The effect of Assertive Community Treatment in Japan.

OBJECTIVE: The aim of this study was to evaluate the effects of the Assertive Community Treatment (ACT) program in a Japanese mental health service setting. METHOD: This study was a randomized controlled trial. ACT was the intervention condition (n = 59), and the usual hospital-based rehabilitation program was the control condition (n = 59). Outcome indicators include in-patient days, psychiatric symptoms, social functioning, quality of life, and client satisfaction. The follow-up period was 12 months after the intervention. RESULTS: We found a significant reduction of in-patient days for the ACT group demonstrated by t-test (t = 2.33, P = 0.02). However, the results of ancova did not show significant differences for in-patient days between the two groups (F = 1.85, P = 0.18). The depression score for Brief Psychiatric Rating Scale for the ACT group was significantly lower than the control group at the 12-month follow-up assessment (F = 5.57, P = 0.03). According to the t-test, the ACT group had a higher client satisfaction than the control group (t = 2.08, P = 0.05). CONCLUSION: We concluded that ACT had a positive influence, as evidenced by a reduction of in-patient days, lower depressive symptoms, and higher client satisfaction.

Collagen content and architecture of the Iliotibialis lateralis muscle in male chicks and broilers with different growth rates fed on different nutritional planes.

1. Varying growth rates in chickens were induced by different nutritional regimes. The collagen content and architecture of iliotibialis lateralis (ITL) muscle were compared among 21-d-old chick types and broiler types at 80 or 95 d of age. 2. Relative size of ITL muscle was greater in the rapid growing (1.16% of live weight) than the slow growing chicks (1.02% of live weight). The 80-d-old broilers with a compensatory growth phase after an earlier slow growth period produced ITL muscle at 1.65-1.69% of live weight. The ITL muscle in 80- and 95-d-old broilers with restricted later growth after an earlier rapid growth period was 1.29 and 1.49% of live weight, respectively. 3. Collagen content of ITL muscle did not differ between chick types and also among the broiler types. However, collagen concentration decreased from 6.00-6.51 mg/g in the chicks to 3.33-4.00 mg/g in the broilers. 4. Thick and thin perimysia and honeycomb endomysia were viewed by scanning electron microscope (SEM) photography. In the perimysia, a central wide layer of longitudinal collagen fibres and peripheral narrow band of transverse fibres were distinguished. Collagen baskets of adipocytes were observed in the perimysia. 5. Perimysial collagen fibres markedly increased in number and formed a larger fibre cluster during growth from chicks to broilers. Endomysia changed from thin to thicker meshwork with growth. However, the collagen architecture of the muscle in broilers did not change under different nutritional regimes. 6. In conclusion, ITL muscle of chicken develops optimally when body growth is enhanced, but the collagen content and architecture in broilers are not affected by different growth processes.

Collagen content and architecture of the puboischiofemoralis muscle in male chicks and broilers with different growth rates on various nutritional planes.

1. Various growth rates of chickens were induced with different nutritional regimes, and the collagen content and architecture of the medial part of the puboischiofemoralis muscle were compared among 21-d-old chicks and 80- or 95-d-old broilers. 2. The percentage muscle weight relative to live weight increased from chicks to 80-d-old broilers and the 95-d-old broilers attained the largest percentage. An inter-relationship of the percentage muscle weight and the growth rates of birds could not be determined. 3. Collagen concentration was related to the growth rates for the first 21 d post hatching and maintained the same level during the later stages up to 80 d. The 95-d-old broilers, that were subjected to early rapid growth followed by restricted later growth, had the highest collagen content. 4. On SEM (Scanning Electron Microscopy) photographs, endomysial honeycombs were small and encircled by perimysia of a collagen network with small mesh size. Thin and thick perimysia were distinguished and the expanded portion of thick perimysia was also observed. Generally, the perimysia were made up of rough collagen tissue where fatty tissue developed, especially in the broilers. 5. Perimysial collagen fibres with mainly transverse striation were divided into two fundamental types, wide collagen platelets and narrow cords. With growth from the chick to broiler stage, features of the collagen fibres did not change regardless of expansion of the thick perimysia. Endomysia increased slightly from thin to thick meshwork as growth progressed. However, the collagen architecture of the muscle in broilers did not change under different nutritional regimes. 6. In conclusion, the puboischiofemoralis muscle of chickens develops relative to live weight when later growth is limited in broilers, but the collagen architecture is not affected by the different growth rates.

Different responses of the circadian system to GABA-active drugs in two strains of mice.

