Itaru Miura

Aim: This study examined the longitudinal association between age and mental health status to identify the risk factors for severe psychological distress in youth who experienced the Great East Japan Earthquake of 2011. Methods: A two‐wave longitudinal study was conducted using data from the Mental Health and Lifestyle Survey of Japan after the event for fiscal years (FY) 2011 and 2016. Multiple logistic regression analyses were conducted using age subcohorts from the baseline, FY2011, and psychological distress from FY2016. Ultimately, 23,682 participants aged 16–24, 25–64, and ≥ 65 years ( n = 711, 13,756, and 9215, respectively, at the FY2011 baseline) were analyzed. Results: Multiple logistic regression analyses revealed that, after adjustment for covariates, the 16–24 age range was significantly and positively associated with severe psychological distress in FY2016 compared with the ≥ 65 age range. Moreover, for the 16–24‐year age group, baseline psychological distress, post‐traumatic stress disorder (PTSD) symptoms, and bereavement were significantly correlated with severe psychological distress in FY2016. Conclusions: The findings suggested that youths showed higher rates of severe psychological distress following the Fukushima disaster. PTSD symptoms and bereavement may have been risk factors for severe psychological distress.

Background: Large-scale disasters may increase cardiovascular disease (CVD) risk through psychological distress, disrupted healthcare access, and lifestyle changes, but existing CVD risk scores may not adequately capture disaster-related vulnerability.Methods: We analysed data from 23,452 participants aged 30–79 years in the Fukushima Health Management Survey after the 2011 Great East Japan Earthquake and Fukushima Daiichi nuclear accident. Incident CVD, defined as stroke or myocardial infarction, was monitored during follow-up. LASSO logistic regression and XGBoost were used only as exploratory screening tools, and predictors selected by both approaches were incorporated into a Cox proportional hazards model to develop the Questionnaire-based Post-Disaster Cardiovascular Risk Score Incorporating Psychological Distress (Q-DISC). Performance was assessed using C-statistics, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and calibration analyses.Findings: During a median follow-up of 8.0 years, 1,368 participants developed incident CVD. Psychological distress assessed using the Kessler-6 Psychological Distress Scale (K6) was selected by both screening approaches and was independently associated with incident CVD. Adding K6 improved discrimination, NRI, and IDI across established CVD risk models. In the test dataset, Q-DISC showed acceptable discrimination (C-statistic, 0.770 [95% CI 0.745–0.800]) and calibration, with performance comparable to established laboratory- and non-laboratory-based models.Interpretation: Psychological distress provided prognostic information beyond conventional cardiovascular risk factors after a large-scale disaster. Q-DISC may support preliminary questionnaire-based cardiovascular risk stratification when laboratory testing or physical measurements are unavailable. External validation and, if necessary, recalibration are required before clinical implementation.

Background: Non‐motor psychiatric symptoms, including anxiety, agitation, and irritability, are common in Parkinson's disease (PD) and may persist despite antidepressant treatment. While monoaminergic dysfunction has traditionally been emphasized, accumulating evidence suggests that glutamatergic dysregulation, particularly involving N‐methyl‐D‐aspartate (NMDA) receptors, may contribute to these symptoms. However, clinical evidence supporting NMDA receptor modulation in early‐stage PD without dementia remains limited. Case Presentation: We report the case of a 65‐year‐old woman with early‐stage PD (Hoehn and Yahr stage I) who developed a severe depressive episode accompanied by prominent anxiety and agitation. Treatment with vortioxetine resulted in partial improvement of depressive symptoms, as reflected by a gradual reduction in the Montgomery–Åsberg Depression Rating Scale score; however, significant anxiety, agitation, and irritability persisted despite adjunctive brexpiprazole, necessitating behavioral restriction. Given the limited response and the clinical characteristics of the residual symptoms, low‐dose memantine (5 mg/day) was introduced as an off‐label adjunctive therapy after obtaining informed consent. Approximately 10 days after memantine initiation, anxiety and agitation markedly improved, allowing discontinuation of behavioral restriction. Motor symptoms and cognitive function remained stable throughout treatment and follow‐up. Conclusion: This case suggests that NMDA receptor antagonism with low‐dose memantine may be a well‐tolerated adjunctive option for residual anxiety and agitation in early‐stage PD without dementia when conventional antidepressant treatment is insufficient. Although interpretation is limited by the single‐case design and concomitant medications, the findings support further investigation of glutamatergic mechanisms and NMDA receptor modulation in the management of non‐motor psychiatric symptoms in PD .

