[Show abstract][Hide abstract] ABSTRACT: The use of the Palliative Prognostic Index (PPI) in relation to the clinical time course has not yet been established.
To investigate the association between the changes in the PPI over time and the survival of terminal cancer patients in a palliative care unit (PCU).
This retrospective cohort study analyzed data from 374 terminal cancer patients who were admitted to the PCU of a university hospital in Japan. Clinical data, such as age, gender, body mass index, vital signs, initial PPI, and subsequent PPI, were collected from the medical records. The PPI change per day (ΔPPI) was calculated using the initial PPI at admission and the one after five to seven days. The factors associated with death within three weeks were identified using Cox proportional hazards model analysis.
After their admission to the PCU, 147 (39.3%) patients were deceased within three weeks. The multivariate-adjusted analysis showed that body temperature (hazard ratio [HR] 0.7; 95% CI 0.5, 1.0), initial PPI (HR 1.3; 95% CI 1.2, 1.4), and ΔPPI (HR 6.6; 95% CI 4.9, 9.0) were significantly and independently associated with death within three weeks. In the subanalysis, the ΔPPI was significantly associated with death within three weeks in the group with initial PPI ≤ 4 (HR 9.3; 95% CI 5.8, 15.0), 4 < initial PPI ≤ 6 (HR 14.4; 95% CI 5.7, 36.2), and initial PPI > 6 (HR 9.0; 95% CI 4.1, 20.0).
Our data suggest that the ΔPPI may be useful for predicting the survival of terminally ill cancer patients.
No preview · Article · Jul 2013 · Journal of pain and symptom management
[Show abstract][Hide abstract] ABSTRACT: We encountered a case of somatoform disorder induced by bullying, and factitious disorder was revealed during treatment. This case was a 14-year-old female, who was admitted to a pediatric ward at first. However, she was transferred to a psychiatric ward after a serious suicidal attempt. She caused many problems, and demanded that medical staff treat her symptoms. We assumed that medical care promoted regression. We performed psychotherapeutic intervention based on consensus among medical staff, similar to behavioral therapy. During the patient's admission to the psychiatric ward, her mother was compulsorily hospitalized. After separation of the mother and child, medical staff could intervene, and this stabilized the mental state of her and her mother.
No preview · Article · Sep 2012 · Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
[Show abstract][Hide abstract] ABSTRACT: The 'solar experience' as an abnormal experience of schizophrenia in which patients directly experience the sun itself was first described by Miyamoto in 1974. Patients have delusions of the sun dying, hallucinations of the sun, and even believe that they become the sun. The patient may draw pictures of the sun similar to Edvard Munch's famous painting "The Sun". Miyamoto explained the progression of the solar experience as follows: (1) in the early stage of schizophrenia, patients believe that the sun falls or dies; (2) in the midst of the illness, they occupy the position of the sun in their delusions; and (3) in the recovery stage, they see or draw the sun against a scenic background, indicating that they no longer perceive themselves to be at the center of the world. Because of the absolute centrality of the sun, Miyamoto noted that the patient never experiences multiple suns (a 'polysolar experience'). However, in his book Memoirs of My Nervous Illness (original German title: Denkwürdigkeiten eines Nervenkranken), Daniel Paul Schreber described that he saw two suns. In this paper, the authors report two patients with schizophrenia who presented with a solar experience. Patient 1 was a man in his early forties. Fourteen years before his 'polysolar experience', he had attempted suicide, developed stupor, and was diagnosed with depression. However, he sometimes exhibited cenestopathy. Three years before the experience, he developed catatonic stupor and auditory hallucinations, and his diagnosis was changed to schizophrenia. After two months of hospitalization, the patient, in partial remission, was discharged. Ten months later, he saw two fragments tumble down from the sun, which he described as sons of the sun. Thereafter, his behavior became erratic, which led to a third hospitalization. In the recovery phase, the patient drew a picture of a large sun covering the entire piece of drawing paper and another of the sun set in scenery. Patient 2 was a married woman in her late thirties. She developed delusions of persecution during high school. She managed to cope with the delusions over the next several years, until she experienced an acute psychotic episode while studying in an Asian country. After returning to Japan, she began treatment for schizophrenia. Her first marriage failed, and she later experienced marital problems in her second marriage. She hoped that having a baby would solve these problems, but neuroleptic-induced hyperprolactinemia made her infertile. She stopped taking the neuroleptics and had delusions, including that she was loved by the Crown Prince of Japan and that they would be married, and that her husband was an imposter and assassin. During a 4-month period of hospitalization, she repeatedly drew pictures of multiple suns. In the recovery phase, she drew the sun set in scenery but assigned it a specific area set apart from the rest of the picture. The solar experience of Patient 1 follows a relatively typical course which Miyamoto schematized. The patient's experience of a fragmented sun is equivalent to the fall or death of the sun, and was thought to occur in the transition between the first and second stages of the progression of the solar experience. The polysolar drawings of Patient 2 were also produced in the period between the first and second stages, where the multiple suns might signify the patient's ideal partner among many imposters.
