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Shuichi Awata

Publications and source records attributed to Shuichi Awata.

28 records · Page 2Linked to original sources
PubMed2005

[Prevention of suicide in the elderly].

In order to establish a comprehensive community intervention program for preventing suicide in late life, a series of observation and intervention studies was conducted in an urban residential district where the elderly population was rapidly increased. In cross-sectional studies, impaired instrumental activities of daily living, lack of social support, and depressive symptoms were independently associated with suicidal ideation in elderly community residents. In addition, mental disorders, particularly depressive and alcohol-related disorders, were found to be strongly associated with recent suicidal ideation. In prospective cohort studies, low motor function or severe pain, alcohol problems, and depressive symptoms independently predicted male suicidal ideation, whereas only depressive symptoms predicted female suicidal ideation. In intervention studies, education, consultation, increased community activity, and screening programs decreased the proportion of residents who indicated a lack of social support, and reduced depressive symptoms (GDS). Additionally, outreach and case management programs improved mental-health wellbeing (WHO-5), and reduced suicidal ideation among elderly with depressive disorders. Screening for depressive symptoms followed by diagnostic evaluation of mental disorders may provide a practical and effective strategy for case identification. However, it should be noted that physical distress and alcohol problems might increase suicide risk irrespective of depression, especially among elderly males. The combination of population and high-risk strategies is recommended for a comprehensive community intervention program for preventing elderly suicide in urban residential districts.

Activities of Daily Living↗
PubMed2004

A questionnaire survey of ECT practice in university hospitals and national hospitals in Japan.

Although electroconvulsive therapy (ECT) is being performed in many hospitals in Japan, there is little information on its present practice. We surveyed ECT practice to improve the practice of ECT in Japan. A mail questionnaire survey of ECT practice was conducted between 1997 and 1999 in Japan. Of 84 university hospitals and 37 national hospitals, 86 respondents (71%) were obtained. ECT was performed in 56 hospitals (65%). Details of ECT practice were further surveyed in 46 hospitals. The number of patients per year receiving ECT varied according to hospitals from 0.5 to 120. Unmodified ECT was still used in two thirds of the hospitals. Modified ECT was mainly performed in an operating room. Unilateral ECT was seldom used. Japan is an under-developed country for ECT and the practice of ECT must be improved.

Depressive Disorder↗
PubMed2004

One-year outcome after response to ECT in middle-aged and elderly patients with intractable catatonic schizophrenia.

BACKGROUND AND OBJECTIVE: ECT is one of the most efficacious treatments for catatonic schizophrenia. However, there has been no study on the efficacy of ECT in elderly patients with catatonic schizophrenia. Thus, we conducted prospective studies on the short-term (phase 1 study) and long-term (phase 2 study) effects of acute ECT on intractable catatonic schizophrenia in middle-aged and elderly patients. SUBJECTS AND METHODS: The phase 1 study included 11 consecutive patients over 45 years of age who fulfilled the DSM-IV criteria for catatonic schizophrenia and were referred to Tohoku University Hospital for the first time for acute ECT between January 1, 1998, and August 31, 2003, after other treatments had failed. We evaluated the clinical response of these patients to acute ECT by means of the Brief Psychiatric Rating Scale (BPRS). We also evaluated adverse effects of acute ECT. The patient or guardian provided written informed consent. Exclusion criterion was a history of dementia or substance abuse. Patients were considered clinical responders if they had a BPRS score ;ek 25 for 1 week after the final ECT session. The phase 2 study included 11 consecutive patients who responded to acute ECT in the phase 1 study. Patients provided written informed consent. Patients' BPRS scores were evaluated weekly (18 items, rated 0-6) for 48 weeks or until relapse/recurrence, during which time they received pharmacotherapy. Patients were considered clinical "relapsers" if they had a BPRS score of at least 37 for 3 consecutive days. Differences in clinical characteristics between patients with and without recurrence were analyzed statistically by the Mann-Whitney U test. RESULTS: All 11 patients completed the phase 1 study, and the acute ECT response rate was 100%. No patient experienced a severe adverse cognitive or physical effect during the course of acute ECT. All 11 patients also completed the phase 2 study. The mean dose of continuation neuroleptics in all 11 cases was 296.8 +/- 277.6 mg (range, 0-982 mg) (chlorpromazine [CPZ] equivalent). Relapse occurred in 7 cases, and all occurred within 6 months. The 1-year recurrence rate was 63.6%. The mean (+/-SD) relapse prevention time in the 7 cases was 76.0 +/- 64.7 days (range, 11-163 days). A significant difference in daily neuroleptic dose before acute ECT was found between the patients suffering recurrence and those not suffering recurrence (766.7 +/- 521.8 CPZ-equivalent mg with recurrence versus 101.9 +/- 75.2 CPZ-equivalent mg without recurrence, U = 2.0, P = 0.923). There was a trend toward a lower Global Assessment of Functioning (GAF) score just before ECT (7.3 +/- 4.0 with recurrence versus 16.8 +/- 11.2 without recurrence, U = 4.5, P = 0.073). CONCLUSIONS: The short-term efficacy of acute ECT for middle-aged and elderly patients with intractable catatonic schizophrenia is excellent. However, the 1-year recurrence rate, especially the 6-month relapse rate, after response to acute ECT is high, despite continuation pharmacotherapy. The need for more effective relapse-prevention strategies, such as continuation ECT, is urgent.

