A 48-year-old man who weighed 216 kg was significantly overweight with a body mass index (BMI)of 75．6kg/m2, and was unable to walk due to disuse syndrome. Because of the psychological and social problems in the background, a psychological examination was performed and the staff took time to build a trusting relationship with the patient, taking into account his characteristics. With diet and rehabilitation, he was able to lose weight to 124kg and BMI 43．9kg/m2 over 600 days, and was able to walk with assistive devices and defecate by himself. The patient was discharged from our hospital after a series of multidisciplinary meetings with medical, nursing, welfare, and governmental agencies to create an environment for home recuperation. The reasons for the improvement to enable him to be discharged from the hospital were due to the multi-disciplinary meetings among the staff inside and outside the hospital, information sharing and advanced coordination, and smooth communication with the patient by taking into account his characteristics from a psychological standpoint.
(Keyword)
Sever obesity / disuse syndrome / Patient-specific care / Multidisciplinary team
川原 綾香, Kiyoe Kurahashi, 鎌田 基夢, Shinsuke Katoh, Yukiko Tomioka, 辻本 賀美, 安井 沙耶, 遠藤 ふうり, 桝田 志保, 三井 由加里, Sumiko Yoshida, Ken-ichi Aihara, Itsuro Endo, Seiji Fukumoto, Munehide Matsuhisa and Masahiro Abe : A case of severe obesity who had been unable to walk but became able to live at home thanks to a high level of coordination and patient-specific care by a multidisciplinary team, Shikoku Acta Medica, Vol.76, No.5-6, 317-322, 2020.
(Summary)
A 48-year-old man who weighed 216 kg was significantly overweight with a body mass index (BMI)of 75．6kg/m2, and was unable to walk due to disuse syndrome. Because of the psychological and social problems in the background, a psychological examination was performed and the staff took time to build a trusting relationship with the patient, taking into account his characteristics. With diet and rehabilitation, he was able to lose weight to 124kg and BMI 43．9kg/m2 over 600 days, and was able to walk with assistive devices and defecate by himself. The patient was discharged from our hospital after a series of multidisciplinary meetings with medical, nursing, welfare, and governmental agencies to create an environment for home recuperation. The reasons for the improvement to enable him to be discharged from the hospital were due to the multi-disciplinary meetings among the staff inside and outside the hospital, information sharing and advanced coordination, and smooth communication with the patient by taking into account his characteristics from a psychological standpoint.
(Keyword)
Sever obesity / Disuse syndrome / Patient-specific care / Multidisciplinary team
Yukiko Tomioka, Makoto Kinoshita, Hidehiro Umehara, Tomohiko Nakayama, Shinya Watanabe, Masahito Nakataki, Shusuke Numata and Tetsuro Ohmori : Association between serum folate levels and schizophrenia based on sex., Psychiatry and Clinical Neurosciences, Vol.74, No.9, 466-471, 2020.
(Summary)
Our findings suggest that: (i) a low serum folate level may be associated with schizophrenia regardless of sex; and (ii) folate administration may be beneficial for the treatment of schizophrenia. In schizophrenic patients with low serum folate levels, folate administration might result in improvements in high tHcy and an increase in low vitamin B6 levels.
Junji Chida, Hideyuki Hara, Masashi Yano, Keiji Uchiyama, Rani Nandita Das, Etsuhisa Takahashi, Hironori Miyata, Yukiko Tomioka, Toshihiro Ito, Hiroshi Kido and Suehiro Sakaguchi : Prion protein protects mice from lethal infection with influenza A viruses., PLoS Pathogens, Vol.14, No.5, e1007049, 2018.
