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1. Randomized open-label study of second-generation antipsychotics for the treatment of schizophrenia: 104-week final results of the JUMPs study assessing treatment discontinuation, remission, and social functioning

Author

Ishigooka, Jun, Nakagome, Kazuyuki, Ohmori, Tetsuro, Iwata, Nakao, Inada, Ken, Iga, Jun-ichi, Kishi, Taro, Fujita, Kiyoshi, Kikuchi, Yuka, Shichijo, Toshiaki, Tabuse, Hideaki, Koretsune, Shotatsu, Terada, Hiroshi, Terada, Haruko, Kishimoto, Toshifumi, Tsutsumi, Yuichiro, and Ohi, Kazutaka

Published
2024
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3. The effect of education regarding treatment guidelines for schizophrenia and major depressive disorders on psychiatrists' hypnotic medication prescribing behavior: a multicenter study

Author

Nakamura, Toshinori, Furihata, Ryuji, Hasegawa, Naomi, Kodaka, Fumitoshi, Muraoka, Hiroyuki, Ichihashi, Kayo, Ochi, Shinichiro, Numata, Shusuke, Tsuboi, Takashi, Makinodan, Manabu, Iida, Hitoshi, Onitsuka, Toshiaki, Kashiwagi, Hiroko, Takeshima, Masahiro, Hashimoto, Naoki, Nagasawa, Tatsuya, Usami, Masahide, Yamagata, Hirotaka, Takaesu, Yoshikazu, Miura, Kenichiro, Matsumoto, Junya, Ohi, Kazutaka, Yamada, Hisashi, Hori, Hikaru, Inada, Ken, Watanabe, Koichiro, Hashimoto, Ryota, and Yasui-Furukori, Norio

Published
2024
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5. General Principles of Pharmacologic Therapy

Author

Inada, Ken, Yamawaki, Shigeto, Kanba, Shigenobu, Shinozaki, Gen, Kasper, Siegfried, El-Mallakh, Rif S., Section editor, Zohar, Joseph, Section editor, Krystal, Andrew D., Section editor, Tasman, Allan, editor, Riba, Michelle B., editor, Alarcón, Renato D., editor, Alfonso, César A., editor, Kanba, Shigenobu, editor, Lecic-Tosevski, Dusica, editor, Ndetei, David M., editor, Ng, Chee H., editor, and Schulze, Thomas G., editor

Published
2024
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7. Effect of the guideline education program on anticholinergic and benzodiazepine use in outpatients with schizophrenia and major depressive disorder: The effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE) project

Author

Yamagata, Hirotaka, Fujii, Yuko, Ochi, Shinichiro, Seki, Tomoe, Hasegawa, Naomi, Yamada, Hisashi, Hori, Hikaru, Ichihashi, Kayo, Iga, Jun-ichi, Ogasawara, Kazuyoshi, Hashimoto, Naoki, Iida, Hitoshi, Ohi, Kazutaka, Tsuboi, Takashi, Numata, Shusuke, Hishimoto, Akitoyo, Usami, Masahide, Katsumoto, Eiichi, Muraoka, Hiroyuki, Takaesu, Yoshikazu, Nagasawa, Tatsuya, Komatsu, Hiroshi, Miura, Kenichiro, Matsumoto, Junya, Inada, Ken, Nakagawa, Shin, and Hashimoto, Ryota

Published
2024
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8. Change of prescription for patients with schizophrenia or major depressive disorder during admission: real-world prescribing surveys from the effectiveness of guidelines for dissemination and education psychiatric treatment project

