Treatment of psychiatric disturbances, including depression, anxiety, and delirium, in the inpatients admitted to our hospital for their somatic diseases

Our hospital does not possess beds for psychiatric patients, and cannot accept the admission to mainly treat psychiatric illnesses. However, some of the somatic inpatients are comorbid with psychiatric disorders or manifest psychiatric symptoms, which are our treatment objectives. Psychiatric diseases include depression, anxiety, schizophrenia, neurodevelopmental disorder, dementia, and delirium.

Liaison psychiatry

After being consulted by the attending physician, our liaison psychiatry team composed of psychiatrist, certified nurse, psychiatric social worker, and clinical psychologist assess and treat the psychiatric problems of the consulted patients with support from the attending doctors and ward nurses. Based on our expertise in psychiatry, we try to make the adequate mental care of the inpatients as well as to help the inpatients to restart their life safely after discharge.

Depression

Anxiety disorder

Delirium

Behavioral and psychological symptoms of dementia (BPSD)

Arousal function

Arousal is a fundamental function that enables various psychological activities. When arousal level is high, a lot of information can be recruited, and some information may be selectively attended. When arousal level is low, information processes are limited, causing relaxed state and sleep. Adequate control of arousal level depending on the situation is necessary to maintain the normal activity of daily life. Disturbances in arousal control are found in mental disorders including depression, anxiety, delirium, and dementia.

Evaluation of arousal control using EEG, autonomic indices, and cerebral blood flow

The symptoms in psychiatric disorders are not easy to be recognized and understood even by the families and close friends. We try to evaluate them from the aspect of arousal uncontrollability, which is related to generation of various psychiatric disturbances, with the use of EEG, autonomic indices, and cerebral blood flow. For EEG, both resting rhythms and event-related potentials are measured. For autonomic indices, heart rate variability (HRV) and skin conductance (SC) are used. For cerebral blood flow, brain hemoglobin concentration is measured. Using these indices, control of arousal level and attention is assessed. Electrical stimulation of the brain is also used to verify its therapeutic applicability.

Arousal function tests

EEG, heart rate variability, skin conductance and cerebral blood flow are measured to examine the arousal function. The measurement takes about 20-60 min.

• Ａ. In EEG measurement, basic rhythms including alpha wave (Figure 1) and event-related potentials during cognitive tasks (Figure 2) are recorded. Figure 2 shows a recording data of contingent negative variation (CNV). Both basic rhythms and CNV are related to brain arousal.
  
  
• Ｂ. Autonomic measures include heart rate and heart rate variability (HRV, Figure 3) and skin conductance (SC) reflecting psychogenic sweating (Figure 4). HRV and SC are good indicators of parasympathetic and sympathetic activities, respectively. The recordings at rest, during a cognitive task and during the rest period after the task enable the evaluation of autonomic arousal control（Autonomic Mental Assessment System、AMAS）. This test is utilized to evaluate the risk of depression, and is also available as Autonomic Mental Health Counseling in our Health Care Center.
  
  
• Ｃ. In the cerebral blood flow measurement, time-resolved near-infrared spectroscopy (TRS) is used to evaluated the absolute hemoglobin concentration in the frontal brain, which is also related to brain arousal.

Electrical stimulation

Transcranial direct current stimulation （tDCS）, electric field treatment (EFT) and other methods are used to stimulate brain to alter the arousal.

In tDCS, weak direct current stimulation of about 1 mA is applied between two areas on the skull surface (right and left foreheads and mastoid bones) for about 20 min. The arousal function tests described above are conducted during the electrical stimulation to see the effects of tDCS on the arousal function. The stimulation is applied once or twice a week for several weeks. Discomfort during stimulation is avoided by using the stimulation electrodes of large surface and low resistance.

In EFT, electric field of 60 Hz and 10 mV/m inside the body is applied using the electrodes under the feet and above head for 20 min a day and 2 or 3 times a week for several weeks (Hakuju Co. Ltd). The arousal function tests are conducted to see the effects on arousal. EFT is reported to have beneficial effects on pain, constipation, and insomnia. The subjects implanted with cardiac pacemaker cannot receive this treatment. (LINK: Paper publication on EFT).

