Tetsuya Hiramoto

Psychological distress is common yet often underrecognized in chronic obstructive pulmonary disease (COPD). Physiological correlates beyond spirometry may support biopsychosocial assessment in routine care, but their relation to depressive and anxiety symptoms remain insufficiently characterized. In this single-center cross-sectional study, 56 clinically stable Japanese COPD outpatients (mean age 73 years; 87.5% men) completed the Self-Rating Depression Scale (SDS) and the State-Trait Anxiety Inventory (STAI). Clinical assessments included spirometry, %DLCO/VA, echocardiographic tricuspid regurgitation pressure gradient (TRPG), body mass index (BMI), and blood biomarkers. Associations were examined using Spearman's rank correlation and multivariable linear regression adjusted for age, sex, and BMI; Model 1 included %DLCO/VA and Model 2 included TRPG. Bootstrap resampling was used to assess the stability of key regression coefficients. Depressive symptoms (SDS ≥ 40) were present in 46.5% of the patients (severe 5.4%), and elevated state anxiety in 41.1% (severe 12.5%). SDS scores were correlated with lower %DLCO/VA, higher TRPG, and lower BMI. STAI-state scores were correlated with higher TRPG. In adjusted analyses, lower %DLCO/VA was independently associated with higher SDS scores, whereas higher TRPG was independently associated with higher SDS and STAI-state scores. %FEV1 was not associated with SDS or STAI scores. In this Japanese outpatient COPD cohort, depressive and anxiety symptoms were common. Elevated TRPG showed a more consistent association with psychological symptoms in bootstrap analyses, whereas lower %DLCO/VA was associated with depressive symptoms but showed less stable bootstrap support than the TRPG findings. These findings support an integrated biopsychosocial assessment approach to routine COPD care, incorporating physiological information beyond spirometric airflow measures.

Background/Objectives: Nemolizumab provides rapid and effective relief from pruritus in patients with atopic dermatitis. However, it is frequently associated with cutaneous adverse events, and reliable predictors of their severity have not yet been clearly identified. This study aimed to investigate the relationship between the severity of nemolizumab-associated cutaneous adverse events and patients’ clinical background and to explore baseline factors that may be useful in predicting their severity. Methods: We retrospectively analyzed data from 40 patients with atopic dermatitis who received nemolizumab between May 2023 and March 2025. Clinical variables included demographics, prior therapies, phenotype, baseline Eczema Area and Severity Index subscores, serum biomarker levels, and treatment courses. The severity of cutaneous adverse events was classified as mild (<10% body surface area or limited to dryness/desquamation) or moderate-to-severe (≥10% body surface area). Results: Cutaneous adverse events occurred in 31 of 40 patients (78%); 13 were moderate-to-severe and 18 were mild. Most events appeared within 16 weeks of treatment initiation. Severity was associated with age, duration of disease, serum Thymus and Activation-Regulated Chemokine (TARC) level, and clinical phenotype. Patients with trunk-dominant phenotypes showed more severe cutaneous adverse events than patients with extremity-dominant or prurigo-type atopic dermatitis. Most cutaneous adverse events resolved within 12 weeks using topical therapy, without requiring treatment discontinuation. Conclusions: Baseline characteristics such as age, duration of disease, serum TARC levels, and severity of trunk lesions may be useful in predicting the risk of severe cutaneous adverse events, supporting their potential use in pre-treatment assessment and patient counseling.

Identifying mental distress is a complex task, particularly when individuals experience physical symptoms. Traditional self-report questionnaires that detect psychiatric symptoms using emotional words may not work for these individuals. Consequently, there is a need for a screening tool that can identify both the physical and mental symptoms of mental distress in individuals without a clinical diagnosis. Our study aimed to develop and validate a scale that measures mental distress by measuring the extent of brain overwork, which can be extrapolated as the burden of mental distress. In this population-based cross-sectional study, we recruited a total of 739 adults aged 16–65 years from 64 sampling centers of a cohort in Mongolia to validate a 10-item self-report questionnaire. Internal consistency was measured using McDonald’s ω coefficient. Test–retest reliability was analyzed using intraclass correlation coefficients. Construct and convergent validities were examined using principal component analysis (PCA) and confirmatory factor analysis (CFA). The Hospital Anxiety and Depression Scale (HADS) and the abbreviated version of World Health Organization Quality of Life (WHOQOL-BREF) were used to evaluate criterion validity. Among the participants, 70.9% were women, 22% held a bachelor’s degree or higher, 38.8% were employed, and 66% were married. The overall McDonald’s ω coefficient was 0.861, demonstrating evidence of excellent internal consistency. The total intraclass correlation coefficient of the test–retest analysis was 0.75, indicating moderate external reliability. PCA and CFA established a three-domain structure that provided an excellent fit to the data (RMSEA = 0.033, TLI = 0.984, CFI = 0.989, χ² = 58, p = 0.003). This 10-item scale, the Brain Overwork Scale (BOS-10), determines mental distress in three dimensions: excessive thinking, hypersensitivity, and restless behavior. All the items had higher item-total correlations with their corresponding domain than they did with the other domains, and correlations between the domain scores had a range of 0.547–0.615. BOS-10 correlated with HADS, whereas it was inversely correlated with WHOQOL-BREF. In conclusion, the results suggest that BOS-10 is a valid and reliable instrument for assessing mental distress in the general population. The scale screens for mental distress that is characterized by subjective symptoms such as excessive thinking, hypersensitivity, and restless behavior. The current findings also demonstrate that the BOS-10 is quantitative, simple, and applicable for large group testing. This scale may be useful for identifying at-risk individuals who may require further evaluation and treatment for mental distress.

(1) Background: We hypothesized measuring the extent of brain overwork can extrapolate the burden of mental distress. This study aimed to develop a scale that measures mental distress and validate it in the general population. (2) Methods: In this population-based cross-sectional study, we recruited a total of 739 adults aged 16-65 years from 64 sampling centers of a clinical cohort across Mongolia to validate a 10-item self-report questionnaire. Internal consistency was measured using the McDonald’s ω. Test-retest reliability was analyzed using intraclass correlation coefficients. Construct and convergent validities were examined using the principal component analysis (PCA) and confirmatory factor analysis (CFA). Hospital Anxiety and Depression Scale (HADS) and the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) were used to evaluate the criterion validity. (3) Results: Among the participants, 70.9% were women, 22% held a bachelor's degree or higher, 38.8% were employed, and 66% were married. The overall McDonald’s ω coefficient was 0.861 demonstrating evidence of excellent internal consistency. The total intraclass correlation coefficient of the test-retest analysis was 0.75, indicating moderate external reliability. PCA and CFA established a three-domain structure that provided an excellent fit to the data (RMSEA=0.033, TLI=0.984, CFI=0.989, χ2=58, p=0.003). This 10-item scale, the Brain Overwork Scale (BOS-10), determines mental distress in three dimensions: Excessive Thinking, Hypersensitivity, and Restless Behavior. All items had higher item-total correlations with their corresponding domain than the other domains, and correlations between the domain scores ranged from 0.547–0.615. The BOS-10 correlated with the HADS, whereas it was inversely correlated with the WHOQOL-BREF. (4) Conclusions: The results suggest that the BOS-10 is a valid and reliable instrument for assessing mental distress in the general population. The current findings also demonstrate that the BOS-10 is quantitative, simple, and applicable for large-group testing.