Liver transplantation (LT) is a life-saving treatment for end-stage liver disease, and psychosocial factors significantly influence eligibility, adherence, and outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed to standardize psychosocial evaluation across four domains: treatment readiness, social support, psychopathology, and substance use. Despite its growing global adoption, evidence regarding its validity, predictive value, and applicability, specifically in LT, remains fragmented and heterogeneous. This scoping review maps and summarizes the available empirical evidence on SIPAT use in adult LT candidates. It focuses on (1) score distributions (2), psychosocial differences by disease etiology, and (3) associations with listing decisions, post-transplant outcomes, relapse risk, and quality of life. A systematic search of PubMed, Scopus, and PsycInfo (January 2012–May 2025) identified ten eligible empirical studies, primarily observational in design, with sample sizes ranging from 22 to 2,825 participants. Across studies, a substantial proportion of LT candidates were classified as having moderate-to-high psychosocial risk, frequently exceeding a SIPAT threshold of ≥ 21, although cutoff values varied across studies. Evidence from a limited number of investigations suggests that domains related to treatment readiness and lifestyle/substance use may be particularly affected in LT populations. Studies examining etiological subgroups reported higher SIPAT scores among candidates with alcohol-associated liver disease (ALD) or acute alcoholic hepatitis compared with non-ALD candidates, although findings were not uniform across all studies. Higher total SIPAT scores were associated in several cohorts with lower likelihood of listing and with adverse post-transplant outcomes, including nonadherence and acute rejection. In ALD samples, elevated SIPAT scores were associated with increased risk of harmful alcohol relapse, independent of abstinence duration. Notably, none of the included studies evaluated associations between SIPAT scores and post-transplant quality-of-life outcomes. Current evidence suggests that the SIPAT is a useful framework for structuring psychosocial assessment in liver transplantation and for identifying potentially modifiable vulnerabilities relevant to listing decisions and selected post-transplant outcomes. However, substantial methodological heterogeneity, inconsistent cutoff thresholds, and limited evidence across some outcome domains, particularly quality of life, constrain comparability and clinical generalizability. Future multicenter, prospective studies are needed to harmonize cutoff values, examine sensitivity to change, and clarify the role of SIPAT in predicting long-term patient-centered outcomes.

Abstract Objective Hereditary angioedema (HAE) is a rare disease that presents with recurrent attacks that can be triggered by stress or other emotions. The emotional impact of HAE is well-documented, although mainly via self-reported questionnaires. In this study, we used physiological measures to investigate stress regulation in patients with HAE and compared them to patients with immune thrombocytopenia (ITP), a disease that also progresses with attacks but without emotional triggers. Methods Twenty-six adult patients with HAE or ITP (13 each) were included in the study. Patients were asked to perform several computerized tasks that activated different branches of the autonomic nervous system (ANS). Heart rate variability and electrodermal activity were measured during the experimental tasks and a medical consultation that followed the experiments. Results Patients with HAE did not differ from patients with ITP in their physiological responses. In the reactivity tasks, a non-significant correlation significance was observed between reaction times (RTs) and peak spread in the HAE and ITP groups only for male patients and in a different way for HAE (negative correlation) and ITP (positive correlation). During medical consultations, an association between the physician’s perception of the patient’s stress and the patient’s physiological measures of stress was found only in female HAE patients, but without significance. Conclusions The ANS of patients with HAE and ITP was similarly and abnormally activated, with a possible effect by sex. These results shed new light on the role of emotional regulation in chronic diseases. Trial registration This article does not report the results of a health care intervention on human participants. The research was not preregistered in any registry. The analysis plan was not preregistered in an independent, institutional registry. Data, analytic methods, and study materials are not made directly available.