Publications

• Naoki Okada, Yutaka Umemura, Shoi Shi, Shusuke Inoue, Shun Honda, Yohsuke Matsuzawa, Yuichiro Hirano, Ayano Kikuyama, Miho Yamakawa, Tomoko Gyobu, Naohiro Hosomi, Kensuke Minami, Natsushiro Morita, Atsushi Watanabe, Hiroyuki Yamasaki, Kiyomitsu Fukaguchi, Hiroki Maeyama, Kaori Ito, Ken Okamoto, Kouhei Harano, Naohito Meguro, Ryo Unita, Shinichi Koshiba, Takuro Endo, Tomonori Yamamoto, Tomoya Yamashita, Toshikazu Shinba, Satoshi Fujimi. "KAIZEN" method realizing implementation of deep-learning models for COVID-19 CT diagnosis in real world hospitals. Sci Rep 2024 Jan 19;14(1):1672. doi: 10.1038/s41598-024-52135-y.
• Shinba, T.; Suzuki, H.; Urita, M.; Shinba, S.; Shinba, Y.; Umeda, M.; Hirakuni, J.; Matsui, T.; Onoda, R. Heart Rate Variability Measurement Can Be a Point-of-Care Sensing Tool for Screening Postpartum Depression: Differentiation from Adjustment Disorder. Sensors 2024, 24 (5)1459. https://doi.org/10.3390/s24051459
• Shinba, T.; Shinba, Y.; Shinba, S. Asymptomatic Autonomic Dysregulation after Recovery from Mild COVID-19 Infection Revealed by Analysis of Heart Rate Variability Responses to Task Load. Healthcare 2024, 12, 43. https://doi.org/10.3390/healthcare12010043
• Shinba T, Kuratsune D, Shinba S, Shinba Y, Sun G, Matsui T, Kuratsune H. Major Depressive Disorder and Chronic Fatigue Syndrome Show Characteristic Heart Rate Variability Profiles Reflecting Autonomic Dysregulations: Differentiation by Linear Discriminant Analysis. Sensors (Basel). 2023 Jun 4;23(11):5330. doi: 10.3390/s23115330.
• Shinji Harakawa, Shingo Yoshioka, Noriaki Nishimura, Takaki Nedachi, Toshikazu Shinba. Heart Rate Variability Analysis for Evaluating Biological Effects of Electric Field Treatment. IEEJ Transactions on Electronics Information and Systems 143(6):608-609 DOI https://doi.org/10.1541/ieejeiss.143.608
• Tomoko Inoue, Toshikazu Shinba, Masanari Itokawa, Guanghao Sun, Maho Nishikawa, Mitsuhiro Miyashita, Kazuhiro Suzuki, Nobutoshi Kariya, Makoto Arai, Takemi Matsui, The development and clinical application of a novel schizophrenia screening system using yoga-induced autonomic nervous system responses. Front Physiol. 2022 Oct 5;13:902979. doi: 10.3389/fphys.2022.902979.
• Shinji Harakawa, Takuya Hori Takao Hiramoto, Takaki Nedachi, Toshikazu Shinba, Hiroshi Suzuki, Suppression of Glucocorticoid Response in Stressed Mice Using 50 Hz Electric Field According to Immobilization Degree and Posture. Biology (Basel) 2022 Sep 9;11(9):1336. doi: 10.3390/biology11091336.
• Shinba T, Nedachi N, Harakawa S (2022) Alterations in Heart Rate Variability and Electroencephalogram during 20-Minute Extremely Low Frequency Electric Field Treatment in Healthy Men during the Eyes-Open Condition. IEEJ Transactions on Electrical and Electronic Engineering, in press, DOI:10.1002/tee.23695
• Shinba T. Characteristic Profiles of Heart Rate Variability in Depression and Anxiety. in: Biosignal Processing eds. Dr. Vahid Asadpour and Dr. Selcan Karakuş. DOI: 10.5772/intechopen.104205, IntechOpen, London, UK, 2022
• Shinba T, Kariya N, Matsuda S, Arai M, Itokawa M, Hoshi Y. Near-Infrared Time-Resolved Spectroscopy Shows Anterior Prefrontal Blood Volume Reduction in Schizophrenia but Not in Major Depressive Disorder. Sensors (Basel). 2022 Feb 18;22(4):1594. doi: 10.3390/s22041594.
• Harakawa S, Nedachi T, Shinba T, Suzuki H. Stress-Reducing Effect of a 50 Hz Electric Field in Mice after Repeated Immobilizations, Electric Field Shields, and Polarization of the Electrodes. Biology (Basel). 2022 Feb 17;11(2):323. doi: 10.3390/biology11020323.
• Nishikawa M, Unursaikhan B, Hashimoto T, Kurosawa M, Kirimoto T, Shinba T, Matsui T, Sun G. Non-contact Measurement of Pulse Rate Variability Using a Webcam and Application to Mental Illness Screening System. Annu Int Conf IEEE Eng Med Biol Soc. 2021 Nov;2021:7016-7019. doi: 10.1109/EMBC46164.2021.9630038.
• Matsuda Y, Ozawa N, Shinozaki T, Aoki K, Nihonmatsu-Kikuchi N, Shinba T, Tatebayashi Y. Chronic antidepressant treatment rescues abnormally reduced REM sleep theta power in socially defeated rats. Sci Rep. 2021 Aug 18;11(1):16713. doi: 10.1038/s41598-021-96094-0.
