Reiji Yoshimura

• MD, Ph.D
• Professor at University of Occupational and Environmental Health Japan

With the increasing incidence of dementia in Japan due to an aging population and declining birthrate, supporting family caregivers is crucial. A survey was conducted at the hospital of the University of Occupational and Environmental Health, Japan from October 1, 2021, to February 29, 2024, involving dementia patients and their working caregiver r...

One of the challenges in diagnosing psychiatric disorders is that the results of biological and neuroscience research are not reflected in the diagnostic criteria. Thus, data‐driven analyses incorporating biological and cross‐disease perspectives, regardless of the diagnostic category, have recently been proposed. A data‐driven clustering study bas...

Introduction Despite the previous inconsistent findings of structural and functional abnormalities of the thalamus in patients with major depressive disorder (MDD), the disruption of the thalamic nuclei in the pathophysiology of this disorder has not yet been adequately studied. Therefore, we investigated the volumetric changes of thalamic subregio...

Background Bipolar disorder is a psychiatric disorder that causes recurrent manic and depressive episodes, leading to decreased levels of social functioning and suicide. Patients who require hospitalization due to exacerbation of bipolar disorder have been reported to subsequently have poor psychosocial functioning, and so there is a need to preven...

Background Major depressive disorder (MDD) is strongly associated with type 2 diabetes mellitus (T2DM). The kynurenine and serotonin pathways, as well as chronic low-grade inflammation, are being considered potential links between them. MDD associated with T2DM is less responsive to antidepressants than that without T2DM; however, the underlying me...

The aim of the present study was to investigate the association between miRNA levels in extracellular vesicles (EVs) from serum and the severity of Major Depression (MD). Patient sera from 16 MD cases were collected at our university hospital. The miRNAs contained in EVs were extracted using a nanofiltration method, and their expression levels were...

Background The creation of a novel diagnostic system using objective biomarkers is expected to take place, due to difficulty of the current diagnostic system based on symptoms in psychiatry. Aims & Objectives We clustered the 5602 subjects based on brain subcortical volumes and showed a four-biotype classification, namely extremely (Brain Biotype...

Background Catatonia is a psychomotor syndrome linked to various medical conditions. Among these, several reports have described antipsychotic‐induced catatonia (AIC). Treatment typically includes benzodiazepines and electroconvulsive therapy. Here, we report a rare case of AIC that showed an improvement in symptoms under hemodialysis. Case Presen...

To date, only a limited number of studies have investigated the potential effects of apelin on mood regulation and emotional behavior. Therefore, this study investigated apelin’s role in major depressive disorder (MDD) by comparing the serum and plasma apelin concentrations between 30 patients with MDD and 30 healthy controls (HCs), and the correla...

Legionnaires’ disease is a form of atypical pneumonia that can present with neurological symptoms, such as headaches, seizures, and focal neurological abnormalities. We report the case of a male patient who developed impaired consciousness and recurrent seizures following pneumonia caused by Legionella. The patient received antibiotics and antiepil...

Objective This cross-sectional study examined the impact of family cohabitation status and work-from-home (WFH) on sleep during the COVID-19 pandemic. Methods An online survey of 27,036 Japanese workers assessed WFH frequency, family cohabitation, and trouble sleeping to estimate odds ratios (OR) for sleep problems from December 22 to 26, 2020. R...

Background Bipolar disorder is a psychiatric disorder characterized by mood swings between manic and depressed states that causes psychosocial problems. Cognitive function deteriorates with each recurrence, making it important to maintain remission through continued treatment. Bipolar disorder often co-occurs with alcohol dependence, which is known...

Patients with epilepsy often require long‐term treatment with antiseizure medications, and their impact on daily activities, particularly driving, is of significant concern. The recently published “Guideline for Evaluating Effects of Psychotropic Drugs on the Performance to Drive a Motor Vehicle” in Japan provides a framework that can be referred t...

Objective: We hypothesized that telecommuting's impact on sleep varied based on preference-frequency mismatch. Here, we evaluated this relationship in a large cohort of Japanese workers. Methods: We collected data from 33,302 Japanese workers through an online survey, and analyzed participant preferences and frequency of telecommuting in 9,425 i...

