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Introduction of Music Therapy Incorporated into Cognitive Remediation: A New Approach to Cognitive Dysfunction in Psychiatric Disorders and a Preliminary Report on Its Effects in Schizophrenia

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Open Journal of Psychiatry 2019年第1期9卷 23-38页

作者： Naoko Kosugi Chiaki Oshiyama Naoki Kodama shin-ichi niwa Division of Healthcare Informatics Faculty of Healthcare Tokyo Healthcare University Tokyo Japan National Institute of Advanced Industrial Science and Technology (AIST) Artificial Intelligence Research Center Tokyo Japan Department of Radiological Technology Faculty of Medical Technology Niigata University of Health and Welfare Niigata Japan Department of Psychiatry Aizu Medical Center Fukushima Medical University Fukushima Japan

Aim: Cognitive dysfunction and negative symptoms interfere social participation in patients with schizophrenia. Cognitive remediation has proven effective for cognitive deficits. While there are few effective treatments for the negative symptoms of schizophrenia, music therapy is expected to ameliorate negative symptoms. With the goal of improving both cognitive dysfunction and negative symptoms, we originally developed a program of Music Therapy incorporated into Cognitive Remediation (MTCR). We introduce the MTCR program and our preliminary results of conducting MTCR in patients with schizophrenia. Methods: The program was based on the NEAR (neuropsychological educational approach to cognitive remediation) program. The MTCR program uses instrumental performances and ensemble vocal performances to train cognitive functions, which consists of 30 sessions in total, with each session being 60 minutes long (45 minutes of music, 15 minutes of verbal session). The participants attended sessions semiweekly in groups of fewer than 12 members. We measured the participants’ symptoms twice, before the intervention and after the final session. For both measurements, we used the BACS and BPRS. Thirty-six individuals (26 men, 10 women;average age of 42.4 years) with schizophrenia participated in this study. They participated in an average of 28.2 sessions. Results: BACS total scores (p Conclusions: The present study demonstrated that MTCR program can improve both cognitive dysfunction and negative symptoms of patients with schizophrenia, which implies that it can also potentially facilitate the social participation of such patients.

关键词： Schizophrenia Cognitive Remediation Music Therapy Social Participation BACS BPRS

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Efficacy of Cognitive Remediation in Schizophrenia: A Short Review of Its Variable Effects According to Cognitive Domain

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Open Journal of Psychiatry 2015年第2期5卷 170-176页

作者： Akihiko Katsumi Hiroshi Hoshino Satoshi Fujimoto shin-ichi niwa Katsumi Clinic Niigata Japan Department of Neuropsychiatry School of Medicine Fukushima Medical University Fukushima Japan Department of Psychiatry Aizu Medical Center Fukushima Medical University Fukushima Japan

Cognitive impairment is a symptom of schizophrenia and strongly associated with impaired social function. In recent years, cognitive interventions (cognitive remediation therapies) have been implemented and their results have also been reported. Intervention studies have been conducted using a variety of methods that differ in terms of terminology, approach, and targeted cognitive domains. In this study, we examined trends in recent cognitive remediation research conducted subsequent to the meta-analyses of McGurk et al. (2007) and Wykes et al. (2011). We identified studies conducted between 2009 and 2013 to examine computer-assisted cognitive remediation and collated and analyzed the literature describing their major results and trends. Our results indicated improved cognitive performance subsequent to cognitive remediation therapy using computer programs. We found promising outcomes, particularly in reasoning and problem solving, verbal learning and memory, verbal working memory, and attention and vigilance, which replicated the findings of Wykes et al. (2011).

关键词： Schizophrenia Cognitive Deficit Cognitive Remediation Variance Cognitive Domain

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Effects of Lithium and Valproic Acid on the Production of Brain-Derived Neurotrophic Factor in Astrocytoma

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Open Journal of Psychiatry 2014年第3期4卷 261-268页

作者： Koji Ohtomo Satoshi Nishino Masatake Kurita Hirobumi Mashiko shin-ichi niwa Department of Cellular Signaling Graduate School of Pharmaceutical Sciences Tohoku University Sendai Japan Department of Cellular Signaling Graduate School of Pharmaceutical Sciences Tohoku University Sendai Japan School of Medicine Department of Neuropsychiatry Fukushima Medical University Fukushima Japan

No systematic investigation considering BDNF and its receptor TrkB has been conducted on the effects of mood-stabilizing drugs. We therefore decided to quantify BDNF production and the expression of TrkB-T1 receptor and PLCγ in astrocytoma. 1321N human astrocytoma cells were grown to a sufficient quantity in 5% fetal calf serum (FCS). The mood-stabilizing drugs Li and VPA were added to the therapeutic concentrations of 1 mM and 600 μM, respectively. The production of BDNF was determined by an enzyme-linked immunosorbent assay. The expressions of TrkB-T1 and PLCγ were determined by Western blot. The production of BDNF was significantly higher on Day 7 in the VPA samples (P < 0.05) and was significantly suppressed beginning on Day 1 in the Li samples (P < 0.05). TrkB-T1 expression, in contrast to BDNF production, was significantly higher in the VPA samples (P γ expression did not change. Li and VPA seem differently affect BDNF production and TrkB-T1 (BDNF receptor) expression.

