Anorexia nervosa restricting type has increased in severity over three decades: Japanese clinical samples from 1988 to 2018.

OBJECTIVE: Although eating disorders (EDs) surged in the late 1900s and are now recognized worldwide, the time trend of ED characteristics remains unknown. This study aimed to clarify changes in characteristics of anorexia nervosa restricting type (AN-R) over 30 years. METHODS: We conducted a cross-sectional study and examined 996 female treatment-seeking patients with AN-R in Japan from 1988 to 2018. Demographics, body mass index (BMI), and Eating Disorder Inventory scores were compared among three groups in accordance with the time of initial consultation: Group 1 (1988-1998), Group 2 (1998-2008), Group 3 (2008-2018). RESULTS: The mean BMI at the initial consultation significantly decreased by 0.6 kg/m2 (from 14.0 kg/m2 in Group 1 to 13.4 kg/m2 in Group 3). Groups 2 and 3 scored significantly higher in drive for thinness, interpersonal distrust, and interoceptive awareness than those in Group 1. The range of onset age is wider and the number of late-onset AN-R with prolonged delay in treatment has increased over time. DISCUSSION: This study shows that AN-R has increased in physical and psychopathological severity over the past 30 years in Japan. Interdisciplinary research is needed to clarify the relationship between AN-R and time trend.

Chronic and Acute Oral Administration of Caffeine Enhance Performance of Olfactory Learning in Crickets.

Crickets were arbitrarily fed a caffeine-containing diet during their lifetime or were orally administered caffeine in solution once during the conditioning session. These chronically or acutely treated crickets were used to test whether there were positive effects of caffeine on their learning performance. The effects of chronic exposure to caffeine on crickets' growth were also examined by measuring their body weight and counting the number of adults that emerged from larvae. Chronic treatment with relatively high concentrations of caffeine (5 mg/g and 0.5 mg/g in the diet) impaired the growth of crickets. Mortality was higher with 5 mg/g caffeine, and the survivors could not attain the final molt (eclosion). Body weight gain and eclosion rate were also negatively influenced in the group fed 0.5 mg/g caffeine. The olfactory learning paradigm was used to examine the effects of chronic caffeine treatment. Of the caffeine concentrations tested (0.5 µg/g to 0.5 mg/g), significant improvement in long-term memory (LTM) formation was observed only with 50 µg/g caffeine. Acute effects on olfactory learning were examined after oral administration of 0.1 nM to 10 µM caffeine solutions during the conditioning session. Administration of caffeine ≥ 1 nM consistently resulted in a significant improvement in LTM formation. These results suggest that chronic exposure to caffeine enhances learning performance in crickets at a specific dose (50 µg/g in the diet), although it inhibits their growth at higher doses (≥ 0.5 mg/g). In contrast, acute oral administration of caffeine in naive crickets may enhance their learning performance even at a very low (nanomolar) concentration.

Burnout and occupational stressors among non-medical occupational health staff.

BACKGROUND: The work required to assist individuals in improving their mental health is stressful and known to be associated with burnout. In Japanese companies, non-medical occupational health (OH) staff often take the role of maintaining and improving workers' mental health. However, few studies have examined burnout in this population. AIMS: To assess the relationship between burnout and occupational stressors among non-medical OH staff. METHODS: We conducted a cross-sectional study of OH staff who had participated in mental health seminars between 2016 and 2018. Occupational stressors were assessed using the Japanese version of the Job Content Questionnaire. Burnout was assessed using the Japanese version of the Maslach Burnout Inventory. RESULTS: We administered the survey to 230 non-medical OH staff, of which 188 completed the questionnaire. According to a hierarchical multiple linear regression analysis, high job demands were associated with greater emotional exhaustion, depersonalization and personal accomplishment. Greater job control was associated only with higher personal accomplishment. Lower job support was associated with greater emotional exhaustion and depersonalization. CONCLUSIONS: The present study found relationships between occupational stressors and burnout dimensions among OH staff. To avoid burnout among non-medical OH staff, it is important to take measures against occupational stressors, especially job demands and low levels of job support.

Plasma Nervonic Acid Is a Potential Biomarker for Major Depressive Disorder: A Pilot Study.

