研究者詳細 - 岸本　泰士郎

論文 - 岸本　泰士郎

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UNDERPIN精神疾患会話コーパスの構築と音声・言語特徴に基づく精神疾患の分類および特徴料分析

田中宏和, 香月祥, 中村啓伸, 岸本泰士郎, 狩野芳伸

人工知能学会全国大会論文集（一般社団法人人工知能学会） JSAI2023 （ 0 ） 3Xin480 - 3Xin480 2023年

<p>我々は1000時間を超える録音時間の診断付き大規模精神疾患会話コーパスUNDERPINを構築してきた。コーパスは疾患名、処方薬、患者の疾患情報と、症状の観察や各種テストによる重症度評価、および対話データからなる。コーパスから抽出した音声・言語特徴量を用いて、うつ病・不安症・統合失調症・認知症・双極性障害と健常者との疾患分類を機械学習によって行ったところ、各疾患の分類性能は疾患により75-91%程度を達成した。特徴量貢献度分析の結果、フォルマント、フィラー、笑い、疑問がこれら疾患を分類するために重要な特徴であると示唆された。</p>

Psychiatrists’ Perspectives on Advantages, Disadvantages and Challenging for Promotion Related to Telemedicine: Japan’s Clinical Experience During COVID-19 Pandemic

Kinoshita S., Kitazawa M., Abe Y., Suda A., Nakamae T., Kanazawa T., Tomita H., Hishimoto A., Kishimoto T.

Journal of Technology in Behavioral Science （Journal of Technology in Behavioral Science） 9 （ 3 ） 532 - 541 2023年

The use of telemedicine in Japan increased during the coronavirus disease pandemic, but is still limited. This study aimed to investigate the perceptions of psychiatrists regarding the use of telemedicine in psychiatry and provide insights into future measures to facilitate its widespread use in Japan. This is the first study of psychiatrists' perceptions of telemedicine in Japan that incorporates quantitative assessments. A web-based questionnaire consisting of 18 Likert scale questions and 6 open-ended questions was conducted in August 2022. Of the 67 psychiatrists who participated in a randomized control trial, initiated in Japan in April 2021 to compare the effectiveness of telemedicine with that of face-to-face treatment, 30 who were in a position to provide regular telemedicine by August 2022 were surveyed. The questionnaire was completed by all 30 psychiatrists surveyed. Ninety percent of the respondents said that telemedicine was a good use of patients’ time, and 93.4% said that it was a cost-effective way for patients to receive care. Of the respondents, 56.6% indicated that telemedicine could be used to address psychiatric problems that could not be resolved through outpatient visits, and 93.4% indicated that the use of telemedicine in clinical research is useful. In response to an open-ended question regarding obstacles to the widespread use of telemedicine, 63.3% of respondents answered that the medical fee determined by the government was inappropriate, and this was the most common response. These results highlight the utility of the use of telemedicine in psychiatry and clinical research. Therefore, more appropriate measures to promote the use of telemedicine are desired in the future.

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Modification of the therapist’s facial expressions using virtual reality technology during the treatment of social anxiety disorder: a case series

Horigome T., Yoshida S., Tanikawa T., Mimura M., Kishimoto T.

Frontiers in Psychology （Frontiers in Psychology） 14 1030050 2023年

ISSN 1664-1078

Exposure therapy is a mainstream of treatment for social anxiety disorder (SAD). However, effort and time are required to recreate interpersonal situations that produce moderate anxiety. On the other hand, virtual reality exposure therapy can easily control anxiety-inducing conditions and allow for graduated exposure. However, artificial intelligence and animations that speak as naturally as actual humans are not yet practical, adding to the limitations of these treatments. The authors propose the use of a virtual reality technology that can transform facial expressions into smiling or sad faces in real time and display them on a monitor, potentially solving the above-mentioned problems associated with virtual reality animations. This feasibility study was conducted to determine whether this system can be safely applied to the treatment of SAD patients. A total of four SAD patients received 16 exposure therapy sessions led by an experienced therapist over a monitor; throughout the sessions, the facial expressions of the therapist were modified using software to display expressions ranging from smiling to sad on the monitor that was being viewed by the patient. Client satisfaction, treatment alliance, and symptom assessments were then conducted. Although one patient dropped out of the study, treatment satisfaction and treatment alliance were scored high in all the cases. In two of the four cases, the improvement in symptoms was sustained over time. Exposure therapy in which the interviewer’s facial expressions are modified to induce appropriate levels of anxiety in the patient can be safely used for the treatment of SAD patients and may be effective for some patients.

