patients with alleviation of insomnia was comparable to that in poor sleepers and significantly higher than that in normal sleepers. CONCLUSIONS: This study demonstrated the reliability and validity of the HAS-J, indicating that it is useful as a clinical scale of hyperarousal. The high level of hyperarousal in insomnia patients who were assessed to be in remission by the Insomnia Severity Index suggests a risk of insomnia recurrence in these patients.
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Longitudinal survey of depressive symptoms among university students during the COVID-19 pandemic in Japan.
Kyoko Nomura, Teiichiro Yamazaki, Eri Maeda, Junko Hirayama, Kyoichi Ono, Masahito Fushimi, Kazuo Mishima, Fumio Yamamoto
Frontiers in psychology 13 863300 - 863300 2022年08月 [査読有り]
研究論文（学術雑誌） 国内共著
While changes in response to the different stages of the pandemic remain unknown, this study investigated the longitudinal impact of the COVID-19 pandemic on depressive symptoms in Japanese university students and identified factors associated with new onset of depression and suicidal ideation. Two surveys were conducted at one university in Akita, Japan, during the first COVID-19 outbreak period (T1: May-June 2020) and 1 year later (T2: March-May 2021). Moderate depressive symptoms were defined as a Patient Health Questionnaire-9 score ≥ 10 and suicide-related ideation score ≥ 1 on question 9 of the questionnaire. Among 985 students who completed surveys in T1 and T2, participants with moderate depressive symptoms and suicide-related ideation increased from 11 to 17% and from 5.8 to 11.8%, respectively. Among 872 students at risk after excluding those with moderate depressive symptoms at T1, 103 students (11.8%) developed moderate depressive symptoms at T2. Among the 928 students at risk, after excluding those who had suicidal ideation at T1, 79 (8.5%) developed suicidal ideation. Multivariate logistic modeling revealed financial insecurity and academic performance as risk factors (ps < 0.01), while having someone to consult about worries was a coping factor for depressive symptoms and suicidal ideation (ps < 0.001). Our findings demonstrated that socioenvironmental factors may determine depressive symptoms of university students.
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Development and acceptability of a decision aid for major depressive disorder considering discontinuation of antidepressant treatment after remission.
Yumi Aoki, Yoshikazu Takaesu, Hajime Baba, Jun-Ichi Iga, Hikaru Hori, Takeshi Inoue, Kazuo Mishima, Aran Tajika, Masaki Kato
Neuropsychopharmacology reports 42 ( 3 ) 306 - 314 2022年07月 [査読有り]
研究論文（学術雑誌） 国内共著
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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Relationship among psychotic features, benzodiazepine receptor agonists, and rehospitalization in patients with electroconvulsive therapy-responsive major depressive disorder: A retrospective 2-year observational study.
Akise Umakoshi, Masahiro Takeshima, Yu Itoh, Mari Yamamoto, Nana Shibata, Masaya Ogasawara, Naoko Ayabe, Kazuo Mishima
Neuropsychopharmacology reports 42 ( 4 ) 449 - 456 2022年07月 [査読有り]
研究論文（学術雑誌） 国内共著
AIM: It is controversial whether psychotic features are a risk factor for relapse in patients with electroconvulsive therapy-responsive major depressive disorder. A recent study reported that benzodiazepine receptor agonists reduce relapse of psychotic depression. As long-term use of these agonists may induce dependence, further research is required. We examined whether psychotic features are associated with rehospitalization in electroconvulsive therapy-responsive major depressive disorder patients. We also investigated whether taking benzodiazepine receptor agonists at the end of electro-convulsive therapy was associated with rehospitalization among patients with psychotic depression. METHODS: This study included 47 hospitalized patients (22 with psychotic depression, 25 with non-psychotic depression) who had responded to electroconvulsive therapy. Rehospitalization for major depressive episodes within two years from the last session was investigated. RESULTS: Twenty-three subjects (49%) were rehospitalized during the two-year follow-up. Kaplan-Meier analysis revealed no difference in rehospitalization between patients with psychotic and non-psychotic depression (Log-rank P = 0.87). Among the 22 responders to electroconvulsive therapy with psychotic depression, there was no difference in benzodiazepine receptor agonist use at the end of electroconvulsive therapy between the rehospitalization and non-rehospitalization groups. CONCLUSION: Our exploratory study found no difference in the benzodiazepine receptor agonists use at the end of electroconvulsive therapy between rehospitalization and non-rehospitalization groups in patients with electroconvulsive therapy-responsive psychotic depression. Thus, the relapse-preventing effect of these agonists in psychotic depression should be investigated in future randomized controlled trials. Further research is also needed to determine whether psychotic features are associated with rehospitalization in these patients.
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Changes in psychotropic polypharmacy and high-potency prescription following policy change: Findings from a large scale Japanese claims database.
Masahiro Takeshima, Minori Enomoto, Masaya Ogasawara, Mizuki Kudo, Yu Itoh, Kazuhisa Yoshizawa, Dai Fujiwara, Yoshikazu Takaesu, Kazuo Mishima
Psychiatry and clinical neurosciences 76 ( 9 ) 475 - 477 2022年06月 [査読有り]
研究論文（学術雑誌） 国内共著