Psychiatry and Clinical Neurosciences

Published by Wiley
Online ISSN: 1440-1819
Publications
Article
Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia. Although there have been some studies on the role of verbal memory in learning ability, there have been no reports on the part played by visual memory. In the present study, the Rey-Osterrieth Complex Figure Test (RCFT) was given to healthy subjects and to those with MCI to determine if visual memory was maintained in these two groups. Additionally, normative data from the learning version of the RCFT for Japanese subjects were examined, for purpose of reference. The participants consisted of 381 clinical dementia rating (CDR) 0 subjects and 137 CDR 0.5 subjects who could perform the full set of RCFT tasks. The CDR 0 group had significantly higher scores than the CDR 0.5 group in all trials. The CDR 0 participants also showed a significant step-by-step learning effect, while the CDR 0.5 participants did not show a significant learning effect. These results suggest that the CDR 0 participants maintained intact learning abilities of encoding and retrieval, while the CDR 0.5 participants did not do so; but further studies will be needed to clarify these findings.
 
Article
The Benton Visual Form Discrimination test (VFD) is one of the non-verbal tests to assess the capacity for complex visual form discrimination. The purposes of the present study were to investigate the effects of age and education level of the VFD in healthy elderly subjects, rigorously excluding participants with Clinical Dementia Rating (CDR) 0.5, and the characteristics of VFD patterns in CDR 0.5 participants. The 597 participants included CDR 0 (healthy elderly, n = 405), CDR 0.5 (mild cognitive impairment, n = 161), and CDR 1 and 2 (dementia, n = 31). The VFD, Digit Forwards, Digit Backwards and Rey-Osterrieth Complex Figure Test (RCFT) copying were used for neuropsychological assessment. There were significant effects of age and education level on the VFD in healthy participants, and the CDR 0.5 group had a lower score on the VFD than the healthy group. Low performance on the VFD was associated with Digit Backward and RCFT copying in both healthy and CDR 0.5 participants. CDR 0.5 participants exhibit deficits of visual form discrimination related to attention, visual construction and organization.
 
Article
While the features of rapid-eye-movement sleep behavior disorder (RBD) have been reported in Caucasian patients, the characteristics of Chinese-Taiwanese patients with RBD have never been examined. Subjects were retrospectively recruited between April 2005 and February 2008 from the neurological clinic and sleep laboratory in the Department of Neurology of Kaohsiung Medical University Hospital. A total of 70 consecutive subjects fulfilling the criteria for RBD were recruited. The records of standard overnight polysomnography in patients with RBD were analyzed retrospectively. Twenty-five (35.7%) of the patients were female; the mean age of diagnosis was 67 years and the mean age of symptom onset was 60 years. Among patients with idiopathic RBD, there were 28 men (61%) and 18 women (39%). Nocturnal wandering in the bedroom was reported in 11 cases and out of the bedroom in seven cases. Nineteen patients (27.1%) had accidental falling from bed and 27 patients (38.6%) had sleep-related injury that resulted in ecchymosis and laceration of the head, face or limbs. We found that some features in Chinese-Taiwanese patients with RBD were different from Caucasian patients, such as a greater female ratio, lower injury episodes during sleep and more sleep wandering.
 
Article
The case of a patient who developed thrombocytopenia during treatment with carbamazepine (CBZ) is described. The platelet count recovered soon after discontinuation of CBZ, Lymphocyte stimulation test with carbamazepine-10, 11-epoxide (CBZ-10, 11-EPOX), a major metabolite of CBZ, was positive, although with CBZ it was negative. These findings suggest that CBZ-10, 11-EPOX was possibly causative in the pathogenesis of CBZ-induced thrombocytopenia in this case.
 
Article
The effect of risperidone on polydipsia-hyponatremia was evaluated in six hospitalized schizophrenic patients. The normalized diurnal weight gain (NDWG), urine-specific gravity (USG), urine and plasma osmolarity, and serum sodium were monitored during 9 months of risperidone treatment. The dose of risperidone (mean +/- SD=8.0 +/- 1.0, range=6-9 mg/day) was determined as approximately half of the haloperidol-equivalent dose of previous neuroleptics. Before risperidone treatment, the mean (+/- SD) BPRS score was 23.5 +/- 7.1; no significant improvement was observed after risperidone (22.0 +/- 7.5). The subjects showed relatively high serum prolactin before risperidone treatment (mean +/- SD=16.5 +/- 9.7 ng/mL), that was not significantly decreased by risperidone (14.2 +/- 7.9 ng/mL). The monthly means (+/- SD) of NDWG and USG before risperidone were 5.5 +/- 1.5 (%) and 1.002 +/- 0.001, respectively. These and other indices did not significantly improve throughout the study period. Although the sample size is relatively small, our preliminary data showed that risperidone might not be effective on polydipsia-hyponatremia of schizophrenic patients.
 