关键词： BDNF Bipolar Disorder Lithium PLCγ TrkB Valproic Acid

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Improvement in social skills in patients with schizophrenia following 6 months of day-care treatment

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Open Journal of Psychiatry 2012年第4期2卷 347-354页

作者： Hiroshi Sakuma Yasuhisa Miyamoto Yoshiko Yamamoto Sachie Miura shin-ichi niwa Department of Neuropsychiatry School of Medicine Fukushima Medical University Fukushima Japan

Using role-playing tests simulating real-life situations, we investigated improvement in the social skills, especially information processing, of patients with schizophrenia in response to day-care in psychiatry and social skills training. From 20 pair-matched schizophrenia patients, 10 were assigned to a day-care/SST group and 10 to a control group undergoing usual treatment. After 6 months, sending and receiving skills were assessed by means of role-playing tests, psychiatric symptoms, social function, and cognitive function. The day-care/SST group showed a significant improvement and a large effect size in sending skills. Receiving skills also improved, showing a medium effect size, but the difference from the control group was not statistically significant. No statistically significant changes were observed in the other measures. That no changes occurred in social function, psychiatric symptoms, or cognitive function leads to two conclusions: 1) cognition targeted, specialized training and comprehension of cognitive remediation, psychiatric rehabilitation, and social skill development are necessary for improvement in other domains, especially symptoms and social functions;and 2) improvement resulting from day-care in psychiatry and SST alone is limited. In addition, further investigations over a longer observation period and a greater sample size are needed.

关键词： Role-Playing Schizophrenia Rehabilitation Social Skills Training Day-Care in Psychiatry Cognitive Dysfunction

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Effects of combination pharmacotherapy and social skills training for schizophrenia: A randomized controlled trial

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Open Journal of Psychiatry 2013年第3期3卷 273-282页

作者： Eiko Shimada Nobuo Anzai Emi Ikebuchi shin-ichi niwa Masahisa Nishizono Department of Clinical Psychology Faculty of Health and Medical Science Teikyo Heisei University Tokyo Japan Department of Psychiatry Aizu Medical Center Fukushima Medical University Fukushima Japan Department of Psychiatry Teikyo University School of Medicine Tokyo Japan Department of Psychology Bunkyo Gakuin University Fujimino Japan Institute for Psycho-Social Psychiatry Fukuoka Japan

Pharmaco-psychosocial treatment (PPST) refers to a treatment paradigm combining pharmacotherapy with psychosocial therapy. We conducted an 18-month randomized controlled tracking study to evaluate the efficacy of social skills training (SST) in 11 individuals with schizophrenia on risperidone monotherapy. They were randomized to either SST or non-SST group, and Global Assessment Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS) scores in the 2 groups showed gradual improvement. In the SST group, Digit Span Distraction Test (DSDT) at 12 and 18 months showed significant improvement. The Subjective Deficit Syndrome Scale (SDSS) scores in the SST group showed significant improvement after 6 months and showed a significant difference in comparison between the groups. After the subjective feeling of health was recovered, the items of motivation were recovered as a direct effect of SST. Some items of the Life Assessment Scale for the Mentally Ill (LASMI) score showed significant improvement (or significant trend) in only the SST group after 6 months. Items of daily life, work skills, and self-recognition were continuously improved. We report 2 cases in the SST group that had DSDT improvement in parallel with change of action and communication as a change of social function. This study is only exploratory due to the small number of cases. However, we have demonstrated potential improvement in cognitive function due to learning experiences that required working memory and attention, thus providing improvement in social life.