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Live two-way video versus face-to-face treatment for depression, anxiety, and obsessive-compulsive disorder: A 24-week randomized controlled trial

Kishimoto T., Kinoshita S., Kitazawa M., Hishimoto A., Asami T., Suda A., Bun S., Kikuchi T., Sado M., Takamiya A., Mimura M., Sato Y., Takemura R., Nagashima K., Nakamae T., Abe Y., Kanazawa T., Kawabata Y., Tomita H., Abe K., Hongo S., Kimura H., Sato A., Kida H., Sakuma K., Funayama M., Sugiyama N., Hino K., Amagai T., Takamiya M., Kodama H., Goto K., Fujiwara S., Kaiya H., Nagao K.

Psychiatry and Clinical Neurosciences （Psychiatry and Clinical Neurosciences） 78 （ 4 ） 220 - 228 2023年

ISSN 13231316

Aim: Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication. Methods: This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. Results: A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction. Conclusion: Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care.

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Electroconvulsive therapy-induced volumetric brain changes converge on a common causal circuit in depression

Argyelan M., Deng Z.D., Ousdal O.T., Oltedal L., Angulo B., Baradits M., Spitzberg A.J., Kessler U., Sartorius A., Dols A., Narr K.L., Espinoza R., van Waarde J.A., Tendolkar I., van Eijndhoven P., van Wingen G.A., Takamiya A., Kishimoto T., Jorgensen M.B., Jorgensen A., Paulson O.B., Yrondi A., Péran P., Soriano-Mas C., Cardoner N., Cano M., van Diermen L., Schrijvers D., Belge J.B., Emsell L., Bouckaert F., Vandenbulcke M., Kiebs M., Hurlemann R., Mulders P.C., Redlich R., Dannlowski U., Erhan K., Kritzer M.D., Ellard K.K., Camprodon J.A., Petrides G., Malhotra A.K., Abbott C.C.

Molecular Psychiatry （Molecular Psychiatry） 2023年

ISSN 13594184

Neurostimulation is a mainstream treatment option for major depression. Neuromodulation techniques apply repetitive magnetic or electrical stimulation to some neural target but significantly differ in their invasiveness, spatial selectivity, mechanism of action, and efficacy. Despite these differences, recent analyses of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)-treated individuals converged on a common neural network that might have a causal role in treatment response. We set out to investigate if the neuronal underpinnings of electroconvulsive therapy (ECT) are similarly associated with this causal depression network (CDN). Our aim here is to provide a comprehensive analysis in three cohorts of patients segregated by electrode placement (N = 246 with right unilateral, 79 with bitemporal, and 61 with mixed) who underwent ECT. We conducted a data-driven, unsupervised multivariate neuroimaging analysis Principal Component Analysis (PCA) of the cortical and subcortical volume changes and electric field (EF) distribution to explore changes within the CDN associated with antidepressant outcomes. Despite the different treatment modalities (ECT vs TMS and DBS) and methodological approaches (structural vs functional networks), we found a highly similar pattern of change within the CDN in the three cohorts of patients (spatial similarity across 85 regions: r = 0.65, 0.58, 0.40, df = 83). Most importantly, the expression of this pattern correlated with clinical outcomes (t = −2.35, p = 0.019). This evidence further supports that treatment interventions converge on a CDN in depression. Optimizing modulation of this network could serve to improve the outcome of neurostimulation in depression.