Article
Although some studies have examined the long-term effects of disasters, very little is known about severe persistent symptoms following disasters. The aim of the present study was to examine persistent mental health problems and to what extent disaster exposure predicts long-term persistent disturbances. Following a major disaster, a four-wave study was conducted (surveys 2-3 weeks, 18 months, 4 years and 10 years after the event) that examined severe post-traumatic stress disorder (PTSD) symptomatology (Impact of Event Scale), anxiety and depression symptoms and sleeping problems (Symptom Check List-90-R), and use of physician-prescribed tranquilizers. Participants were affected adult Dutch native residents (n = 1083). At wave 2 and 3, a control group participated (n = 694). At wave 1, severity of disaster exposure was examined. Multiple imputation was used to target the problem of missing data across surveys due to non-response such as in the fourth wave (61%). In total, 6.7% (95% confidence interval [CI]: 5.1-8.2) developed persistent PTSD symptoms during the 10 years after the event. For anxiety, depression, sleeping problems these prevalences were 3.8% (95%CI: 2.7-5.0), 6.2% (95%CI: 4.7-7.6) and 4.8% (95%CI: 3.5-6.1) respectively. In total 1.3% (95%CI: 0.6-2.0) used tranquilizers at all waves. Approximately one out of 10 with severe symptoms 2-3 weeks after the event, developed persistent symptoms. Even in the long term, affected residents compared to controls had more often chronic anxiety symptoms and sleeping problems. High disaster exposure independently predicted persistent PTSD symptoms (adjusted odds ratio [adj. OR], 4.20; 95%CI: 2.02-8.74, P < 0.001), anxiety (adj. OR, 3.43; 95%CI: 1.28-9.20, P < 0.01), depression symptoms (adj. OR, 2.95; 95%CI: 1.26-6.93, P < 0.01), and sleeping problems (adj. OR, 3.74; 95%CI: 1.56-8.95, P < 0.001). Post-disaster mental health care should (also) target persistent mental health disturbances in the long term, especially PTSD, anxiety, depression symptoms, and sleeping problems. High disaster exposure may be an early marker for risk of persistent symptoms.
 
Article
The effect of 3 mg of melatonin on the rate of re-entrainment of plasma melatonin rhythm after an 11-h eastward flight was assessed. Eight subjects participated in the study, and underwent 24-h blood samplings once before the flight and twice after the flight. Subjects were exposed to natural zeitgeber outdoors and took 3 mg of malatonin at 20:00 h local time on the days when no blood sampling was done. Antidromic re-entrainment was dominant whereby melatonin administration in the evening promoted re-entrainment. Melatonin accelerated the rate of re-entrainment by 15 min per day and alleviated the jet lag symptoms.
 
Article
No instrument for assessing impulsiveness has been developed in Japan. After translating the Barratt Impulsiveness Scale 11th version (BIS-11) into Japanese, we investigated reliability and validity in student (n = 34) and worker (n = 416) samples. To assess test-retest reliability, the intraclass coefficient between test and retest was calculated in the student sample. Internal consistency was examined by calculating Cronbach's alpha in the worker sample. To see factor validity, we examined by confirmatory factor analysis whether the three-factor model, proposed by a previous report, fit the data. The results showed that the Japanese version of the BIS-11 had excellent test-retest reliability and acceptable internal consistency reliability. In addition, the Japanese version was judged to have similar factor structure to the original one. The Japanese version of the BIS-11 is a reliable and valid measure and has possible utility for assessing impulsiveness.
 
Article
We investigated the re-entrainment of melatonin rhythm in an 11-h eastward-bound flight. Eight male subjects participated in the present study. Blood sampling was carried out once before the flight and twice after the flight. During the daytime the subjects were exposed to natural zeitgeber outdoors on the day except the blood sampling. Seven of eight subjects showed antidromic re-entrainment, and the other subject showed orthodromic re-entrainment. The intensity of natural day light in New York amounted to 20 000 lx. As for the direction of the re-entrainment in New York the antidromic re-entrainment is naturally dominant.
 
Article
A reason for the necessity to revise ICD-10 and DSM-IV is the increase of knowledge in the past 20 years, especially neurobiological knowledge. But is this increase of knowledge, for example in the field of neurogenetics, of such magnitude that a revision of the psychiatric classification is necessary and promises to be fruitful? The current plans for DSM-V or ICD-11, respectively, focus on different improvements. In this context also the introduction of a purely syndromatic/dimensional approach without including etiopathogenetic hypotheses, is discussed. A switch to such a dimensional approach, which was discussed among others in the DSM-V task force Deconstructing Psychosis, would be the most radical development. It could avoid many theoretical pre-assumptions about causal hypotheses, which are still associated with ICD-10 and DSM-IV. This would indeed increase the validity of psychiatric classification, but it would also reduce the information as compared to traditional diagnostic categories with all the current implications concerning etiopathogenesis, therapy and prognosis. Such a dimensional approach would also mean that the syndromes would have to be assessed in a standardized way for each person seeking help from the psychiatric service system or for each person undergoing psychiatric research. This would have to be a multi-dimensional assessment covering all syndromes existing within different psychiatric disorders. Based on the different aspects that must be considered in this context, a careful revision seems more advisable than a radical change of classification.
 
Article
We have examined the effects of repetitive transcranial magnetic stimulation (rTMS) on central dopaminergic function in patients with depression using positron emission tomography with L-[β-11C]DOPA, a ligand to assess the rate of endogenous dopamine synthesis. Eight patients were treated with 10-daily sessions of rTMS over the left dorsolateral prefrontal cortex. Positron emission tomography scanning was performed in each patient twice, before the first session and 1 day after the last session. Although four out of eight patients responded to rTMS, there were no changes in the striatal dopamine synthesis rate (k) following rTMS. These results suggest that chronic rTMS had a limited effect on the dopaminergic system.
 
