Intracranial calcifications associated with factors related and unrelated to atherosclerosis in older people: A community dwelling cohort study.

The cause of intracranial calcification is not fully understood. The aim of the current study was to identify factors associated with intracranial calcification and to determine whether these factors differ in calcification of different sites. A total of 404 community-dwelling people aged 65 or older were included in the study. All subjects underwent brain computed tomography (CT), blood tests, and a Mini-Mental State Examination (MMSE). Intracranial calcifications were scored using CT. Stepwise regression analysis was performed to examine factors associated with intracranial calcification, with each calcification score used as a dependent variable. Independent variables included age, gender, hemoglobin A1c (HbA1c), dyslipidemia, estimated glomerular filtration rate (eGFR), blood pressure, body mass index (BMI), smoking, serum iron, ferritin, and intact parathyroid hormone (PTH). Stepwise regression analysis detected male gender as a predictor of pineal gland calcification and intact PTH as a predictor of basal ganglia calcification. Age and lifestyle diseases were identified as predictors of calcification of the falx cerebri, internal carotid arteries, and vertebral arteries. These results indicate that the mechanisms of calcifications of the pineal gland and basal ganglia might differ from that of artery calcification, and that causes of intracranial calcification might be classified using factors that are and are not related to atherosclerosis.

Effect of toki-shakuyaku-san on regional cerebral blood flow in patients with mild cognitive impairment and Alzheimer's disease.

The aim of this study was to examine the effect of toki-shakuyaku-san (TSS) on mild cognitive impairment (MCI) and Alzheimer's disease (AD) using single-photon emission computed tomography (SPECT). All subjects were administered TSS (7.5 g/day) for eight weeks. SPECT and evaluations using the Mini Mental State Examination (MMSE), Neuropsychiatric Inventory, and Physical Self-Maintenance Scale were performed before and after treatment with TSS. Three patients with MCI and five patients with AD completed the study. No adverse events occurred during the study period. After treatment with TSS, regional cerebral blood flow (rCBF) in the posterior cingulate was significantly higher than that before treatment. No brain region showed a significant decrease in rCBF. TSS treatment also tended to improve the score for orientation to place on the MMSE. These results suggest that TSS could be useful for treatment of MCI and AD.

Neuropsychological and functional correlates of clock-drawing test in elderly institutionalized patients with schizophrenia.

BACKGROUND: There has been a growing need for a cognitive assessment tool that can be used for older adults with schizophrenia in clinical settings. The clock-drawing test (CDT) is a brief cognitive test that covers a wide range of cognitive function. Although it is widely used to assess patients with dementia, limited data are available on its usefulness in older patients with schizophrenia. Thus, we investigated the psychometric properties of the CDT and their relationship with life functions to examine the test's usefulness for assessing cognitive function in older adults with schizophrenia. METHODS: Seventy-three older adults with chronic schizophrenia who had been hospitalized for over 1 year participated in the study. We adopted the executive clock-drawing task for administration and scoring of the CDT, which consists of free-drawn and copy conditions. The Mini-Mental State Examination and the Brief Assessment of Cognition in Schizophrenia were administered. Symptom severity and life functions were assessed with the Positive and Negative Syndrome Scale and the Life Skills Profile, respectively. RESULTS: Both free-drawn and copy scores significantly correlated with the Mini-Mental State Examination score and the Brief Assessment of Cognition in Schizophrenia composite score. These scores also significantly correlated with symptom severity and length of current hospitalization. Stepwise regression analysis showed that only the copy score, together with symptom severity, predicted the Life Skills Profile score. CONCLUSIONS: The CDT can assess cognitive function in older adults with schizophrenia. Moreover, CDT performance is associated with life functions independent from other clinical variables. These results suggest that the CDT is a useful cognitive assessment tool for this population.

Longitudinal Course of Illness in Congenitally Deaf Patient with Auditory Verbal Hallucination.

Auditory verbal hallucination is one of the core symptoms of schizophrenia, same as delusions, and also occurs in many other psychiatric disorders. Significant numbers of people with congenital deafness experience auditory verbal hallucinations; however, there are only a few reports regarding the course of psychosis in people with congenital deafness. Herein, we report the case of a patient with congenital deafness and auditory verbal hallucinations whose diagnosis was changed from psychotic major depression to schizophrenia 7 years after the onset of the disease. His psychotic symptoms decreased when his primary medication was changed from an antidepressant to antipsychotic drugs, based on the change of diagnosis. In the treatment of congenitally deaf patients with auditory verbal hallucinations, the inability to communicate through spoken language may interfere with proper diagnosis and treatment. The ability to collect detailed information in ways other than through verbal language is imperative for psychiatrists to determine the appropriate diagnosis and treatment for these patients during the longitudinal course of illness.