BackgroundAlthough seated isometric yoga has been shown to reduce the fatigue and pain of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), some patients who are for the most part bedridden have difficulty practicing it. Many patients with this disease also suffer from fibromyalgia (FM). We developed a recumbent isometric yoga program for patients who were for the most part bedridden, including patients with comorbid FM. The aim of this study was to investigate the effect of this recumbent isometric yoga intervention with such patients.MethodsThis was a randomized, controlled trial of 48 adult patients (7 male, 41 female, age 20–70 years) with ME/CFS without satisfactory improvement after ≥ 3 months of conventional therapy. They were divided randomly into a yoga group (n = 24) and a control group (n = 24). The yoga group received conventional therapy with recumbent isometric yoga practice for ~ 12 weeks (25-min sessions with a yoga instructor at hospital visits and daily in-home sessions). The control group received conventional therapy alone. The effect of recumbent isometric yoga on the level of functioning was assessed by measuring Performance Status (PS). Fatigue was assessed with self-rated questionnaires, including the Chalder Fatigue Scale (FS) and Profile of Mood States (POMS). Adverse events and benefits were recorded for the yoga group.ResultsAfter the intervention period, the PS score of the yoga group was significantly lower than that of the control group (P < 0.001), suggesting an improvement in functioning level. The Chalder FS score decreased in both groups, but the decrease was greater in the yoga group than in the control group (P < 0.01). Subgroup analysis showed that the Chalder FS score was reduced significantly only in the yoga group in patients with severe disease (P < 0.001) and those with comorbid FM (P < 0.01), although the PS scores did not differ significantly. In the yoga group, a single practice session with a yoga instructor significantly reduced fatigue and increased vigor in patients with severe disease and patients with comorbid FM. Patients reported no serious adverse effects and many benefits of recumbent isometric yoga, including improvements in physical symptoms and brain fog, enhanced awareness of their limits to activities that cause post-exertional malaise, and promotion of behavioral changes to live better within their limits.ConclusionsRecumbent isometric yoga is an effective adjunctive therapy for patients with ME/CFS, including those for the most part bedridden and those who have FM.Trial registrationUniversity Hospital Medical Information Network (UMIN CTR) UMIN000023472 (Registered Aug. 4, 2016) and UMIN000030051 (Registered Nov. 20, 2017).

BackgroundCognitive behavioral therapy for insomnia (CBT-I) has a high potential for improving insomnia and depressive symptoms; however, it is unclear whether the improvement of symptoms reaches the level of healthy people without these symptoms. We aimed to examine whether digital CBT-I can improve the insomnia and depression symptoms of workers to healthy levels.MethodsThe study included 752 workers who were divided into four groups by the use of the cutoff scores of insomnia and depression scales: insomnia alone, depression alone, combined insomnia with depression (COMB), and healthy. All groups were administered digital CBT-I for 2 weeks, and changes were compared post-treatment and at 1- and 3-month follow-ups.ResultsA significant decrease in insomnia symptoms from post-treatment to the 3-month follow-up was found in the insomnia alone (Hedges’ g: 1.07–1.52) and COMB groups (g: 1.17–1.41). The COMB group also showed a significant decrease in depressive symptoms (g: 0.38–0.70). Moreover, there were significant differences in insomnia symptoms between both of the insomnia groups and the healthy group and in depressive symptoms between the COMB group and the healthy group, post-treatment and at the 1- and 3-month follow-ups.ConclusionsDigital CBT-I effectively reduced insomnia and depressive symptoms but did not achieve the levels of healthy people within 3 months.Trial registration.UMIN, UMIN000050353. Registered 15 February 2023—Retrospectively registered, umin.ac.jp/ctr.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13030-025-00334-y.

To study how common are disordered eating behaviors among medical residents in different specialties and how certain preceding factors might contribute to that risk. Self-administered questionnaires were administered to residents from each year and specialty using the Eating Attitudes Test-26 (EAT-26) and the Sick, Control, One, Fat, Food (SCOFF) questionnaires. We used binary logistic regression to study the relationship between individuals at high risk and possible triggers of eating disorders. Among the 399 participants, the risk of disordered eating behavior was 8% using the EAT-26 and 14.3% using SCOFF. There was no difference in the risk according to sex or specialty except for dermatology (p = 0.004). BMI was also among the affecting factors (p < 0.05), in addition to a positive family and personal history of mental disorders (p < 0.001). Recent exposure to stressors, living and marital status did not prove to affect risk. We found that a percentage of medical residents in different specialties are at greater risk for developing eating disorders and exhibit alarming behaviors related to feeding habits. This risk stems from a number of variables, a few of which were studied in this article. Our results demonstrate a need for better awareness of mental health.