Article
This study evaluated the striatal specific binding ratio (SBR), the anterior to posterior ratio of the striatum (APR) and its reproducibility by employing a template-based registration (TBR) method using the coregistered to the standard T1 magnetic resonance (MR) template (SMRT) as a replacement for the MR image of each patient. The 123I-IPT single photon emission computed tomography (SPECT) images of 30 patients with Idiopathic Parkinson's disease (IPD) and 11 normal controls were analyzed. The region of interest (ROI) was positioned manually in the same slice showing the highest striatal activity using the manual ROI method, while the ROI were positioned automatically in the mid striatal slice of the SPECT image coregistered to the SMRT. The SBR obtained using the TBR method showed a strong correlation with those using the manual method in all groups: normal controls (r = 0.851, P = 0.001), early IPD (r = 0.841, P < 0.001), and severe IPD (r = 0.702, P = 0.007). The APR obtained by the TBR correlated with those using the manual method in only the early IPD (r = 0.72, P = 0.001), while those obtained using the manual method showed no correlation in the three groups (P > 0.05). The reproducibility (rmsCV) of the TBR method was 7.2% (normal controls, 5.2%; mild IPD, 4.2%; severe IPD, 10.8%), while the reproducibility of the manual method was 31% (normal controls, 19.7%; mild IPD, 21.7%; severe IPD, 46.2%). This shows that the use of 123I-IPT SPECT for assessing IPD is affected by the method used to position the striatal ROI. This study showed that the TBR method using the SMRT is useful in diagnosing the IPD and assessing the disease severity with a high reproducibility, indicating a possibility of using the TBR method as a good replacement for the manual method.
 
Article
It has been hypothesized that the activation of the immune system may be involved in the neuropathological changes occurring in the central nervous system of schizophrenic patients. Cytokines play a key role in the activation of the immune system. Moreover, they strongly influence the dopaminergic, noradrenergic and serotonergic neurotransmission. To the best of our knowledge, in schizophrenic patients, plasma levels of interleukin (IL)-12 were investigated only in one study, where deregulation of IL-12 was determined. However, genotypical variations of the IL-12B (p40) gene have not been investigated for schizophrenic patients yet. Therefore, in the present study, we aimed to examine polymorphic variants of IL-12B (p40) gene promoter region in patients with schizophrenia in a population of the Elazig Region of East Anatolia, Turkey. One hundred Turkish patients diagnosed with schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and 116 healthy control subjects participated in the present study. The genotype characteristics were determined by polymerase chain reaction-based restriction fragment length polymorphism method using DNA extracted from peripheral blood. Significant differences in both the genotype and allele frequencies were found between schizophrenia patients and control groups (P < 0.01). These findings may support the hypothesis that activation of the inflammatory response system and in particular, of Th-1 cells, is involved in the pathophysiology of schizophrenia. We think that this study is the first trial associated with IL-12 cytokine at the molecular genetic level on immune mechanisms for neuropsychiatric disorders including schizophrenia, and this perspective and the role of the cytokines in the pathogenesis of schizophrenia may constitute a reasonable target for the present and future treatment strategies and prognosis.
 
Family structure and psychiatric phenotype. Individual 20 displayed a chromosomal abnormality, while both parents demonstrated normal karyotypes.
Karyotype of individual 20. Balanced translocation between 4p and 13q is illustrated, 46,XY,t (4; 13) (p16.1; q21.31).
Diagram showing normal chromosomes 4 and 13 (top) and cytogenetic interpretation of the breakpoints (arrow) involved in the translocation (below).
Article
Herein is reported the case of a male patient with schizophrenia who displayed a de novo balanced translocation between the short arm of chromosome 4 and the long arm of chromosome 13, t(4; 13)(p16.1; q21.31). The 4p16.1 region is where the causative gene (WFS1) for Wolfram syndrome has been mapped. In Wolfram syndrome, approximately 60% of patients suffer from major mental illness. The other breakpoint, chromosome 13q21.31, is another region where previous linkage studies have repeatedly detected linkage to schizophrenia. The documentation of the present case could therefore provide a valuable resource for identifying disease susceptibility genes by localizing the breakpoints.
 
Article
Although scales specific to resilience are available and widely used, qualities of resilience could be culturally sensitive. This study aimed to develop a concise scale of resilience for Japanese populations, and compare its validity to that of the Resilience Scale 14-item version (RS-14), one of the most widely used scales for measuring resilience. The Tachikawa Resilience Scale (TRS) was developed on the basis of data obtained from unstructured interviews with Japanese motor vehicle accident survivors without psychiatric disorder. The reliability and validity of the TRS and RS-14 were then examined in cross-sectional studies performed with 523 company workers and 140 psychiatric outpatients. The TRS and RS-14 were negatively correlated with depressive symptoms in company workers and psychiatric outpatients and with anxiety in psychiatric outpatients, and were positively correlated with social support in company workers. Internal consistency and test-retest reliability of the TRS were high. Construct validity of the TRS was equivalent to that of the RS-14 in company workers, and higher than that of the RS-14 in psychiatric outpatients. The reliability and validity of the TRS and RS-14 in Japanese company workers and patients with psychiatric disorders were acceptable. The validity of the TRS was equivalent to or better than that of the RS-14. Although the TRS cannot be regarded as an established scale due to a lack of theoretical rationale, the results of this study suggest that scales measuring resilience that cover cultural aspects might be more relevant in given populations.
 