Background: Diagnostic biomarkers of major depressive disorder, bipolar disorder, and schizophrenia are urgently needed, because none are currently available. Methods: We performed a comprehensive metabolome analysis of plasma samples from drug-free patients with major depressive disorder (n=9), bipolar disorder (n=6), schizophrenia (n=17), and matched healthy controls (n=19) (cohort 1) using liquid chromatography time-of-flight mass spectrometry. A significant effect of diagnosis was found for 2 metabolites: nervonic acid and cortisone, with nervonic acid being the most significantly altered. The reproducibility of the results and effects of psychotropic medication on nervonic acid were verified in cohort 2, an independent sample set of medicated patients [major depressive disorder (n=45), bipolar disorder (n=71), schizophrenia (n=115)], and controls (n=90) using gas chromatography time-of-flight mass spectrometry. Results: The increased levels of nervonic acid in patients with major depressive disorder compared with controls and patients with bipolar disorder in cohort 1 were replicated in the independent sample set (cohort 2). In cohort 2, plasma nervonic acid levels were also increased in the patients with major depressive disorder compared with the patients with schizophrenia. In cohort 2, nervonic acid levels were increased in the depressive state in patients with major depressive disorder compared with the levels in the remission state in patients with major depressive disorder and the depressive state in patients with bipolar disorder. Conclusion: These results suggested that plasma nervonic acid is a good candidate biomarker for the depressive state of major depressive disorder.

High prevalence of shoplifting in patients with eating disorders.

PURPOSE: Shoplifting, prevalent in patients diagnosed with bulimia nervosa (BN), is a serious behavioral problem in eating disorder (ED) patients. However, little is known about its overall presence, etiology, and consequences. This study aimed to determine whether shoplifting occurs before or after the onset of ED and to investigate the prevalence and correlates of shoplifting in ED patients. METHODS: This was a cross-sectional study of 284 treatment-seeking female patients aged 13-45 with EDs [171 anorexia nervosa (AN); 113 BN]. Shoplifting, impulsive behaviors (self-injury, suicide attempt, sexual promiscuity, alcohol, and illicit drug use), depression, self-esteem, and clinical features of EDs were assessed with an interview. RESULTS: Lifetime shoplifting prevalence was 28.5% (81/284) with 70.4% (57/81) occurring before ED onset. Multivariate logistic regression analysis revealed that depression [odds ratio (OR), 2.63; 95% confidence interval (CI), 1.24-5.60], alcohol abuse (OR, 3.91; 95% CI 1.34-11.38), illicit substance use (OR, 14.42; 95% CI, 1.65-125.86), and self-esteem (OR, 0.90; 95% CI; 0.82-0.99) were associated with lifetime shoplifting, while illness duration, BN, and ED symptom severity were not. CONCLUSIONS: Shoplifting is common in ED patients and precedes ED onset in most patients with a shoplifting history, although the causal relationship between shoplifting and EDs remains inconclusive. Shoplifting may be associated with impulsive behaviors (e.g., alcohol and illicit drug use), depression, and low self-esteem, but not with ED severity. Future research should focus on the unrecognized role of shoplifting as a marker to identify patients at risk of impulsive behaviors and consider treatment options. LEVEL OF EVIDENCE: Level V, observational cross-sectional descriptive study.

Search for plasma biomarkers in drug-free patients with bipolar disorder and schizophrenia using metabolome analysis.

AIM: There is an urgent need for diagnostic biomarkers of bipolar disorder (BD) and schizophrenia (SZ); however, confounding effects of medication hamper biomarker discovery. In this study, we conducted metabolome analyses to identify novel plasma biomarkers in drug-free patients with BD and SZ. METHODS: We comprehensively analyzed plasma metabolites using capillary electrophoresis time-of-flight mass spectrometry in patients with SZ (n = 17), BD (n = 6), and major depressive disorder (n = 9) who had not received psychotropics for at least 2 weeks, and in matched healthy controls (n = 19). The results were compared with previous reports, or verified in an independent sample set using an alternative analytical approach. RESULTS: Lower creatine level and higher 2-hydroxybutyric acid level were observed in SZ than in controls (uncorrected P = 0.016 and 0.043, respectively), whereas they were unaltered in a previously reported dataset. Citrulline was nominally significantly decreased in BD compared to controls (uncorrected P = 0.043); however, this finding was not replicated in an independent sample set of medicated patients with BD. N-methyl-norsalsolinol, a metabolite of dopamine, was suggested as a candidate biomarker of BD; however, it was not detected by the other analytical method. Levels of betaine, a previously reported candidate biomarker of schizophrenia, were unchanged in the current dataset. CONCLUSION: Our preliminary findings suggest that the effect of confounding factors, such as duration of illness and medication, should be carefully controlled when searching for plasma biomarkers. Further studies are required to establish robust biomarkers for these disorders.

