Electroconvulsive therapy (ECT) is established as a treatment of catatonia. Recent studies have shown that catatonia can occur in patients with autistic spectrum disorder (ASD). ECT is indicated when patients are unresponsive to other treatments and required rapid improvement. In addition, maintenance ECT is often performed for recurrence prevention of catatonia. Here we describe a patient with autism in her 40s who presented severe catatonia and for whom ECT was effective against catatonia and recurrence prevention.

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In 1938, electroconvulsive therapy (ECT) was developed on the basis of the theory that a biological antagonism exists between seizures and severe psychopathologic states such as psychosis. During the period after its introduction, ECT was found effective for treating various psychiatric illnesses, especially depression. Recently, ECT has been used in treating other neuropsychiatric disorders including Parkinson’s disease and thalamic pain. However, few studies have been done concerning the use of ECT for psychiatric conditions associated with epilepsy in Japan. In non-Japanese literature, ECT is considered safe even in patients with epilepsy (PWE). However, the effectiveness of ECT in PWE is controversial. Furthermore, recent studies revealed that the pathogenesis and symptoms of psychiatric conditions associated with PWE are more complex and diverse than were previously thought. To contribute to research worldwide research in the future, Japanese psychiatrists familiar with epilepsy need to collaborate with Japanese experts on ECT to gain knowledge about these issues.

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ECT is effective for treatment-resistant depression, schizophrenia, and catatonic syndrome. Quite a few psychiatric diseases and related conditions do not sufficiently respond to current pharmacotherapy. To relieve patients from suffering, various treatments have been tried. Parkinson’s disease with psychotic symptoms is the case. We discuss herewith the effectiveness of ECT on Parkinson’s disease with psychotic symptoms, showing changes in regional cerebral blood flow.

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Previous clinical trials of repetitive transcranial magnetic stimulation (rTMS) applied to major depression have shown that the grand mean of reported effect sizes was medium and less than that of electroconvulsive therapy (ECT), although rTMS exhibited much higher safety and tolerability than ECT. Recently, the utility of rTMS has been demonstrated in terms of durability of antidepressant effects and relapse prevention, in addition to antidepressant effects during the acute phase. However, the response rate of rTMS was reported to be 30 to 40% of medication-resistant patients with major depression, which was not satisfactory. It is crucial for clinical introduction of rTMS to define a targeted clinical population and a suitable position of rTMS within a comprehensive treatment algorithm of major depression. Hypothetical antidepressant mechanisms of rTMS were addressed at the levels of neurotransmitter, neuroplasticity, and macroanatomical neuronal networks. Additionally, rTMS applications to other psychiatric disorders were briefly introduced. Finally, clinical introduction of rTMS was discussed in terms of existing situations and challenges in Japan.

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In this article, I aim to outline the present state and findings on the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) and magnetic seizure therapy (MST). In addition, I introduce foreign guidelines for the treatment of patients with major depressive disorder and treatment-resistant depression (TRD). Although rTMS treatment for TRD in the acute phase is not usually superior to electroconvulsive therapy (ECT) in terms of its antidepressant effect, it is suggested that rTMS has an effect comparable to that of ECT in relapse prevention during the continuation and/or maintenance phase of treatment. On the other hand, MST has characteristics comparable to those of ECT even in the acute phase of treatment and results in faster recovery of orientation after treatment. Furthermore, it is assumed that rTMS and MST have no specific “social stigma”, or the adverse cognitive effect that ECT usually has. It is also estimated that the cost-effectiveness of rTMS is almost equivalent to that of ECT. Moreover, neurostimulation therapy has the potential to reduce the adverse effects of medication as well as overall healthcare costs in the long term. For optimization of treatment parameters and protocols, further research is needed for a more detailed understanding of the therapeutic mechanism of the neurostimulation represented by rTMS. In the future, through such efforts, it would be possible to implement personalized neurostimulation therapy tailored to the condition of the individual patient with TRD.

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Sociocultural background might explain differences in predictors for postnatal depression between countries. Based on previous studies, we hypothesized that feeling social pressure to have a child predicts postnatal depression in Japan, and tested the hypothesis in this study. Pregnant women from 12-24 weeks’ gestation were consecutively recruited at a maternity hospital in Japan. Then, 118 participants completed the Edinburgh Postnatal Depression Scale at baseline and 1 month after childbirth. An EPDS score of 9 or more 1 month after childbirth was set as the dependent variable. Multivariable logistic regression analysis revealed that feeling social pressure to have a child predicted postpartum depressive symptoms. It might be clinically relevant for general hospitals to check whether pregnant women feel social pressure to have a child in order to predict postnatal mental health.

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We measured depression in Japanese child and adolescent recipients of kidney transplants and examined the relation between depression and quality of life (QOL). The survey comprised 35 recipients (7–15 years old, 22 elementary-school children, 13 junior-high-school children, 4.2 ± 2.9 years after transplant，living donor 74.3%) who completed a mail-back questionnaire survey. We administered the Birleson Depression Self-Rating Scale for Children (DSRSC) to assess depression and the KINDL^Ⓡ questionnaires (KINDL) for QOL. Of the 35 patients, 14.3% met the criteria for depression (16 ≦ DSRSC), representing 13.6% of elementary-school and 15.4% of junior-high-school children. In elementary-school children, score of the QOL domain in schools was lower than the standard value of healthy subjects. In junior-high-school children, score of the QOL domain of self-esteem was higher than the standard value. The total score of QOL was lower in high-depression group than low-depression group. Our results indicated that it is important to take into account depression and the QOL domains correlated with depression in both child and adolescent transplant recipients.

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Risperidone is an antipsychotic agent frequently used for the treatment of delirium. It has been reported that the clearance of risperidone and the active moiety (risperidone plus 9-hydroxy-risperidone) was reduced in renal disease patients, and thus renal impairment can result in prolonged sedation in patients with delirium during the administration of risperidone. Such prolonged sedation may result in adverse events including aspiration pneumonia and falls. The purpose of this retrospective study was to investigate the association between the prolonged sedation and renal function in inpatients with delirium who were administered risperidone at the Kurashiki Central Hospital from January 2013 to October 2014. The renal function of patients was evaluated by serum creatinine (Cr), estimated glomerular filtration rate (eGFR) and estimated creatinine clearance by Cockcroft-Gault formula (CCr). Among 84 patients who received risperidone, prolonged sedation did not occur in 69 patients. From 68 patients with a normal Cr level, 60 did not experience prolonged sedation under risperidone administration (sensitivity 87.0%, specificity 46.7%). From 53 patients with a eGFR ≧60ml/min/1.73m² and CCr ≧50ml/min, 48 did not experience prolonged sedation (sensitivity 69.6%, specificity 66.7%). From 17 patients with a eGFR ≧90ml/min/1.73m² and CCr ≧80ml/min, there were no patients who experienced prolonged sedation (sensitivity 24.6%, specificity 100%). The result of this study suggests that patients with high risk of prolonged sedation under risperidone might be identified according to Cr, eGFR and CCr values.

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