Article
14-3-3 proteins play roles in phosphorylation of tau proteins in neurofibrillary tangles (NFT) in Alzheimer's disease (AD). Tau is phosphorylated at serine (pSer) and threonine (pThr) in NFT, and NFT morphology varies according to phosphorylated sites and tau isoform. The roles of 14-3-3 proteins in NFT morphology remain unknown. This study was performed to examine the relationships between 14 and 3-3 proteins and tau phosphorylation of NFT. NFT were labeled with Gallyas impregnation, tau and 14-3-3 immunohistochemistry in paraffin-embedded hippocampal sections from seven AD and three control brains. Anti-tau antisera included monoclonal antisera that recognize pSer262 (pSer262), pSer422 (pSer422), pSer202/pThr205 (AT8), Thr231 (AT180), three-repeat (RD3) and four-repeat (RD4) tau isoform. Anti-14-3-3 protein isoform antisera included polyclonal antisera to beta, gamma, zeta, epsilon, tau, mu and sigma isoforms and monoclonal antiserum to beta antiserum (H8-beta). NFT density was obtained by counting labeled NFT in cornu ammonis (CA) 1-CA4, subiculum and entorhinal cortex. H8-beta and zeta isoforms were strongly expressed in NFT. Regional densities of NFT positive for pSer262, AT8, AT180, and Gallyas impregnation were similar to RD3-positive NFT density with high densities in CA1 and entorhinal cortex. NFT positive for pSer422 showed a similar regional distribution to RD4-positive NFT with high NFT density in CA2-CA4. H8-beta-positive NFT showed a similar regional distribution to RD3-positive NFT. In contrast, zeta isoform-positive NFT showed no specific distribution. In conclusion, H8-beta isoform is associated with development of 3-repeats NFT but a role of 14-3-3 zeta isoform in NFT could not be specified.
 
Article
The present study examined the spatiotemporal changes of slow wave (delta and theta bands) activities before and after 14 Hz/12 Hz sleep spindles during stage 2 sleep, using topographic mapping of electroencephalogram (EEG) power. Both types of sleep spindles appeared after slow wave activities of background EEG decreased. Moreover, the appearance of sleep spindles provided increasing EEG slow wave activities in the subsequent period. Further, the present results showed that an appearance of 14 Hz sleep spindle facilitated slow wave activities at the centro-parietal areas, while an appearance of 12 Hz sleep spindle facilitated slow wave activities at the fronto-central areas. These results suggest that sleep spindles provide cortical de-arousal, and serve to maintain sleep.
 
Article
The hyperactivity of dopaminergic systems is one of the major etiological hypotheses of schizophrenia. The major support for this hypothesis is that effective antipsychotic drugs bind to dopamine receptors and improve acute schizophrenic symptoms. For this reason, we investigated the allelic association between schizophrenia and polymorphisms of the DRD2 genes for the Ser/Cys311 and -141C Ins/Del. The subjects were 190 schizophrenics (120 males and 70 females) and 103 normal controls (53 males and 50 females). There were no significant differences between the patients and controls in the allele frequencies and the frequencies of the genotypes. We found no statistical association between schizophrenia and polymorphisms of the DRD2 genes for the Ser/Cys311 and -141C Ins/Del. These results indicate that the DRD2 gene may not develop schizophrenia. Next, we examined whether the genotypes influence the symptoms of schizophrenia the using Positive and Negative Symptom Scale scores. The Ser/Cys patients exhibited significantly lower positive and negative symptom scores than Ser/Ser patients. Patients with Del/Del, Ins/Del, or Ins/Ins showed higher positive symptom scores in descending order. This result suggested that the Del allele worsens the positive symptoms. We concluded that the DRD2 receptor gene may not influence the onset of schizophrenia, but there is a strong possibility that the Cys311 and -141C Del have a significant influence on the symptoms of schizophrenia.
 
Article
Attention deficit has been reported in both schizophrenia patients and patients with major depressive disorder (MDD). The aim of this study was to elucidate the deficits in sustained attention and associated neural network dysfunctions in schizophrenia patients and MDD patients, and to investigate the difference between the two patient groups. Twelve schizophrenia patients, 12 patients with non-psychotic MDD, and 12 healthy control subjects participated in this study. A sustained attention to response task (SART) was used to measure attention capacity. Cerebral blood flow (CBF) during attention tasks was measured using H(2) (15) O positron emission tomography. Statistical parametric mapping and analysis of covariance were performed to compare the behavioral performance and CBF changes during SART among three groups. Behavioral performances were not significantly different among the three groups except for an increased commission error rate in the schizophrenia group. Regional CBF during SART was significantly reduced in the left inferior frontal gyrus, the left cuneus, and the right superior parietal lobule and increased in the right superior frontal gyrus and the right cuneus in the schizophrenia group compared to the healthy control group. In the MDD group, neither significant regional CBF difference nor behavioral deficit was found compared to the healthy control group. Behavioral performance deficit and perfusion changes in the prefrontal and parietal cortices during SART were observed only in the schizophrenia group. Prefrontal and parietal network dysfunction for sustained attention may be involved in the pathophysiology of schizophrenia.
 
Article
To assess nurses' workload with 16-h night shifts on a 2-shift system, we investigated the differences between workloads with each shift on the 2- and 3-shift systems with questionnaires on subjective symptoms and measuring heart rate and physical activity. It was found that the 2-shift nurses during the 16-h night shifts complained of fatigue less frequently and showed general decreases in heart rate and physical activity compared with the 3-shift nurses during 8-h evening and night shifts. The results suggest that a 2-h nap, an increase of staff, and a day off may reduce the nurses' workload when they have 16-h night shifts.
 
Article
The purpose of the present study was to evaluate the clinical effectiveness of kamishoyosan for antipsychotic-induced tardive dyskinesia, and to investigate the relationship between tardive dyskinesia and serum brain-derived neurotrophic factor (BDNF) levels. Sixty-nine schizophrenia patients were enrolled; of these, 49 presented with tardive dyskinesia while the remaining 20 patients showed no tardive dyskinesia. The tardive dyskinesia group was treated for 16 weeks with kamishoyosan and assessed using the abnormal involuntary movement scale. The abnormal involuntary movement scale scores in the tardive dyskinesia group were evaluated at baseline and after 4, 8, and 16 weeks of treatment. The BDNF levels of all subjects were measured at baseline in order to compare differences in serum BDNF levels between the tardive dyskinesia group and the non-tardive dyskinesia group, and to correlate the severity of tardive dyskinesia and serum BDNF in the tardive dyskinesia group. A meaningful reduction in total abnormal involuntary movement scale scores was observed in the tardive dyskinesia group treated with kamishoyosan at 4, 8, and 16 weeks of treatment (P < 0.01). No significant differences in serum BDNF levels were detected between the tardive dyskinesia group and the non-tardive dyskinesia group at baseline. Furthermore, no significant correlation was seen between the severity of tardive dyskinesia and serum BDNF levels. The present study suggests that kamishoyosan might be a promising adjunctive treatment for antipsychotic-induced tardive dyskinesia.
 