Insight and quality of life in long-term hospitalized Japanese patients with chronic schizophrenia.

AIM: The aim of the study was to investigate the relationship between insight and quality of life (QOL) and the respective predictive factors in long-term hospitalized patients with chronic schizophrenia. METHODS: The present subjects were 47 Japanese patients with chronic schizophrenia who were hospitalized for >1 year (mean hospitalization period, 9.8 years). Assessments were made using the Scale of Unawareness of Mental Disorder (SUMD) and the EuroQoL-5 Dimensions (EQ-5D) scale. Sociodemographic details and illness-related variables were also evaluated, including use of the Positive and Negative Syndrome Scale. RESULTS: There was no association between SUMD and EQ-5D scores. Hallucinatory behavior was a predictor of good insight. Poor rapport was a predictor of bad insight. Poor attention was a predictor of bad QOL. CONCLUSION: The relationship between insight and QOL and the respective predictive factors might be different between acute and chronic stages. Further studies are needed to investigate how these changes occur.

Correlation between anosognosia and regional cerebral blood flow in Alzheimer's disease.

The purpose of this study was to determine the brain regions associated with anosognosia in Alzheimer's disease (AD). Anosognosia for memory disturbance was assessed in 29 probable AD patients, based on the discrepancy between questionnaire scores of the patients and their caregivers. In I-123-IMP single photon emission computed tomography (SPECT), a significant association was found between anosognosia and decreased perfusion in the orbitofrontal cortex, using regression analysis. This result is consistent with the previous studies that have reported an association between frontal dysfunction and anosognosia, and further suggests that the orbitofrontal cortex specifically associates with anosognosia in AD within the frontal cortex.

Alteration of fractional anisotropy and apparent diffusion coefficient in obsessive-compulsive disorder: a diffusion tensor imaging study.

BACKGROUND: Abnormalities of fractional anisotropy (FA) have been reported in previous diffusion tensor imaging (DTI) studies in patients with obsessive-compulsive disorder (OCD). However, there are some inconsistencies in the results and the apparent diffusion coefficient (ADC) has not been investigated. The goal of this study was to investigate white matter abnormalities and water diffusivity, as reflected by FA and ADC, using DTI in patients with OCD. METHODS: Fifteen patients with OCD and 15 healthy volunteers underwent DTI. Voxelwise analysis was used to compare FA in white matter and ADC in gray matter/white matter of the two groups. RESULTS: Compared with healthy volunteers, the patients had higher FA in the bilateral semioval center extending to the subinsular white matter; and a higher ADC in the left medial frontal cortex. There were no areas with a significantly lower FA or ADC in patients compared with healthy volunteers. CONCLUSIONS: A significantly higher FA was found in regions associated with the emotion of disgust and a trend for a higher ADC was found in a region associated with the regulation of emotions. These findings suggest that neurocircuits involved in disgust processing may play an important role in the pathophysiology of OCD.

Relationships among burnout, coping style and personality: study of Japanese professional caregivers for elderly.

AIM: To investigate relationships among burnout, coping style and personality. METHODS: Seventy-two professional caregivers working at nursing homes in Japan were assessed using the Maslach Burnout Inventory (MBI), NEO Five-Factor Inventory (NEO-FFI), 30-item General Health Questionnaire (GHQ) and Coping Inventory for Stressful Situation (CISS). RESULTS: GHQ (beta = 0.34, P < 0.01) and emotion-oriented coping (CISS-E; beta = 0.31, P < 0.05) were the predictors of emotional exhaustion (MBI-EE), and neuroticism (NEO-N; beta = 0.45, P < 0.001) and age (beta = -0.23, P < 0.05) were the predictors of depersonalization (MBI-DP). Structural equation modeling showed that NEO-N affected the burnout scores through CISS-E, and that age and GHQ affected the burnout scores independently. CONCLUSION: Personality affects burnout through coping style in professional caregivers.

[Addictive behavior disorders].