Recent work in our laboratory has shown that sodium pentobarbital injections can induce phase-dependent phase shifts of the circadian rhythm of locomotor activity with the maximum advance at circadian time (CT) 8 and the maximum delay at CT0 in SK/Nga mice but no phase shifts in C57BL/6 mice. In the present study, the possibility that the differences in the effects of pentobarbital on the circadian rhythm may be due to different contributions of the GABA-ergic system to circadian organization in the two strains was tested by comparing the responses of SK mice with those of C57BL mice to muscimol (2 mg/kg), a GABA receptor agonist, and triazolam (25 mg/kg), which is thought to act by potentiating the action of GABA. The hypothesis that pentobarbital-induced phase shifts of SK mice are mediated by the GABA receptor system was also tested by observing whether the phase-shifting effects of pentobarbital were blocked by bicuculline (0.5 mg/kg), a selective antagonist of GABA, injected 3 min prior to pentobarbital (30 mg/kg). The results indicated that muscimol induced phase advances at CT8 and phase delays at CT0, and triazolam induced phase advances at CT8 in SK mice. No phase shifts were induced by any treatment in C57BL mice. These results suggest that the role of GABA-ergic systems in circadian organization may be different in SK and C57BL mice. In addition, bicuculline could block the phase-shifting effects of pentobarbital in SK mice, suggesting that the GABA receptor system may mediate phase-shifting effects of pentobarbital in SK mice.

Application of in vivo microdialysis to pineal research in birds: measurement of circadian rhythms of melatonin.

Circadian rhythms of pineal melatonin release were measured in free-moving pigeons, Japanese quails, and chickens under light-dark cycles followed by constant dim light. Although melatonin levels differed among individual birds, circadian rhythms of melatonin were observed in all of them. Using this technique, we could examine phase shifts of melatonin rhythms and suppression of melatonin release by photic stimulation in pigeons. We could also examine effects of norepinephrine infusion on melatonin release. These results indicate that microdialysis is useful for the study of pineal melatonin rhythms in birds.

The locus controlling pineal serotonin N-acetyltransferase activity (Nat-2) is located on mouse chromosome 11.

Melatonin is synthesized from serotonin by the enzymes serotonin N-acetyltransferase (SNAT) and hydroxyindole-O-methyl-transferase (HIOMT). We have previously reported that C57BL/6 mice do not have SNAT activity because of a mutation in an autosomal gene which is responsible for the absence of normal SNAT activity. In the present study, we have tried to map the loci of Nat-2 (the locus controlling SNAT activity) on chromosomes using a set of the BxH recombinant inbred strains which were derived from an initial cross between C3H/He with SNAT and C57BL/6 without the enzyme. Based on strain distribution patterns (SDPs), a close linkage on chromosome 11 was found between Nat-2, Es-3 (esterase-3), Glk (the locus controlling galactokinase activity) and Myla (myosin alkali light chains expressed in cardiac atrial muscle). The linkage between Nat-2 and Es-3 was confirmed by a conventional linkage test and the recombination frequency between these loci was estimated to be 16.1 +/- 3.6% (mean +/- S.E.M.).

No relationship between schizophrenic birth and influenza epidemics in Japan.

The finding that influenza epidemics are associated with an increased risk of adult schizophrenia has been controversial. Data was obtained from Japan's governmental statistics, the Patient Survey. Index years were defined as 1957/1958, 1962, and 1965, and comparison years were defined 2 years before and 2 years after the index year. Subjects were patients with schizophrenia who were born in the index years of influenza epidemics. Periods 5 months after the influenza epidemics were defined as exposed months. Proportions of patients born during the exposed period in the index years were compared with those of patients born in the corresponding months in the comparison years. The proportions of patients born in the exposed months in the index years were not significantly different from those born in the corresponding months in the comparison years, with odds ratios around 1 in the whole country, the Kanto area, and the Shikoku/Kyushu area where a remarkable influenza epidemic was observed in 1957. No difference was observed in analyses stratified by sex. In Japan, there was no relationship between influenza epidemics and schizophrenic birth.

Comparison of half-disappearance times, distribution volumes and metabolic clearance rates of exogenous glucagon-like peptide 1 and glucagon in rats.