Article
This study aimed at examining the effects on the subjective symptoms in nurses of both timing and length of a 2-h nap during a 16-h night shift. Compared to pre-nap levels, sleepiness, fatigue, and dullness increased immediately after napping. Afterwards, sleepiness decreased significantly, and the other symptoms returned to the pre-nap values. The nurses' subjective symptoms after napping were not associated with the timing of the nap and post-nap fatigue lasted longer as the nap time increased (> 1.5 h). These results suggest that for effective napping during long night shifts, the nap length should be determined carefully to avoid persistent sleep inertia.
 
Article
FRONTOTEMPORAL DEMENTIA WITH parkinsonism linked to chromosome 17 (FTDP-17) is characterized by motor, psychiatric and cognitive symptoms. Executive dysfunction and behavioral disturbances such as disinhibition, socially inappropriate behavior, and unsafe driving habits are crucial for differential diagnosis and are usually described as changes in personality. In most cases of frontotemporal dementia, personality assessment is limited to the detection of behavioral abnormalities by means of symptom-oriented scales such as Neuropsychiatric Inventory. To our knowledge, personality changes in FTDP-17 have never been described in the paradigm of individual differences to show which personality traits are altered by the disease. The use of personality questionnaires enables direct observation of personality changes during progression of the disease, and the results can be interpreted in the context of personality dimensions according to a given personality theory.
 
Patient profiles: Demographic features and clinical characteristics
Increased FDOPA metabolism in OCD patients' brains compared to normal control group subjects
Article
Obsessive-compulsive disorder (OCD) is a chronic disabling neuropsychiatric disorder. Current treatment modalities, such as pharmacological and behavioral methods, are sometimes unsatisfactory. The mesolimbic dopaminergic pathway is supposed to have a role in the pathogenesis of OCD. In this study, L-3,4-Dihydroxy-6-[F-18]fluorophenylalanine (F-18 FDOPA) positron emission tomography (PET) is exploited to investigate the possible abnormality of dopaminergic neuronal circuits in the brains of OCD patients in vivo. The study subjects were recruited after psychological assessment and gave written informed consent to participate. The F-18 FDOPA PET scans were performed on five OCD patients and six healthy volunteers at 120 min after 185 MBq of F-18 FDOPA intravenous injection. The PET results were analyzed with the Statistical Parametric Mapping tool. Compared to the healthy subjects, the OCD brains showed increased dopaminergic metabolism in the left frontal premotor cortex (P < 0.001), along with trends toward an increase in the left posterior cingulate gyrus, the left cuneus, the left lingual gyrus, the right cuneus and precuneus, the right lingual gyrus, the right middle temporal gyrus, the left cerebellum, and the right cerebellum (P < 0.01). Our observations suggest that the increased dopaminergic neuronal function in these brain areas may be implicated in the pathogenesis of OCD.
 
Article
A survey was conducted on the present behavioral characteristics of 187 cases of adult autism in patients over 18 years of age employing Achenbach's Child Behavior Checklist (CBCL). When their behavioral characteristics were evaluated in relation to Present Language Developmental Level (PLDL) and Present Adaptive Level (PAL), it was seen that greater variation in behavior characteristics was seen among those exhibiting increasingly lower PLDL and PAL scores. Behavior characteristics reminiscent of depression were noted even among those exhibiting high PLDL. Behavior pointing to obsession was found in common among almost all cases of autism irrespective of PLDL or PAL. Psychotic symptoms such as hallucinations and delusions were absent in most cases. The results of the present study were indicative not only of the significance of obsessive behavior in autism, but also its significance in terms of delving further into the psychopathology of the disorder.
 
Article
Nineteen-hour variation of subjective sleepiness, performance and physiological indices were assessed during sleep deprivation. Longitudinal data of each index had its characteristic curve through which the values changed from day level to night level. A comparison of the time when each curve crossed its mid-range (50% value of its range) showed that those of subjective sleepiness and heart rate were significantly earlier than those of tracking error and coefficient of variation of R-R interval (CV(R-R)), P<0.01. That of rectal temperature was located at between 1:00 and 4:00 am. These temporal relationships were reproducible under two lighting conditions. These results will be useful in considering the occurrence of human errors by night-time workers in the early morning.
 