Author

Hashimoto, Naoki, Yasui-Furukori, Norio, Hasegawa, Naomi, Ishikawa, Shuhei, Hori, Hikaru, Iida, Hitoshi, Ichihashi, Kayo, Miura, Kenichiro, Matsumoto, Junya, Numata, Shusuke, Kodaka, Fumitoshi, Furihata, Ryuji, Ohi, Kazutaka, Ogasawara, Kazuyoshi, Iga, Jun-ichi, Muraoka, Hiroyuki, Komatsu, Hiroshi, Takeshima, Masahiro, Atake, Kiyokazu, Kido, Mikio, Nakamura, Toshinori, Kishimoto, Taishiro, Hishimoto, Akitoyo, Onitsuka, Toshiaki, Okada, Tsuyoshi, Ochi, Shinichiro, Nagasawa, Tatsuya, Makinodan, Manabu, Yamada, Hiroki, Tsuboi, Takashi, Yamada, Hisashi, Inada, Ken, Watanabe, Koichiro, and Hashimoto, Ryota

Published
2023
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13. Characteristics of the treatments for each severity of major depressive disorder: A real-world multi-site study

Author

Muraoka, Hiroyuki, Kodaka, Fumitoshi, Hasegawa, Naomi, Yasui-Furukori, Norio, Fukumoto, Kentaro, Kashiwagi, Hiroko, Tagata, Hiromi, Hori, Hikaru, Atake, Kiyokazu, Iida, Hitoshi, Ichihashi, Kayo, Furihata, Ryuji, Tsuboi, Takashi, Takeshima, Masahiro, Komatsu, Hiroshi, Kubota, Chika, Ochi, Shinichiro, Takaesu, Yoshikazu, Usami, Masahide, Nagasawa, Tatsuya, Makinodan, Manabu, Nakamura, Toshinori, Kido, Mikio, Ueda, Ikki, Yamagata, Hirotaka, Onitsuka, Toshiaki, Asami, Takeshi, Hishimoto, Akitoyo, Ogasawara, Kazuyoshi, Katsumoto, Eiichi, Miura, Kenichiro, Matsumoto, Junya, Ohi, Kazutaka, Yamada, Hisashi, Watanabe, Koichiro, Inada, Ken, Nishimura, Katsuji, and Hashimoto, Ryota

Published
2022
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14. Clinical significance of direct fast scarlet staining on the diagnosis of eosinophilic colitis: A comparative study focusing on the eosinophil degranulation in colonic mucosal tissue.

Author

Ikeda, Mina, Kato, Hiroyuki, Arakawa, Satoshi, Kobayashi, Takashi, Hashimoto, Senju, Katano, Yoshiaki, Inada, Ken‐ichi, Kiriyama, Yuka, Ishihara, Takuma, Yamamoto, Satoshi, Asano, Yukio, and Horiguchi, Akihiko

Subjects
MUCOUS membranes, HEMATOXYLIN & eosin staining, EOSINOPHILS, REFERENCE values, COLITIS
Abstract

This study aimed to validate the DFS (direct fast scarlet) staining in the diagnosis of EC (eosinophilic colitis). The study included 50 patients with EC and 60 with control colons. Among the 60 control samples, 39 and 21 were collected from the ascending and descending colons, respectively. We compared the median number of eosinophils and frequency of eosinophil degranulation by HE (hematoxylin and eosin) and DFS staining between the EC and control groups. In the right hemi‐colon, eosinophil count by HE was useful in distinguishing between EC and control (41.5 vs. 26.0 cells/HPF, p < 0.001), but the ideal cutoff value is 27.5 cells/HPF (high‐power field). However, this method is not useful in the left hemi‐colon (12.5 vs. 13.0 cells/HPF, p = 0.990). The presence of degranulation by DFS allows us to distinguish between the groups even in the left hemi‐colon (58% vs. 5%, p < 0.001). DFS staining also enabled a more accurate determination of degranulation than HE. According to the current standard to diagnose EC (count by HE staining ≥20 cells/HPF), mucosal sampling from left hemi‐colon is problematic since the number of eosinophils could not be increased even in EC. Determination of degranulated eosinophils by DFS may potentiate the diagnostic performance even in such conditions. [ABSTRACT FROM AUTHOR]

Published
2024
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15. The characteristics of patients receiving psychotropic pro re nata medication at discharge for the treatment of schizophrenia and major depressive disorder: A nationwide survey from the EGUIDE project

Author

Ichihashi, Kayo, Kyou, Yoshitaka, Hasegawa, Naomi, Yasui-Furukori, Norio, Shimizu, Yoshihito, Hori, Hikaru, Hashimoto, Naoki, Ide, Kenta, Imamura, Yayoi, Yamada, Hisashi, Ochi, Shinichiro, Iga, Jun-ichi, Takaesu, Yoshikazu, Ohi, Kazutaka, Tsuboi, Takashi, Iida, Hitoshi, Yamagata, Hirotaka, Hishimoto, Akitoyo, Horai, Tadasu, Usami, Masahide, Makinodan, Manabu, Nagasawa, Tatsuya, Komatsu, Hiroshi, Kido, Mikio, Muraoka, Hiroyuki, Atake, Kiyokazu, Takeshima, Masahiro, Kubota, Chika, Inagaki, Takahiko, Tamai, Shinichiro, Kishimoto, Taishiro, Furihata, Ryuji, Matsumoto, Junya, Miura, Kenichiro, Inada, Ken, Watanabe, Koichiro, Kasai, Kiyoto, and Hashimoto, Ryota

Published
2022
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16. Hypnotic medication use among inpatients with schizophrenia and major depressive disorder: results of a nationwide study

Author

Furihata, Ryuji, Otsuki, Rei, Hasegawa, Naomi, Tsuboi, Takashi, Numata, Shusuke, Yasui-Furukori, Norio, Kashiwagi, Hiroko, Hori, Hikaru, Ochi, Shinichiro, Muraoka, Hiroyuki, Onitsuka, Toshiaki, Komatsu, Hiroshi, Takeshima, Masahiro, Hishimoto, Akitoyo, Nagasawa, Tatsuya, Takaesu, Yoshikazu, Nakamura, Toshinori, Asami, Takeshi, Miura, Kenichiro, Matsumoto, Junya, Ohi, Kazutaka, Yasuda, Yuka, Iida, Hitoshi, Ogasawara, Kazuyoshi, Hashimoto, Naoki, Ichihashi, Kayo, Yamada, Hisashi, Watanabe, Koichiro, Inada, Ken, and Hashimoto, Ryota

Published
2022
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18. The characteristics of discharge prescriptions including pro re nata psychotropic medications for patients with schizophrenia and major depressive disorder from the survey of the “Effectiveness of guidelines for dissemination and education in psychiatric treatment (EGUIDE)” project

Author

Kyou, Yoshitaka, Yasui-Furukori, Norio, Hasegawa, Naomi, Ide, Kenta, Ichihashi, Kayo, Hashimoto, Naoki, Hori, Hikaru, Shimizu, Yoshihito, Imamura, Yayoi, Muraoka, Hiroyuki, Iida, Hitoshi, Ohi, Kazutaka, Yasuda, Yuka, Ogasawara, Kazuyoshi, Numata, Shusuke, Iga, Jun-ichi, Tsuboi, Takashi, Ochi, Shinichiro, Kodaka, Fumitoshi, Furihata, Ryuji, Onitsuka, Toshiaki, Makinodan, Manabu, Komatsu, Hiroshi, Takeshima, Masahiro, Kubota, Chika, Hishimoto, Akitoyo, Atake, Kiyokazu, Yamagata, Hirotaka, Kido, Mikio, Nagasawa, Tatsuya, Usami, Masahide, Kishimoto, Taishiro, Kikuchi, Saya, Matsumoto, Junya, Miura, Kenichiro, Yamada, Hisashi, Watanabe, Koichiro, Inada, Ken, and Hahimoto, Ryota

Published
2022
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21. Characteristics of discharge prescriptions for patients with schizophrenia or major depressive disorder: Real-world evidence from the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project