BackgroundPremenstrual disorder (PMD), which includes premenstrual syndrome and premenstrual dysphoric disorder, has a complex pathogenesis and may be closely related to emotional cognition and memory. However, the mechanisms underlying these associations remain unclear. Therefore, this study used machine learning to explore the roles of various factors that are not typically considered risk-factors for PMD.MethodsA predictive model for PMD was constructed using a dataset of questionnaire responses and heartrate variability data collected from 60 participants during their follicular and luteal phases. Based on the Japanese version of the Premenstrual Symptom Screening Tool, the binary objective variable (PMD status) was defined as “PMD” for moderate-to-severe premenstrual syndrome and premenstrual dysphoric disorder and other conditions as “non-PMD.” The contribution of each feature to the predictive model was assessed using the Shapley Additive exPlanations (SHAP) model-interpretation framework.ResultsOf the 58 participants (providing 117 data points), 17 (34 data points) were in the PMD group and 41 (83 data points) were in the non-PMD group. The area under the receiver operating characteristic curve was 0.90 (95% confidence interval: 0.82–0.98). Among the top 20 features with the highest SHAP values, six were associated with maternal bonding. Four of the six mother-related characteristics were associated with overprotection.ConclusionsBased on these findings, parental bonding experiences, including maternal overprotection, may be associated with the presence of PMD.

BackgroundIn Europe, an herbal medicine containing peppermint oil is widely used in patients with irritable bowel syndrome (IBS). In Japan, however, no clinical evidence for peppermint oil in IBS has been established, and it has not been approved as a drug for IBS. Accordingly, we conducted a clinical study to confirm the efficacy and safety of peppermint oil (ZO-Y60) in Japanese patients with IBS.MethodsThe study was a multi-center, open-label, single-arm, phase 3 trial in Japanese outpatients with IBS aged 17–60 years and diagnosed according to the Rome III criteria. The subjects were treated with an oral capsule of ZO-Y60 three times a day before meals, for four weeks. The efficacy of ZO-Y60 was evaluated using the patient’s global assessment (PtGA), IBS symptom severity score, stool frequency score, stool form score, and physician’s global assessment (PGA). The safety of ZO-Y60 was also assessed.ResultsSixty-nine subjects were treated with ZO-Y60. During the four-week administration of ZO-Y60, the improvement rate of the PtGA was 71.6% (48/67) in week 2 and 85.1% (57/67) in week 4. It was also suggested that ZO-Y60 is effective against any type of IBS (IBS with constipation, IBS with diarrhea, and mixed/unsubtyped IBS). The improvement rate of the PGA was 73.1% (49/67) in week 2 and 85.1% (57/67) in week 4, also confirming the efficacy of ZO-Y60. Adverse events were observed in 14 subjects (20.3%), however, none of these adverse events were categorized as serious.ConclusionThe efficacy of treatment was confirmed, subjective symptoms were improved, as was observed in previous clinical studies of ZO-Y60 conducted outside of Japan. All adverse reactions were previously known and were non-serious. These findings suggest that peppermint oil may be effective in the Japanese population and that it has an acceptable safety profile.Trial registrationJAPIC Clinical Trials Information number: JapicCTI-121727 https://jrct.niph.go.jp/en-latest-detail/jRCT1080221685. Registration date: 2012–01-10.