Article
Kraepelin's system of mental diseases has contributed substantially to the foundation of modern psychiatric diagnosis in the DSM-IV and ICD-10. Considering Kraepelin's influence in the creation of these diagnostic tools, the question arises as to how Kraepelin's contemporaries and successors reacted to his nosology. Historical libraries and archives in Munich, Berlin and Paris were searched for European and American psychiatric literature using the keywords 'Kraepelin', 'dichotomy' and 'manic-depressive disorder'. Literature from 1900 to 1960 was examined and compared to the current literature regarding Kraepelin's impact on modern classification systems. The sixth edition of Kraepelin's 'Lehrbuch' (1899) presented the dichotomy in its entirety and led to three different periods of critical comment on dichotomy and methodology between 1900 and 1960. But on the whole, Kraepelin's system was quickly and completely adopted in clinical diagnosis. The publications appearing on and following Kraepelin's centenary in 1956 represent his work as generally being the foundation of modern psychiatry. The neo-Kraepelinian movement, beginning in the late 1960s, developed more differentiated views of Kraepelin's scientific background and methodology. Notwithstanding all the criticism of Kraepelin's dichotomy, it remains more than ever the basis of psychiatric diagnosis. The criticism today shows parallels to the statements made during Kraepelin's era, mainly concerning the issue of diagnostic overlapping of the two disease entities, manic-depressive disorder and schizophrenia, and includes the question of syndromatology.
 
Article
Morita therapy was founded in 1919 by Shoma Morita (1874-1938) and is a systematic psychotherapy based on Eastern psychology. Since its founding 75 years ago, the treatment theory, treatment environment, treatment population and its cultural environment have been examined and modified in some areas. In this review, we first examine Morita theory and discuss the changes that have occurred in subsequent theories and methodologies. Our discussion presents the founding of Morita therapy and the characteristics of Morita theory; the practice of Morita therapy; Morita therapy from the perspectives of transcultural psychiatry and comparative psychotherapy; subsequent developments and modifications of Morita therapy; and the biological studies of Morita therapy. We attempt to clarify the universality and uniqueness of Morita therapy and provide a new framework for understanding Morita therapy.
 
Article
The height, weight and body mass index (BMI) of Japanese males and females aged from 6 to 24 years between 1960 and 1995 were studied. From 1960 to 1995 in males of all ages and in females aged 6-14 years height, weight and BMI increased. In females aged 15-24 years, the height increased and the weight slightly increased, but the BMI gradually decreased from 21.5 in 1960 to 20.5 in 1995. Over the last 35 years adolescent and young adult women have become thinner. Dieting to be slim has become much more prevalent among young women. These findings suggest that young females in Japan have decreased their BMI by dieting in order to become slim. If this tendency persists, with regard to a close relationship between restrained eating or dieting and eating disorders, Japanese young women have a much greater risk of developing eating disorders.
 
Article
To increase both the within- and between-researcher agreement in sleep stage identification and to foster the development of computer algorithms for automatic analyses of sleep, a need for additional definitions was recognized. In 1991, the Subcommittee for Automatic Sleep Staging (SASS) was formed by the JSSR. The Subcommittee comprised 53 investigators and seven project leaders selected for their skill in scoring sleep records: S. Sugita (Chair), M. Okawa (co-Chair), T. Kobayashi, T. Hori, A. Miyasita, S. Shirakawa and Y. Atsumi. In 1995, based on their 5 year discussions, the Subcommittee proposed supplementary definitions and amendments for the Standard Scoring System to the JSSR. These proposals were reported in the JSSR Newsletter (1996; No. 13, February 1, pages 5–13).
 
Article
Several countries, such as the USA, inadvertently created a different behavioral health payment system from the rest of medicine through the introduction of diagnostic-related group exemptions for psychiatric care. This led to isolation in the administration and delivery of care for patients with mental health and substance abuse disorders from other medical services with significant, yet unintended, consequences. To insure an efficient and effective health-care system, it is necessary to recognize the problems introduced by segregating behavioral health from the rest of medical care. In this review, the authors assess trends in behavioral health services during the last two decades in the USA, a period in which independently managed behavioral health care has dominated administrative practices. During this time, behavioral health has been an easy target for aggressive cost cutting measures. There have been no clinically significant improvements in the number of adults receiving minimally adequate treatment or in the percentage of the population with behavior health problems receiving psychiatric care with the possible exception of depression. While decreased spending for behavioral health services has been well documented during this period, these savings are offset by costs shifted to greater medical service use with a net increase in the total cost of health care. Targeting behavioral health for reduction in health-care spending through independent management, starting with diagnostic procedure code or diagnostic-related group exemption may not be the wisest approach in addressing the increasing fiscal burden that medical care is placing on the national economy.
 
Article
The relationship between suicide and disaster is an important problem but it's not clear. We conducted this study to determine whether a natural disaster affects suicide rates. We collected data on suicides during the 84 months before and the 60 months after the earthquake and compared the suicide rate in Kobe to that in Japan as a whole. We also examined what groups were significantly affected. Compared with Japan as a whole, the suicide rates in Kobe significantly decreased in the 2 years after the earthquake. An influence on suicide rate after the disaster clearly appeared in middle-aged men.
 
Article
As many as 96% of all residents of Taiwan have been enrolled in the National Health Insurance (NHI) program since 1996. The NHI database was used to examine the prevalence and incidence of schizoprenia. The National Health Research Institute provided a database of 200 432 random subjects, about 1% of the population, for study. By means of exclusion criteria, a random sample of 136 045 subjects as a fixed cohort dated from 1996-2001 was obtained. Those study subjects who had at least one service claim during these years for either ambulatory or inpatient care, with a principal diagnosis of schizophrenia, were identified. The cumulative prevalence increased from 3.34 per 1000 to 6.42 per 1000 from 1996 to 2001. The annual incidence density decreased from 0.95 per 1000/year to 0.45 per 1000/year from 1997 to 2001. Male subjects had higher treated prevalence in younger age groups than did female subjects. Higher prevalence was associated with the 25-44 and 45-64 age groups, insurance amount less than US$640, the eastern region, and suburban areas. Lower incidence was associated with the 45-64 age group. Higher incidence was associated with insurance amount less than US$640, and the eastern region. According to the trends of cumulative prevalence and incidence density, the treated prevalence and incidence rate will be approximate to community rates gradually. Most persons with schizophrenia had received treatment in Taiwan after the NHI program was implemented. Future studies should focus on outcome and cost evaluation.
 