(Summary)
The cellular prion protein, designated PrPC, is a membrane glycoprotein expressed abundantly in brains and to a lesser extent in other tissues. Conformational conversion of PrPC into the amyloidogenic isoform is a key pathogenic event in prion diseases. However, the physiological functions of PrPC remain largely unknown, particularly in non-neuronal tissues. Here, we show that PrPC is expressed in lung epithelial cells, including alveolar type 1 and 2 cells and bronchiolar Clara cells. Compared with wild-type (WT) mice, PrPC-null mice (Prnp0/0) were highly susceptible to influenza A viruses (IAVs), with higher mortality. Infected Prnp0/0 lungs were severely injured, with higher inflammation and higher apoptosis of epithelial cells, and contained higher reactive oxygen species (ROS) than control WT lungs. Treatment with a ROS scavenger or an inhibitor of xanthine oxidase (XO), a major ROS-generating enzyme in IAV-infected lungs, rescued Prnp0/0 mice from the lethal infection with IAV. Moreover, Prnp0/0 mice transgenic for PrP with a deletion of the Cu-binding octapeptide repeat (OR) region, Tg(PrPOR)/Prnp0/0 mice, were also highly susceptible to IAV infection. These results indicate that PrPC has a protective role against lethal infection with IAVs through the Cu-binding OR region by reducing ROS in infected lungs. Cu content and the activity of anti-oxidant enzyme Cu/Zn-dependent superoxide dismutase, SOD1, were lower in Prnp0/0 and Tg(PrPOR)/Prnp0/0 lungs than in WT lungs. It is thus conceivable that PrPC functions to maintain Cu content and regulate SOD1 through the OR region in lungs, thereby reducing ROS in IAV-infected lungs and eventually protecting them from lethal infection with IAVs. Our current results highlight the role of PrPC in protection against IAV infection, and suggest that PrPC might be a novel target molecule for anti-influenza therapeutics.
Yukiko Tomioka, Shusuke Numata, Makoto Kinoshita, Hidehiro Umehara, Shinya Watanabe, Masahito Nakataki, Y Iwayama, T Toyota, M Ikeda, H Yamamori, S Shimodera, A Tajima, R Hashimoto, N Iwata, T Yoshikawa and Tetsuro Ohmori : Decreased serum pyridoxal levels in schizophrenia: meta-analysis and Mendelian randomization analysis., Journal of Psychiatry & Neuroscience, Vol.43, No.3, 194-200, 2018.
(Summary)
Alterations in one-carbon metabolism have been associated with schizophrenia, and vitamin B6 is one of the key components in this pathway. We first conducted a case-control study of serum pyridoxal levels and schizophrenia in a large Japanese cohort ( = 1276). Subsequently, we conducted a meta-analysis of association studies ( = 2125). Second, we investigated whether rs4654748, which was identified in a genome-wide association study as a vitamin B6-related single nucleotide polymorphism, was genetically implicated in patients with schizophrenia in the Japanese population ( = 10 689). Finally, we assessed the effect of serum pyridoxal levels on schizophrenia risk using a Mendelian randomization (MR) approach. Serum pyridoxal levels were significantly lower in patients with schizophrenia than in controls, not only in our cohort, but also in the pooled data set of the meta-analysis of association studies (standardized mean difference -0.48, 95% confidence interval [CI] -0.57 to -0.39, = 9.8 × 10-24). We failed to find a significant association between rs4654748 and schizophrenia. Furthermore, an MR analysis failed to find a causal relationship between pyridoxal levels and schizophrenia risk (odds ratio 0.99, 95% CI 0.65-1.51, = 0.96). Food consumption and medications may have affected serum pyridoxal levels in our cross-sectional study. Sample size, number of instrumental variables and substantial heterogeneity among patients with schizophrenia are limitations of an MR analysis. We found decreased serum pyridoxal levels in patients with schizophrenia in this observational study. However, we failed to obtain data supporting a causal relationship between pyridoxal levels and schizophrenia risk using the MR approach.
Masatoshi Inoshita, Hidehiro Umehara, Shinya Watanabe, Masahito Nakataki, Makoto Kinoshita, Yukiko Tomioka, Atsushi Tajima, Shusuke Numata and Tetsuro Ohmori : Elevated peripheral blood glutamate levels in major depressive disorder., Neuropsychiatric Disease and Treatment, Vol.14, 945-953, 2018.
(Summary)
There is growing evidence that glutamatergic signaling may be involved in major depressive disorder (MDD). In regard to peripheral blood glutamate changes in MDD, inconsistent findings have been reported. The purpose of the present study was to evaluate whether blood glutamate levels differed between MDD patients and control participants. We conducted a systematic review and meta-analysis of 12 association studies between blood glutamate levels and MDD in a total of 529 MDD patients and 590 controls. Subsequently, we conducted subgroup analyses and a meta-regression analysis to examine the sources of potential heterogeneity. A random effects model showed that blood glutamate levels were significantly higher in MDD patients than in controls (standardized mean difference=0.54, 95% CI=0.27-0.82, =8.5×10) with high heterogeneity (=75.0%, <0.05). Subgroup analyses showed elevated glutamate levels in MDD patients compared with controls in plasma, but not serum studies, and in studies using high-performance liquid chromatography but not with mass spectrometry for glutamate assay. A meta-regression analysis showed no effects of age, gender, medication use, sample size, and published year on blood glutamate levels. Our findings suggest that altered glutamate levels may be implicated in MDD, which provides further evidence of glutamatergic dysfunction in MDD.