Author

Hashimoto, Naoki, Yasui-Furukori, Norio, Hasegawa, Naomi, Ishikawa, Shuhei, Numata, Shusuke, Hori, Hikaru, Iida, Hitoshi, Ichihashi, Kayo, Furihata, Ryuji, Murata, Atsunobu, Tsuboi, Takashi, Takeshima, Masahiro, Kyou, Yoshitaka, Komatsu, Hiroshi, Kubota, Chika, Ochi, Shinichiro, Takaesu, Yoshikazu, Usami, Masahide, Nagasawa, Tatsuya, Hishimoto, Akitoyo, Miura, Kenichiro, Matsumoto, Junya, Ohi, Kazutaka, Yamada, Hisashi, Inada, Ken, Watanabe, Koichiro, Shimoda, Kazutaka, and Hashimoto, Ryota

Published
2021
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36. Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study

Author

Hasegawa, Naomi, primary, Yasuda, Yuka, additional, Yasui‐Furukori, Norio, additional, Yamada, Hisashi, additional, Hori, Hikaru, additional, Ichihashi, Kayo, additional, Takaesu, Yoshikazu, additional, Iida, Hitoshi, additional, Muraoka, Hiroyuki, additional, Kodaka, Fumitoshi, additional, Iga, Jun‐ichi, additional, Hashimoto, Naoki, additional, Ogasawara, Kazuyoshi, additional, Ohi, Kazutaka, additional, Fukumoto, Kentaro, additional, Numata, Shusuke, additional, Tsuboi, Takashi, additional, Usami, Masahide, additional, Hishimoto, Akitoyo, additional, Furihata, Ryuji, additional, Kishimoto, Taishiro, additional, Nakamura, Toshinori, additional, Katsumoto, Eiichi, additional, Ochi, Shinichiro, additional, Nagasawa, Tatsuya, additional, Atake, Kiyokazu, additional, Kubota, Chika, additional, Komatsu, Hiroshi, additional, Yamagata, Hirotaka, additional, Ide, Kenta, additional, Takeshima, Masahiro, additional, Kido, Mikio, additional, Kikuchi, Saya, additional, Okada, Tsuyoshi, additional, Matsumoto, Junya, additional, Miura, Kenichiro, additional, Shimazu, Taichi, additional, Inada, Ken, additional, Watanabe, Koichiro, additional, and Hashimoto, Ryota, additional

Published
2023
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38. Development and acceptability testing of a decision aid for considering whether to reduce antipsychotics in individuals with stable schizophrenia

Author

Aoki, Yumi, primary, Takaesu, Yoshikazu, additional, Matsui, Kentaro, additional, Tokumasu, Takahiro, additional, Tani, Hideaki, additional, Takekita, Yoshiteru, additional, Kanazawa, Tetsufumi, additional, Kishimoto, Taishiro, additional, Tarutani, Seiichiro, additional, Hashimoto, Naoki, additional, Takeuchi, Hiroyoshi, additional, Mishima, Kazuo, additional, and Inada, Ken, additional

Published
2023
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40. Effects of chronic haloperidol treatment on the expression of fear memory and fear memory extinction in the cued fear‐conditioned rats.

Author

Enomoto, Kosuke, Shibata, Kazuro, Muraoka, Hiroyuki, Kawano, Masahiko, Inada, Ken, Ishigooka, Jun, Nishimura, Katsuji, and Oshibuchi, Hidehiro

Subjects
CYCLOSERINE, DOPAMINE antagonists, MEMORY disorders, HALOPERIDOL, DOPAMINE receptors, MEMORY, NEURAL circuitry
Abstract