Article
The aim of this study was to examine the characteristic features of suicides in Thailand between 1998 and 2003. Collected data during 1998-2003 from the Bureau of Policy and Strategy, Ministry of Public Health were analyzed to reveal the mortality from suicide according to age, gender, rate and methods of suicides. Suicide rates were found to have increased to a peak of 8.6 per 100 000 (5290 suicides) in 1999 and then to have decreased to 7.1 per 100 000 in 2003. The average suicide rate during 1998-2003 was 7.9 per 100 000 with a male to female ratio of 3.4:1. Male suicide reached a peak for those aged 25-29 years (21.9 per 100 000) while female suicide showed less variation with age. Hanging was the most common method used, followed by ingestion of agricultural toxic substances. Suicide was most prevalent in upper northern region where HIV infection might be related to the high prevalence. Suicide prevention program should focus on males in early adulthood, and particular measures should be conducted to reduce risk factors related to HIV infection among people in northern Thailand.
 
Article
Haloperidol decanoate is widely used in the maintenance treatment of schizophrenia and other psychotic disorders, but knowledge concerning its pharmacokinetics at the injected region is very limited. Because the chemical structure of haloperidol contains fluorine, in vivo 19F-magnetic resonance (MR) spectroscopy (repetition time (TR) = 1 s) and chemical shift imaging (CSI; TR = 1 s, pixel size = 15 x 15 mm) were performed in schizophrenic patients who were treated with haloperidol decanoate (three men and one woman) to measure its diachronic change at the injection point and visualize its local distribution after intramuscular injection. 19F signals (T1 time = 365 ms) were obtained at the haloperidol decanoate-injected region. The decrease rate of the signal-to-noise ratio (SNR) by 19F-MR spectroscopy seemed large in comparison with that of the plasma haloperidol concentration. The distribution was clearly visualized by 19F-CSI for a few days after the injection, but after 1 week could no longer be seen. Although the slow-release characteristics of depot neuroleptics have been explained by the slow diffusion of esterified neuroleptics from the oil vehicle, this result may suggest that there are other mechanisms involved in maintaining the plasma haloperidol concentration. In vivo 19F-MR spectroscopy and CSI are potentially applicable for the pharmacokinetic analysis of haloperidol and other drugs containing fluorine in their structure.
 
5-HTR1A polymorphisms 
Characteristic and life events in suicide victims vs 5-HTR1A polymorphism 
Article
The association of serotonin 1A receptor (5-HTR1A) gene polymorphisms with suicidal behavior has been reported in several previous studies, but the results have been inconsistent, which might be due to ethnic differences. The aim of the present study was therefore to investigate the association between polymorphisms -1019C>G, 47C>T (Pro16Leu) and 815G>A (Gly272Asp) and suicidal behavior, taking into account age, gender, and the presence of stressful life and loss events in 1 year prior to suicide. A total of 191 suicide victims and 218 healthy control subjects were included in the present study. 5-HT1RA gene polymorphisms were determined on polymerase chain reaction-restriction fragment length polymorphism. The distribution of -1019C>G genotypes was significantly different in suicide victims and healthy controls (P = 0.002), and the GG genotype was associated with a significantly higher number of more stressful life and loss events in the suicide victims (P = 0.017, P = 0.037, respectively). The distribution of 47C>T (Pro16Leu) and 815G>A (Gly272Asp) genotypes was not significantly different in the suicide victims and control subjects (P > 0.05). Moreover, these genotypes were not associated with stressful life and loss events (P > 0.05). The frequency of the -1019G allele in the 5-HTR1A gene was higher in suicide victims (with stressful life events) as compared with the control group. In contrast, neither 47C>T (Pro16Leu) nor 815G>A (Gly272Asp) polymorphisms were related with suicide and stressful life events.
 
Article
We have developed a radioreceptor binding assay (RRA) method for melatonin using membranes from Chinese hamster ovary cells that can stably express human mel-1a receptors. We measured melatonin levels in plasma samples collected every 4h for 24h using the RRA and radioimmunoassay (RIA) methods, simultaneously. There was a statistically significant correlation between the melatonin levels measured by the two methods, this newly developed method providing a sensitive bioassay. As it is possible to circumvent the cross-reactivity usually occurring in the RIA method, this method may be an important tool for detecting bioactive substances relative to the mel-1a receptor.
 
Article
Interferon-ß is used in patients with multiple sclerosis to reduce autoimmunity; although other psychiatric side-effects are common, in contrast to interferon-alpha, psychosis has been reported only once. A patient with multiple sclerosis developed auditory hallucinations, paranoid delusions, and increased aggressiveness after 16 months of treatment with interferon-ß-1b, 250 mg every other day. He responded after about one month to antipsychotic treatment, but tended to relapse upon dose reduction, and after 2 years still needs antipsychotics to control his symptoms. Because there was no change in his magnetic resonance imaging between pre- and post-treatment with interferon, we concluded that psychosis was more related to interferon treatment than to the underlying disease.
 
Article
Brainstem function was evaluated by proton magnetic resonance (MR) spectroscopy (1H-MRS) in a 69-year-old man with idiopathic rapid eye movement (REM) sleep behavior disorder. An analysis of spectral peak area ratios revealed an increase in the choline/creatine ratio. This change suggests that brainstem neurons have functional impairment at the cell membrane level. Further, our results suggest that 1H-MRS may provide for non-invasive, metabolic evaluation of brainstem neuronal function in REM sleep behavior disorder and find application in the differentiation of secondary REM sleep behavior disorders with neurodegenerative disorders from idiopathic disorders.
 
