Open Journal of Psychiatry

Published by Scientific Research Publishing
Online ISSN: 2161-7325
Publications
Article
Analysis of the pattern of altered cognition observed in schizophrenia provides better insight into neurocognitive deficits. It reveals a potential novel target for schizophrenia research. To understand this target we reviewed the findings of neuroimaging studies on implicit [nonconscious] memory. These studies have consistently reported attenuated activity in the area V3A of the extrastriate cortex during retrieval of studied items. It was suggested that the attenuation limits the pool of information available for further cognitive processing. Therefore, if V3A is functionally damaged, individuals will have access to a larger pool of information for cognitive processing. Since cognitive tasks that are not dependent on attention [attention independent] process a larger pool of information more efficiently, performance in these tasks is likely to improve after V3A is damaged. Conversely, tasks that are dependent on attentional resources are more efficient in processing smaller pool of information. Performance in these tasks therefore is expected to deteriorate if a large pool of information is made available following V3A damage. A review of cognitive performance in schizophrenia suggests that patients perform at above normal level in attention independent priming tasks and perform at subnormal level in attention dependent episodic and working memory tasks. These findings indicate possible impairment of V3A activity. It could therefore be a potentially important unstudied target for schizophrenia research, particularly because a number of investigators have reported that the activity in this area is altered in schizophrenia.
 
Micrograph showing spines on the basal dendrites of a pyramidal cell. Scale bar = 0.01 mm. 
Article
Recent morphological studies in schizophrenia sug-gest atrophic changes in the neuropil of the prefrontal cortex. Most recently, we showed a schizophrenia-associated decrease in MAP2 in schizophrenia, which we believed is not due to neuroleptic exposure. MAP2 is a very important protein in the assembly of micro-tubule in neurons; therefore, it plays a major role in neuronal processes like dendrites, spines and syn-apses. Additionally, recent studies from our lab showed decreases in dendrites in area 32 and area 9. In this study we examined the dendrites and spines in area 9 and 17 to determine if neuroleptic drugs play a role. Huntington's patients take neuroleptics similar to schizophrenics; therefore, by comparing the two groups to controls we can determine if neuroleptics play a role in the deficits reported in schizophrenia. Our results showed a significant decrease in both basal dendrites and spines for both layers III and V in area 9 in schizophrenia compared to controls. The Huntington's brains, on the other hand, showed no significant difference compared to controls. In area 17, there was also no significant difference when comparing the three groups. The data suggest that neuroleptic drugs may not be responsible for the changes observed in schizophrenia.
 
Article
Research has indicated that child maltreatment is associated with an increased likelihood of mental disorders and suicidal ideation and attempts that continues into adulthood. The purpose of this paper is to provide a synopsis of the recent published research from 2006 to 2010 on the association between child maltreatment and Axis I mental disorders and suicidal ideation and attempts. The databases MEDLINE and PsycINFO were searched for relevant and high quality citations up to October 2010. The results indicated that all types of child maltreatment examined are linked to reduced mental health. A general noted trend in the literature is that earlier age of onset of child maltreatment is associated with poorer mental health outcomes. Sex differences do exist with some disorders being more likely among males (e.g., antisocial behaviour) and other more likely among females (e.g., depression, PTSD, substance use disorders) following child maltreatment.
 
A plain erect abdominal radiograph film (X-ray).
Investigations done.
Article
Introduction: Globally, 20 million people are affected by schizophrenia. In Uganda, the prevalence is reported to be 710 per 100,000 population. Unlike normal adults who are less likely to have foreign body ingestion, patients with mental illnesses such as schizophrenia are at an increased risk of both intentional and accidental foreign body ingestion. Therefore, health workers must be vigilant while assessing such patients not to miss out on the diagnosis as unwitnessed foreign body ingestion presents a diagnostic challenge. Observation: We received a 33-year-old female diagnosed with schizophrenia four years before this admission as a referral. She presented at MNRH A&E with complaints of abdominal pain, non-bilious vomiting, and progressive weight loss. She had multiple admissions in private hospitals before her referral to MNRH where several investigations were done with inconclusive results. Upper GI endoscopy revealed multiple foreign bodies in the stomach. An erect abdominal x-ray was then done to rule out distal gastrointestinal involvement and/or perforation. An emergency laparotomy was performed and over 170 different metallic objects of varying sizes were completely evacuated. She reported that she ingested them in response to the compelling auditory hallucinations but had no intention of self-harm. Conclusion: Foreign body ingestion presents a diagnostic challenge in adults. The various impairments among mentally ill patients put them at an increased risk hence the need for suspicious diagnostic evaluation of those presenting with abdominal symptoms. Both health workers and families have a role to play in the prevention of such life-threatening emergencies.
 