Association of the Clinical Subtype and Etiology for Delirium with the Outcome after Risperidone Monotherapy in Patients Having Cancer.

Background Delirium is the most frequent psychiatric syndrome in patients with advanced cancer, but its management is complicated by its multifactorial pathology. In this study, we investigated the association of the clinical subtypes, possible etiologies, and reversibility of delirium in patients having cancer with risperidone monotherapy. Methods This study included 16 inpatients with advanced cancer who were consecutively referred to psychiatric consultation service or palliative care team and were diagnosed with delirium by a psychiatrist. These patients were assessed using the Delirium Rating Scale Revised 98 (DRS-R98) at baseline and on a follow up visit (seventh day). The etiologies of delirium were determined using the Delirium Etiology Checklist. Oral risperidone was given once a day (0.5 or 1 mg/day) with routine clinical management. A detailed examination of the association between each clinical factor and their reversibility after risperidone treatment was examined retrospectively. Results Of the 15 patients (mean age 64.1? 9.5 years) whose data were available, 53% had hyperactive delirium and 47% had mixed delirium, while no patient showed hypoactive delirium. The most frequent etiology of delirium was metabolic/endocrine disturbance, drug intoxication, and systemic infection. In 10 patients (67%), remission of delirium was achieved, according to the DRS-R98. Neither clinical subtypes nor possible etiologies were associated with delirium reversibility after risperidone treatment. Conclusions Risperidone monotherapy is effective for treating delirium in patients with advanced cancer.

Clinical Features of Japanese Males with Anorexia Nervosa.

BACKGROUND: Anorexia nervosa (AN) is a mental disease with a high mortality rate, and progresses to a serious state, even in males; however the characteristics of male AN patients, including the sex ratio in Japan and the consultation behavior, have not yet been clarified. Therefore, the objective of the present study was to investigate the clinical characteristics of Japanese male AN patients, with the aim of achieving early interventions. METHODS: A total of 2015 AN patients, 60 males and 1955 females, were extracted from 4606 eating disorder patients who consulted Osaka City University Hospital for 34.5 years. The sex ratio was examined, and clinical features, mainly those related to consultation behavior, were compared between males and females. The rate of early drop-outs from outpatient treatments was also determined in male AN patients. RESULTS: The male ration in AN patients was 3.0%, which was markedly lower than generally considered. No significant sex difference was noted in the mean age at the time of consultation or delays in treatment. The rate of weight loss from the premorbid to lowest body weight was similar between males and females. Regarding social backgrounds, the employment rate was higher in males than in females. Male AN patients were more likely to initially consult the psychiatry department. Furthermore, the rate of early drop-outs from outpatient treatments appeared to be higher among males than females. CONCLUSIONS: The male ratio in Japanese clinical AN patients was low. Consultation between may be restricted in males more than in other countries because eating disorders are considered to be female diseases. Male AN is physically severe, similar to female AN; therefore, early interventions were considered important. Educational programs for eating disorders not only in the general public, but also in school and companies may promote early interventions. Treatments that considered sex differences need to be developed in order to prevent early drop-outs.

Subclinical Manic Symptoms in Children with Autism Spectrum Disorder.

Background: Children with autism spectrum disorder (ASD) have varied comorbidities. With regard to comorbidity, there has been increasing interest in bipolar disorder (BP) in children. However, the prevalence of BP with ASD has varied because of the methodological differences used. Therefore the adequate criteria for determining BP in children are still debated. The purpose of this study is to identify reliable prevalence of BP and to evaluate a variety of subclinical BP symptoms in children with ASD. Methods: This is a cross-sectional and case-control study. The participants were 110 referred children aged 6-15 years: 46 with ASD (the case group), 64 without ASD (the control group). We used the strict operational criteria for diagnosing BP, and assessed the presence of subclinical BP symptoms using a semi-structured diagnostic interview. Results: None of the children were diagnosed with BP in the case group, although two children were diagnosed with BP in the control group. Based on the subclinical BP symptoms, the prevalence of elation/expansive mood and racing thoughts was significantly higher in the case group than in the control group: 26.1% versus 3.1% (p<.001) and 32.6% versus 9.4% (p=0.002), respectively. Conclusions: Our finding indicates that school-aged ASD children frequently present subclinical BP symptoms. It is important to be aware of over-diagnosis of BP, even though the children present subclinical BP symptoms, and to provide -the children with effective treatments.