Sayo Hamatani, Masahito Tomotake, Tomoya Takeda, Naomi Kameoka, Masashi Kawabata, Hiroko Kubo, Masashi Ohta, Yukio Tada, Yukiko Tomioka, Shinya Watanabe, Masatoshi Inoshita, Makoto Kinoshita and Tetsuro Ohmori : Impaired central coherence in patients with anorexia nervosa, Psychiatry Research, Vol.259, 77-80, 2017.
(Summary)
The purpose of this study was to investigate the characteristics of central coherence in patients with anorexia nervosa (AN). 22 female patients with AN (median age = 31.50 (QD = 8.13) years) and 33 female healthy controls (HC) (median age = 28.00 (QD = 8.50) years) participated in the study. Their central coherence was assessed with the Rey Complex Figure Task (RCFT). Clinical symptoms were evaluated with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Form JYZ. The results showed that AN patients' Central Coherence Index and accuracy scores in copy, 3-min delayed recall and 30-min delayed recall tasks of the RCFT were significantly lower than those of HC. Moreover, the significant differences in Central Coherence Index score in copy task and accuracy scores in 3-min delayed recall and 30-min delayed recall tasks remained when the effects of depression, anxiety and starvation were eliminated statistically. These findings may explain some characteristics of AN patients such as focusing on local rather than global picture in their perception of body or life.
Hidehiro Umehara, Shusuke Numata, Shinya Watanabe, Yutaka Hatakeyama, Makoto Kinoshita, Yukiko Tomioka, Kiyoshi Nakahara, Takeshi Nikawa and Tetsuro Ohmori : Altered KYN/TRP, Gln/Glu, and Met/methionine sulfoxide ratios in the blood plasma of medication-free patients with major depressive disorder., Scientific Reports, Vol.7, No.1, 4855, 2017.
(Summary)
Capillary electrophoresis-time-of-flight mass spectrometry (CE-TOFMS) is a comprehensive, quantitative, and high throughput tool used to analyze metabolite profiles. In the present study, we used CE-TOFMS to profile metabolites found in the blood plasma of 33 medication-free patients with major depressive disorder (MDD) and 33 non-psychiatric control subjects. We then investigated changes which occurred in the metabolite levels during an 8-week treatment period. The medication-free MDD patients and control subjects showed significant differences in their mean levels of 33 metabolites, including kynurenine (KYN), glutamate (Glu), glutamine (Gln), methionine sulfoxide, and methionine (Met). In particular, the ratios of KYN to tryptophan (TRP), Gln to Glu, and Met to methionine sulfoxide were all significantly different between the two groups. Among the 33 metabolites with altered levels in MDD patients, the levels of KYN and Gln, as well as the ratio of Gln to Glu, were significantly normalized after treatment. Our findings suggest that imbalances in specific metabolite levels may be involved in the pathogenesis of MDD, and provide insight into the mechanisms by which antidepressant agents work in MDD patients.
Sayo Hamatani, Masahito Tomotake, Tomoya Takeda, Naomi Kameoka, Masashi Kawabata, Hiroko Kubo, Y Tada, Yukiko Tomioka, Shinya Watanabe, Masatoshi Inoshita, Makoto Kinoshita, Masashi Ohta and Tetsuro Ohmori : Influence of cognitive function on quality of life in anorexia nervosa patients, Psychiatry and Clinical Neurosciences, Vol.71, No.5, 328-335, 2017.