Background: Studies on the impact of dietary habits on sleep in children remain inconsistent. The study aimed to evaluate associations between dietary habits and sleep duration in Japanese children. Methods: Dietary habits and sleep time questionnaire data were available for 28,429 children from the Fukushima Health Management Survey, 2014–2019. Five dietary habit questions were asked of children aged 1–15 years, four additional questions of those aged 4–15 years, one additional question of those aged 7–15 years, and one additional question of those aged 13–15 years. Accordingly, dietary habit scores (score‐5, score‐9, score‐10, and score‐11) were calculated for the corresponding age groups. Linear mixed models were used to examine associations between dietary habits and sleep duration. Results: In the cross‐sectional analysis, the coefficients (95% confidence intervals [CIs]), expressed as hours per score unit, for dietary habit score‐5, score‐9, score‐10, and score‐11 with sleep duration were 0.018 (0.012–0.025), 0.018 (0.011–0.025), 0.018 (0.011–0.024), and 0.024 (0.010–0.038), respectively. In the longitudinal analysis, associations of changes in score‐5, score‐9, and score‐10 with changes in sleep duration were no longer statistically significant after multivariable adjustment. Among students aged 13–15 years, each one‐point increase in score‐11 was associated with higher odds of adequate sleep time (odds ratio, 1.06; 95% CI, 1.02–1.09). Conclusions: Healthier dietary habits may be associated with longer sleep duration in Japanese children; however, the longitudinal findings did not provide sufficient evidence of an independent association over time.

The aim of this analysis was to examine the impact of treatment with lurasidone on a broad range of symptoms during an acute episode of schizophrenia. In patients with an acute exacerbation of schizophrenia treated with lurasidone in a 6-week, double-blind, placebo-controlled trial, a mixed-effect model for repeated measures was used to analyze weekly change in both the five Marder Factors and the 30 individual items of the Positive and Negative Syndrome Scale (PANSS). Treatment with lurasidone was associated with significant endpoint improvement on all five Marder PANSS factors with effect sizes ranging from 0.22 to 0.44. Significant early (week 2), sustained improvement was observed on four of the five Marder Factors, with significant improvement occurring by week 4 on the Marder Negative Symptom factor. In addition to significant improvement on five out of eight Marder Positive Symptom items, the following non-Positive PANSS items were notable for being especially responsive to lurasidone treatment in terms of significant early improvement and endpoint effect sizes >0.3: anxiety, tension, preoccupation, active social avoidance, and conceptual disorganization. The results of this non-USA study confirm results from previous studies indicating that lurasidone is an effective antipsychotic medication.

Background: Predicting early treatment response in acute schizophrenia is critical yet challenging. This observational study aimed to determine whether improvements in specific symptom domains after 2 weeks predict overall response at 6 weeks in patients treated with aripiprazole (ARI) or brexpiprazole (BRE). Methods: We included 65 patients (34 antipsychotic-naïve and 31 antipsychotic-free recurrent) treated with flexible doses of ARI or BRE. Benzodiazepines were used in 41 patients (64.1%), and their use did not significantly impact prediction. The Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Improvement were used to assess responses. Results: Receiver operating characteristic analysis revealed area under the curve values for PANSS total (PANSS-T), negative, excitement, cognitive, positive, and depressive/anxiety components of 0.788, 0.783, 0.603, 0.746, 0.738, and 0.735, respectively. Kendall’s tau correlation and Cramer’s V revealed significant predictive relationships for PANSS-T (0.413, PPP PPP=0.001), but not for excitement (0.15, P=0.151). Benzodiazepine use did not significantly impact these predictive associations. Conclusions: This study is the first to evaluate the predictive validity of the PANSS 5-factor model in patients with acute schizophrenia treated with ARI/BRE. Early symptom improvements, particularly in negative domains, are stronger predictors of overall response, while excitement symptom improvements showed a weaker relationship. These findings underscore the importance of early, symptom-specific assessments to optimize treatment strategies for acute schizophrenia. Further studies with larger samples are necessary to validate these results.