Age Factors↗
PubMed2004

[Association between social support and depression in the elderly Japanese population].

To determine the association between social support and depression in elderly Japanese, we conducted a Comprehensive Geriatric Assessment among residents aged 70 years or over. Out of 2,730 eligible subjects, 1,179 participated in the survey and 1,146 (480 men and 666 women) were analyzed. The Geriatric Depression Scale (GDS) was used to estimate depression status. The subjects were divided into two groups: depressive (GDS>11 or taking antidepressant drugs) and non-depressive (GDS<11). Various levels of social support were assessed by the following questions: Do you have someone (1) whom you can consult when you are in trouble ? (2) whom you can consult when your physical condition is not good ? (3) who can help you in daily housework ? (4) who can take you to a hospital when you don't feel well ? (5) who can take care of you when you are ill in bed? In multivariate logistic regression analysis, the calculated odds ratios (95% CIs) for the lack of each type of social support for depression status were: (1) 2.5 (1.5-4.1),(2) 1.9 (1.1-3.2),(3) 2.7 (1.7-4.4),(4) 1.9 (1.1-3.2),(5) 2.8 (1.6-4.9) in men, and (1) 1.2 (0.8-1.8),(2) 1.2 (0.8-1.8),(3) 1.4 (1.0-2.0),(4) 1.6 (1.1-2.3),(5) 2.0 (1.4-2.9) in women. A significant association was found between social support and depression in this elderly population. We also found that this association was stronger in men.

Aged↗
PubMed2003

Electroconvulsive shock increases serotonin transporter in the rat frontal cortex.

The antidepressive action of electroconvulsive shock (ECS) is thought to involve the alteration in serotonin (5-HT) neurotransmission, including the increase in 5-HT release and uptake. In our previous study, 5-HT transporter (5-HTT) mRNA expression was decreased after single and repetitive ECS in rat raphe nucleus. In the present study, we investigated the effects of single and repetitive ECS on the protein levels of 5-HTT in the frontal cortex, hippocampus and raphe nucleus of rat brain using quantitative Western blot analysis. Single ECS did not alter 5-HTT protein expression in any brain regions examined. Repetitive ECS stably increased 5-HTT protein in the frontal cortex, but not in the hippocampus and raphe nucleus. Because ECS is known to facilitate the release of neurotransmitters, our results suggest that the increased 5-HTT protein expression in the frontal cortex might be a compensatory change against the enhanced 5-HT release by ECS in presynaptic terminals.

Animals↗
PubMed2003

Context-dependent cortical activation in response to financial reward and penalty: an event-related fMRI study.

An event-related fMRI technique was used to assess neural responses to financial reward and penalty during a simple gambling task. We attempted to determine whether brain activities are dependent on the unique context of an event sequence. Thirty-six healthy volunteers participated in the study. The task was to guess the color of the suit of a card on each trial and to respond by pressing a button. Every correct response ("win") and incorrect response ("loss") was associated with financial reward and penalty, respectively. The magnitude of reward or penalty in each trial did not change; however, the subjects' self-reported emotional arousal was significantly higher for the events of "the fourth win of four wins in a row" and "the fourth loss of four losses in a row." We also found that the bilateral anterior cingulate and medial prefrontal cortices were specifically activated when the subjects experienced "the fourth win of four wins in a row" and "the fourth loss of four losses in a row." When the subjects experienced "a win following four losses in a row" or "a loss following four wins in a row," the right dorsolateral prefrontal cortex was specifically activated. Our data indicate that there exist brain activities associated with the event-sequence context in which abstract reward or penalty is received. These context-dependent activities appear to be crucial for adapting oneself to new circumstances and may account for clinical symptoms of various mental illnesses in which dysfunction of these regions has been reported.

