Aims:  The aim of the present study was to develop a subscale of the Positive and Negative Syndrome Scale (PANSS) that would be brief and sensitive to changes in the clinical features of schizophrenia (i.e. the Brief PANSS, or bPANSS). Methods:  The PANSS before and after treatment, and the Clinical Global Impression–Change (CGI‐C) was rated for 714 schizophrenia patients. Of these, Clinical Global Impression–Severity (CGI‐S) was also evaluated in 30 of these patients. The bPANSS items were extracted from full PANSS items based on the following aims: (i) to develop a brief scale; (ii) to develop a scale sensitive to changes resulting from antipsychotic treatment; and (iii) to reflect the broad spectrum of schizophrenia symptoms. Results:  The following six items were extracted to serve as the bPANSS: delusion, suspiciousness, emotional withdrawal, passive/apathetic social withdrawal, tension, and unusual thought content. The coefficients of correlation between the bPANSS and full PANSS before and after treatment were 0.86 and 0.92, respectively (both P < 0.001). The coefficient of correlation between the degrees of change in the scores for the bPANSS and the full PANSS was 0.93 (P < 0.001), and that between delta bPANSS and CGI‐C was 0.73 (P < 0.001). Conclusions:  bPANSS is able to capture the overall clinical features of schizophrenia within a short assessment period.

Reported herein is a case of methamphetamine psychosis in which tardive dystonia was treated successfully with clonazepam.The patient was a 69-year-old man who had taken methamphetamine habitually for approximately 40 years. Auditory hallucinations had developed 25 years previously, for which haloperidol had been prescribed. Tardive dystonia had developed in December 2005.Haloperidol was withdrawn and risperidone or olanzapine alone had been administered, but neither had improved the dystonic posture. However, when clonazepam was added, a gradual improvement in the dystonic posture became evident. Tardive dystonia is currently treated on a trial-and-error basis. Accumulation of further cases similar to the present one is very important for establishing an effective treatment.

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Bofu-tsusho-san effectively attenuates the weight gain observed after receiving olanzapine T HE INTRODUCTION OF second-generation antipsychotics has led to a reduction in extrapyramidal symptoms and cognitive dysfunction and improved adherence. The potential for adverse metabolic effects, however, such as weight gain, is markedly increased. We found that concomitant use of bofu-tsusho-san, a traditional oriental herbal medicine, effectively attenuates the weight gain observed after receiving such an antipsychotic, olanzapine. Here, we discuss a representative case.A 20-year-old woman presented with a psychiatric diagnosis of disorganized schizophrenia (DSM-IV-TR: 295.10). Her height was 157 cm, weight 58.2 kg and body mass index (BMI), 23.6 kg/m 2 . The patient had begun to suffer from auditory hallucinations and was admitted to Shimofusa Psychiatric Medical Center. She received olanzapine 7.5 mg/day and promethazine 75 mg/day, and her psychosis improved. Her appetite and meal volume, however, increased. Her total Drug Attitute Inventory-10 (DAI-10) score, which indicates the level of drug compliance and ranges from -10 points to +10 points, 1 was 1 at discharge from hospital. Three months after the start of treatment, her weight had increased by 4.5 kg (to 62.7 kg), and her BMI to 25.4 kg/m 2 . At this point she hinted that she intended to stop her treatment because of her weight gain. We therefore prescribed bofu-tsusho-san 7.5 g/day in addition to the medication. Subsequently, her weight decreased gradually but her appetite and meal volume remained unchanged. Six months after the start of concomitant use of bofu-tsusho-san, her weight had decreased to 60.0 kg, a 2.7-kg weight loss, and her BMI to 24.3 kg/m 2 . Her total DAI-10 score had increased to 5. She is currently continuing to visit hospital.In a study of obese mice, bofu-tsusho-san produced a significant decrease in fat mass and weight compared with placebo, without affecting the amount of food ingested. Bofu-tsusho-san contains various herbal ingredients, including Ephedrae herba, Glycyrrhizae radix, Schizonepetae spica, Forsythiae fructus and Rhei rhizoma. Ephedrae herba contains ephedrine derivatives such as L-ephedrine, which stimulate the release of norepinephrine from nerve endings. One effect of this is to accelerate metabolism (as measured by heat production) in brown fat cells through the action of activated cyclic adenosine monophosphate (cAMP). Lipolysis in white fat cells is also promoted.3 The cAMP is inactivated by phosphodiesterase (PDE). Caffeine has an inhibitory action on PDE, and thus prolongs the activation of cAMP. Therefore, weight decreases significantly more in subjects treated with both caffeine and ephedrine than in those receiving ephedrine alone, and this effect lasts for an extended period.4 Glycyrrhizae radix, Forsythiae fructus and Schizonepetae spica have a PDE-inhibiting effect approximately 2.5-fold greater than that of caffeine. Thus, cAMP activation is prolonged and whole-body metabolism accelerates. Second-generatio...

The Inventory of Depressive Symptomatology, clinician version (IDS‐C), was developed by Rush et al. to evaluate the severity of major depressive episodes. The aim of the present study was to establish the inter‐rater reliability of the Japanese version of the IDS‐C. A total of 16 subjects with DSM‐IV major depressive episode were evaluated. Two psychiatrists, who had completed a training session for evaluating the IDS‐C before starting this reliability study, attended systematic interview sessions with each subject to evaluate the IDS‐C independently, using the Japanese version of the structured interview guide for combined rating of the IDS‐C and the Hamilton Depression Rating Scale. The severity of the 30 IDS‐C items assessed by the two raters ranged from 0 to 4 for 27 items and from 0 to 3 for 3 items. The analysis of variance intra‐class correlation inter‐rater reliability values for the individual scale items ranged from 0.874 to 1.000. The present results suggest that the Japanese version of the IDS‐C is a potentially useful rating instrument with high inter‐rater reliability for measuring the severity of depressive symptoms in the hands of psychiatrists with sufficient evaluation training.