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A Sphrical Waterflow Vector Sensor in Deep Sea

Kishimoto, T; Matsudaira, K; Tanaka, H; Takahashi, H

2023 IEEE SENSORS 2023年

ISSN 1930-0395

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診断付き精神疾患会話コーパスを用いたうつ病の重症度自動分類と特徴量分析

香月祥, 田中宏和, 中村啓信, 岸本泰士郎, 狩野芳伸

人工知能学会全国大会論文集（一般社団法人人工知能学会） JSAI2023 （ 0 ） 4Xin150 - 4Xin150 2023年

<p>我々はこれまで、診断や疾患評価、音声とその文字起こしや音声・言語学的アノテーションが付与されたUNDERPIN大規模精神疾患会話コーパスを構築してきた。このコーパスを用いて、うつ病患者の分類実験を行った。分類の際は、健常者・軽症患者・中等度以上の患者・うつ病と診断されたことがあるがテストの評価値で症状のない患者の4分類を設定し、4分類のすべてのペア6つそれぞれで2値分類を行った。結果、軽症・中等度以上の重症度に応じた分類ができること、また現在の症状にかかわらずうつ病になった性質で分類可能であることを確認した。分類に貢献した特徴量の分析では、重症度ごとに異なる特徴量や共通している特徴量を確認できた。今後は、新しい特徴量を追加しての学習や、特徴のもととなった人手のアノテーションを自動付与するシステムを構築したい。</p>

Development of medical device software for the screening and assessment of depression severity using data collected from a wristband-type wearable device: SWIFT study protocol

Kishimoto T., Kinoshita S., Kikuchi T., Bun S., Kitazawa M., Horigome T., Tazawa Y., Takamiya A., Hirano J., Mimura M., Liang K.C., Koga N., Ochiai Y., Ito H., Miyamae Y., Tsujimoto Y., Sakuma K., Kida H., Miura G., Kawade Y., Goto A., Yoshino F.

Frontiers in Psychiatry （Frontiers in Psychiatry） 13 1025517 2022年12月

ISSN 1664-0640

Introduction: Few biomarkers can be used clinically to diagnose and assess the severity of depression. However, a decrease in activity and sleep efficiency can be observed in depressed patients, and recent technological developments have made it possible to measure these changes. In addition, physiological changes, such as heart rate variability, can be used to distinguish depressed patients from normal persons; these parameters can be used to improve diagnostic accuracy. The proposed research will explore and construct machine learning models capable of detecting depressive episodes and assessing their severity using data collected from wristband-type wearable devices. Methods and analysis: Patients with depressive symptoms and healthy subjects will wear a wristband-type wearable device for 7 days; data on triaxial acceleration, pulse rate, skin temperature, and ultraviolet light will be collected. On the seventh day of wearing, the severity of depressive episodes will be assessed using Structured Clinical Interview for DSM-5 (SCID-5), Hamilton Depression Rating Scale (HAMD), and other scales. Data for up to five 7-day periods of device wearing will be collected from each subject. Using wearable device data associated with clinical symptoms as supervisory data, we will explore and build a machine learning model capable of identifying the presence or absence of depressive episodes and predicting the HAMD scores for an unknown data set. Discussion: Our machine learning model could improve the clinical diagnosis and management of depression through the use of a wearable medical device. Clinical trial registration: [https://jrct.niph.go.jp/latest-detail/jRCT1031210478], identifier [jRCT1031210478].

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Understanding psychiatric illness through natural language processing (UNDERPIN): Rationale, design, and methodology

Kishimoto T., Nakamura H., Kano Y., Eguchi Y., Kitazawa M., Liang K.C., Kudo K., Sento A., Takamiya A., Horigome T., Yamasaki T., Sunami Y., Kikuchi T., Nakajima K., Tomita M., Bun S., Momota Y., Sawada K., Murakami J., Takahashi H., Mimura M.