No preview · Article · Jan 2010 · Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
[Show abstract][Hide abstract] ABSTRACT: In this study, the authors investigated the features of depression associated with hypochondriac symptoms. The subjects were inpatients of the psychiatry clinic of Jichi Medical School who were clinical diagnosed with depression and enrolled in the study between June 1, 1997, and June 30, 1999. Of 86 subjects enrolled, 49 exhibited hypochondriac symptoms ("hypochondriac group"). Patients in the hypochondriac group tended to be older at diagnosis and admission than those in the "non-hypochondriac group". Our findings suggested that symptoms of both hypochondriasis and depression are related to situational, psychological and organizational factors. As many patients consulted health professionals in specialties other than psychiatry, we emphasize that primary-care doctors need to keep the possibility of depression in mind when examining patients. The frequency of delusions associated with depression was higher in the hypochondriac group than in the non-hypochondriac group. We therefore suggest that hypochondriac attitudes are related to the three major diagnostic features in depressive delusions. Many hypochondriac subjects complained of constipation and pain as concrete symptoms, but the sites of hypochondriac symptoms showed considerable variation. In terms of symptoms of pain, however, affected sites were more localized, with many patients reporting headache or lumbago.
No preview · Article · Feb 2004 · Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
[Show abstract][Hide abstract] ABSTRACT: To study the long-term clinical course and outcomes of atypical psychosis, 8 patients diagnosed with atypical psychosis were observed for more than 12 years (mean, 20 years). Retrospective examination was performed, particularly with respect to clinical features at each episode. The overall course of each case was classified as one of the following three types: Type I--"Recurrent confused state" type. Patients frequently repeated acute transient confused or dream-like states in a similar way, sometimes and/or for part of the episode accompanied by a floating paranoid-hallucinatory state. Duration of psychotic episode was short, persisting for a few days to about one month. Type II--"Manic-depressive illness similar" type. After a long course of disease, the predominantly early middle-aged patients (30- to 40 years-old) demonstrated fewer original characteristic features of acute confused or dream-like states. Instead, manic or depressive episodes tended to predominate. Duration of psychotic episodes exceeded the duration of type I episodes, to a maximum of about 3 months. Type III--"Appearance of residual state" type. After several episodes characterized by transient confused state during middle age, residual states consisting of a slight depressive state, reduced spontaneity and flattening of emotions appear. These states become durable and the periodicity of the disease disappeared. We conclude that the core group of atypical psychosis patients presents with confused symptoms as a clinical feature of episodes, and with the recurrent confused state type representing the long-term clinical course. "Shift to manic-depressive illness similar" and "appearance of residual state" types were considered to be derived from the core group, according to the interplay of personality structure and viable dynamics.
No preview · Article · Feb 2002 · Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
[Show abstract][Hide abstract] ABSTRACT: The appropriate management of chronic diseases is important to ensure a high quality of life. In particular, depression has been reported to occasionally accompany diabetes mellitus. Here, we investigated depression onset in individuals with diabetes mellitus. Subjects were outpatients with a clinical diagnosis of depression in combination with diabetes mellitus between August 1, 1998 and September 30, 1998 of the psychiatry clinic of Jichi Medical School. Of 34 individuals (20 males, 14 females) included in the preliminary investigation, 22 were interviewed. We investigated the social demographic background, the treatment, family history of depression and diabetes mellitus, and measured the Hamilton's Rating Scale for Depression and the value of HbA1c. The overall male/female ratio was 13/9, indicating that this pattern of disease onset was more common in males than in females. The Hamilton's Rating Scale for Depression correlated closely with the percentage of patients being treated with insulin. Furthermore, the timing of the diagnosis of these two diseases correlated closely with each other. The ratio of males to females suggested that the different gender roles and lifestyles and the biological bases of these differences may play roles in the onset of depression among diabetic patients. Moreover, as more patients with insulin dependence developed depression than patients without insulin, insulin was implicated in the onset of depression. Furthermore, as the onset of the two diseases correlated closely with one another, the onset of one disease may have hastened the onset of the other.
No preview · Article · Feb 2002 · Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica