Effect of milnacipran on insight and stress coping strategy in patients with Taijin Kyofusho

Abstract

Objective Taijin-Kyofusho (TKS) is a Japanese culture-bound syndrome similar to social anxiety disorder. Recent studies have shown antidepressants to be effective in treating TKS. The effects on insight or coping strategies have not, however, been studied. The present study investigated changes in insight and stress coping strategies during treatment with milnacipran. Method The study was a 12-week open trial in 16 patients with offensive type TKS. Offensive anxiety was assessed by an original TKS scale. Insight regarding TKS symptoms was assessed by the "Insight into obsessions and compulsions" subscale of the Yale-Brown Obsessive Compulsive Scale. Coping strategies were assessed by the Coping Inventory for Stressful Situations. The primary efficacy variable was global improvement on the Clinical Global Impression scale (CGI). Results Of the sixteen patients, only 10 completed the study and seven patients responded to the drug (a score of 2 or less on CGI at endpoint). Six patients dropped out in the first few days because of nausea. Last observation carried forward analysis (N=16) showed a significant reduction of offensive anxiety of TKS. Insight and emotional coping strategies were also significantly improved. Conclusion The results suggested that not only TKS symptoms, but also insight and stress coping, may be improved by treatment with milnacipran.

Cultural influences on body dissatisfaction, body change behaviours, and disordered eating of Japanese adolescents

“…In this disorder the sufferer experiences intense fear and embarrassment about body parts or functions, including appearance, odour, facial expressions, and movements. Rates of TKS have been increasing over the past decade among both Japanese children and adults (Nagata, Wada, Yamada, Iketani, & Kiriike, ; Tarumi, Ichimiya, Yamada, Umesue, & Kuroki, ).…”

Japanese experience with milnacipran, the first serotonin and norepinephrine reuptake inhibitor in Japan

“…In addition, results from open studies suggest that both milnacipran (Nagata et al 2003, 2005) and fluvoxamine (Matsunaga et al 2001) may be active in the treatment of Taijin Kyofusho: a specific Japanese form of social anxiety disorder (see below). Milnacipran is thus likely to be useful in the treatment of social anxiety disorder.…”

“…In a follow-up study 16 patients with TKS were treated with milnacipran for 12 weeks (Nagata et al 2005). Six patients discontinued in the first few days of treatment because of nausea.…”

Cross-Cultural Study of Conviction Subtype Taijin Kyofu

“…Alternatively, the diagnostic criteria for psychotic disorders and/or body dysmorphic disorder in the DSM-IV could be modified to diagnose such patients with high reliability. Nevertheless, there are some case reports and case series reports that suggest that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are more effective for conviction subtype TK than antipsychotics (Clarvit et al, 1996;Matsunaga et al, 2001;Nagata et al, 2003;Nagata et al, 2006;Nagata et al, 2005). Our own experiences with six cases of offensive subtype SAD also suggest that they respond to the CBT program as well as those without offensive fears (Chen et al, submitted, Group cognitive-behavior therapy for Japanese patients with social anxiety disorder: Outcomes and their predictors).…”

“…It is possible that many clinicians in the West are diagnosing patients with conviction subtype TK as conditions other than SAD, including delusional disorder, body dysmorphic disorder or paranoid disorder, since the diagnostic criteria for SAD in DSM-IV and ICD-10 do not fully cover conviction subtype TK (Kasahara, 2005;Lochner et al, 2003;TanakaMatsumi, 1979). Importantly, there are some single case reports and case series reports that suggest that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are more effective for conviction subtype TK than antipsychotics (Clarvit et al, 1996;Matsunaga et al, 2001;Nagata et al, 2003;Nagata et al, 2006;Nagata et al, 2005).…”