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Tetsu Tomita, Yui Sakamoto, Manabu Saito, Kojiro Hashimoto, Yasuki Ono, Kazuhiko Nakamura Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, JapanCorrespondence: Tetsu Tomita, Tel +81-172 39 5066, Fax +81-172 39 5067, Email ttomita1984@yahoo.co.jpBackground: We observed two cases of patients with schizophrenia who were treated with clozapine (250mg/day and 275mg/day, respectively) and showed neutropenia after receiving a COVID-19 vaccine (BNT162b2).Case Presentation: Case 1 is a twenty-two year old woman with a diagnosis of schizophrenia. She enrolled in Clozaril® Patient Monitoring Service in 2017 and had been taking clozapine for 4 years. She received two doses of a COVID-19 vaccine and developed neutropenia (1850/mm3 (37.9% of white blood cell 4880/mm3)) 6 days after the second vaccination, but her neutropenia self-resolved naturally. Case 2 is a twenty year old woman with a diagnosis of schizophrenia. She enrolled in Clozaril® Patient Monitoring Service in 2020 and had been taking clozapine for 10 months. She received two doses of a COVID-19 vaccine and white blood cell and neutrocyte counts were below (3730/mm3 and 1440/mm3 (38.6%), respectively) the lower limits 3 days after the second vaccination. She had to discontinue clozapine according to the withdrawal definition (her neutrocyte count was < 1500/mm3), and her neutropenia self-resolved naturally.Conclusion: Physicians need to have a strict follow-up protocol in place for patients after vaccination for COVID-19.Keywords: clozapine, COVID-19, vaccine, neutropenia

Tetsu Tomita,1 Shuhei Kudo,2 Norio Sugawara,3 Akira Fujii,4 Koji Tsuruga,5 Yasushi Sato,1 Masamichi Ishioka,6 Kazuhiko Nakamura,1 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan; 2Department of Psychiatry, Tsugaru General Hospital, Goshogawara, Japan; 3Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan; 4Department of Mental Health, Mutsu General Hospital, Mutsu, Japan; 5Department of Psychiatry, Aomori Prefectural Tsukushigaoka Hospital, Aomori, Japan; 6Department of Psychiatry, Minato Hospital, Hachinohe, JapanCorrespondence: Tetsu TomitaDepartment of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki 036-8562, JapanTel +81 172 39 5066Fax +81 172 39 5067Email ttomita1984@yahoo.co.jpBackground: We aimed to reveal sex differences in depression comprehension by reanalyzing data from a previous study of patients who were administered antidepressants.Methods: A total of 424 outpatients were enrolled in the study. Participants were provided an original self-administered questionnaire that comprised eight items: depressive symptoms, course of depression, cause of depression, treatment plan, duration of antidepressant use, how to discontinue antidepressants, side effects of antidepressants, and psychotherapy. Each item consisted of the following two questions: “Have you received an explanation from the doctor in charge?” and “How much do you understand about your treatment?” The level of patients’ comprehension of these questions was rated on a scale of 0–10 (11 anchor points). Symptoms were evaluated using the Quick Inventory for Depressive Symptomatology, Japanese version, and other scales. Patients were divided on the basis of sex, regardless of whether they were in remission.Results: Compared with male patients, female patient

Kenji Kishi, Kazutoshi Kubo, Tetsu Tomita, Kazuhiko Nakamura, Norio Yasui-Furukori Department of Neuropsychiatry, Hirosaki University Graduate School of Medicine, Hirosaki, Japan Abstract: Some patients with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed with psychiatric disease. We present the case of a 72-year-old Japanese female who exhibited violent behavior while asleep and received a diagnosis of suspected rapid eye movement sleep behavior disorder (RBD). She was admitted to the psychiatry ward after receiving levomepromazine 25 mg intramuscularly. The patient’s blood glucose level was 27 mg/dL at the time of hospitalization, and a biochemical examination revealed that her insulin level was 9.1 µU/mL and C-peptide level was 2.16 ng/mL. A contrast-enhanced computed tomography revealed a mass 8 mm in diameter in the pancreatic head. The diagnosis was changed from RBD to insulinoma. The sleep behavior disorder disappeared after continuous glucose administration. After enucleation of the insulinoma, the administration of glucose was discontinued, and her blood glucose levels recovered. This case suggests that insulinoma should be considered by physicians and psychiatrists in the differential diagnosis of patients with symptoms presenting as RBD. Keywords: insulinoma, differential diagnosis, hypoglycemia, rapid eye movement sleep behavior disorder