In December 2022, the Ministry of Health, Labour and Welfare (MHLW) of Japan issued and implemented the guideline for evaluating the effects of psychotropic drugs on motor vehicle driving performance. This guideline recommends the use of a tiered approach to assess clinically meaningful driving impairment. It is noted that adverse events cannot be...

Introduction Major depressive disorder (MDD) is a major cause of poor quality of life and disability and is highly prevalent worldwide. Various pathological mechanisms are implicated in MDD, including the reward system. The human brain is equipped with a reward system that is involved in aspects such as motivation, pleasure, and learning. Several s...

Background: We investigated volumetric alterations in the bilateral choroid plexus (ChP) and brain ventricles of patients during their first episode of major depressive disorder (MDD) prior to antidepressant treatment. Methods: Seventy-one first-episode drug-naïve patients with MDD and seventy-four healthy control (HC) subjects were recruited. MRI...

Anorexia nervosa (AN) presents with a variety of physical complications such as hypoglycemia, electrolyte abnormalities, and dehydration associated with starvation, requiring rapid weight gain through nutritional therapy. However, despite nutritional therapy, patients are at risk of many serious medical complications, including hypoglycemia, hypoph...

Marchiafava-Bignami disease is a rare disorder characterized by demyelination and necrosis of the central nervous system. Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions. Herein, we present the case of a patient with Marchiafava-Bignami disease who developed acute oromandibular dystonia after receiving...

Background Bipolar disorder is a mental illness characterized by recurring episodes of mania and depression and is known to cause social impairment. Additionally, it has been revealed that bipolar disorder increases the risk of divorce and loss of family member support, which can worsen the prognosis. However, there is limited evidence regarding th...

Major depressive disorder (MDD) is strongly associated with type 2 diabetes mellitus (T2DM). The kynurenine and serotonin pathways, as well as chronic low-grade inflammation, are being considered potential links between them. MDD associated with T2DM is less responsive to treatment than that without T2DM; however, the underlying mechanism remains u...

Background Primary aldosteronism (PA) is an adrenal gland disease, that induces increased secretion of the mineralocorticoid, aldosterone, resulting in symptoms such as hypertension. This study reports a patient with agoraphobia and panic attacks, associated with PA. This patient’s psychiatric symptoms improved after treatment with eplerenone, a mi...

Objective: Psychological distress is commonly reported sequela in COVID-19-infected people. We investigated the association between experiencing COVID-19 infection and psychological distress in Japan. Method: 14,901 persons who participated in a follow-up survey in December 2022-were included in the analysis. Odds ratios (ORs) and regression coe...

Introduction Previous studies have suggested association between brain‐derived neurotrophic factor (BDNF) and the stress level of workers. However, no studies have investigated the potential of salivary mature BDNF (mBDNF) level as a noninvasive biomarker for psychological distress. This study aimed to explore the reliability of salivary mBDNF as a...

The aim of the present study was to examine the association between miRNA levels in extracellular vesicles (EVs) from serum and the severity of Major Depression (MD). Patient sera from 16 MD cases were collected at our university hospital. The miRNAs contained in EVs were extracted using a nanofiltration method, and their expression levels were ana...

Background: In patients with human immunodeficiency virus (HIV) infection,HIV-associated neurocognitive disorder (HAND) occurs in 18-50% of cases. Symptoms, including memory impairment, impaired attention, concentration, executive dysfunction, slowed motor speed, apathy, personality changes, and abnormal behavior vary. However, psychotic symptoms,...

According to the operational diagnostic criteria, psychiatric disorders such as schizophrenia (SZ), bipolar disorder (BD), major depressive disorder (MDD), and autism spectrum disorder (ASD) are classified based on symptoms. While its cluster of symptoms defines each of these psychiatric disorders, there is also an overlap in symptoms between the d...