Frontiers in Psychiatry （Frontiers in Psychiatry） 13 954703 2022年12月

ISSN 1664-0640

Introduction: Psychiatric disorders are diagnosed through observations of psychiatrists according to diagnostic criteria such as the DSM-5. Such observations, however, are mainly based on each psychiatrist's level of experience and often lack objectivity, potentially leading to disagreements among psychiatrists. In contrast, specific linguistic features can be observed in some psychiatric disorders, such as a loosening of associations in schizophrenia. Some studies explored biomarkers, but biomarkers have yet to be used in clinical practice. Aim: The purposes of this study are to create a large dataset of Japanese speech data labeled with detailed information on psychiatric disorders and neurocognitive disorders to quantify the linguistic features of those disorders using natural language processing and, finally, to develop objective and easy-to-use biomarkers for diagnosing and assessing the severity of them. Methods: This study will have a multi-center prospective design. The DSM-5 or ICD-11 criteria for major depressive disorder, bipolar disorder, schizophrenia, and anxiety disorder and for major and minor neurocognitive disorders will be regarded as the inclusion criteria for the psychiatric disorder samples. For the healthy subjects, the absence of a history of psychiatric disorders will be confirmed using the Mini-International Neuropsychiatric Interview (M.I.N.I.). The absence of current cognitive decline will be confirmed using the Mini-Mental State Examination (MMSE). A psychiatrist or psychologist will conduct 30-to-60-min interviews with each participant; these interviews will include free conversation, picture-description task, and story-telling task, all of which will be recorded using a microphone headset. In addition, the severity of disorders will be assessed using clinical rating scales. Data will be collected from each participant at least twice during the study period and up to a maximum of five times at an interval of at least one month. Discussion: This study is unique in its large sample size and the novelty of its method, and has potential for applications in many fields. We have some challenges regarding inter-rater reliability and the linguistic peculiarities of Japanese. As of September 2022, we have collected a total of >1000 records from >400 participants. To the best of our knowledge, this data sample is one of the largest in this field. Clinical Trial Registration: Identifier: UMIN000032141.

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The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the “Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)” project

Kyou Y., Yasui-Furukori N., Hasegawa N., Ide K., Ichihashi K., Hashimoto N., Hori H., Shimizu Y., Imamura Y., Muraoka H., Iida H., Ohi K., Yasuda Y., Ogasawara K., Numata S., Iga J.i., Tsuboi T., Ochi S., Kodaka F., Furihata R., Onitsuka T., Makinodan M., Komatsu H., Takeshima M., Kubota C., Hishimoto A., Atake K., Yamagata H., Kido M., Nagasawa T., Usami M., Kishimoto T., Kikuchi S., Matsumoto J., Miura K., Yamada H., Watanabe K., Inada K., Hahimoto R.

Annals of General Psychiatry （Annals of General Psychiatry） 21 （ 1 ） 52 2022年12月

ISSN 1744-859X

Background: Several guidelines recommend monotherapy in pharmacotherapy for schizophrenia and major depressive disorder. The content of regular prescriptions has been reported in several studies, but not enough research has been conducted on the content of pharmacotherapy, including pro re nata (PRN) medications. The purpose of this study was to evaluate the content of pharmacotherapy, including PRN medications, and to clarify the relationship with regular prescriptions. Methods: We used data from the “Effectiveness of Guidelines for Dissemination And Education in psychiatric treatment” (EGUIDE) project to investigate the presence or absence of PRN psychotropic medications at discharge for each drug category. We compared the PRN psychotropic prescription ratio at discharge by diagnosis for each drug category. The antipsychotic monotherapy ratio and no prescription ratio of other psychotropics for schizophrenia at discharge and the antidepressant monotherapy ratio and no prescription ratio of other psychotropics for major depressive disorder at discharge were calculated for each regular prescription, including PRN psychotropic medications, as quality indicators (QIs). Spearman's rank correlation test was performed for QI values of regular prescriptions and the QI ratio between regular prescriptions and prescriptions including PRN medications for each diagnosis. Results: The PRN psychotropic prescription ratio at discharge was 28.7% for schizophrenia and 30.4% for major depressive disorder, with no significant differences by diagnosis. The prescription ratios of PRN antipsychotic medications and PRN antiparkinsonian medications were significantly higher for schizophrenia. The prescription ratios of PRN anxiolytic and hypnotic and PRN antidepressant medications were significantly higher for patients with major depressive disorder. For both schizophrenia and major depressive disorder, the QI was lower for discharge prescriptions, including PRN medications, than for regular prescriptions. QI values for regular prescriptions and the QI ratio were positively correlated. Conclusions: Considering PRN psychotropic medications, the monotherapy ratio and no prescription ratio of other psychotropics at discharge decreased in pharmacotherapy for schizophrenia and major depressive disorder. A higher ratio of monotherapy and no prescription of other psychotropics on regular prescriptions may result in less concomitant use of PRN psychotropic medications. Further studies are needed to optimize PRN psychotropic prescriptions.