关键词： Schizophrenia Social Skills Training Randomized Controlled Trail Cognitive Function Risperidone

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Comparison of adults with attention-deficit/hyperactivity disorder versus Asperger’s disorder using the WAIS-R

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Open Journal of Psychiatry 2013年第2期3卷 223-229页

作者： Yasuko Takanashi Hirobumi Mashiko Shuntaro Itagaki Hiromichi Ishikawa Norihiro Miyashita shin-ichi niwa Fukushima Medical University School of Medicine Fukushima Japan

Objective: The present study compared results on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) among adult patients with attention-deficit/hyperactivity disorder (AD/HD) and those with Asperger’s disorder (AD). Method: WAIS-R results were compared between 16 adults with AD/HD (8 men and 8 women;mean age, 33.81 years;mean full-scale IQ, 101.5) and 15 adults with AD (12 men and 3 women;mean age, 30.93 years;mean full-scale IQ, 104.6). Results: Verbal IQ was significantly higher than performance IQ in the AD group. Among various subtests, scores were the highest for similarities in the AD/HD group and for block design in the AD group. Picture completion test scores were the lowest scores obtained in both groups. A comparison of subtest scores between the AD/HD and AD groups showed scores for information to be significantly higher in the AD group than in the AD/HD group. Conclusions: Our results suggest that there are no differences in verbal IQ, performance IQ, and full-scale IQ scores (except for scores on the information subtest) among adult patients with AD/HD compared with adult patients with AD.

关键词： Attention-Deficit/Hyperactivity Disorder (AD/HD) Asperger’s Disorder (AD) Wechsler Adult Intelligence Scale-Revised (WAIS-R) Adult High-Functioning

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UBOM-4, a New Scale for Psychic Function and Energy: General Population Normative Values and Influencing Parameters

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Open Journal of Psychiatry 2018年第4期8卷 390-412页

作者： Daisuke Gotoh Hiroshi Hoshino Kumi Yoshida Yoshiko Akiyama Satoshi Fujimoto Emiko Yoshioka Yumiko Namae shin-ichi niwa Fukushima Prefectural Mental Health and Welfare Center Fukushima Japan Department of Neuropsychiatry School of Medicine Fukushima Medical University Fukushima Japan Koriyama Institute of Health Sciences Fukushima Japan NPO Society of Utena’s Brief Objective Measures of 4 Axes for Psychic Function and Energy Fukushima Japan Niigata University of Rehabilitation Fukushima Japan Aizu Medical Center Fukushima Medical University Fukushima Japan

Objective: We introduce Utena’s Brief Objective Measures of 4 Axes for Psychic Function and Energy (UBOM-4), a new brief test battery for evaluating psychic function concerning intellect, emotion, volition, and imagination. To date, insufficient general population data on the UBOM have been collected. This study aimed to establish the normative values for the general population in UBOM-4 and examine the effects of age, sex, and mental health status on the values. Methods: The General Health Questionnaire, 12-item version (GHQ-12) and UBOM-4 were administered to 149 individuals working in or attending professional schools or universities (73 males, 76 females;age: 19 - 65 years). Participants were classified as healthy based on their GHQ-12 responses and psychiatrist interviews. Results: UBOM-4 measures (mean ± SD) were: pulse rate difference (PRD or UBOM-pulse), −0.72 ± 4.31 beats/min;ruler catching time (RCT or UBOM-ruler), 18.42 ± 3.73 cm;degree of randomness (DOR or UBOM-random), 0.94 ± 0.18;mean randomizing time (MRT or UBOM-time), 0.60 ± 0.31 sec. The Baum Test drawings were classified as usual (86%) and unusual patterns (14%). Sex effects were observed for RCT (UBOM-ruler) and DOR (UBOM-random), but not for PRD (UBOM-pulse) and MRT (UBOM-time). Therefore, the normative values for RCT (UBOM-ruler) (males: 17.37 ± 3.25 cm;females: 19.42 ± 3.90 cm) and DOR (UBOM-random) (males: 0.92 ± 0.18;females: 0.95 ± 0.18) should be differentiated by sex. The patterns of the Baum Test drawings were affected by age, with individuals over 51 years showing the unusual pattern more frequently (42%). Discussion: Compared to previous results for healthy individuals, the present results were similar for RCT (UBOM-ruler), DOR (UBOM-random), MRT (UBOM-time), and the drawing pattern, but different for PRD (UBOM-pulse). This difference is probably because PRD is sensitive to test situation habituation, sex of examiner, order of subtests, etc. Thus, PRD (UBOM-pulse) should be meas

关键词： UBOM-4 Psychic Function Normative Value GHQ-12 Shared Decision Making

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DNA methylation of the Monoamine Oxidases A and B genes in postmortem brains of subjects with schizophrenia

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Open Journal of Psychiatry 2012年第4期2卷 374-383页

