Electroconvulsive Therapy for Depression


An 82-year-old woman with severe depression, including psychotic symptoms, is referred for consideration of electroconvulsive therapy. She has had four episodes of major depression consisting of crying spells, loss of interest in usual activities, insomnia, loss of appetite and weight, difficulty with concentration, feelings of helplessness and hopelessness, and thoughts of suicide.








Case 16-2013 — A 12-Year-Old Girl with Irritability, Hypersomnia, and Somatic Symptoms


A 12-year-old girl with a history of celiac disease, anxiety, and depression was seen in the outpatient psychiatry clinic of this hospital because of irritability, hypersomnia, and multiple somatic symptoms. Psychotherapy and the administration of antidepressants were begun.


症例16-2013年 過敏症、過眠症および身体症状のある12歳の少女







Use of Buprenorphine in treatment of refractory depression-A review of current literature.



Current treatment strategies for depressive disorders have limited efficacy, leaving many patients unimproved or with significant residual symptoms. The development of additional treatments represent a significant unmet need for providers. Several lines of evidence suggest that the opioid system may be involved in regulation of mood and incentives salience. Intervention based on modifying central opioid receptors may represent a novel approach to treatment of depressive disorders among those unresponsive to accepted treatments.


We searched the English language literature using keywords: Buprenorphine AND Major Depression; Buprenorphine AND Bipolar Depression; Buprenorphine AND Affective Disorders.


Use of low dose buprenorphine as augmentation of pharmacotherapy for depression has shown promise in several reported studies. Effect size of available randomized controlled studies is comparable if not greater than most accepted augmentation strategies.


Review of available literature on the use of buprenorphine in individuals with treatment resistant depression demonstrated efficacy in the treatment of depressive disorders. Further prospective randomized controlled trials should be undertaken to evaluate the efficacy of buprenorphine as an adjunct for depression refractory to current pharmacotherapies.




















Comparison of neurocognitive function in major depressive disorder, bipolar disorder, and schizophrenia in later life: A cross-sectional study of euthymic or remitted, non-demented patients using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J).



Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ) are associated with cognitive dysfunction both in adulthood and in later life. In this study, we directly compared neurocognitive function between these three conditions in later life, employing stringent definitions of euthymia and symptomatic remission. Cognitive function in 60 elderly outpatients with MDD, BD, or SZ (20 patients per group) was assessed using the Japanese version of the Brief Assessment of Cognition in Schizophrenia. Patients with MDD had significantly higher z scores than both the other groups with large or moderately large effect sizes, for verbal fluency, attention and speed of information processing, and composite scores. In contrast, there were no significant differences in the degree of neurocognitive impairment between patients with BD and SZ. In later life, patients with BD and SZ showed a similar degree of neurocognitive impairment, while patients with MDD showed smaller impairments in several neurocognitive domains compared to patients with either of the other two disorders.










Advanced paternal age is associated with earlier schizophrenia onset in offspring. Results from the national multicentric FACE-SZ cohort.



The association between advanced paternal age (APA) and increased risk of schizophrenia (SZ) is well established. The objectives of the present study were to further determine if SZ participants with APA (APA+), versus those without (APA-), had: (i) different illness characteristics; (ii) different responses to antipsychotic medication; and (iii) different cognitive characteristics. Participants were a non-selected representative multicentric sample of stabilized community-dwelling people diagnosed with SZ included in the FACE-SZ cohort. 389 participants (73% males, mean aged 32.7 years, mean illness duration 10.8 years) formed the study sample, with each comprehensively evaluated, clinically and neuropsychologically, over 2 days. 118 participants (30.3%) were defined as APA+ according to their father's age at birth (≥35 years). APA+ was associated with a wide range of cognitive dysfunctions in univariate analyses. In multivariate analyses, the only significant difference was the age at onset, with a mean 1.6 year earlier in APA+, compared to APA- (20.7 vs. 22.3 years; p=0.02). This difference is independent of sociodemographic characteristics and I.Q. No association with clinical symptomatology and treatment response was found. The present study supports the neomutation hypothesis and confirms APA as a relevant clinical variable to discriminate potential schizophrenia subtypes. Potential underlying pathophysiological mechanisms are discussed.