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Identifying neurocognitive disorder using vector representation of free conversation

Horigome T., Hino K., Toyoshiba H., Shindo N., Funaki K., Eguchi Y., Kitazawa M., Fujita T., Mimura M., Kishimoto T.

Scientific Reports （Scientific Reports） 12 （ 1 ） 12461 2022年12月

ISSN 2045-2322

In recent years, studies on the use of natural language processing (NLP) approaches to identify dementia have been reported. Most of these studies used picture description tasks or other similar tasks to encourage spontaneous speech, but the use of free conversation without requiring a task might be easier to perform in a clinical setting. Moreover, free conversation is unlikely to induce a learning effect. Therefore, the purpose of this study was to develop a machine learning model to discriminate subjects with and without dementia by extracting features from unstructured free conversation data using NLP. We recruited patients who visited a specialized outpatient clinic for dementia and healthy volunteers. Participants’ conversation was transcribed and the text data was decomposed from natural sentences into morphemes by performing a morphological analysis using NLP, and then converted into real-valued vectors that were used as features for machine learning. A total of 432 datasets were used, and the resulting machine learning model classified the data for dementia and non-dementia subjects with an accuracy of 0.900, sensitivity of 0.881, and a specificity of 0.916. Using sentence vector information, it was possible to develop a machine-learning algorithm capable of discriminating dementia from non-dementia subjects with a high accuracy based on free conversation.

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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 J.i., 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

Aims: The Guidelines for the Pharmacotherapy of Schizophrenia were established to improve the quality of medical care, and the EGUIDE project was conducted to train clinicians on guideline usage. A quality indicator (QI) was established to measure the prevalence of the guidelines, and a survey was conducted, which revealed a gap between the guidelines and actual clinical practice (evidence-practice-gap). The purpose of this study was to develop an individual fitness score (IFS) formula that expresses the degree to which prescribers adhere to the Guidelines for Pharmacological Therapy of Schizophrenia in a simple manner, and to determine the validity of this formula from a survey of the prescriptions of the EGUIDE project participants'. Methods: To establish appropriate scores, members discussed the proposed formula and then voted on them. The IFS formula developed was set up so that antipsychotic monotherapy would be given 100 points, with points deducted if concomitant or adjunctive antipsychotic medications were used, and a minimum score of 0. To validate this formula, prescriptions of hospitalized schizophrenic patients at admission and at discharge were scored and compared. Result: IFS points vary and ranged from 0 to100. The average pre-admission score for all subjects was 45.6, and the average score at discharge was 54, those were significantly higher during discharge. Conclusions: We developed an IFS formula, a tool to easily visualize the degree to which current prescriptions conform to the guidelines for the pharmacological treatment of schizophrenia.

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Case report: Non-Alzheimer's disease tauopathy with logopenic variant primary progressive aphasia diagnosed using amyloid and tau PET

Momota Y., Konishi M., Takahata K., Kishimoto T., Tezuka T., Bun S., Tabuchi H., Ito D., Mimura M.