BackgroundNoncardiac chest pain (NCCP) is persistent angina-like chest pain without cardiac origin that affects the patient’s health related quality of life (HrQoL), although it does not affect mortality. The effect of a comprehensive training program for NCCP focused on quality of life, psychological state, peripheral muscle strength, physical activity, and quality of life has not been previously established or published. Therefore, this study aimed to show the effectiveness of our combined training program that focuses on functional capacity, physical activity, pulmonary function, respiratory and peripheral muscle strength, dyspnea, fatigue, anxiety, and depression perception in NCCP patients with dyspnea.Case presentationA 38-year-old man with shortness of breath and NCCP was referred to to us for cardiopulmonary rehabilitation. Respiratory muscle strength (mouth pressure device), functional capacity (6 min walking test, 6-MWT), peripheral muscle strength (dynamometer), pulmonary function (spirometry), fatigue (fatigue severity scale), shortness of breath (MMRC, Modified Medical Council Research, Modified Borg Scale-MBS), physical activity (International Physical Activity Questionnaire, IPAQ), health related quality of life (SF-36, Short Form-36), and depression and anxiety (Hospital Depression and Anxiety scale, HADs) were assessed. Aerobic training combined with inspiratory muscle training (loading 30% maximal inspiratory pressure (MIP)) was administered at least 5 days/week for 6 weeks. Functional capacity, physical activity, pulmonary function, and respiratory and peripheral muscle strength improved, and dyspnea, fatigue, anxiety, and depression perception were decreased after the management.ConclusionsThis combined training program was effective for patients with NCCP and shortness of breath. Future studies should be conducted to find the most effective biopsychosocial training protocol for NCCP patients.

BackgroundGlycemic control is an important issue in the treatment of diabetic patients. However, traditional methods, such as medication (the usual treatment), have limitations. Cognitive behavioral therapy (CBT) might be a useful option to help control the glycemic condition. The effects can be revealed by systemic review or meta-analysis of randomized clinical trials (RCT).MethodsA systematic search and a meta-analysis for the RCT were done of the short- and long-term effects of CBT on the glycemic control of diabetic patients in a comparison with the usual treatment. Nineteen RCT studies and 3,885 diabetic patients were enrolled in this meta-analysis. Subgroup analyses of types 1 and 2 diabetes and individual and group CBT were also performed.ResultsPatients treated with CBT showed no significant difference in HbA1c when compared to the usual treatment within six months. However, CBT was more effective in reducing HbA1c when compared to usual treatment with at least six months of treatment duration [standardized mean difference: -0.44 (95% confidence interval (CI): -0.63 ~ -0.25), Z = 4.49]. Subgroup analysis of type 1 and 2 diabetic patients supported a long-term effect of CBT on glycemic control [standardized mean difference: -0.85 (95% CI: -1.19 ~ -0.10), Z = 2.23, standardized mean difference: -0.33 (95% CI:-0.47 ~ -0.19), Z = 4.52, respectively].ConclusionsCBT would be a useful option for improving the glycemic control of diabetic patients undergoing long-term treatment. The advantages of the long-term effects of CBT should be considered by clinicians and staff.

BackgroundForeign nationals residing in Japan account for approximately 2% of the total population (i.e., approximately 2.6 million people). Of these, 12% are not proficient in speaking Japanese and 25% experience difficulty reading Japanese. Therefore, a simple, convenient, and accurate scale in the native language of foreign nationals is required to support their mental health. In this study, the Public Health Research Foundation Stress Checklist Short Form (PHRF-SCL (SF)) was translated into five languages and the reliability and validity of the translations were confirmed.MethodsThe five translated versions of the PHRF-SCL (SF) have been reverse-translated into the original language, Japanese. The creator confirmed that there were no inconsistencies between the Japanese and reverse-translated versions. A total of 777 adults aged 18–64 years participated in the study. They were asked to complete the native language versions of the PHRF-SCL (SF) and Depression Anxiety Stress Scale 21 (DASS 21) online.ResultsAn exploratory factor analysis yielded the same four-factor structure as the original. Internal consistency was confirmed by the alpha coefficients of the subscales. Participants were classified into two groups on the basis of the severity classification obtained from each subscale of the DASS 21. Scores of PHRF-SCL (SF) are significantly higher in groups classified as symptomatic by DASS 21, thereby confirming construct validity. Concomitant validity was confirmed based on correlations with the DASS 21.ConclusionsEnglish, Chinese, Korean, Indonesian, and Vietnamese versions of the PHRF-SCL(SF) have been prepared. Although these versions are subject to further statistical analysis, the results were sufficiently substantiated for practical use. This scale is expected to contribute to the promotion of mental health services for people from these countries.