Tetsu Tomita,1 Norio Yasui-Furukori,1 Taku Nakagami,2 Shoko Tsuchimine,3 Masamichi Ishioka,4 Ayako Kaneda,1 Kazuhiko Nakamura1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan; 2Department of Psychiatry, Nakagami Mental Clinic, Odate, Japan; 3Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; 4Department of Psychiatry, Minato Hospital, Hachinohe, Japan Background: We studied the differences between groups that were divided according to personality characteristics with respect to the relationship between drug concentration and symptom improvement.Methods: A total of 120 patients with major depressive disorder were treated with paroxetine for 6 weeks, and 89 patients completed the protocol. The Montgomery–Åsberg Depression Rating Scale (MADRS) was used to evaluate the patients. Patients’ paroxetine plasma concentrations at week 6 were measured. Their personalities were evaluated by the Temperament and Character Inventory (TCI) at the first visit. We divided the patients into two groups according to the median of each TCI dimension. We compared the responder rate between “high” and “low” groups in each TCI dimension and analyzed Pearson’s correlation coefficients of paroxetine plasma concentration and MADRS-improvement rate.Results: A total of 62 patients completed the TCI. Low-novelty-seeking, high-harm-avoidance, low-reward-dependence, and low-self-directedness groups exhibited significant negative correlations between paroxetine plasma concentration and MADRS improvement. Among the groups with combined personality traits, the high-harm-avoidance and low-self-directedness groups showed a markedly significant negative correlation.Conclusion: Patients with depression exhibiting specific personality traits, especially those with high harm-avoidance and low self

Tetsu Tomita,1 Shuhei Kudo,2 Norio Sugawara,3 Akira Fujii,4 Koji Tsuruga,5 Yasushi Sato,1 Masamichi Ishioka,6 Kazuhiko Nakamura,1 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, 2Department of Psychiatry, Tsugaru General Hospital, Goshogawara, 3Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, 4Department of Mental Health, Mutsu General Hospital, Mutsu, 5Department of Psychiatry, Aomori Prefectural Tsukushigaoka Hospital, Aomori, 6Department of Psychiatry, Minato Hospital, Hachinohe, Japan Background: We analyzed data on the understanding of depression among patients who were prescribed antidepressants to determine when psychoeducation should be provided.Patients and methods: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire consisting of eight categories: (A) depressive symptoms, (B) the course of depression, (C) causes of depression, (D) the treatment plan, (E) the duration of antidepressant use, (F) discontinuation of antidepressants, (G) the side effects of antidepressants, and (H) psychotherapy. Each category was assessed with the following two questions: “Have you received an explanation of this topic from the doctor in charge?” and “How much do you understand about your treatment?” The level of understanding of patients was rated on a scale from 0 to 10 (no understanding to full understanding; 11 anchor points). Symptoms were evaluated using the Quick Inventory for Depressive Symptomatology, Japanese version (QIDS-J) and other scales. Participants were divided into two groups: patients receiving psychoeducation at their first visit vs patients receiving psychoeducation after their first visit.Results: Of the patients who had received an explanation of each psychoeducation item, a greater proportion were in the first visit group

Tetsu Tomita,1 Shuhei Kudo,2 Norio Sugawara,3 Akira Fujii,4 Koji Tsuruga,5 Yasushi Sato,1 Masamichi Ishioka,6 Kazuhiko Nakamura,1 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan; 2Department of Psychiatry, Tsugaru General Hospital, Goshogawara, Japan; 3Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan; 4Department of Mental Health, Mutsu General Hospital, Mutsu, Japan; 5Department of Psychiatry, Aomori Prefectural Tsukushigaoka Hospital, Aomori, Japan; 6Department of Psychiatry, Minato Hospital, Hachinohe, Japan Background: To reveal characteristics of understand­ing of depression among older patients, we reanalyzed the data from a previous study of patients who were administered antide­pressants.Methods: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire consisting of eight items: depressive symptoms, the course of depression, the cause of depression, the treatment plan, the duration of antide­pressant use, how to discontinue antidepressants, the side effects of antidepressants, and psychotherapy. Each item consisted of the following two questions: “Have you received an explanation from the doctor in charge?” and “How much do you understand about your treatment?”. The level of understanding was rated on a scale of 0–10 (11 anchor points). Subjects were divided into two groups: younger patients who were <65 years of age and older patients who were ≥65 years of age. Results: Older patients with depression showed lower levels of understanding of depression and did not receive sufficient psychoeducation from their physicians, but their understanding of depression might not be associated with their remission. In the younger group, the scores of understanding of the course of depres