Frontiers in Neurology （Frontiers in Neurology） 13 1049113 2022年11月

ISSN 1664-2295

We report a patient with logopenic variant primary progressive aphasia (lv-PPA) who was diagnosed as having non-Alzheimer's disease (AD) tauopathy after multiple biophysical/biological examinations, including amyloid and 18F-florzolotau tau positron emission tomography (PET), had been performed. A woman in her late 60s who had previously been diagnosed as having AD was referred to us for a further, detailed examination. She had been unaware of any symptoms at the time of AD diagnosis, but she subsequently became gradually aware of a speech impairment. She talked nearly completely and fluently, although she occasionally exhibited word-finding difficulty and made phonological errors during naming, word fluency testing, and sentence repetition; these findings met the criteria for the diagnosis of lv-PPA, which is known to be observed more commonly in AD than in other proteinopathies. Magnetic resonance imaging, single photon emission computed tomography, and plasma phosphorylated tau and plasma neurofilament light chain measurements showed an AD-like pattern. However, both 11C-Pittsburgh compound-B and 18F-florbetaben amyloid PET showed negative results, whereas 18F-florzolotau tau PET yielded positive results, with radio signals predominantly in the left superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, and frontal operculum. Whole-genome sequencing revealed no known dominantly inherited mutations in AD or frontotemporal lobar degeneration genes, including the genes encoding amyloid precursor protein, microtubule-associated protein tau, presenilin 1 and 2. To the best of our knowledge, this patient was a rare case of lv-PPA who was diagnosed as having non-AD tauopathy based on the results of multiple examinations, including whole-genome sequencing, plasma measurement, and amyloid and 18F-florzolotau tau PET. This case underscores the clinicopathologically heterogeneous nature of this syndrome.

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The Potential Impact of Age on Gut Microbiota in Patients with Major Depressive Disorder: A Secondary Analysis of the Prospective Observational Study

Miyaho K., Sanada K., Kurokawa S., Tanaka A., Tachibana T., Ishii C., Noda Y., Nakajima S., Fukuda S., Mimura M., Kishimoto T., Iwanami A.

Journal of Personalized Medicine （Journal of Personalized Medicine） 12 （ 11 ） 2022年11月

ISSN 2075-4426

We aimed to investigate the impact of aging on the relationship among the composition of gut microbiota, gastrointestinal (GI) symptoms, and the course of treatment for major depressive disorder (MDD) by analyzing the datasets from our previous study. Patients with MDD were recruited, and their stools were collected at three time points (baseline, midterm, and endpoint) following the usual antidepressant treatment. Gut microbiota were analyzed using 16S rRNA gene sequencing. Patients were categorized into two groups based on their age: the late-life group over 60 years and the middle-aged group under 60 years. GI symptoms were assessed with scores of item 11 of the Hamilton Anxiety Rating Scale. One hundred and ninety samples were collected from 32 patients with MDD. Several gut microbes had higher relative abundances in the late-life group than in the middle-aged group. In addition, the late-life group showed significantly higher diversity in the Chao1 index at baseline compared with the middle-aged group. We further found possible microbial taxa related to GI symptoms in patients with late-life depression. The abundance of several bacterial taxa may contribute to GI symptoms in the late-life depression, and our findings suggest that the therapeutic targets for the application of gut microbiota may differ depending on the age group of patients with depression.

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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 J.I., 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 S.I., Watanabe K., Inada K., Hashimoto R.

International Journal of Neuropsychopharmacology （International Journal of Neuropsychopharmacology） 25 （ 10 ） 818 - 826 2022年10月

ISSN 14611457

Background: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas 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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Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis

Takamiya A., Sienaert P., Gergel T., Gather J., Kishimoto T., Zilles-Wegner D.

