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The referring doctors in this survey had an insufficient level of diagnostic accuracy for psychiatric disorders. Delirium and psychoactive substance-use disorders were often misdiagnosed as depression.

BackgroundDaikenchuto (DKT), a traditional Japanese herbal medicine, is widely used for treatment of gastrointestinal disorders. We evaluated the efficacy and safety of DKT for abdominal bloating in patients with chronic constipation.ObjectiveTo evaluate the efficacy and safety of DKT for the treatment of abdominal bloating.MethodsAfter discontinuing as-needed use of laxatives, 10 patients received oral DKT for 14 days (15 g/d). To evaluate small intestinal bacteria overgrowth (SIBO), a glucose breath test was performed before and after treatment with DKT. Before beginning the treatment, 4 patients (40%) had a diagnosis of SIBO based on a positive glucose breath test result. In both the SIBO and non-SIBO groups, bowel movement frequency and stool form remained unchanged after DKT treatment.ResultsFor all patients, median total Gastrointestinal Symptoms Rating Scale score and the median Gastrointestinal Symptoms Rating Scale indigestion and constipation subscales were significantly decreased, whereas the median visual analog score for decreased abdominal bloating was significantly increased. Improvements of those symptoms were the same in both the SIBO and non-SIBO groups, indicating that DKT does not have effects on small intestine bacteria. No serious side effects were reported.ConclusionsDKT treatment improved quality of life for patients with chronic constipation regardless of the presence of SIBO and showed no effects on small intestine bacteria. UMIN Clinical Trial Registry identifier: UMIN000008070.

Summary Background : The incidence and severity of non‐steroidal anti‐inflammatory drugs (NSAIDs)‐induced gastro‐duodenal ulcer have not been extensively studied in Japan. Aim : We performed a prospective study to clarify NSAIDs‐induced gastro‐duodenal injury, focusing especially on low‐dose aspirin (L‐A). Methods : Two hundred and thirty‐eight patients with bleeding peptic ulcers admitted to our hospital. History of taking NSAIDs and anti‐ulcer drugs was obtained from all patients who underwent endoscopic examinations. The lesion scores of patients taking L‐A were classified numerically from zero (no lesion) to five (ulcer). Results : The NSAIDs were associated with 28.2% of hemorrhagic ulcers. The rates of patients using L‐A, loxoprofen, diclofenac, and combination of two of these drugs were 27, 16, 10 and 9%, respectively. Co‐administered anti‐ulcer drugs were cytoprotective anti‐ulcer drugs (27%), H2 receptor antagonists (16%), PPI (4%), and none (53%). In patients taking L‐A, H2 receptor antagonists were used most frequently. The HP was positive in 63% of L‐A‐induced ulcer cases and in 69% of NSAIDs other than low‐dose aspirin‐induced ulcer cases. The lesion scores of patients taking L‐A with H2 receptor antagonists or PPI were significantly lower than those of patients who were taking only L‐A (P < 0.05). Conclusions : Approximately one‐third of hospitalized patients with NSAIDs‐induced hemorrhagic ulcer showed an association with L‐A. Prospective randomized controlled trials including H2 receptor antagonists are required to establish preventive efforts aimed at L‐A‐induced gastro‐duodenal injury.

3,4-Dihydroxyphenylacetic acid (DOPAC) is one of the major colonic microflora-produced catabolites of quercetin glycosides, such as quercetin 4'-glucoside derived from onion. Here, we investigated whether DOPAC modulates the aldehyde dehydrogenase (ALDH) activity and protects the cells from the acetaldehyde-induced cytotoxicity in vitro. DOPAC was shown to enhance not only the total ALDH activity, but also the gene expression of ALDH1A1, ALDH2 and ALDH3A1 in a concentration-dependent manner. DOPAC simultaneously stimulated the nuclear translocation of NFE2-related factor 2 and aryl hydrocarbon receptor. The pretreatment of DOPAC completely protected the cells from the acetaldehyde-induced cytotoxicity. The present study suggested that DOPAC acts as a potential ALDH inducer to prevent the alcohol-induced abnormal reaction.