The pharmacokinetics of glucagon-like peptide-1 (GLP-1) in vivo after bolus and continuous i.v. administrations of the peptide were compared with those of glucagon in rats. The half-disappearance time (t1/2) distribution volume (Vd) and metabolic clearance rate (MCR) of GLP-1 given as a bolus injection and by constant infusion, were, respectively, as follows: t1/2 (min), 47.7 +/- 14.5 and 39.5 +/- 15.5 (mean +/- S.D.); Vd (ml), 903.8 +/- 62.4 and 516.3 +/- 92.1 and MCR (ml kg-1 min-1), 27.4 +/- 10.8 and 18.6 +/- 8.6. These values differed significantly from the respective values for glucagon (t1/2, 3.3 +/- 0.6 and 5.8 +/- 1.0; Vd, 206.5 +/- 25.9 and 240.0 +/- 76.1; and MCR, 83.1 +/- 8.2 and 46.7 +/- 13.3). These findings demonstrate that GLP-1 is degraded more slowly than glucagon in vivo.

The phase-shifting effects of pentobarbital on the circadian rhythm of locomotor activity in the mouse: strain differences.

The phase response curves (PRCs) generated by pentobarbital injections (30 mg/kg) were obtained in SK and C57BL mice. Pentobarbital injections induced both advance and delay phase-shifts in the circadian rhythm of locomotor activity in SK mice but no phase-shifts were observed at any circadian time (CT) for pentobarbital injections in C57BL mice. The observation that a higher dose of pentobarbital (80 mg/kg) does not induce phase-shifting in C57BL mice has indicated that the differences in phase-shifting effects of pentobarbital are not quantitative but qualitative. These strains may be useful for studying the neurochemical regulation of the mammalian circadian rhythm.

Administration of melatonin in drinking water promotes the phase advance of light-dark cycle in senescence-accelerated mice, SAMR1 but not SAMP8.

We analyzed effects of aging on behavioral rhythms in the mouse showing senescence acceleration, SAMP8 strains. The free-running rhythms had longer free-running periods (tau) in SAMP8 than in the control strain (SAMR1). Drinking of melatonin promoted the adaptation to advanced LD in SAMR1 but not in SAMP8, although both strains exhibited melatonin MT1 and MT2 receptors. The present results suggest that melatonin promotes the adaptation to advanced LD cycles in normal aging mice.

Effect of transection on choline acetyltransferase, thyrotropin releasing hormone and substance P in the cat cervical cord.

The effects of a transection on the choline acetyltransferase activity, the thyrotropin releasing hormone and substance P contents in the cat cervical spinal cord have been investigated. Seven days after the hemitransection at the C1 level, the grey matter of the C6-7 levels of the spinal cord were dissected for the biochemical measurements. The choline acetyltransferase activity and the thyrotropin releasing hormone content remained unchanged in any regions in the grey matter following the high cervical transection. On the other hand, the substance P content was decreased by approx. 70% in the ventral horn. These results suggest that the fibers originating the supraspinal structures and terminating in the grey matter of the spinal cord, contain the substance P-releasing fibers, whereas there seems to be little cholinergic or thyrotropin releasing hormone-containing fibers.

Effect of poly(ADP-ribose) synthetase inhibitor administration to streptozotocin-induced diabetic rats on insulin and glucagon contents in their pancreas.

This study was conducted in order to clarify whether the poly(ADP-ribose) synthetase inhibitors, nicotinamide and 3-aminobenzamide, have any influence upon the content and physicochemical properties of insulin and glucagon in streptozotocin (STZ)-treated rat pancreas. STZ-treated rats received intraperitoneal injection of 350 mg/kg nicotinamide or 50 mg/kg 3-aminobenzamide 15 min before and 180 min after the administration of STZ and once a day thereafter for 23 weeks. The blood glucose levels and body weight of nicotinamide- and 3-aminobenzamide-treated rats did not differ from those of the control rats at the end of the experiment. The insulin content in poly(ADP-ribose) synthetase inhibitor-treated rat pancreas was restored partially and reached approximately 60% of the control level, while the glucagon content did not differ from that in the normal rats. Treatment with poly(ADP-ribose) synthetase inhibitor resulted in no alteration in the physicochemical properties of extracted insulin and glucagon. Immunohistological examination of the pancreas revealed that insulin- and glucagon-containing cells in the islets in the poly(ADP-ribose) synthetase inhibitor-treated rat appeared to be normalized. These results suggest that poly(ADP-ribose) synthetase inhibitor normalizes the function but not the insulin content of B cells and that it does not act on A cells in STZ-treated rat pancreas. Restoration of the insulin content would be large enough to keep the function of B cells normal.

Seasonality of birth in patients with mood disorders in Japan.

