清水 栄司

AIM: Somatic symptom disorder (SSD) is prevalent in primary healthcare settings and is often challenging to diagnose and treat. This study examined the neurodevelopmental and personality traits of individuals with probable SSD. METHODS: This cross-sectional study utilized anonymous online surveys. In this study, individuals with a score of 23 or higher on the Somatic Symptom Disorder-B Criteria Scale (SSD-12) were defined as having probable SSD, and individuals with no somatic symptoms and who scored 0 were defined as the healthy control (HC) group. We compared groups regarding neurodevelopmental traits, personality traits, depression, and anxiety using self-report questionnaires and analysis of covariance. In addition, we examined the association between neurodevelopmental traits, emotional problems, and SSD in the probable SSD group using structural equation modeling. RESULTS: A total of 491 people with probable SSD and 532 age- and sex-matched HCs were analyzed. The scores for somatic symptom severity, depression, generalized anxiety, health anxiety, attention deficit/hyperactivity disorder traits, autism spectrum disorder traits, personality traits, and personality disorder traits showed significant differences between the probable SSD group and the HC group. In the probable SSD group, neurodevelopmental traits positively and directly affected emotional problems and SSD. CONCLUSION: Most neurodevelopmental and personality traits were associated with probable SSD. When approaching patients suspected of having SSD, clinicians may consider not only somatic symptoms, but also neurodevelopmental traits, personality traits, depression, and anxiety.

OBJECTIVE: Non-verbal Screening Test for Aphasia and Dysarthria scores correlate with post-stroke cognitive function; however, their correlations with activities of daily living dependency and home discharge (cognitive function-associated outcomes) remain unclear. We investigated the correlation of these scores with activities of daily living dependency and home discharge outcomes. MATERIALS AND METHODS: Disability levels and functional outcomes of 278 inpatients with brain injury (age: 72.8 ± 13.0 years) were evaluated using the modified Rankin Scale. Patients were grouped according to activities of daily living dependency (independent [n = 96; modified Rankin Scale score≤2]) and non-home discharge (n = 126) status. Factors predicting home discharge were analyzed using univariate and multivariate logistic regression analyses. RESULTS: Cognitive impairment was more prevalent in the activities of daily living-dependent group than in the independent group (odds ratio: 6.34 [95 % confidence interval: 3.57-11.52]; p < 0.001) and in the non-home discharge than in the home discharge group (2.78 [1.65-4.73]; p < 0.001). Non-verbal test scores correlated moderately with activities of daily living independence and home discharge. Age, modified Rankin Scale score, cognitive impairment, and the Screening Test for Aphasia and Dysarthria scores were significantly associated with home discharge in univariate analyses. Only modified Rankin Scale and non-verbal test scores were significantly associated with home discharge in multivariate analysis (p < 0.001). CONCLUSIONS: Non-verbal test scores were significantly associated with activities of daily living independence and home discharge in patients with stroke. The non-verbal test, being less influenced by communicative disorders, offers a novel tool for estimating cognitive function.

児童生徒の自殺予防に係る取組として,WEBでの子どものストレスチェックを推進している.現時点で,学校長,教頭,副校長,学年主任,担任等が職員会議,教育相談部会で子どものストレスチェックの実施の情報共有を行い,教育相談担当教員が中心となり,実施する学校が多い.今後は,2次予防の健康診断のように学校医が養護教諭とともに,1次予防の子どものストレスチェックを実施する形や保健体育の教員が保健体育の「心身の相関とストレス」単元等の授業の中でアクティブ・ラーニングとして活用する形も期待している.ストレス対処法である認知行動療法を活用し,不登校の児童生徒等が登校再開する際の3次予防として,復帰支援,再発予防にも取り組むべきである.政策提言として,いじめの認知件数のように,高ストレス児童生徒の認知件数を全国の小・中・高等学校及び特別支援学校から文部科学省がデータ収集し,自殺対策に活用していただきたいと考えている.(著者抄録)

BACKGROUND: Background: Cognitive behavioral therapy for psychosis (CBTp) is not widespread enough in clinical practice, although evidence has been presented. OBJECTIVE: Objective: The purpose of this study was to explore whether one-on-one CBTp using video-conference (vCBTp) was more effective than usual care (UC) treatment alone in improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. METHODS: Methods: In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp was conducted once a week, with each section lasting for 50 min, for a total of seven sessions in real-time and one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline at week 0 to post-test at week 8. RESULTS: Results: There were 24 participants in the study. There were no significant differences between the two groups at baseline. With regard to significant differences between the two groups on the primary outcome, the mean change in PANSS total score from baseline to week 8 in the vCBTp plus UC group was -9.5 (95% CI -12.09 to -6.91); the mean change in the UC alone group was 6.9 (95% CI 1.54 to 12.30). The difference between the two groups was significant at P<.001. In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder (GAD-7, P=.042) and the EuroQol 5-dimensions 5-lines (EQ-5D-5L, P=.005). There were no dropouts and no serious adverse events in this study. CONCLUSIONS: Conclusions: A total of seven remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life (QoL). However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the two groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety about transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. CLINICALTRIAL: Trial Registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544. INTERNATIONAL REGISTERED REPORT: RR2-DOI: 10.1136/bmjopen-2022-069734.

BACKGROUND: School-based cognitive behavioral therapy (CBT) programs could contribute toward preventing anxiety disorders in children. However, setting aside class time for such programs is difficult. Internet-based CBT (I-CBT) is an efficient way to provide CBT. However, studies on I-CBT for anxiety prevention remain scarce, including I-CBT for school-based universal prevention programs. Therefore, we developed an e-learning version of a school-based anxiety-prevention CBT program, "Journey of the Brave," which was effective in Japan, to make it more flexible and accessible. This study evaluated its feasibility. METHODS: We conducted a single-arm study based on 44 parents and children. Children aged 10-12 years took the e-learning program at home. Parents and children responded to a questionnaire three times: before the learning (Pre), after the learning (Post), and three months later (FU: Follow-up). Feasibility was comprehensively evaluated through dropout rates, satisfaction and learning records, and changes in scores on psychological scales assessing anxiety symptoms, emotion-regulation skills, and children's emotional and behavioral problems. RESULTS: Of the 44 children, 42 started the e-learning, and 32 continued it (dropout rate of 23.8%). Furthermore, 83.9% of the children and 96.8% of the parents responded "agree" or "somewhat agree" regarding overall satisfaction. The parent-rated Spence Children's Anxiety Scale(SCAS) (SCAS-P) showed a significant decrease between Pre and FU (p = 0.014, 95% CI = (-9.22, -0.84)); however, the child-rated SCAS (SCAS-C) reduction was not significant (p = 0.08). The Emotion‑Regulation Skills Questionnaire (ERSQ) also increased significantly between Pre and FU (p = 0.045, 95% CI = (0.18, 18.31)). The Total Difficulties Score of the Strengths and Difficulties Questionnaire(SDQ) decreased significantly from Pre to Post (p = 0.025, 95% CI = (-3.62, -0.19)); however, it was not significantly different between Pre and FU (p = 0.67). CONCLUSION: The e-learning version showed low dropout rates and high satisfaction ratings from parents and children. Moreover, this study did not rule out the possibility that the program reduced children's anxiety and improved their emotional-regulation skills. Therefore, its potential and feasibility were indicated. TRIAL REGISTRATION: UMIN, UMIN000049182, Registered 11 October 2022.