Norio Sugawara,1,2 Kazuma Danjo,3 Hanako Furukori,4 Yasushi Sato,2,5 Tetsu Tomita,2,6 Akira Fujii,7 Taku Nakagami,2,8 Kazuyo Kitaoka,9 Norio Yasui-Furukori2 1Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 2Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori, 3Mizoguchi Mental Hospital, Shizuoka, 4Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi, 5Department of Psychiatry, Mutsu General Hospital, Mutsu, 6Department of Psychiatry, Hirosaki-Aiseikai Hospital, Kitazono, Hirosaki, 7Department of Psychiatry, Seihoku-Chuoh Hospital, Goshogawara, Aomori, 8Department of Psychiatry, Odate Municipal General Hospital, Odate, Akita, 9Mental Health Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan Background: Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work–family conflict (WFC) in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan. Methods: In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work–Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis. Results: The relationship between emotional exhaustion and occupational factors, including quantitat

Tetsu Tomita,1 Norio Yasui-Furukori,1 Norio Sugawara,1,2 Kohei Ogasawara,3 Koki Katagai,3 Hisao Saito,4 Kaori Sawada,5 Ippei Takahashi,5 Kazuhiko Nakamura1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan; 2Aomori Prefectural Center for Mental Health and Welfare, Aomori, Japan; 3School of Medicine, Hirosaki University, Hirosaki, Japan; 4Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan; 5Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan Background: We investigated the prevalence of depression in hemodialysis (HD) patients using the Center for Epidemiologic Studies for Depression (CES-D) scale and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) and compared the rates with those of community dwelling people in Japan.Patients and methods: A total of 99 patients undergoing HD were recruited. Blood sampling was performed no later than 2 weeks prior to assessment. As a reference group for SCID and CES-D evaluation, 404 age- and sex-matched healthy controls who had participated in the Iwaki Health Promotion Project were included in this study. The SCID and the CES-D scale were administered to all participants to diagnose their depression. Participants who met the criteria of a major depressive episode according to the SCID were classified as SCID depression and the participants whose CES-D score was 16 or higher were classified as CES-D depression.Results: Ninety-nine HD patients completed the evaluation and data collection. There were no significant differences in age, sex, or CES-D scores between HD patients and controls. There were 12 cases of SCID depression in HD patients and four cases in controls. There was a significant difference between HD patients and controls in the prevalence of SCID depression. There were no significant differences between the two groups with regard to dem

Tetsu Tomita,1 Norio Yasui-Furukori,1 Masaki Oka,1 Takaaki Shimizu,2 Aya Nagashima,2 Kento Mitsuhashi,2 Hisao Saito,3 Kazuhiko Nakamura1 1Department of Neuropsychiatry, Graduate School of Medicine, 2School of Medicine, Hirosaki University, 3Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan Background: Many studies have investigated insomnia and the factors associated with this condition in hemodialysis (HD) patients, although the influence of HD duration has not been thoroughly investigated. In the present study, we investigated the factors, especially the duration of HD, associated with insomnia in HD patients.Patients and methods: A total of 138 patients undergoing HD were recruited, and the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess the quality of sleep. Subjects with a total PSQI score up to 4 and those with a score of at least 5 were identified as normal subjects and subjects with insomnia, respectively. Additionally, we assessed restless legs syndrome, depression using the Center for Epidemiologic Studies Depression Scale, and health-related quality of life (QOL) using the Short Form 8 Health Survey. We divided the subjects into two groups according to the median HD duration.Results: The prevalence rate of insomnia was 54.3% among all the subjects. Twenty-one subjects (15.2%) had depression, 26 (18.8%) had restless legs syndrome, and 75 (54.3%) had insomnia. The median HD duration was 4 years. The scores of components 1 and 4 of the PSQI, subjective sleep quality and habitual sleep efficiency, did not show a significant difference between the normal and insomnia groups. The score of component 7, daytime dysfunction, showed a significant difference between the short and long HD duration groups. In multiple regression analysis, the score of the Short Form 8 Health Survey showed a significant association with the PSQI score in the long HD duration group, but no variable showed a significant ass