BACKGROUND: Findings about seasonality of birth in individuals with mood disorders have been inconsistent. METHODS: Data were collected from the governmental statistics, the Patient Survey in Japan in 1996. The number of patients with mood disorders was 13,969. We obtained information about each patient's date of birth, sex, and diagnosis according to ICD-10. Distributions of monthly birth numbers of patients with mood disorders were compared to those of the general population. RESULTS: Birth excess was observed from winter to early-spring in both sexes, compared to births of the general population. The magnitude of the excess was larger in females than in males. Although the same tendencies were observed in patients with bipolar disorder and depressive disorder, the differences were more marked in females. LIMITATIONS: Insufficient birth data in the general population before 1940 and hospital diagnosis. CONCLUSION: Among Japanese patients with mood disorders, there are excess births from winter to early-spring, compared to the general population. This difference is more marked in females than in males.

A newly established strain of spontaneously hypertensive rat with a defect of ascorbic acid biosynthesis.

To investigate the effects of ascorbic acid deficiency on the pathogenesis of hypertension and/or its complications, we established a rat strain with both genetic hypertension and a defect of ascorbic acid biosynthesis. The od gene (L-gulono-gamma-lactone oxidase gene) of the ODS (Osteogenic Disorder Shionogi) rat, which is a rat mutant unable to synthesize ascorbic acid, was introduced into spontaneously hypertensive rats (SHR), and a novel congenic strain, SHR-od, was established. SHR-od showed scurvy when fed an ascorbic acid-free diet. Systolic blood pressure of male SHR-od began to increase at 9 weeks of age and reached 190-200 mmHg at 20 weeks of age. In 25-week-old SHR-od, ascorbic acid deficiency when fed an ascorbic acid-free diet for 6 weeks caused a remarkable reduction of blood pressure to lower than 110 mmHg. The wall to lumen ratio of the testicular artery in ascorbic acid-deficient SHR-od was lower than that of the control rats. When rats were fed a diet supplemented with ascorbic acid (300 mg/kg), ascorbic acid concentration in SHR-od was lower in the serum and liver than that in ODS rats. These results indicate that ascorbic acid could be closely related to the development of hypertension in SHR-od. We believe that SHR-od will be a useful model for experimental studies on hypertension and its complications, since all of them suffer from hypertension spontaneously and the level of ascorbic acid deficiency in these rats could be controlled at will both in concentration and duration.

The measurement and analysis of circadian locomotor activity and body temperature rhythms by a computer-based system.

A new computer-based system for collection and analysis of circadian body temperature and locomotor activity rhythms is described. This system makes possible the simultaneous measurements of body temperature and locomotor activity rhythms from 16 animals kept in separate cages. Several programs were developed for measurement and analysis of the data. This system is available not only in the study of circadian rhythms but also in other biological studies where long-term recordings of rest-activity cycles and body temperature are required.

Radioimmunoassay of human pancreatic amylase with monoclonal antibody.

A monoclonal antibody (E-21) was obtained that specifically binds to human pancreatic amylase and shows negligible cross-reaction with human salivary amylase. Using this antibody a radioimmunoassay was developed for pancreatic amylase in human serum. The assay was shown to be sensitive (detectable up to 7 mg/L), reproducible, and specific for pancreatic amylase. In normal subjects, the mean concentration of serum pancreatic amylase determined by this method was 36.3 mg/L with a 95% confidence range of 16.5 to 79.2 mg/L. A good correlation was observed between the concentrations of immunoreactive pancreatic amylase (IR-PA) and enzymatic activities in 20 serum samples (r = 0.97). The concentration of serum IR-PA was below the detectable limit in pancreatectomised patients, and was greatly increased in patients with acute pancreatitis; the latter was accompanied by parallel changes in total enzymic activity. In patients with mumps, the serum IR-PA level was within the normal range whereas the total enzymic activity was elevated.

Nitroblue tetrazolium reduction of neutrophils in heat stressed goats is not influenced by selenium and vitamin E injection.

Experiment was designed to determine whether heat stress suppresses neutrophil function and injections of selenium and vitamin E prior to heat stress prevent suppression of neutrophil function in goats. Twelve female goats were divided into 2 groups of 6 each and were kept at 25 degrees C. Goats in the treatment group were injected intramuscularly with 0.1 mg/kg of selenium and 2.72 IU/kg of vitamin E at 8 and 1 day prior to the initiation of heat stress. The other group was kept as control. All goats were exposed to hot environment at 38 degrees C from day 0 through 8. Decreased tendency in plasma cortisol concentrations and temporary increase in plasma glucose concentrations were shown in both groups. In the control group, plasma selenium concentration gradually increased and alpha-tocopherol concentration decreased during the first 2 days. After the second injection with selenium and vitamin E, plasma selenium and alpha-tocopherol concentration significantly increased and remained higher than those in the control group. Whole blood glutathione peroxidase (GSH-Px) activity in the treatment group tended to be greater than that in the control group, but no significant difference was observed between 2 groups. The nitroblue tetrazolium (NBT) reduction by activated neutrophils significantly decreased on day 6 in the control group but not in the treatment group. The NBT reduction by resting neutrophils significantly decreased in both groups. These data suggest that heat stress depresses neutrophil function, and selenium and vitamin E injection prior to heat stress has no apparent effect on neutrophil function during the stress.