• Shinba T, Murotsu K, Usui Y, Andow Y, Terada H, Kariya N, Tatebayashi Y, Matsuda Y, Mugishima G, Shinba Y, Sun G, Matsui T. Return-to-Work Screening by Linear Discriminant Analysis of Heart Rate Variability Indices in Depressed Subjects. Sensors (Basel). 2021 Jul 30;21(15):5177. doi: 10.3390/s21155177.
• Shinba T, Nedachi T, Harakawa S (2021) Extremely Low‐Frequency Electric Field Exposure Increases Theta Power of EEG in both Eyes‐Open and Eyes‐Closed Resting Conditions in Healthy Male Subjects. IEEJ Transactions on Electrical and Electronic Engineering 16(4) 592-599, https://doi.org/10.1002/tee.23334.
• Hasebe H, Shinba T, (2020) Decreased anxiety after catheter ablation for paroxysmal atrial fibrillation is associated with augmented parasympathetic reactivity to stress. Heart Rhythm O2, DOI: 10.1016/j.hroo.2020.05.008
• Shinba T, Murotsu K, Usui Y, Andow Y, Terada H, et al. (2020) Usefulness of heart rate variability indices in assessing the risk of an unsuccessful return to work after sick leave in depressed patients. Neuropsychopharmacol Rep 40(3):239-245 doi: 10.1002/npr2.12121.
• Shinba T, Inoue T, Matsui T, Kimura KK, Itokawa M, Arai M. (2020) Changes in heart rate variability (HRV) after yoga are dependent on HRV at baseline and during yoga: a study showing autonomic normalization effect in yoga-naïve and experienced subjects. International Journal of Yoga 13(2): 160-167.
• Shinba T, Kariya N, Matsuda S, Matsuda H, Obara Y. (2018) Increase of frontal cerebral blood volume during transcranial magnetic stimulation in depression is related to treatment effectiveness: A pilot study with near-infrared spectroscopy. Psychiatry Clin Neurosci. 72(8):602-610
• Urita M, Matsunaga M, Ando M, Ishiyama M, Shinba T. (2018) Characteristic profiles of suicide attempts treated at the emergency room of general hospital: Acute exacerbation of depressiveness. Shizuoka Saiseikai General Hospital Medical Journal. 28: 17-21 (in Japanese).
• Shinba T. (2017) Major depressive disorder and generalized anxiety disorder show different autonomic dysregulations revealed by heart-rate variability analysis in first-onset drug-naïve patients without comorbidity. Psychiatry Clin Neurosci.71(2):135-145.
• Shinba T. (2014) Altered autonomic activity and reactivity in depression revealed by heart-rate variability measurement during rest and task conditions. Psychiatry Clin Neurosci. 68:225-233.
• Shinba T, Takahashi K, Kanetake S, Nedachi T, Yamaneki M, Doge F, Hori T, Harakawa S, Miki M, Hara H, Suzuki H, Hara A. (2012) A pilot study on electric field therapy for chronic pain with no obvious underlying diseases. Japanese Society for Integrative Medicine. 5:68–72 (in Japanese).
• Shinba T, Ozawa N, Yoshii M, Yamamoto K. (2010) Delayed increase of brain noradrenaline after acute footshock stress in rats. Neurochemical Research 35:412-417.
• Shinba T (2009) 24-h profiles of direct current brain potential fluctuation in rats. Neuroscience Letter 465:104-107
• Shinba T, Kariya N, Matsui Y, Ozawa N, Matsuda Y, Yamamoto K. (2008) Decrease in heart rate variability response to task is related to anxiety and depressiveness in normal subjects. Psychiatry Clin Neurosci.62(5):603-609
• Shinba T, Kariya N, Ishii T, Matsui Y, Onishi R, Andow Y. (2007)　Stress and Autonomic Nerve: Evaluation of anxiety and depressiveness using heart rate variability analysis. Seishinigaku 49:1173-1181 (in Japanese)
• Shinba T, Ishii T, Onishi R, Matsui Y. (2007) Usefulness of heart rate variability indices in prolonged exposure therapy for post-traumatic stress disorder: A case report on domestic violence Shinryo Naika 11:218-223 (in Japanese)
• Shinba T. (2005) Random number generation and frontal cerebral blood flow in schizophrenia Shingaku Giho [TL2004] 37:7-12.
• Shinba T, Nagano M, Kariya N, Ogawa K, Shinozaki T, Shimosato S, Hoshi Y (2004) Near-infrared spectroscopy analysis of frontal lobe dysfunction in schizophrenia. Biological Psychiatry 55:154-164.
• Shinba T. (2002) Attention and arousal function of the brain and the central noradrenaline system. Kankaku Togo Shogai Kenkyu 9, 9-18 (in Japanese)