Objective: The mismatch negativity (MMN) reflects automatic cognitive function in response to auditory stimulation. The MMN to duration deviant (d-MMN) amplitude is known to be lower in children with autism spectrum disorder (ASD) than in healthy controls (HCs). Moreover, the d-MMN is known to be a trait maker of schizophrenia because it is unaffected by the duration of illness. This study aimed to identify robust tools to distinguish adults with ASD from HCs by measuring the d-MMN. Methods: Fifteen adults with ASD (age range, 20– 40 years) and 20 HCs were compared. After excluding patients with a low intelligence quotient, those using central nervous system stimulants, and those with excessive alcohol consumption, we conducted an auditory oddball task to measure the d-MMN. Results: Compared with HCs, the patients with ASD showed significantly shorter d-MMN latencies for Fz and Cz. Conclusion: The present findings suggest that the automatic cognitive function indicated by MMN amplitude might be improved by growth. Alternatively, the hypersensitivity indicated by d-MMN latencies suggests that it could persist into adulthood. Significance: The d-MMN latency was shortened in patients with ASD compared with HCs. We believe that this is the first report to reveal that hypersensitivity in ASD as reflected by a shortened d-MMN latency should be maintained, even in adults.

Background: Cognitive abnormalities associated with electroconvulsive therapy (ECT) are limited to the first few days after treatment. Mismatch negativity (MMN) is an event‐related potential that reflects an automatic auditory change detection process under nonattention conditions and cognitive function in psychotic disorders and may be trait‐ or state‐dependent. This study aimed to report the changes in MMN and cognitive function after two ECT treatments in a female patient who underwent maintenance ECT for atypical psychosis.Case Presentation: A 67‐year‐old Japanese woman with atypical psychosis was admitted to our hospital for the maintenance of ECT. She received two ECT treatments. We measured her duration‐MMN (MMN‐D) at baseline, the day after two ECT treatments, and approximately 40 days after the two ECT treatments. After the two ECT treatments, the peak latency of the MMN on the following day was delayed compared with that before the first ECT treatment. Forty days after the two ECT treatments, the peak latency reverted to the baseline. The Brief Assessment of Cognition in Schizophrenia scores measured at the same time point also showed a similar temporary decrease in scores.Conclusion: Peak latency prolongation in MMN‐D may reflect transient cognitive abnormalities after ECT. MMN can be useful to evaluate cognitive dysfunction, one of the adverse events of ECT. However, future studies are needed to examine the reproducibility and to examine the results in diseases other than atypical psychosis.

Purpose: To evaluate the effect of lurasidone on a new, patient Life Engagement scale in schizophrenia. Patients and Methods: This post-hoc analysis included participants (ages 18 to 74) diagnosed with schizophrenia who were randomized to lurasidone (40 mg/day) or placebo in a 6-week double-blind efficacy study and those who continued in a subsequent 12-week open-label extension study during which patients received either 40 or 80/mg day lurasidone (flexibly dosed). Change in life engagement was measured using the Positive and Negative Syndrome Scale (PANSS) 11-item Life Engagement subscale score, and individual subscale items, at week 6 during the double-blind phase and extension phase week 12 during the open-label extension phase. Results: Analysis focused on 478 subjects randomized to lurasidone or placebo during the 6-week trial, and 146 who received lurasidone during the extension phase. During the 6-week trial, there was a significantly greater change on the PANSS₁₁ Life Engagement subscale score from baseline to week 6 in the lurasidone group compared to the placebo group (mean changes of − 6.4 and − 4.8, respectively, p = 0.006; effect size = 0.27). Further improvement was evident during the extension phase for patients who received lurasidone in both phases, with a mean change from double-blind baseline to week 12 of the open-label treatment phase of − 10.1 on in PANSS₁₁ Life Engagement subscale. Conclusion: This post-hoc analysis suggests that lurasidone may improve life engagement in patients with schizophrenia, a meaningful outcome from patients’ perspective. Further studies are needed to confirm this effect. Eudract Number: Trial registration: EudraCT Numbers: 2016-000060-42; 2016-000061-23.