Tetsu Tomita,1 Norio Yasui-Furukori,1 Norio Sugawara,1,2 Ippei Takahashi,3 Kaori Sawada,3 Kazuhiko Nakamura11Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, 2Aomori Prefectural Center for Mental Health and Welfare, Aomori, 3Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, JapanBackground: We aimed to discriminate individuals with depressive state from individuals with cognitive impairment among community-dwelling people using the subjective memory complaints (SMC) scale.Methods: The study group consisted of 289 volunteers (over 60 years old; 104 males and 185 females). Participants’ SMCs were assessed using the SMC scale. The Japanese version of the Center for Epidemiologic Studies for Depression scale and the Mini-Mental State Examination were administered. Participants whose Center for Epidemiologic Studies for Depression scores were 16 or higher were defined as the depressive group and participants whose Mini-Mental State Examination scores were less than 24 were defined as the cognitive impairment group. Exploratory factor analysis was performed to identify the factor structure of the items of the SMC scale. A multiple logistic regression analysis of the association between depressive state and cognitive impairment and the score of each factor was performed.Results: In the final factor analysis model, six items of the SMC scale remained, and a two-factor structure was adequate. Factor 1 included the items 8, 9, and 10 about thought or the ability to think; thus, Factor 1 was defined as “thought disturbance factor”. Factor 2 included the items 1, 2, and 4 about memory or forgetfulness; thus, Factor 2 was defined as “memory disturbance factor”. In the multiple logistic regression analysis, Factor 1 was significantly associated with depressive state and Factor 2 was sign

Norio Sugawara,1 Norifumi Metoki,2 Joji Hagii,2 Shin Saito,2 Hiroshi Shiroto,2 Tetsu Tomita,1 Minoru Yasujima,2 Ken Okumura,3 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan; 2Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan; 3Department of Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan Background: Depression after stroke is one of the most serious complications of stroke. Although many studies have shown that the length of hospital stay (LOHS) is a measurable and important stroke outcome, research has found limited evidence concerning the effect of depression on LOHS among patients who have experienced acute stroke. The objective of this study was to assess the effect of depression on LOHS among patients hospitalized for acute ischemic stroke in Japan. Methods: We retrospectively examined 421 patients who had experienced acute ischemic stroke. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS) on the 7th day of hospitalization. On the 10th day of hospitalization, depressive symptoms and functional assessment were assessed by the Japan Stroke Scale (Depression Scale) and the Functional Independence Measure, respectively. A general linear model was employed to assess the effect of probable depression on LOHS. Results: The prevalence of probable depression in the current sample was 16.3% in males and 17.8% in females. The mean LOHS of participants with probable depression (76.4±49.2 days) was significantly longer than that of participants without probable depression (44.9±39.2 days). An analysis using the general linear model to assess the effect on LOHS revealed a significant interaction between the presence of probable depression and NIHSS scores. Conclusion: Depression after stroke was associated with significant increases in LOHS. Early detection and treatment for depression are necessary for patients with ischemic

Shuhei Kudo,1 Tetsu Tomita,1 Norio Sugawara,1,2 Yasushi Sato,1 Masamichi Ishioka,3 Koji Tsuruga,4 Taku Nakagami,5 Kazuhiko Nakamura,1 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, 2Aomori Prefectural Center for Mental Health and Welfare, Aomori, 3Department of Psychiatry, Hirosaki Aiseikai Hospital, Hirosaki, 4Department of Psychiatry, Aomori Prefectural Tsukushigaoka Hospital, Aomori, 5Department of Neuropsychiatry, Odate City General Hospital, Odate, Japan Background: We used self-administered questionnaires to investigate the level of understanding of depression among outpatients who were administered antidepressants. Methods: A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire that consisted of eight categories: (A) depressive symptoms, (B) the course of depression, (C) the cause of depression, (D) the treatment plan, (E) the duration of taking antidepressants, (F) how to discontinue antidepressants, (G) the side effects of the antidepressants, and (H) psychotherapy. Each category consisted of the following two questions: “Have you received an explanation from the doctor in charge?” and “How much do you understand about it?” The level of understanding was rated on a scale of 0–10 (11 anchor points). The Quick Inventory of Depressive Symptomatology Japanese version, Global Assessment of Functioning, and Clinical Global Impression – Severity scale were administered, and clinical characteristics were investigated. Results: The percentages of participants who received explanations were as follows: 61.8% for (A), 49.2% for (B), 50.8% for (C), 57.2% for (D), 46.3% for (E), 28.5% for (F), 50.6% for (G), and 36.1% for (H). The level of understanding in participants who received explanations from their physicians was significantly higher compared with patients who did not