Differential diagnosis is sometimes difficult in practical psychiatric settings, in terms of using the current diagnostic system based on presenting symptoms and signs. The creation of a novel diagnostic system using objective biomarkers is expected to take place. Neuroimaging studies and others reported that subcortical brain structures are the hu...

Objective: To investigate the effect of electroconvulsive treatment (ECT) on dynamic structural network connectivity in major depressive disorder (MDD), based on the triple-network model. Methods: Twenty-one first-episode, drug-naïve patients with MDD and 21 age- and sex-matched healthy subjects were recruited. Bilateral electrical stimulation w...

Aim An assertive case management intervention program, ACTION‐J, proved effective for preventing suicide attempters from reattempting suicide within 6 months. The ACTION‐J randomized trial was conducted as part of the “National Strategic Research Projects.” The program has been covered by the national medical payment system of Japan since 2016. The...

[This corrects the article DOI: 10.3389/fresc.2023.1121034.].

Background This study determined the effects of personality traits on depressive symptoms and social adaptation in healthy workers, and the effects of depressive symptoms or social adaptation before and after exercise therapy, and personality traits before exercise therapy on the achievement rates of exercise therapy aimed at preventing major depre...

Background Although the costs of bipolar disorder (BD) treatments are associated with local and universal factors, data from non-Western countries remain limited. The associations between clinical features and costs of outpatient pharmacotherapy have not been well characterize. To estimate the costs of outpatient BD treatments and their association...

Background Valproic acid (VPA) is a relatively safe drug widely used for the treatment of epileptic seizures and mania in bipolar disorder, as well as the prevention of migraine headaches. Here, we present a case of VPA-induced pancreatitis in a patient with vascular dementia, epileptic seizures, and psychiatric symptoms. He had no distinctive abdo...

Objective In patients with bipolar disorder (BD), rapid cycling (RC) presents a risk for a more severe illness, while euthymia (EUT) has a better prognosis. This study focused on the progression of RC and EUT, which are contrasting phenomenology, and aimed to clarify the influence of patient backgrounds and prescription patterns on these different...

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is less common in the elderly, and most have some sequelae. However, even in the elderly, MERS may have a good prognosis, and a specific treatment is not always required. image

In December 2022, the new guideline for evaluating the effect of psychotropic drugs on the performance to drive a motor vehicle was issued by the Ministry of Health, Labour and Welfare (MHLW) and implemented in Japan. Of the safety information, information on the influence of medications on driving performance is particularly important because it c...

The COVID-19 pandemic infected many people worldwide with SARS-CoV2. Psychological distress is one of the sequelae reported to occur in many of those infected (Choutka et al., 2022). We investigated the association between personal experience of COVID-19 infection and psychological distress in Japan. A total of 18,560 persons participated in the or...

Background: Primary aldosteronism (PA) is an adrenal gland disease, that induces increased secretion of the mineralocorticoid, aldosterone, resulting in symptoms such as hypertension. This study reports a patient with agoraphobia and panic attacks, associated with PA. This patient's psychiatric symptoms improved after treatment with eplerenone, a m...

Several suicide attempts presented at the emergency department are due to drug overdose associated with psychiatric disorders. We examined and identified the major risk factors among Japanese drug overdose patients and several close associations of suicide risk. We enrolled 101 patients who attempted suicide by drug overdose between January 2015 an...

Introduction Despite the previous inconsistent findings of structural and functional abnormalities of the thalamus in patients with major depressive disorder (MDD), the disruption of the thalamic nuclei in the pathophysiology of this disorder has not yet been adequately studied. Therefore, we investigated the volumetric changes of thalamic subregio...

Background Bipolar disorder is a psychiatric disorder that causes recurrent manic and depressive episodes, leading to decreased levels of social functioning and suicide. Patients who require hospitalization due to exacerbation of bipolar disorder have been reported to subsequently have poor psychosocial functioning, and so there is a need to preven...

A patient with schizoaffective disorder and receiving long‐term treatment with lithium developed prolonged delirium. She had recently been diagnosed with stage IVB endometrial cancer and presented a deteriorating general condition. Toxic levels of lithium were measured in serum. After hemodialysis, lithium levels gradually decreased and the symptom...

