小林 聡幸

Matsumoto T, Matsumoto K, Kobayashi T, Kato S, Psychiatry and clinical neurosciences, 2012, vol. 66, no. 3, pp. 242-243

We report on rare side effects of paroxetine. A 67-year-old female patient who had been suffering from prolonged depression for over a year but had not received appropriate treatment was administered 20-mg paroxetine daily. However, the patient required hospital admission after 16 days because of behavioural disturbances and delusions that she was being chased by evil persons from a religious group. The delusions were ultimately confirmed to be serial nightmares and an oneiroid state. The nightmares gradually disappeared following discontinuation of paroxetine. The Adverse Drug Reaction Probability Scale showed a score of 6 (probable). Reports on paroxetine-induced nightmares are rare, and there is a possibility that, in this case, parexetine caused the nightmares in association with depression and assumed underlying brain dysfunction due to ageing.

Kobayashi T, Inoue K, Shioda K, Kato S, Case reports in psychiatry, 2012, vol. 2012, pp. 627460

Depression and dementia, among the most common conditions in clinical practice, sometimes coexist, sometimes succeed each other, and often confuse clinicians. In the present paper, the clinical concept of 'depression-dementia medius' (which includes pseudodementia and depression in Alzheimer's disease as exemplars) is proposed, in reference to Janet's concept of psychological tension. Because psychosomatically complex human lives are always in a state of dynamic equilibrium, it seems sensible to propose that pseudodementia and depression in Alzheimer's disease are located within a spectrum extending from depression without dementia symptoms to dementia without depression. From the Janetian viewpoint, pseudodementia is regarded as uncovered latent dementia as a result of reduced psychological tension. Dementia is more than a fixed progressive condition under this view, and is a manifestation of dynamic mental activities. Characterizing these entities through perspectives such as psychological tension may yield deep insights in clinical practice.

目的:初回エピソード統合失調症の精神病未治療期間(Duration of untreated psychosis:DUP)と治療予後との関係はこれまでにも多数報告されている。しかし,その報告のほとんどは初回入院患者を対象としている。今回われわれは,すべての外来初診患者を対象にして,DUPと1年後治療予後との関係を調査した。方法:ICD-10 F20:統合失調症と診断された56名の初回エピソード患者らは初診時と1年後に簡易精神症状評価尺度(Brief Psychiatric Rating Scale:BPRS)と全般的機能評価尺度(Global Assessment of Functioning:GAF)で臨床評価をされた。結果:DUPが短いほどBPRS改善率,GAF改善率は良好であった。DUPはBPRS改善率,GAF改善率に対して独立した予測因子である可能性が示唆された。短期DUP群(<7ヶ月)は長期DUP群(>7ヶ月)よりBPRS改善率,GAF改善率が有意に良好であった。結論:DUPが短いほど1年後治療予後は良好であった。DUPは1年後治療予後に対して他の予測因子の影響を受けない独立した予測因子である可能性が高いことが示された。DUPは1年後治療予後に対して有意性があることも確認された。

Saito S, Kobayashi T, Osawa T, Kato S, Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, 2010, vol. 10, no. 1, pp. 45-48

Creutzfeldt-Jacob disease (CJD) broadly involves the central nervous system and exhibits a wide variety of symptoms; consequently, patients are frequently misdiagnosed in its early stages with other neuropsychiatric syndromes. In the present paper, the authors report a case of CJD in a patient with alcohol dependence. A 65-year-old woman drank heavily for several years and occasionally had delusions of persecution. After a year of abstinence, she resumed drinking and exhibited behavioral anomalies. She was admitted to an internal medicine ward of a hospital because of an asthmatic attack. She then became unresponsive, bedridden and incontinent, and was moved to the psychotic ward of our hospital. From findings of rapidly progressing dementia, myoclonus, characteristic electroencephalogram, and signal increase in the cortex and basal ganglia on diffusion-weighted magnetic resonance imaging the woman was diagnosed with CJD. CJD is a rare but considerable syndrome in the differential diagnosis of alcohol-related disorders.

Kobayashi T, Kato S, Psychiatry and clinical neurosciences, 2009, vol. 63, no. 6, pp. 773-774

Olfactory reference syndrome (ORS) is a psychiatric condition characterized by a persistent preoccupation with body odor and is regarded as a common clinical entity known as jiko-shu-kyofu orjiko-shu-sho in published Japanese medical reports. However, the condition has not been assigned appropriate significance in recent operational diagnostic criteria. While adolescent patients with ORS seem to nosologically range from patients with obsessive-compulsive disorder to patients with schizophrenia, ORS is likely to be observed in depressive patients during presenile and senile periods. In this paper, two elderly patients with depression and ORS are presented and the relationship between depression and ORS is discussed from the viewpoint of psychopathology. The first case involved a 60-year-old woman with depression who complained that she was emitting a decaying body odor. Six years prior to this episode, she had been plagued by typical depression with inhibition in the next phase of her illness, she manifested little inhibition, but developed ORS, which was effectively treated with clomipramine. The second case was an 88-year-old woman with depression and mild senile dementia who was placed in a nursing home for the elderly. After a delirium-like episode, she became depressed and complained that she was emitting a bad body odor. Clomipramine was efficacious in providing relief from her symptoms. These case studies show two aspects of the relation between depression and ORS. First, ORS appears to arise from the ambiguity surrounding the onset of depressive delusion, in line with S. Kato's discussion of the 'semantic horizon of evil'. Second, ORS appears to be equivalent to the mixed state defined by T. Miyamoto as 'the matrix of both mania and depression'.

The outcome of first-admission schizophrenic patients at Jichi Medical School Hospital was investigated to identify outcome predictors of schizophrenia among the symptoms at the time of the first hospitalization. The subjects were 62 schizophrenic patients, 29 females and 33 males, consecutively discharged from the Department of Psychiatry, Jichi Medical School Hospital, between June 1983 and May 1988. The mean interval between first admission and follow-up was 13 years. Eguma's Social Adjustment Scale was used to measure social outcome. The subjects were divided into two groups according to their rating on Eguma's Scale; a favorable outcome group and an unfavorable outcome group. Information on premorbid status and psychopathology at the time of the first hospitalization was obtained from clinical records and analyzed by comparing them between the two groups. Of the 62 patients, 56 were followed-up. Nine of the 56 patients followed-up had died. While 47 patients were alive; 39 were receiving psychiatric treatment and eight were not. The 47 patients who were still living were divided into two groups; a favorable outcome group (n = 22), and an unfavorable outcome group (n = 25). No significant differences in premorbid status were found. Comparison of psychopathology at the time of the first hospitalization between the outcome groups revealed significant differences in lack of spontaneity and hypochondriac-cenestopathic symptoms. Lack of spontaneity may reflect negative symptomatology, while hypochondriac-cenestopathic symptoms may reflect a serious disturbance of ego function. There is a strong possibility that evaluation of body-related symptoms in schizophrenia will be helpful in predicting outcome.

Toshiyuki KOBAYASHI, Yoshifumi MIYATA, Sohei OKAMOTO, Satoshi KATO, 2004, 'Musical hallucinations induced by bromocriptine', <i>Psychogeriatrics</i>, vol. 4, no. 3, pp. 102-106

Shioda K, Nisijima K, Kobayashi T, Kato S, General hospital psychiatry, 2004, vol. 26, no. 1, pp. 83-84

Kobayashi T, Osawa T, Kato S, European psychiatry : the journal of the Association of European Psychiatrists, 2002, vol. 17, no. 3, pp. 172-173