Brain Stimulation （Brain Stimulation） 15 （ 5 ） 1246 - 1253 2022年09月

ISSN 1935861X

Background: Electroconvulsive therapy (ECT) is provided for patients with severe and often life-threatening illness, who lack decision making capacity to consent to treatment (DMC-T) in clinical settings. Objective: The aim of this study is to summarize previous studies investigating clinical outcomes of ECT in patients lacking DMC-T. Methods: A systematic review and meta-analysis of studies reporting clinical outcomes of ECT in patients lacking DMC-T with any psychiatric diagnoses was conducted. The primary outcome was clinical improvement. Secondary outcomes were cognitive outcomes and six month readmission rate. Hedges’ g and odds ratios were calculated using a random-effects model. The protocol was registered in Open Science Framework (https://osf.io/rxjkm). Results: Of 3552 identified articles, 41 studies (n = 1299) were included. Approximately 80% of patients lacking DMC-T responded to ECT, and part of the patients regained capacity to consent and consented to further treatment with ECT. A total of seven studies (n = 1081) were included for meta-analysis. Patients without DMC-T showed superior clinical improvement and less cognitive side effects compared with those with DMC-T, whereas the groups did not show any difference in readmission rate. Several clinical characteristics at baseline and ECT techniques were significantly different between the groups. Conclusion: ECT is equally, if not superiorly, effective in patients lacking DMC-T compared to patients with DMC-T. ECT can potentially enhance patients’ autonomy, without increasing the risk of cognitive side effects. These results support the clinical and ethical legitimacy of ECT provision for patients with the most severe illness who lack DMC-T at start of treatment.

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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 J.i., Iida H., Inada K., Watanabe K., Hashimoto R.

Neuropsychopharmacology Reports （Neuropsychopharmacology Reports） 42 （ 2 ） 221 - 225 2022年06月

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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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 J.I., 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05月

ISSN 2056-4724

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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Characteristics of single-channel electroencephalogram in depression during conversation with noise reduction technology

Mitsukura Y., Tazawa Y., Nakamura R., Sumali B., Nakagawa T., Hori S., Mimura M., Kishimoto T.

PLoS ONE （PLoS ONE） 17 （ 4 April ） e0266518 2022年04月

ISSN 1932-6203

Background Previous studies have attempted to characterize depression using electroencephalography (EEG), but results have been inconsistent. New noise reduction technology allows EEG acquisition during conversation. Methods We recorded EEG from 40 patients with depression as they engaged in conversation using a single-channel EEG device while conducting real-time noise reduction and compared them to those of 40 healthy subjects. Differences in EEG between patients and controls, as well as differences in patients’ depression severity, were examined using the ratio of the power spectrum at each frequency. In addition, the effects of medications were examined in a similar way. Results In comparing healthy controls and depression patients, significant power spectrum differences were observed at 3 Hz, 4 Hz, and 10 Hz and higher frequencies. In the patient group, differences in the power spectrum were observed between asymptomatic patients and healthy individuals, and between patients of each respective severity level and healthy individuals. In addition, significant differences were observed at multiple frequencies when comparing patients who did and did not take antidepressants, antipsychotics, and/or benzodiazepines. However, the power spectra still remained significantly different between non-medicated patients and healthy individuals. Limitations The small sample size may have caused Type II error. Patients’ demographic characteristics varied. Moreover, most patients were taking various medications, and cannot be compared to the non-medicated control group. Conclusion A study with a larger sample size should be conducted to gauge reproducibility, but the methods used in this study could be useful in clinical practice as a biomarker of depression.

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特集 AI時代の医師のクリニカル・スキル-君は生き延びることができるか? 【Ⅰ章】AIの特性と能力 ❸10年後のAIはどこまで「診断」できるようになるか?

古川渉太, 木下翔太郎, 岸本泰士郎

総合診療（株式会社医学書院） 32 （ 3 ） 303 - 307 2022年03月

ISSN 21888051

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岸本 泰士郎

論文 - 岸本 泰士郎

岸本　泰士郎

論文 - 岸本　泰士郎