Introduction: Patients with schizophrenia experience the most prolonged hospital stay in Japan. Also, the high re-hospitalization rate affects their quality of life (QoL). Despite being an effective predictor of treatment, QoL has not been widely utilized due to time constraints and lack of interest. As such, this study aimed to estimate the schiz...

Objective: This study aimed to seek a new method of evaluation and surrogate markers for diffuse neuropsychiatric systemic lupus erythematosus (NPSLE). Methods: We enrolled 44 patients with SLE between 2017 and 2020 who fulfilled at least one of three specific inclusion criteria: high disease activity, abnormal findings (cerebrospinal fluid [CSF...

Objective: This study aimed to determine whether telecommuting's impact on psychological distress differed depending on the status of workers' cohabiting family members during the COVID-19 pandemic. Methods: We collected data from 33 302 workers in Japan through an Internet survey, and included 27 036 valid responses in the analysis. The survey...

Brain-derived neurotrophic factor (BDNF) is a growth factor synthesized in the cell bodies of neurons and glia, which affects neuronal maturation, the survival of nervous system, and synaptic plasticity. BDNF play an important role in the pathophysiology of major depression (MD). The serum BDNF levels changed over time, or with the improvement in d...

Background A close relationship exists between major depressive disorder (MDD) and diabetes mellitus. The metabolomic difference and similarity between patients with and without diabetes mellitus have not been well studied in the context of MDD. We aimed to examine these differences and common serum metabolomics patterns, pathways and biomarkers th...

Background and objectives Cortical structural changes in major depressive disorder (MDD) are usually studied using a voxel-based morphometry approach to delineate the cortical gray matter volume. Among cortical structures, gyrification patterns are considered a relatively stable indicator. In this study, we investigated differences in gyrification...

Background High-dose corticosteroids may be accompanied by central nervous system side-effects, including psychiatric disorders. These psychiatric disorders tend to appear relatively early in treatment. We report an unusual case of mania after long-term administration of a small dose of prednisolone. Case Presentation A patient was treated for rel...

Complex networks inside the hippocampus could provide new insights into hippocampal abnormalities in various psychiatric disorders and dementia. However, evaluating intra-networks in the hippocampus using MRI is challenging. Here, we employed a high spatial resolution of conventional structural imaging and independent component analysis to investig...

Background There are increasing concerns that prevention measures against coronavirus disease 2019 (COVID-19) such as social distancing and telework are leading to loneliness and poor lifestyle habits like increased alcohol consumption. The purpose of this study was to assess whether loneliness reported among workers during the COVID-19 pandemic is...

A patient with schizoaffective disorder and receiving long-term treatment with lithium developed prolonged delirium. She had recently been diagnosed with stage IIIC1 endometrial cancer and presented a deteriorating general condition. Toxic levels of lithium were measured in serum. After hemodialysis, lithium levels gradually decreased and the sympt...

Background Childbearing-aged female patients and elderly patients with bipolar disorder need special attention for pharmacological treatments, but current guidelines provide little information on their pharmacological treatment. In particular, the risk/benefit balance of pharmacological treatment for childbearing-aged females with bipolar disorder...

Major depressive disorder (MDD) manifests either with or without melancholic features. Differences in catecholamine dynamics between these two types of MDD are yet to be clarified definitively. We compared and investigated serum catecholamine metabolite levels in patients presenting with MDD for the first time who had never received treatment. We e...

We investigated the plasma levels of MHPG, a metabolite of noradrenaline or IL-6, and the clinical response to paroxetine in major depression (MD). Twenty-eight patients who met the MD criteria as per DSM-5 were enrolled in this study (age 42 ± 8 years; male/female 15/13; single-/repeated-episode 12/16). The plasma levels of MHPG were not altered b...

Background: Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is an adrenal insufficiency caused by a decrease in ACTH that does not affect other anterior pituitary hormones. IAD is often overlooked because it causes nonspecific symptoms. We report a case of IAD associated with primary hypothyroidism with mild cognitive impairment (MCI)....