国民の大多数からFACE-SZ コホートの結果、高年齢の父親をもつ子供は早期統合失調症を発症する関連性がある



高年齢の父親(APA)統合失調症(SZ)のリスクの関連性は十分確立されている。現在の研究の目的は、高年齢の父親(APA+)から生まれた子供の統合失調症(SZ)と高年齢ではない父親(APA-)から生まれた子供の統合失調症(SZ)は、(1)疾患の特徴は異なるのか、(2)抗精神病薬の投薬による反応の違い、(3)認知の特徴の違いを未来に向けて明らかにしたかった。当事者はFACE-SZコホートの中からSZと診断された人で多数の安定したコミュニティー住宅から無選抜で代表者を選択した。389人の当事者たち(73%男性で平均32.7歳、発症から平均10.8)が、臨床的かつ神経心理学的に2日以上それぞれ包括的に見極めて、研究のサンプルに使われた。118人の当事者たち(30.3%)は、父親35歳以上の時に生まれたAPA+として定められた。APA+は、単変量解析における認知機能障害が大幅に関連していた。多変量解析によると、単に発症の年齢が明らかに異なっており、APA+APA-を比較してAPA+1.6年早く発症していた (20.7歳対22.3歳、p=0.02) 。この違いは、社会人口学的特徴とI.Q.による独自のものである。臨床症候と治療の反応と関連するものは見つからなかった。現在の研究は、新型突然変異の仮説を支持し、潜在的統合失調症亜型と識別するために、臨床的に変異性と関連あるようなAPAを確認する。潜在的な根底にある病態生理学的メカニズムについて議論されている。



若年性筋緊張性ジストロフィー 1型における妄想性障害および精神病性障害

Delusional and psychotic disorders in juvenile myotonic dystrophy type-1.



We investigated the clinically derived hypothesis of a relatively high incidence of delusional and psychotic disorders in adolescents with juvenile Myotonic Dystrophy type-1 (DM1). Twenty-seven subjects of age 16-25 with juvenile DM1 and their parents were invited to have a clinical psychiatric interview, and to complete an ASEBA behavior checklist (YSR, ASR, CBCL, and ABCL). We diagnosed a Delusional Disorder in 19% of our patients and a Psychotic Disorder not otherwise specified in another 19%. These two groups of patients had a significantly worse level of clinically defined general functioning. It is clinically relevant to investigate in patients with juvenile DM the symptom of delusions and the presence of a delusional and psychotic disorder, and to consider the presence of juvenile DM in youngsters presenting with such a thought disorder. These disorders compromise the general functioning of the subjects and are often to some extent treatable.


若年性筋緊張性ジストロフィー 1型における妄想性障害および精神病性障害



若年性筋緊張性ジストロフィー 1 (DM1) を有する青年において、高い確率の妄想性障害および精神病性障害に関して臨床的に導きだされた仮説を調査した。若年性DM1を有する16歳~25歳までの27名の被検者とその両親は、臨床精神医学の面接を受け、ASEBA行動チェックリスト(YSR,ASR,CBCLおよびABCL)の完成を求められた。患者の19%が妄想性障害、その他の患者のうち19%が特定されていない精神病であると診断された。これらの患者の2つのグループは、臨床的に定義された一般の機能的レベルより顕著に悪かった。若年性DMを有する患者より妄想の症状、妄想と精神病の存在を調査し、そのような障害が若者の間で存在することを考察することは、臨床的に適切なことである。これらの疾患は課題から一般的要因に歩み寄り、よくある治療にこぎつける。




Case 14-2016 — A 37-Year-Old Woman with Adult-Onset Psychosis


Examination of a 37-year-old woman with adult-onset psychosis revealed weight loss, a thyroid nodule, anemia, and micronutrient deficiencies. Diagnostic tests were performed.


症例14-2016 成人発症精神病の37歳女性