ERS power showing significant differences between patients and controls during the auditory oddball task. 
Article
We studied differences in imaginary coherence (IC) of the gamma band between brain regions of female schizophrenia patients during the auditory oddball task using magnetoencephalography (MEG). Subjects were 12 right-handed female schizophrenia patients, who were evaluated by the Positive and Negative Syndrome Scales (PANSS). Functional connectivity during an auditory oddball task was reconstructed in low gamma (30-50 Hz) and high gamma (50-100 Hz and 100-150 Hz) bands, and represented by IC using seeds determined by the significant oscillatory power changes obtained by event-related synchronization (ERS) and event-related desynchronization (ERD) power measurements. Gamma ERS (30-50 Hz) power was decreased in the left precuneus at 500-750 ms and in the right precuneus at 750-1000 ms. IC in the gamma band (50-100 Hz) was decreased between the right precuneus (seed) and right para-central lobule (target) and between the right precu-neus and right hypothalamus at 0-250 ms. IC in the gamma band (100-150 Hz) was increased between the left precuneus and right cuneus (Brodmann area 7) at 250-500 ms, between the left precuneus and right culmen at 500-750 ms, and between the left precuneus and right cuneus (Brodmann area 17), between the left precuneus and right posterior cingu-late cortex, and between the left precuneus and right caudate nucleus at 750-1000 ms. In the high gamma band (50-100 Hz) at 0-250 ms, significant positive correlations were shown between IC and conceptual disorganization in PANSS scores, between IC and unusual thought content score, and between IC and positive scale score. IC within the high gamma band in female schizophrenia patients showed two types of functional disconnection, intrahemispheric and in-terhemispheric. IC between the right or left precu-neus and other specific cortical areas showed dys-function, suggesting that the parietal lobe plays an important role in dysfunction in connectivity in the gamma band during the oddball task.
 
Control group data: number of fixations in each AOI in the four different stimuli. 
Article
Background: Eye-tracking has been used to investigate social perception in autism spectrum disorder (ASD) with variable results. This heterogeneity may be due to the types of stimuli used. In this study, we investigated whether the use of moving vs static stimuli or human actors vs cartoons characters would be more sensitive in detecting gaze abnormalities and discriminating children with ASD from typically developing children. Methods: We studied 18 children with ASD (mean age = 12.9 ± 2.9) and 21 typically developing controls (mean age = 11.3 ± 2.5). Gazes were tracked using Tobii-T120 eye-tracker. Four different types of stimuli were presented: movie with human actors, cartoon movie, picture with human actors and cartoon picture. To identify the type of stimuli that best discriminate the ASD group from the control group, a two-way ANOVA was performed using ecological dimension [human-actors/cartoon] and presentation form [movie/picture] as factors. Results: Children with ASD presented significantly less fixations to eyes and faces in the movie with human actors and in the picture with human actors. Children with ASD also presented significantly more fixations to non-social backgrounds in the movie with human actors and in the cartoon movie. A significant ecological effect was observed for the reduction in fixa-tions to the eyes [human-actors > cartoon]. A significant presentation form effect was observed for the increased fixations to the non-social background [movie > picture]. Conclusions: The direct comparison of gaze behavior across four different types of stimuli demonstrates that gaze abnormalities in ASD depend on the type of stimuli that is used. Our results suggest that general gaze abnormalities in children with ASD are better detected when using dynamic stimuli, and finer details of these abnormalities, especially looking less to the eyes, are better detected in a more ecologically relevant situation presenting human characters.
 