Aim: Impairments in emotional memory are frequently observed in several mental disorders, highlighting their significance as potential therapeutic targets. Recent research on the cued fear conditioning model has elucidated the neural circuits involved in fear memory processing. However, contradictory findings have been reported concerning the role of dopamine and the impact of dopamine D2 receptor (D2R) antagonists. There is notably limited knowledge regarding the clinical utility of chronic D2R antagonist treatments. This study aimed to uncover how such treatments affect fear memory processing. Methods: We utilized a cued fear conditioning rat model and conducted chronic haloperidol treatment for 14 days. Subsequently, to investigate the effect of chronic haloperidol treatment on fear‐conditioned memory expression and extinction, we observed freezing behavior under exposure to a conditioned stimulus for 14 days. Results: Chronic haloperidol treatment suppressed freezing time on the fear memory expression. In contrast, a single haloperidol administration enhanced the freezing time on fear memory expression and delayed extinction. Conclusion: The results of this study suggest that chronic administration of antipsychotic drugs affects fear memory processing differently from single‐dose administration. This indicates that the effects of chronic D2R antagonist treatment are distinct from the nonspecific effects of the drugs. This study provides fundamental insights that may contribute to our understanding of therapeutic mechanisms for fear memory disorders related to D2R in the future. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Combination Psychotropic Use for Schizophrenia With Long-Acting Injectable Antipsychotics and Oral Antipsychotics

Author

Onitsuka, Toshiaki, primary, Okada, Tsuyoshi, additional, Hasegawa, Naomi, additional, Tsuboi, Takashi, additional, Iga, Jun-ichi, additional, Yasui-Furukori, Norio, additional, Yamada, Naoki, additional, Hori, Hikaru, additional, Muraoka, Hiroyuki, additional, Ohi, Kazutaka, additional, Ogasawara, Kazuyoshi, additional, Shinichiro, Ochi, additional, Takeshima, Masahiro, additional, Ichihashi, Kayo, additional, Fukumoto, Kentaro, additional, Iida, Hitoshi, additional, Yamada, Hisashi, additional, Furihata, Ryuji, additional, Makinodan, Manabu, additional, Takaesu, Yoshikazu, additional, Numata, Shusuke, additional, Komatsu, Hiroshi, additional, Hishimoto, Akitoyo, additional, Kido, Mikio, additional, Atake, Kiyokazu, additional, Yamagata, Hirotaka, additional, Kikuchi, Saya, additional, Hashimoto, Naoki, additional, Usami, Masahide, additional, Katsumoto, Eiichi, additional, Asami, Takeshi, additional, Kubota, Chika, additional, Matsumoto, Junya, additional, Miura, Kenichiro, additional, Hirano, Yoji, additional, Watanabe, Koichiro, additional, Inada, Ken, additional, and Hashimoto, Ryota, additional

Published
2023
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45. Treatment strategy for insomnia disorder: Japanese expert consensus

Author

Takaesu, Yoshikazu, primary, Sakurai, Hitoshi, additional, Aoki, Yumi, additional, Takeshima, Masahiro, additional, Ie, Kenya, additional, Matsui, Kentaro, additional, Utsumi, Tomohiro, additional, Shimura, Akiyoshi, additional, Okajima, Isa, additional, Kotorii, Nozomu, additional, Yamashita, Hidehisa, additional, Suzuki, Masahiro, additional, Kuriyama, Kenichi, additional, Shimizu, Eiji, additional, Mishima, Kazuo, additional, Watanabe, Koichiro, additional, and Inada, Ken, additional

Published
2023
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47. Development and acceptability of a decision aid for anxiety disorder considering discontinuation of benzodiazepine anxiolytic

Author

Aoki, Yumi, Takaesu, Yoshikazu, Inada, Ken, Yamada, Hiroki, Murao, Tomohiko, Kikuchi, Toshiaki, Takeshima, Masahiro, Tani, Masayuki, Mishima, Kazuo, Otsubo, Tempei, Aoki, Yumi, Takaesu, Yoshikazu, Inada, Ken, Yamada, Hiroki, Murao, Tomohiko, Kikuchi, Toshiaki, Takeshima, Masahiro, Tani, Masayuki, Mishima, Kazuo, and Otsubo, Tempei