Article
We utilized single-voxel (1) H magnetic resonance spectroscopy to determine biochemical abnormalities related to major depressive disorder (MDD) in the bilateral dorsolateral prefrontal cortex, anterior cingulate cortex (ACC), and cerebellar hemisphere before and after antidepressant treatment. Fifteen adult MDD patients and 15 age- and sex-matched healthy controls were involved. Magnetic resonance spectroscopy of the brain was conducted in all subjects at the beginning of the study and the depressed subjects were reassessed after 8 weeks of antidepressant treatment. At baseline, N-acetyl aspartate (NAA), total glutamine plus glutamate (Glx) and myo-inositol (MI) levels in the bilateral ACC were significantly lower in MDD patients than in controls (P < 0.05/3). MI in the bilateral cerebellar hemisphere were also decreased in patients compared with controls. After the treatment, the lower NAA, Glx and MI in ACC were normalized in MDD patients and the NAA and Glx increased compared to baseline values. The MI levels in the bilateral cerebellar hemisphere were also normalized in patients. MI and choline levels in the right cerebellar hemisphere were elevated compared to those at baseline. Our study suggests that metabolic abnormalities in the ACC and cerebellar hemisphere are implicated in MDD. Antidepressants may alter the local metabolic abnormalities in these areas.
 
Article
To estimate the prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) mental disorders in community populations in Japan, face-to-face household surveys were conducted in four community populations in Japan. A total of 1663 community adults responded (overall response rate, 56%). The DSM-IV disorders, severity, and treatment were assessed with the World Mental Health version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered psychiatric diagnostic interview. The prevalence of any WMH-CIDI/DSM-IV disorder in the prior year was 8.8%, of which 17% of cases were severe and 47% were moderate. Among specific disorders, major depression (2.9%), specific phobia (2.7%), and alcohol abuse/dependence (2.0%) were the most prevalent. Although disorder severity was correlated with probability of treatment, only 19% of the serious or moderate cases received medical treatment in the 12 months before the interview. Older and not currently married individuals had a greater risk of having more severe DSM-IV disorders if they had experienced any within the previous 12 months. Those who had completed high school or some college were more likely to seek medical treatment than those who had completed college. The study confirmed that the prevalence of DSM-IV mental disorders was equal to that observed in Asian countries but lower than that in Western countries. The percentage of those receiving medical treatment was low even for those who suffered severe or moderate disorders. Possible strategies are discussed.
 
Article
The aim of the present study was to provide basic descriptive data regarding utilization of 12-month mental health services in the Japanese community population. Face-to-face household surveys were carried out in four areas (two urban cities and two rural municipalities), and a total of 1663 persons participated (overall response rate: 56.4%). For data collection, the structured psychiatric interview, World Mental Health version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) was used, allowing DSM-IV diagnoses, severity, and service utilization. It was found that 7.3% of total respondents had received any service, either professional or non-professional, in the past 12 months, including 20.0% of those with 12-month DSM-IV disorders and 6.2% of those without. Thirty-three percent of those with any mood disorder used any service, and 26.8% of those used some type of health care. The probability of people with 13-15 years of education receiving mental health treatment was fourfold higher than those with >or=16 years of education. Gender, age, or income were not found to contribute to utilization of mental health services. The results confirm that the majority of people with a recent psychiatric disorder have not used mental health care or other support systems. The mental health care system in Japan has improved over the past decade, but not enough for people suffering from mental disturbances.
 
Article
Sociodemographic correlates of Japanese attitudinal barriers to mental health services might be different from previous studies in Western countries, reflecting a different culture. We investigated sociodemographic correlates of attitudinal barriers to mental health services in a community population in Japan, based on data collected in the World Mental Health Survey Japan surveys. An interview survey was conducted of a random sample of residents living in 11 communities across Japan during 2002-2006. A total of 1359 participants were analyzed. The variables on attitudinal barriers to mental health services were measured by using the World Health Organization Composite International Diagnostic Interview 3.0. The association between these variables and sociodemographic variables were analyzed by using multiple logistic regressions. Being male was significantly associated with willingness to go for professional help and feeling comfortable to talk with a professional. Compared to the youngest group (20-34 years old), those aged from 35 to 49 years had a significantly lower prevalence of feeling embarrassed about friends knowing about their getting professional help, while the oldest group (aged over 65 years) had a significantly higher prevalence of being embarrassed. Being currently married was significantly associated with higher expectations about mental health services, but it was significantly and negatively associated with willingness to go for professional help. These results suggest that demographic patterns of attitudinal barriers to mental health services in Japan are unique, compared with previous studies in Western countries. An anti-stigma campaign may need to consider such country-specific patterns in a particular country.
 
Article
Cross-correlation was examined for the volume of suicide-related Internet searches and suicide death rate. Analysis of Google data and figures released by the Ministry of Health, Labour, and Welfare indicated that the volume of searches using the search terms jisatsu (suicide) and jisatsu houhou (suicide method) are not correlated with the suicide death rate. In addition, a rising suicide death rate might be related to the increase in suicide-related search activity (particularly utsu[depression]), but an increase in suicide-related search activity itself is not directly linked to the rise of suicide death rate.
 
Top-cited authors
Ju-Yu Yen
  • Kaohsiung Medical University
Chih-Hung Ko
  • Kaohsiung Medical University
Shigenobu Kanba
  • Kyushu University
Takahiro A. Kato
  • Kyushu University
Cheng-Chung Chen
  • Universitäre Psychiatrische Kliniken Basel