Article
The present study aimed to describe the characteris-tics of auditory abnormalities present in cases of au-tism. One hundred and fifty six children with autism and 141 matched controls with language delay were investigated via direct observations combined with parent/caregiver reports. All of the autistic indivi-duals demonstrated auditory abnormalities especially in the domain of hyposensitivity, compared with 33.3% of children with language delay. The auditory abnor-malities in autism primarily comprised of auditory hyposensitivity, auditory hypersensitivity, phonopho-bia, and peculiar interests in certain sounds. Partici-pants with autism were rated as having more prob-lems than the language-delayed children in all the items of each domain. No significant differences in the range of auditory abnormalities were observed be-tween mild and severe autistic children except for the presence of phonophobia. Children with autism pre-sented with diverse auditory abnormalities which may be specific features in autism and may play an im-portant role in the early identification of autism.
 
Descriptive properties of variables used in this study (N = 1198).
Final SEM model of the association between Bondeing Failure, Depression, and Child Abuse. (Significant paths and covariances are in bold.) 
Comparison of SEM models. BF, Bonding Failure; CA, Child Abusive; DEP, Depressive Mood; AIC difference is greater than two higher in # than $.
Article
Objective: To investigate the relationships between depressive mood, bonding failure, and abusive parenting. Method: We distributed questionnaires to 1198 mothers attending a three-month postnatal health check-up in rural areas in Japan. The questionnaires assessed these three variables along with demographics. We evaluated the causal relationships by comparing different structural equation models to the data. Results: Although all the models fit the data well, the best Akaike Information Criterion was obtained from a model where both depressive mood and bonding failure predict abusive parenting, but depressive mood and bonding failure do not predict each other directly. The determinant coefficient of child abuse in the final model was 0.13. Discussion: We found depressive mood and bonding failure during postpartum period impacted negatively on mother’s parenting behaviour. Because only 13% of the variance of abusive parenting was explainable by this model, further study should be needed to identify other risk factors of child abuse. Similarly, midwives and public health nurse in community should pay attention to not only depression but also bonding failure to prevent child abuse.
 
Sample characteristics by group.
Mean MAAC emotion ratings and order of selection by group.
Article
Objective: Mood Assessment via Animated Characters (MAAC) is a novel, computer-based instrument to improve assessment and communication about feelings in young children with internalizing distress. Well-validated assessment instruments are lacking for those under age eight years. Method: Children ages 4 - 10 years with primary diagnosis of anxiety disorder (n = 74; 33 boys, 41 girls) or no diagnosis (n = 83; 40 boys, 43 girls) completed MAAC for 16 feelings. Those 8 - 10 years also completed standardized measures of internalizing symptoms. Results: MAAC’s emotions clustered into positive, negative, fearful, and calm/neutral factors. Clinical children rated themselves less positive (difference score -3.18; p = 0.002) and less calm/neutral (difference score -2.06; p = 0.04), and explored fewer emotions spontaneously (difference score = -2.37; p = 0.02) than nonanxious controls. Older children’s responses correlated with scores on several standardized measures. Conclusions: MAAC appears to be highly engaging, with clinical utility in the assessment of young anxious children. Applications in other populations are considered for future study.
 
Percentages of each answer for the question “Do you want to do the work related to the forensic psychiatry?” are shown. Chi-square test did not suggest statistical significance. 
Article
Objective: The forensic mental health system in Japan changed dramatically with the enforcement of the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity” or MTS Act, in 2005. The aim of this study is to evaluate the changes in attitude and behavior of general psychiatrists, towards forensic psychiatry. Methods: We conducted a questionnaire survey in 2010 on forensic psychiatry for Japanese psychiatrists, mirroring a previous study from 2007. Results: Comparing the results from both questionnaires, it is not evident that awareness of forensic mental health has improved among psychiatrists in the intervening three years. Conclusion: Further education about forensic mental health needs to be considered inJapan.
 