"Addiction" used to remind anyone of the use or abuse of chemical substances. In recent years, however, researchers and clinicians have begun to classify other excessive behaviors including gambling, eating shopping and self-injury into the addictive behavior. Above all, pathological gambling and bulimia nervosa patients often make trouble for psychiatrists and psychologists, not only for their family. On the other hand, the neural substrata underlying substance dependence have been revealed. Especially, it is implicated that the mesolimbic neuron plays a crucial role on the reward system. The recent studies suggest that reduced activation of the reward system might be related to the addictive behaviors such as pathological gambling, binge eating and sexual behavior. Further biological researches about the addictive behavior would help our deeper understanding of its disorders. As to the pharmacotherapy, many studies have demonstrated the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating the addictive behaviors.

Regional cerebral blood flow changes in a patient with delusional parasitosis before and after successful treatment with risperidone: a case report.

The pathophysiology and appropriate pharmacological interventions for delusional parasitosis (DP) remain unknown. Here, we present a case of DP following brain infarction of the right temporoparietal region. Pharmacotherapy with risperidone resulted in a dramatic therapeutic response over a short period. In a sequential N-isopropyl-p-[(123)I]-iodoamphetamine single photon emission computed tomography ([(123)I]-IMP SPECT) study, post-treatment SPECT images revealed a marked increase of rCBF in the large areas including the bilateral frontal and left temporoparietal regions, the right parietal operculum and the bilateral basal ganglia, in contrast to pre-treatment SPECT images showing a global decrease of rCBF. Our clinical outcome suggests the efficacy and safety of risperidone for treatment of DP and that both dopaminergic and serotonergic dysfunction may play a role in DP. Our sequential SPECT findings suggest that psychiatric improvement of DP is associated with increased rCBF.

Regional cerebral blood flow changes associated with interoceptive awareness in the recovery process of anorexia nervosa.

BACKGROUND: An abnormality in regional cerebral blood flow (rCBF) in anorexia nervosa (AN) patients has been reported. There are very few studies that have investigated the rCBF changes in the recovery process of AN. METHODS: For eight female AN patients, we performed (123)I-IMP single photon emission computed tomography (SPECT) and four psychological assessments (Eating Disorder Inventory (EDI), Eating Attitude Test (EAT), Self-Rating Depression Scale (SDS) and State-Trait Anxiety Inventory (STAI)) both before and after inpatient-behavioral therapy. SPECT images were analyzed using statistical parametric mapping software. We also performed correlational analysis between rCBF and clinical variables. RESULTS: Following treatment, the patients showed significant body weight recovery. They showed significant improvement in EAT, SDS, STAI and a subscale of EDI - interoceptive awareness (IA) - but not in total EDI or other EDI subscales. Significant rCBF increases were observed in the precuneus, posterior cingulate cortex (PCC), right dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC) and medial prefrontal cortex (MPFC) by the treatment. Significant correlation was observed between rCBF of right DLPFC and IA score before treatment. CONCLUSIONS: Changes of rCBF in right DLPFC, ACC, MPFC, PCC and precuneus were related to the AN recovery process and might be associated with improvement of IA following treatment.

[Diagnosis, assessment, and treatment of alcohol withdrawal syndrome].

Alcohol withdrawal syndrome is the one of the most critical status among alcohol related disorders. Early detection, diagnosis, and appropriate treatment of alcohol withdrawal syndrome are keys to a successful outcome. This article describes the concrete method of diagnosis, assessment, and treatment of alcohol withdrawal syndrome.

Effect of institutional smoking prohibition on Japanese inpatients with chronic schizophrenia.

OBJECTIVE: A higher prevalence of smoking among schizophrenic patients has been well documented in Japan and other countries. Smoking reduction or cessation is desirable to reduce various physical complications in schizophrenic patients, but the effect of smoking reduction on psychiatric status and BMI remains ambiguous. The aim of this study was to determine the effect of an institutional smoking prohibition on smoking status, psychiatric status and BMI in Japanese inpatients with schizophrenia. METHOD: Smoking status, psychiatric status (Clinical Global Impression (CGI) scores: global severity score and global change score) and BMI were investigated in 256 chronic schizophrenic inpatients before and 3 months after prohibition of smoking in a Japanese psychiatric hospital building. RESULTS: Following prohibition, the smoking rate decreased from 36.3% to 22.2%. A weak positive correlation was found between decreased cigarette consumption and the CGI global change score (r=0.140, p=0.025), but the mean global change scores in the smoking groups were less than 6 (minimally worse). No significant increase in BMI was observed. CONCLUSION: Institutional smoking prohibition is effective in reducing the smoking rate, while having only a minor unfavorable effect on psychiatric status and BMI in chronic schizophrenic inpatients.