Abstract

Aim: We aimed to develop a decision aid (DA) for individuals with anxiety disorders who consider tapering benzodiazepine (BZD) anxiolytics, and if tapering, tapering BZD anxiolytics with or without cognitive behavioral therapy (CBT) for anxiety. We also assessed its acceptability among stakeholders. Methods: First, we conducted a literature review regarding anxiety disorders to determine treatment options. We cited the results of the systematic review and meta-analysis, which we conducted previously, to describe the related outcomes of two options: tapering BZD anxiolytics with CBT and tapering BZD anxiolytics without CBT. Second, we developed a DA prototype in accordance with the International Patient Decision Aid Standards. We carried out a mixed methods survey to assess the acceptability among stakeholders including those with anxiety disorders and healthcare providers. Results: Our DA provided information such as explanation of anxiety disorders, options of tapering or not tapering BZD anxiolytics (if tapering, the options of tapering BZD anxiolytics with or without CBT) for anxiety disorder, benefits and risks of each option, and a worksheet for value clarification. For patients (n = 21), the DA appeared to be acceptable language (86%), adequate information (81%), and well-balanced presentation (86%). The developed DA was also acceptable for healthcare providers (n = 10). Conclusion: We successfully created a DA for individuals with anxiety disorders who consider tapering BZD anxiolytics, which was acceptable for both patients and healthcare providers. Our DA was designed to assist patients and healthcare providers to involve decision-making about whether to taper BZD anxiolytics or not.

Published
2023

48. Physicians’ attitudes toward hypnotics for insomnia: A questionnaire-based study

Author

Takeshima, Masahiro, Aoki, Yumi, Ie, Kenya, Katsumoto, Eiichi, Tsuru, Eiichi, Tsuboi, Takashi, Inada, Ken, Kise, Morito, Watanabe, Koichiro, Mishima, Kazuo, Takaesu, Yoshikazu, Takeshima, Masahiro, Aoki, Yumi, Ie, Kenya, Katsumoto, Eiichi, Tsuru, Eiichi, Tsuboi, Takashi, Inada, Ken, Kise, Morito, Watanabe, Koichiro, Mishima, Kazuo, and Takaesu, Yoshikazu

Abstract

Introduction: Benzodiazepines and non-benzodiazepines are still widely prescribed despite safety concerns and the introduction of novel hypnotics (orexin receptor antagonists [ORA] and melatonin receptor agonists [MRA]), which may be influenced by physicians’ attitudes toward hypnotics. Methods: A questionnaire survey was administered to 962 physicians between October 2021 and February 2022, investigating frequently prescribed hypnotics and the reasons for their selection. Results: ORA were the most frequently prescribed at 84.3%, followed by nonbenzodiazepines (75.4%), MRA (57.1%), and benzodiazepines (54.3%). Compared to non-frequent prescribers of hypnotics, a logistic regression analysis showed that frequent ORA prescribers were more concerned with efficacy (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.01–2.54, p = 0.044) and safety (OR: 4.52, 95% CI: 2.99–6.84, p < 0.001), frequent MRA prescribers were more concerned with safety (OR: 2.48, 95% CI: 1.77–3.46, p < 0.001), frequent non-benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91–6.04, p < 0.001), and frequent benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91–6.04, p < 0.001) but less concerned with safety (OR: 0.25, 95% CI: 0.16–0.39, p < 0.001). Discussion: This study suggested that physicians believed ORA to be an effective and safe hypnotic and were compelled to prescribe benzodiazepine and nonbenzodiazepine frequently, choosing efficacy over safety.