Hospitalizations per time period in the retrospective and prospective periods (pp population). 
Article
The objectives of e-STAR Romania (NCT00283517) were to collect clinical outcome data of Romania schizophrenia or schizo-affective disorder patients; prospectively to assess the reasons of treatment initiation, medication usage patterns; to document (long-term) clinical efficacy; and to collect safety data, as well as recording 2-year corresponding retrospective data. In total, 378 eligible subjects were enrolled who were initiated either on risperidone long-acting injectable (RLAI) (290) or on an oral antipsychotic (OA) (88) at baseline as required by the local Summary of the Product Characteristics. Data were collected from per patient both retrospectively and prospectively over a 24-month period at 3-month intervals after starting treatment. The results indicated that subjects suffering from schizophrenia or schizo-affective disorder initiated on RLAI were less likely to be hospitalized within the first 24 months after the initiation of treatment. Moreover, subjects treated with RLAI experienced significant improvements in their illness severity and functioning. Discontinuation rates for RLAI were low and doses were stable throughout the 24 months following the initiation of treatment. In addition, the necessity for supplementary concomitant medication was reduced. Adverse events were reported in 20.3% (RLAI) and 11.4% (OA) of the subjects. In general, patients initiated on RLAI and OA at baseline both clinically improved on all assessed parameters but a larger improvement was observed for patients on RLAI. Incidences of reported AEs during the use of RLAI in a naturalistic setting are comparable with those described in clinical studies; however, the incidence of extrapyramidal signs and weight gain was lower than expected.
 
A patient with schizophrenia, Gender: man, Aged: 57. Height: 148 cm. Weight: 61.5 kg. BMI: 28.08 kg/m 2 . ALAI dosage: 400 mg. Right side DEUF of gluteus maximus was 16.2 mm and gluteus medius was 21.4 mm Left side DEI was 63.4 mm. (a) Iliac Bone appears as a distinct bright echogenic line with no visible structures beneath. (b) View of gluteal muscle: By the insertion of the needle to the gluteus medius muscle membrane, distortion of the fascia is observed. (c) this is the image of RLAI at the time of start injection. (d) In the deep area, attenuation by acoustic shadow is observed by ALAI injection. This image is an injection of ALAI into the gluteus medius; diffusion of ALAI is also observed in the gluteus maximus muscle. (e) Acoustic shadow is maximized by the injection of ALAI, the iliac cannot verify in this image. (f) This is an image after ALAI injection. Case 3: Typical Example of ALAI Ultrasound Data Figure 3 is a typical example of the diffusion of the ALAI. Gender: female. Age: 56 years old. Height: 148 cm. Weight: 63.9 kg. BMI: 29.17 kg/m 2 . ALAI dosage: 400 mg. Left side DEUF of gluteus medius was 17.4 mm, and DEI was 54.0 mm.  
A patient with schizophrenia, Gender: woman. Aged: 56. Height: 148 cm. Weight: 63.9 kg. BMI: 29.17 kg/m 2 . ALAI dosage: 400 mg. Left side DEUF of gluteus medius was 17.4 mm Left side DEI was 54.0 mm. (a) Before needle puncture, iliac can be confirmed. (b) Insertion position of the injection needle. (c) The tip of the needle has been confirmed in the gluteus maximus. (d) The needle has been confirmed in the gluteus maximus muscle, the fascia of the gluteus maximus is distorted at the bottom by pressure on the fascia of the injection needle. (e) By the penetration of the injection needle, the gluteus maximus is returned to the original position. (f) ALAI injection at the start of the image. By injection of ALAI, attenuation by acoustic shadow was observed in the deep part. (g) By acoustic shadow due to the injection of ALAI, iliac is unclear.  
Article
The aim of this study was to consider the characteristics of intramuscular diffusion status of risperidone and aripiprazole long acting injectable (LAI) by ultrasonography. Subjects were 40 adult subjects diagnosed with schizophrenia and treated with LAI [32 patients were risperidone LAI (RLAI) and 8 patients were aripiprazole LAI (ALAI)]. However, in this paper, only three cases (one RLAI case and 2 ALAI cases) were selected to illustrate the diffusion effects of both LAI. Dorsogluteal intramuscular (IM) injection sites were measured at prone position using the “double cross” method. Before LAI injection, the distance from the epidermis to the under-fascia (DEUF), and distance from the epidermis to the iliac bone (DEI) at the IM injection site were assessed by using ultrasonography: 1) the injection needle was inserted to the gluteus medius, and 2) observed the diffusion status within the muscle injected RLAI and ALAI were confirmed using the B-mode ultrasonography. Both RLAI and ALAI were depicted as high echogenicity with acoustic shadowing. It was considered that the diffusion states of LAIs by ultrasonography were important time course evaluations providing objective evidence.
 