Norio Sugawara,1 Norio Yasui-Furukori,1 Tetsu Tomita,1,2 Hanako Furukori,3 Kazutoshi Kubo,1,4 Taku Nakagami,1,4 Sunao Kaneko1 1Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, 2Department of Psychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, 3Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi, 4Department of Psychiatry, Odate Municipal General Hospital, Odate, Japan Background: Recently, a relationship between obesity and schizophrenia has been reported. The prediction of resting energy expenditure (REE) is important to determine the energy expenditure of patients with schizophrenia. However, there is a lack of research concerning the most accurate REE predictive equations among Asian patients with schizophrenia. The purpose of the study reported here was to compare the validity of four REE equations for patients with schizophrenia taking antipsychotics. Methods: For this cross-sectional study, we recruited patients (n=110) who had a Diagnostic and Statistical Manual of Mental Disorders, fourth edition, diagnosis of schizophrenia and were admitted to four psychiatric hospitals. The mean (± standard deviation) age of these patients was 45.9±13.2 years. Anthropometric measurements (of height, weight, body mass index) were taken at the beginning of the study. REE was measured using indirect calorimetry. Comparisons between the measured and estimated REEs from the four equations (Harris–Benedict, Mifflin–St Jeor, Food and Agriculture Organization/World Health Organization/United Nations University, and Schofield) were performed using simple linear regression analysis and Bland–Altman analysis. Results: Significant trends were found between the measured and predicted REEs for all four equations (P<0.001), with the Harris–Benedict equation demonstrating the strongest correlation in both men and women (r=0.617, P<0.001). In all participants, Bland&ndash

Tetsu Tomita, Yasui-Furukori Norio, Yasushi Sato, Taku Nakagami, Shoko Tsuchimine, Ayako Kaneda, Sunao KanekoDepartment of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, JapanBackground: We investigated cutoff values for the early response of patients with major depressive disorder to paroxetine and their sex differences by using a receiver operating characteristic (ROC) curve analysis to predict the effectiveness of paroxetine.Methods: In total, 120 patients with major depressive disorder were enrolled and treated with 10–40 mg/day paroxetine for 6 weeks; 89 patients completed the protocol. A clinical evaluation using the Montgomery–Asberg Depression Rating Scale (MADRS) was performed at weeks 0, 1, 2, 4, and 6.Results: In male subjects, the cutoff values for MADRS improvement rating in week 1, week 2, and week 4 were 20.9%, 34.9%, and 33.3%, respectively. The sensitivities and the specificities were 83.3% and 80.0%, 83.3% and 80.0%, and 100% and 90%, respectively. The areas under the curve (AUC) were 0.908, 0.821, and 0.979, respectively. In female subjects, the cutoff values for the MADRS improvement rating in week 1, week 2, and week 4 were 21.4%, 35.7%, and 32.3%, respectively. The sensitivities and the specificities were 71.4% and 84.6%, 73.8% and 76.9%, and 90.5% and 76.9%, respectively. The AUCs were 0.781, 0.735, and 0.904, respectively.Conclusion: Early improvement with paroxetine may predict the long-term response. The accuracy of the prediction for the response is higher in male subjects.Keywords: antidepressants, paroxetine, early response, sex differences, receiver operating characteristic curve analysisCorrigendum for this paper has been published

Tomita T, Norio YF, Sato Y, et al. Neuropsychiatr Dis Treat. 2014;10:599–606.On page 599, there is an error in the author list "Yasui-Furukori Norio" should read "Norio Yasui-Furukori".Read the original article