Case of prolonged alcohol withdrawal syndrome accompanied with hyperthyroidsim.

Hyperthyroidism is associated with increased psychiatric morbidity. It may alter the clinical course of alcohol withdrawal syndrome. We report a 69 year old man who presented prolonged alcohol withdrawal syndrome associated with hyperthyroidism. Initially, he developed typical alcohol withdrawal syndrome including tremor, disorientation, delirium and visual hallucination of small animals. Thyroid function tests revealed a free triiodothyronine (T3) of 6.1 pg/dl (range, 3.0 to 5.8), a free thyroxine (T4) of 2.3 ng/dl (range, 0.85 to 2.15) and a thyroid stimulating hormone (TSH) of 0.003 microU/ml (range, 0.3 to 4.0), and thiamazole was administered. Even after a month, he continuously presented persecutory delusion, auditory hallucination and cognitive dysfunction. Although these symptoms did not respond to the medication including antipsychotics, they totally passed away after the thyroid function reached down to the normal level (free T3 3.0 pg/ml, free T4 1.1 ng/dl, TSH 0.004 microU/ml). In addition, cognitive function was recovered to the normal level as he scored 28/30 on the Mini Mental State Examination. We propose that hyperthyroidism contributed to the occurrence of psychotic symptoms and cognitive dysfunction.

Chronic high-dose nitrazepam dependence 123I-IMP SPECT and EEG studies.

A patient who took 50-100 mg nitrazepam per day for 25 years is presented. (123)I-IMP SPECT (autoradiography method) and EEG were performed sequentially on the subject during and after the withdrawal syndrome. Severe hypoperfusion of the whole brain on SPECT and diffuse slow activity on EEG were demonstrated during the withdrawal syndrome and subsequently remarkably improved. However, the hypofrontal pattern on both early and delayed images in SPECT was unchanged. The changes observed on SPECT and EEG reflect the pathophysiology of dependence and withdrawal. Additionally, the hypofrontal pattern remained unchanged suggesting that organic brain damage can develop as a result of chronic high-dose benzodiazepine abuse.

[Changes of serotonergic neurons induced by low dose nicotine in rat forebrain].

Nicotine has been reported to exert several biological and pharmacological activities in central nervous system. There are many studies on the relationship between dopaminergic neurons and nicotine dependence. However, the relevance between nicotine and serotonergic neurons on dependence remains unknown. We demonstrate here that the effect of continuous low dose nicotine administration on setoronergic neurons (5-HT) immunoreactive fibers and terminals were increased in nicotine (0.5 mg/kg/day, 28 days) treated rat forebrain including anterior cingulate cortex and hippocampus. These results indicate that low dose nicotine, levels of smoking, may be related the developing the dependence of nicotine via the changes of 5-HT neurons in forebrain.

[Case report of pentazocine dependence from a standpoint of the cognitive therapy].

Drug dependence is a social problem of over the world and resistant to medical intervention by psychiatrist as well as general clinicians. In Japan, methamphetamine dependence is one of the most critical social problems, but opioid dependence is relatively rare. Pentazocine was called the non-addictive opioid at the time of development and release and there are few reports of its dependence. We experienced a medical worker with pentazocine dependence. He started to use pentazocine to reduce serious migraine and felled into dependence by changing the purpose to relaxation of stammering fear and strain towards other people. He was successfully treated by cognitive therapy.

[Change in body image of patients with alcohol dependence during treatment process].

In order to find useful information for the establishment of new treatment method to alcohol dependence, we investigated the change of the body image of patients with alcohol dependence before and after the treatment. HABIT (Haga Body Image Test), a questionnaire about body image developed in department of psychiatry in Kyoto Prefectural University of Medicine, was used to examine the change of body image between pre- and post-3-month conventional treatment program in 46 patients with alcohol dependence hospitalized into special institutions for treatment of the disease in Kyoto. Patients with poor outcome of the treatment showed improvement of body image on visceral function, feeling of appetite and outward appearance, while patients with good outcome indicated no significant change in these aspects. This finding likely suggests that the treatment would result in good outcome in patients having stable feeling of physical health, and the cognitive treatment approach about these aspects of body image should be performed on the patients with poor treatment outcome. On the other hand, the body image about motor function showed significantly higher score in the patients approach for the patients with poor outcome to become aware of their physical activity would be effective.