Published
2023

49. Management of unspecified anxiety disorder: Expert consensus

Author

Sakurai, Hitoshi, Inada, Ken, Aoki, Yumi, Takeshima, Masahiro, Ie, Kenya, Kise, Morito, Yoshida, Eriko, Tsuboi, Takashi, Yamada, Hisashi, Hori, Hikaru, Inada, Yasushi, Shimizu, Eiji, Mishima, Kazuo, Watanabe, Koichiro, Takaesu, Yoshikazu, Sakurai, Hitoshi, Inada, Ken, Aoki, Yumi, Takeshima, Masahiro, Ie, Kenya, Kise, Morito, Yoshida, Eriko, Tsuboi, Takashi, Yamada, Hisashi, Hori, Hikaru, Inada, Yasushi, Shimizu, Eiji, Mishima, Kazuo, Watanabe, Koichiro, and Takaesu, Yoshikazu

Abstract

Aims: Treatment guidelines with respect to unspecified anxiety disorder have not been published. The aim of this study was to develop a consensus among field experts on the management of unspecified anxiety disorder. Methods: Experts were asked to evaluate treatment choices based on eight clinical questions concerning unspecified anxiety disorder using a nine-point Likert scale (1 = “disagree” to 9 = “agree”). According to the responses from 119 experts, the choices were categorized into first-, second-, and third-line recommendations.aResults: Benzodiazepine anxiolytic use was not categorized as a first-linearecommendationafor the primary treatment of unspecified anxiety disorder, whereas multipleanonpharmacological treatment strategies, including coping strategies (7.9 ± 1.4), psychoeducationafor anxiety (7.9 ± 1.4), lifestyle changes (7.8 ± 1.5), and relaxation techniquesa(7.4 ± 1.8), were categorized as first-linearecommendations. Various treatmentastrategies were categorized as first-linearecommendations when a benzodiazepineaanxiolytic drug did not improve anxiety symptoms, that is, differential diagnosisa(8.2 ± 1.4), psychoeducation for anxiety (8.0 ± 1.5), coping strategies (7.8 ± 1.5), lifestyleachanges (7.8 ± 1.5), relaxation techniques (7.2 ± 1.9), and switching to selectiveaserotonin reuptake inhibitors (SSRIs) (7.0 ± 1.8). These strategies were also highly endorsedawhen tapering the dosage of or discontinuing benzodiazepine anxiolytic drugs.aThere was no first-linearecommendation regarding excusable reasons for continuingabenzodiazepine anxiolytics. Conclusions: The field experts recommend that benzodiazepine anxiolytics should not be used as a first-line option for patients with unspecified anxiety disorder. Instead, several nonpharmacological interventions and switching to SSRIs were endorsed for the primary treatment of unspecified anxiety disorder and as alternatives to benzodiazepine anxiolytics.

Published
2023

50. Treatment strategy for insomnia disorder: Japanese expert consensus

Author

Takaesu, Yoshikazu, Sakurai, Hitoshi, Aoki, Yumi, Takeshima, Masahiro, Ie, Kenya, Matsui, Kentaro, Utsumi, Tomohiro, Shimura, Akiyoshi, Okajima, Isa, Kotorii, Nozomu, Yamashita, Hidehisa, Suzuki, Masahiro, Kuriyama, Kenichi, Shimizu, Eiji, Mishima, Kazuo, Watanabe, Koichiro, Inada, Ken, Takaesu, Yoshikazu, Sakurai, Hitoshi, Aoki, Yumi, Takeshima, Masahiro, Ie, Kenya, Matsui, Kentaro, Utsumi, Tomohiro, Shimura, Akiyoshi, Okajima, Isa, Kotorii, Nozomu, Yamashita, Hidehisa, Suzuki, Masahiro, Kuriyama, Kenichi, Shimizu, Eiji, Mishima, Kazuo, Watanabe, Koichiro, and Inada, Ken

Abstract

Purpose: There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and nonpharmacological treatments. Methods: Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = “disagree” to 9 = “agree”). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations. Results: The primary pharmacological treatment, lemborexant (7.3 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 1.8) and suvorexant (6.8 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding nonpharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 1.1) and maintenance insomnia (8.1 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 2.3) and maintenance insomnia (5.7 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 1.8) and suvorexant (6.9 1.9) were categorized as first-line recommendations. Conclusion: Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.

Published
2023

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