Adolescent↗
PubMed2003

Short-term effect of ECT in middle-aged and elderly patients with intractable catatonic schizophrenia.

BACKGROUND AND OBJECTIVE: The management of middle-aged and elderly patients with catatonic schizophrenia has long been a major problem in clinical geriatric psychiatry. Most cases are intractable because of medication resistance, medication intolerance, or severe medical conditions. Electroconvulsive therapy (ECT) is recognized as one of the most efficacious therapies for catatonic schizophrenia. Thus, we conducted a prospective study of the short-term effect of acute ECT on middle-aged and elderly patients with intractable catatonic schizophrenia. MATERIALS AND METHODS: Subjects were nine consecutive patients older than 45 years who had fulfilled the DSM-IV criteria for catatonic-type schizophrenia and had been referred for first-time acute ECT after other treatments had failed. The patients were treated at Tohoku University Hospital between January 1998 and March 2002. We evaluated the clinical response of these patients to acute ECT by means of the brief psychiatric rating scale (BPRS). We also evaluated adverse effects of acute ECT. RESULTS: The response rate was 100%. The total BPRS score was improved in all nine subjects at the end of the ECT course and 1 week after the final session in comparison with the total pre-ECT BPRS score (11.9 +/- 7.5 and 9.3 +/- 9.2 versus 57.1 +/- 13.1, respectively, p = 0.008, p = 0.008). The total Global Assessment of Functioning score was also improved significantly (from 10.8 +/- 9.4 just before ECT to 61.6 +/- 18.9 1 week after ECT, p = 0.008). Guy's five factors (thought disturbance, activation, anxiety-depression, hostility-suspiciousness, and anergia) improved significantly (p = 0.008, p = 0.008, p = 0.018, p = 0.012, p = 0.008, respectively). One patient showed supraventricular premature contractions (SVPCs) during an ECT seizure. After some ECT sessions, three patients exhibited mild to moderate delirium that disappeared within 3 days. However, no patient experienced a severe cognitive or physical adverse effect during the course of ECT. CONCLUSIONS: Acute ECT has a good short-term effect on middle-aged and elderly patients with intractable catatonic schizophrenia and appears to be safe. Our results indicate that systematic studies on a large scale are warranted for further investigation of the efficacy and safety of acute ECT for treating middle-aged and elderly patients with catatonic schizophrenia.

Age Factors↗
PubMed2002

Changes in regional cerebral blood flow abnormalities in late-life depression following response to electroconvulsive therapy.

The impact of electroconvulsive therapy (ECT) on the regional cerebral blood flow (rCBF) abnormalities in late-life depression is still unknown and the clinical significance of these findings in late-life depression has not been fully discussed. Using single photon emission computed tomography (SPECT) with 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO), we examined the changes of rCBF patterns in nine late-life patients with major depressive episodes before and following response to ECT compared with nine age- and sex-matched healthy volunteers. Statistical comparisons were made on both region-of-interest (ROI) and voxel-by-voxel bases. In ROI-based analyses, a mean rCBF was significantly decreased in the patients before ECT compared with the control, significantly increased (normalized) in the patients 2 weeks after ECT compared with that before ECT, and still increased in the patients 12 weeks after ECT compared with that before ECT. In voxel-by-voxel analyses, a significant rCBF reduction was found in the bilateral pre- and subcallosal anterior cingulate cortex, the bilateral caudal orbitofrontal cortex, the right insular cortex and the right posterior middle frontal gyrus in patients before ECT compared with the control, and similar rCBF patterns were shown at 2 weeks and 12 weeks after ECT. We propose the hypothesis that a mean rCBF reduction may have a state-related property while persistent anterior paralimbic hypoperfusion may have a trait-like property, which relates to the relapse vulnerability as well as a tendency toward medication failure and illness chronicity in late-life depression.

Age Factors↗