[The effects of family interventions for the patients with mental illness in health centers focusing on the relatives' own life].

Recently, the burden on relatives of patients with mental illness has been recognized and the need for support to reduce such burden has increased. In Japan, family interventions have been conducted at Health Centers, most of them focusing on the family functioning as a caregiver. However, it is also important to focus on the relative's functioning to live their own life in family interventions. In this study, we executed a program focusing on relatives' life and health, and investigated the effects of this program on both family functioning. Family intervention programs were conducted at 10 Health Centers including both urban and rural areas in Japan. A total of 102 relatives responded to the self-administered questionnaire at the first and the last session of the family interventions. We measured functioning as a caregiver using the Support for the Disabled Score and Rejective Feeling Score, and functioning to live their own life by GHQ Distress in Daily life Score, Perceived Health Condition Score and Life Satisfaction Score. During interventions, GHQ score and Distress in Daily Life score which indicate the disfunction in living their own life decreased, and Support score increased in all sample. In the short-term illness group (n = 35), only the GHQ score decreased, while in long-term illness group (n = 44) Distress score decreased and Support Score increased. The intervention program focusing on relatives' life and health may improve both family functionings to give adequate care for patients, and to live their own daily life. Results suggested that the short-term illness group requires more intensive and personal advices, and the long-term illness group need continuous support focusing on the relative's own life. Expected roles of Health Centers are cooperation with family interventions provided at hospitals and coordination of the services in the community, as well as providing family interventions in terms of relatives' life.

[A study of the guideline of case management for persons with mental disorders analyzed with fidelity index. The conditions of effective implementation].

OBJECTIVE: The present study examines the condition of effective case management based on the guideline of case management for persons with mental disorders. METHODS: A total of 295 clients were admitted to a case management trial for about 2 months. A fidelity index of program implementation and outcome measures of case management were developed. The relationship between implementation of critical program components measured by fidelity index, and outcome was analyzed. RESULTS: Fidelity Index was significantly correlated with outcome measures of clients, staffs and the care system. Effective but not-easily-feasible elements of program were having case-conference, application, of informal support and development of services. CONCLUSION: It is necessary to facilitate application of informal support with liaison with public health nurses, to standardize case-conference and to place development of care services in the core of programs for ensuring effective implementation of case management for persons with mental disorders in Japan.

[Evaluation of effectiveness of community mental health system in Kawasaki City--a comparison with national statistics].

UNLABELLED: The pioneering community mental health system of Kawasaki was evaluated by comparison with national statistics using the data from a citywide survey of patients with schizophrenia. METHOD: Subjects were citizens of Kawasaki who were receiving medical treatment for schizophrenia (ICD-9) in the city. All inpatients (565 cases) and a random sample of outpatients (685 cases; extraction rate was 1/3) who met the criteria were asked to complete the questionnaires by themselves. The responsible medical staffs of the subjects were also asked to complete the questionnaires. In order to calculate the total prevalence rate in the city, the number of patients who received medical treatment outside the city was estimated by extrapolation. RESULTS: Higher outpatient rate and lower inpatient rate of Kawasaki were indicated despite the almost equal prevalence (i.e. 32.7 per 10,000 population) compared to the national rate. The outpatient rate was 70.6% in Kawasaki, which was 16% higher than the national average. And the rate of outpatients with schizophrenia living alone in Kawasaki was three times higher. While national outpatient rates declined significantly when patients became 40 years old, such a decline was not evident in Kawasaki. On the other hand, as patients with schizophrenia got older, the rate of outpatients living alone or living with spouse increased in Kawasaki due to the change of caregivers' generation. CONCLUSION: The higher outpatient rate especially of people over 40 years old and the higher rate of patients who lived alone may be explained by the effective community care system in Kawasaki. However, more an intensive support system which provides' daily services such as home-help and group home services should be developed, as the living conditions of outpatients who lived alone were very difficult.