(Summary)
The purpose of this study was to elucidate determinants of quality of life (QOL) in anorexia nervosa (AN) patients. Twenty-one female patients with AN participated in the study. QOL was assessed with the 36-Item Short Form Health Survey (SF-36), and cognitive function was evaluated using the Wisconsin Card Sorting Test Keio version, the Rey Complex Figure Test, and the Social Cognition Screening Questionnaire. Clinical symptoms were evaluated with the Beck Depression Inventory-II, the State-Trait Anxiety Inventory-Form JYZ (STAI-JYZ), and the Maudsley Obsessive Compulsive Inventory. The Difficulty Maintaining Set score of the Wisconsin Card Sorting Test Keio version was negatively correlated to the SF-36 Physical Component Summary. Scores of the Beck Depression Inventory-II and the STAI-JYZ State and Trait were negatively correlated to the SF-36 Mental Component Summary (MCS), and the Central Coherence Index 30-min Delayed Recall score of the Rey Complex Figure Test was positively correlated with the MCS. Stepwise regression analysis showed that the Difficulty Maintaining Set score was an independent predictor of the Physical Component Summary and scores for Central Coherence Index 30-min Delayed Recall and the STAI-JYZ Trait-predicted MCS. These results suggest that not only trait anxiety but also poor central coherence and impaired ability to maintain new rule worsen AN patients' QOL.
Sayo Hamatani, Masahito Tomotake, Tomoya Takeda, Naomi Kameoka, Masashi Kawabata, Hiroko Kubo, Yukio Tada, Yukiko Tomioka, Shinya Watanabe and Tetsuro Ohmori : Impaired social cognition in anorexia nervosa patients, Neuropsychiatric Disease and Treatment, Vol.12, 2527-2531, 2016.
(Summary)
The purpose of this study was to investigate the characteristics of social cognition in patients with anorexia nervosa (AN). Eighteen female patients with AN (mean age =35.4±8.6 years) and 18 female healthy controls (HC) (mean age =32.8±9.4 years) participated in the study. Their social cognition was assessed with the Social Cognition Screening Questionnaire (SCSQ). The results showed that total score of the SCSQ and scores of theory of mind and metacognition were significantly lower in AN group than those in HC group. Moreover, significant differences in theory of mind, metacognition, and total score of the SCSQ remained when the effects of depression, anxiety, and starvation were eliminated statistically. These results suggest that patients with AN may have difficulty inferring other people's intention and also monitoring and evaluating their own cognitive activities. Therefore, these features may explain some aspects of the pathology of AN.
(Tokushima University Institutional Repository: 114104)
Proceeding of International Conference:
1.
Shinya Watanabe, Hidehiro Umehara, Yukiko Tomioka, Makoto Kinoshita, Masahito Nakataki, Shusuke Numata and Tetsuro Ohmori : Effects of processing conditions on plasma L-glutamate levels in non-psychiatric healthy subjects., 6th Congress of AsCNP Asian College of Neuropsychopharmacology, Fukuoka, Oct. 2019.
2.
Yukiko Tomioka, Hidehiro Umehara, Shinya Watanabe, Masahito Nakataki, Masuda Rumiko, Kazuaki Mawatari, Takeshi Nikawa, Akira Takahashi, Shusuke Numata and Tetsuro Ohmori : Altered plasma metabolites related to one-carbon metabolism in schizophrenia., WFSBP Asia Pacific Regional Congress of Biological Psychiatry, Kobe, Sep. 2018.
3.
Hamatani Sayo, Masahito Tomotake, Tomoya Takeda, Naomi Kameoka, Masashi Kawabata, Hiroko Kubo, Yukio Tada, Yukiko Tomioka, Shinya Watanabe and Tetsuro Ohmori : Characteristics of social cognition in women with anorexia nervosa., London Eating Disorders Confirence., London, Mar. 2017.
4.
Sayo Hamatani, Masahito Tomotake, Tomoya Takeda, Naomi Kameoka, Masashi Kawabata, Hiroko Kubo, Yukio Tada, Yukiko Tomioka, Shinya Watanabe and Tetsuro Ohmori : Impaired social cognition in anorexia nervosa patients, 13th London International Eating Disorders Conference, Vol.12, 2527-2531, London, Mar. 2017.
(Summary)
The purpose of this study was to investigate the characteristics of social cognition in patients with anorexia nervosa (AN). Eighteen female patients with AN (mean age =35.4±8.6 years) and 18 female healthy controls (HC) (mean age =32.8±9.4 years) participated in the study. Their social cognition was assessed with the Social Cognition Screening Questionnaire (SCSQ). The results showed that total score of the SCSQ and scores of theory of mind and metacognition were significantly lower in AN group than those in HC group. Moreover, significant differences in theory of mind, metacognition, and total score of the SCSQ remained when the effects of depression, anxiety, and starvation were eliminated statistically. These results suggest that patients with AN may have difficulty inferring other people's intention and also monitoring and evaluating their own cognitive activities. Therefore, these features may explain some aspects of the pathology of AN.