Characteristics of the sample (n = 251) and associations with BIAC scale score. 
Scree plot of eigenvalues.
Correlation matrix of individual items of BIAC scale and total scale score (n = 245). 
Characteristics of the sample (n = 251) and associations with BIAC scale score.
Article
Objective: Our goal was to develop a comprehensive measure of religious involvement for those affiliated with monotheistic religious traditions that fully captures the centrality of religion in life. Methods: A convenience sample of female caregivers of those with chronic disabling illness, recruited from North Carolina and California, completed a questionnaire including a new 10-item scale called the Belief into Action (BIAC) scale (possible score range: 10-100). Psychometric properties of the BIAC were examined. Results: 231 participants completed the BIAC (87% Christian). The average score was 46.3 (range: 10-90). Cronbach alpha was 0.89 (95% CI 0.86-0.91) and the intra-class correlation coefficient between two administrations (n = 60) was 0.919 (95% CI 0.869-0.951). Convergent validity was demonstrated by high correlations between the BIAC and existing religiosity scales; divergent validity by weak correlations with mental, social, and physical health outcomes; construct validity by high correlations between individual items and total scale score (r's 0.58-0.80); factor analytic validity by a single factor that explained 94.4% of the scale's variance ; and predictive validity by small to moderate correlations with psychosocial outcomes in expected directions. Conclusion: The BIAC is a reliable and valid scale for comprehensively assessing religious involvement in female caregivers affiliated with monotheistic religions, Christianity in particular. Psychometric properties of the scale need to be established in other populations.
 
Article
The aim of this case study is to review the literature and report the first published case of olanzapine-in-duced acute pancreatitis in New Zealand. A case re-port of acute pancreatitis with new onset diabetes mellitus secondary to olanzapine in a 42-year-old male, in the absence of medical risk factors is reported. Eleven previous case reports of olanzapine induced acute-pancreatitis were identified in the literature. A 42-year-old male was diagnosed with acute pancreati-tis and new diabetes mellitus induced by olanzapine. Although rare, pancreatitis is associated with use of some atypical antipsychotic medications. It is impor-tant for prescribers to be aware of this potentially fatal side effect. In addition to this, we are highlight-ing the well documented evidence of metabolic dis-ruption associated with olanzapine.
 
Article
Objective: Baseline characteristics of acute schizophrenia patients were analyzed to identify dif- ferences in the baseline characteristics of patients treated with olanzapine monotherapy com- pared with those treated with other antipsychotic monotherapies. Methods: This prospective, na- turalistic observational study was designed to evaluate discontinuation rates of olanzapine and non-olanzapine antipsychotic monotherapy in Japanese adult patients with acute schizophrenia. Results: A total of 1089 patients were assessed: 578 patients were treated with olanzapine, 487 with non-olanzapine atypical antipsychotics, and 24 with typical antipsychotics. The mean Clinical Global Impression-Severity (CGI-S) Schizophrenia, Brief Psychiatric Rating Scale (BPRS) total, and BPRS positive scores were higher in patients treated with olanzapine compared with most of the non-olanzapine treated patients. The majority of patients with a CGI-S Schizophrenia score of 7 (29/41 patients) as well as patients with a BPRS total score of 90 or higher (14/18 patients) were treated with olanzapine. On the other hand, physicians tended to prescribe antipsychotics other than olanzapine for patients with heavier body weight or diabetes mellitus. Conclusion: The * Corresponding author.
 
Article
Aftercare is crucial once an individual has completed drug or alcohol treatment and is in recovery. There is a continuity of care that should be followed once initial treatment is completed. This usually involves a lower level of treatment such as outpatient care and a sober living environment. In order to assess the efficacy and benefit of our addiction treatment program, we investigate a set of patients in which addiction treatment outcome and rehabilitation is determined for patients who have completed treatment and followed up. We determine abstinence rates and identify predictors of treatment outcome.
 
Top-cited authors
Harold Koenig
  • Duke University Medical Center
Faten Al Zaben
  • King Abdulaziz University
Nancy Koven
  • Bates College
Mohammad Gamal Sehlo
  • Zagazig University
Naseem Akhtar Qureshi
  • Ministry of Health, Riyadh