作者： Qiaohui Yang Keiko Ikemoto Satoshi Nishino Junko Yamaki Yasuto Kunii Akira Wada Yoshimi Homma shin-ichi niwa Department of Biomolecular Science School of Medicine Fukushima Medical University Fukushima Japan Department of Neuropsychiatry School of Medicine Fukushima Medical University Fukushima Japan

Aims: We focused on DNA methylation of the promoter regions of the Monoamine Oxidase (MAO) A and B genes from postmortem brains of subjects with schizophrenia. Methods: We determined levels of DNA methylation using genomic DNA samples purified from four brain areas: prefrontal cortex (PFC), hippocampus, occipital cortex and nucleus accumbens (NAc), by a bisulfite sequencing method from seven normal subjects and six subjects with schizophrenia. Results: Although very few methylated CpGs of the MAOA and MAOB genes were detected in male samples, various DNA methylation patterns were present in female samples, and some differences were found in such patterns between normal subjects and subjects with schizophrenia. In the PFC, the average level of methylation of both genes was significantly higher in subjects with schizophrenia than in normal subjects. The content of highly methylated alleles of the MAOA gene in the NAc was significantly associated with schizophrenia, with similar results obtained for the MAOB gene in both the NAc and PFC. Some CpG sites showed higher levels of methylation in schizophrenia than in normal subjects. Conclusions: Levels of methylation were quite high in NAc and PFC in female subjects with schizophrenia compared with those in female normal subjects.

关键词： DNA Methylation Monoamine Oxidase Nucleus Accumbens Postmortem Brain Schizophrenia

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Milnacipran for Attention-Deficit Hyperactivity Disorder Symptoms in Adult Asperger’s Disorder

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Open Journal of Psychiatry 2014年第3期4卷 195-201页

作者： Hirobumi Mashiko Hiromichi Ishikawa Shuntaro Itagaki Yasuko Takanashi Norihiro Miyashita Takaaki Okano shin-ichi niwa Hirooki Yabe Department of Neuropsychiatry School of Medicine Fukushima Medical University Fukushima City Japan

The efficacy of milnacipran for the treatment of ADHD symptoms in adult Asperger’s disorder patients was examined. Fifteen consecutive adult Asperger’s disorder patients with ADHD symptoms were treated with milnacipran for 8 weeks. Global Assessment of Functioning (GAF) and Conners’ Adult ADHD Rating Scales Objective Screening Version (CAARS-O-SV) were used for the assessment. The mean GAF scores in the 15 patients improved significantly. Inattention, inattention + hyperactivity/impulsivity and ADHD index in CAARS-O-SV were also significantly improved. Milnacipran might be useful for ADHD symptoms, exerting its effects by increasing serotonin and noradrenaline activities in Asperger’s disorder.

关键词： Milnacipran ADHD Asperger’s Disorder

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Longitudinal rCBF Changes Measured with SPECT in Patients with Depression Undergoing Treatment

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Open Journal of Psychiatry 2017年第3期7卷 147-161页

作者： Norihiro Miyashita Hiromichi Ishikawa Shuntarou Itagaki Yasuko Takanashi Takaaki Okano Hirobumi Mashiko Humio Shishido shin-ichi niwa Fukushima Medical University School of Medicine Department of Neuropsychiatry Fukushima Japan Kumamoto Clinic of Psychosomatic Medicine Kumamoto Japan Fukushima Medical University School of Medicine Department of Radiology Fukushima Japan Department of Psychiatry Aizu Medical Center Fukushima Medical University Fukushima Japan

Regional cerebral blood flow (rCBF) studies of major depression have yielded variable results. The present study employed a longitudinal observation method to measure rCBF every 3 months during treatment. Thirteen patients with major depressive disorder underwent single-photon emission computed tomography (SPECT) with 99mTc-HMPAO three times over a 6-month period. rCBF was analyzed with the Statistical Parametric Mapping. The findings were compared to scans from 14 normal control subjects. Depression symptoms were rated using the Hamilton Rating Scale for Depression. At baseline, the main regions with lower rCBF compared to controls were the middle and inferior frontal gyri, superior temporal gyrus, and cingulate cortex. Three months later, despite significant improvement of depressive symptoms, decreased rCBF was observed in the same regions, but to lesser extent. At 6 months, depressive symptoms showed continued improvement, and rCBF in the superior temporal gyrus increased up to control levels, but rCBF in the temporal pole, cingulate, and inferior frontal gyrus remained low. The results of the present study suggest that there might be time- and state-dependent differences in rCBF recovery in patients with major depression.

关键词： Depression Regional Cerebral Blood Flow SPECT Dorsolateral Prefrontal Cortex Cingulate Cortex

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