Background and objectives: The number of workers taking temporary leave due to clinical depression is increasing, and the probability that these workers will take such leave again after returning to work is high. In response to this dilemma, institutions involved in psychiatric care across Japan now implement “rework programmes,” aiming to help emp...

Background Childbearing-aged female patients and elderly patients with bipolar disorder need special attention for pharmacological treatments, but current guidelines provide little information on their pharmacological treatment. In particular, the risk/benefit balance of pharmacological treatment for childbearing-aged females with bipolar disorder...

Background There has been increasing evidence that exercise therapy is effective in the treatment and prevention of major depression (MD). However, the basic molecular mechanisms underlying the effects of exercise on MD remain unclear. We conducted a preliminary study to clarify the effect of exercise therapy on MD, focusing on the dynamics of nitr...

Background: Suicidal attempts by psychotic drug overdose are a common reason for the emergency ward consultation. The epidemiology of suicide and the psychiatric perspective has been well studied; however, the investigation of the frequency and direction of the patients’ background factors and their associations was not studied adequately. The pres...

Objective: This study examined the association between increased alcohol consumption and telecommuting, comparing employees who expressed a preference for telecommuting and those who did not. Methods: We conducted an internet monitor survey. Responses from 20 395 of the 33 302 participants were included in the final sample. Participants were ask...

The aim of the present study was to investigate associations between hippocampal subfield volumes and plasma levels of brain-derived neurotrophic factor (BDNF) in patients experiencing a first episode of major depression (MD) (n = 30) as compared to healthy controls (HC) (n = 49). Covariate-adjusted linear regression was performed to compare the MD...

Background There is limited evidence regarding predictors of long-term clinical outcomes in patients with bipolar disorder (BD). The objective of this study was to describe 3-year clinical outcomes and identify their predictors from participants in the multicenter treatment survey for BD in psychiatric outpatient clinics (MUSUBI). Methods The MUSU...

The amygdala is a prominent region of the brain that plays a critical role in the pathophysiology of major depressive disorder (MDD). The amygdala is formed from a collection of interconnected substructures (nuclei) that relay signals from multiple brain areas, which suggests that the amygdala has different functions depending on its subregion. The...

Background The coronavirus disease 2019 (COVID-19) pandemic has been linked to a rise in loneliness. Loneliness is associated with sleep-related problems, which in turn can be a risk factor for various psychiatric disorders. However, it is unclear whether loneliness is linked to sleep-related problems during the pandemic. Here, we studied the assoc...

Purpose: To clarify the relationship between the length of unstable periods and employment status of patients with bipolar disorder. Patients and methods: Medical records of outpatients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics were investigated during September-October 2016, an...

Purpose: We investigated the serum levels of cytokines, including interleukin 1β (IL-β), IL-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), and growth factors, including brain-derived neurotrophic factor, vascular endothelial growth factor, and insulin-like growth factor 1, and their association with major depression in patients with and with...

We examined amygdala subregion volumes in patients with a first episode of major depression (MD) and in healthy subjects. Covariate-adjusted linear regression was performed to compare the MD and healthy groups, and adjustments for age, gender, and total estimated intracranial volume showed no differences in amygdala subregion volumes between the he...

The impairment of endothelial function by reduced endothelial production of nitric oxide (NO) may contribute to the increased risk of developing cardiovascular disease in patients with depression. NO also plays an essential role in the efficacy of antidepressants. The present study aimed to confirm our previous preliminary findings using a larger s...

Background Numerous protocols exist to counteract prolonged seizures during modified electroconvulsive therapy (mECT), such as anaesthetic adjustments and ventilation. Evidence on methods for deciding whether to continue with the next round of mECT after a prolonged seizure and to prevent recurrent seizures is currently not well established. Case...

Background Bipolar disorder is a mental illness in which manic and depressive states are repeated, causing psychosocial dysfunction. Manic/hypomanic episodes cause problems with interpersonal, social and financial activities, but there is limited evidence regarding the predictors of manic/hypomanic episodes in real-world clinical practice. Methods...