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Mana Yamamoto,1 Teiji Yagasaki,1,2 Sho Ichikawa,1 Takuto Nakamura,3,4 Yuumi Konishi,5 Yoshimi Yokoyama1 1Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan; 2Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan; 3Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan; 4Japan Society for the Promotion of Science, Tokyo, Japan; 5Department of Computer Science, School of Computing, Tokyo Institute of Technology, Tokyo, JapanCorrespondence: Mana Yamamoto, Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjo Minami-ku, Nagoya, Aichi, 457-8510, Japan, Tel +81-52-691-7151, Fax +81-52-692-5220, Email yama357moto@gmail.comObjective: To determine the reliability of the Kinect-based semi-automatic scoring method (KSSM) using Kinect for Windows v2 for head posture compared to the cervical range-of-motion (CROM) device.Methods and Analysis: Head positions between − 40° and +40° of chin up/down (X), head turn (Y), and lateral tilt (Z) were measured in 10° increments in healthy volunteers. Their head positions were simultaneously measured using the KSSM and CROM. The following four points were analyzed: the success rate of the KSSM, the correlation between the two methods, the comparison of results by 95% limits of agreement (LA), and proportional error at 95% LA.Results: The measurability of the KSSM for all positions within ± 30° of the X, Y, and Z axes was 100%. The correlations for both methods were 0.979 (95% CI: 0.967– 0.987), 0.985 (0.976– 0.991), and 0.988 (0.981– 0.993) for the X-, Y-, and Z-axes, respectively. The simple linear regression analysis equations for 95% LA were Y=− 0.024X-0.452 for X axes, Y=0.024X-0.363 for Y axes, and Y=− 0.045X+0.217 for Z axes (95% confidence interval for each axis: − 0.055– 0.007, − 0.006– 0.050, and − 0.071– 0.018). However, the proportional biases were small because the predictive values of the differences in head positions from − 40° to 40° determined by the equations were within ± 5° for chin up/down and within ± 3° for head tilt.Conclusion: Head posture measurements using the KSSM and CROM were found to be similar when used in clinical settings.Keywords: anomalous head posture, Kinect, CROM, spine, reliability

Naomichi Okamoto,1 Yuki Konishi,1 Hirofumi Tesen,1 Atsuko Ikenouchi,1,2 Reiji Yoshimura1 1Department of Psychiatry, University of Occupational and Environmental Health Kitakyushu, Fukuoka, 8078555, Japan; 2Medical Center for Dementia, University Hospital, University of Occupational and Environmental Health Kitakyushu, Fukuoka, 8078555, JapanCorrespondence: Reiji YoshimuraDepartment of Psychiatry, University of Occupational and Environmental Health Kitakyushu, Fukuoka 8078555, JapanTel +81936917253Email yoshi621@med.uoeh-u.ac.jpAbstract: Clozapine is recommended for patients with schizophrenia and tardive dystonia (TD); however, the appropriate dose remains unclear. In this case, a low dose (150 mg/day) of clozapine improved refractory TD and further ameliorated psychiatric symptoms. Herein, we report on a 41-year-old female with schizophrenia and TD who was treated with a low clozapine dose. After eight weeks of continuous clozapine at 150 mg/day (16 weeks after clozapine initiation), her TD dramatically improved, and her psychiatric symptoms were relieved. Low clozapine doses could ameliorate refractory TD. However, this effect might require up to several weeks. Clinicians should be patient unless they consider it better to increase the clozapine dose.Keywords: clozapine, tardive dystonia, schizophrenia

Reiji Yoshimura, Atsuko Ikenouchi, Naomichi Okamoto, Yuki Konishi Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 8078555, JapanCorrespondence: Reiji YoshimuraDepartment of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 8078555, JapanTel +81936927153Fax +81935924894Email yoshi621@med.uoeh-u.ac.jpAbstract: We reported a case involving a patient diagnosed with major depression with associated burning mouth syndrome (BMS) and tinnitus who was successfully treated with vortioxetine. The case was 57-year-old Japanese woman diagnosed with major depression according to DSM-5. She experienced increased levels of stress when performing daily duties. Her dominant symptoms were depressive mood, anxiety, restlessness, insomnia, loss of appetite, difficulty of concentration, general fatigue, BMS, and tinnitus. She complained of pain as well as tongue and oral mucosa discomfort. She also experienced tinnitus, which she described as sounding like the buzz of cicadas. To treat symptoms, 20 mg/day duloxetine was initially administered, which was gradually increased to 40 mg/day. Depressive mood, restlessness, loss of appetite, and general fatigue were moderately ameliorated with treatment; however, symptoms such as anxiety, insomnia, and loss of concentration persisted. Vortioxetine (10 mg/day) was added to duloxetine and clonazepam therapy. Within 2 weeks, duloxetine and clonazepam treatments were gradually tapered, and the dosage of vortioxetine prescribed was increased to 20 mg/day. Her BMS completely disappeared, and her glossodynia relieved.Keywords: major depression, burning month syndrome, tinnitus, vortioxetine

Reiji Yoshimura, Asuka Katsuki, Kiyokazu Atake, Hikaru Hori, Ryohei Igata, Yuki KonishiDepartment of Psychiatry, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan Objectives: The etiology of depression remains unknown. There is, however, a growing body of evidence that cytokines are involved in the pathophysiology of depression. The aim of this study is to investigate the effects of fluvoxamine on plasma interleukin-6 (IL-6) levels and on clinical improvement of the depressive state.Subjects and methods: Thirty patients who met the DSM-IV criteria for major depressive disorder (MDD) were enrolled in the study. Thirteen were male and 17 were female, and their ages ranged from 26 to 70 years (mean ± standard deviation 45.0±14.2). The patients were treated with fluvoxamine for 8 weeks. The dosages of fluvoxamine varied among the patients and, based on ethical considerations, were not fixed.Results: The fluvoxamine doses were positively related to plasma fluvoxamine levels (r=0.8798, P