Parahippocampal Atrophy is Associated with Depressive Symptoms in Alzheimer's Disease.

Background Alzheimer's disease (AD) patients frequently show depressive symptoms, yet the pathological background remains unclear. The voxel-based specific regional analysis system for AD (VSRAD) allows quantification of atrophy in the medial temporal structures. We measured the degree of parahippocampal atrophy in AD patients using VSRAD, and investigated the association between imaging analysis results and the severity of depressive symptoms. Methods Brain magnetic resonance imaging (MRI) was conducted in 39 AD outpatients, and all MRI data were analyzed using VSRAD. The target region of interest (ROI) mainly consisted of the parahippocampal gyrus. The degree of atrophy in the ROI was obtained from the averaged positive z score (Z-score) of the ROT. AD patients were divided into two groups based on the severity of their depressive symptoms using the Geriatric Depression Scale (GDS), the depressive group (D group: 20 patients) and non- depressive group (ND group: 19 patients), and the clinical characteristics and VSRAD results of both groups were compared. Results There were no significant differences in demographics or cognitive function between the two groups. The Z-scores of the D group were significantly higher than those of the ND group (p<0.05). Additionally, there was a significant positive correlation between the GDS score and Z-scores in the parahippocampal gyrus. Conclusions Our findings suggested that the severity of depressive symptoms is associated with the severity of parahippocampal atrophy in AD patients.

[National Guidelines and Useful Guidance for Psychiatrists When Cooperating with Companies].

Good coordination between the principal doctor and companies will benefit workers with mental health disorders, and for that reason a common understanding is required. Companies seeks to preserve a workers' health from the viewpoint of obligation of security, while "caseness", being the trouble in the companies, is undesirable from the viewpoint of risk management. The principal doctor needs to understand that the companies reaction sets the caseness above the illness. There are various national guidelines and forms of guidance for workers' mental health."Guidelines for the Promotion of Workers' Mental Health at Work"was indicated in 2000 for the development of an organizational framework, and the "Manual on Workplace Reentry Support for Workers Returning from Leave Due to Mental Health Issues" was indicated in 2004. "Certification Criteria for Mental Disorders Caused by Psychological Stress" was also indicated in 2011 and, in which, harassment was recognized as an injury of workers. In many cases, companies consider employees with mental health disorders with these guidelines and guidance in mind to avoid lawsuits, and principal doctors are similarly expected to share a common understanding, promoting favorable coordination.

The Relationship Between Medial Temporal Lobe Atrophy and Cognitive Impairment in Patients With Dementia With Lewy Bodies.

BACKGROUND: The relationship between medial temporal lobe atrophy (MTA) and cognitive impairment in patients with dementia with Lewy bodies (DLB) remains unclear. We examined this relationship using voxel-based specific regional analysis system for Alzheimer disease (VSRAD) advance software, which allowed us to quantify the degree of MTA on images obtained from magnetic resonance imaging (MRI) scans. METHODS: Thirty-seven patients diagnosed with DLB were recruited and scanned with a 1.5 Tesla MRI scanner. All MRI data were analyzed using VSRAD advance. The target volume of interest (VOI) included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of MTA was obtained from the averaged positive z-score (Z score) on the target VOI, with higher scores indicating more severe MTA. Mini-Mental State Examination (MMSE) and the Revised Hasegawa Dementia Scale (HDS-R), which strengthened the measures of memory and language more than MMSE, were used to assess the presence of cognitive impairment. RESULTS: A negative correlation was found between the Z score and MMSE total scores or the HDS-R total scores. A stepwise multiple regression analysis performed to adjust the covariate effects of sex, age, the onset age of the disease, duration of DLB, years of education, and donepezil treatment showed that the HDS-R total scores were independently associated with the Z score, whereas MMSE total scores were not. CONCLUSIONS: These results suggest that MTA is related to cognitive impairment in patients with DLB, particularly the regions of orientation, immediate and delayed recall, and word fluency.

High Prevalence of Non-psychotic Delusions in Children with High-functioning Pervasive Develonmental Disorder.

BACKGROUND: Non-psychotic delusions are reported to be associated with depression and anxiety. When these delusions occur in high-functioning pervasive developmental disorder (HFPDD) children, they are often misdiagnosed as schizophrenia and have consequently been studied less. This study has three goals: to investigate the prevalence of non-psychotic delusions in HFPDD children, to test the hypothesis that HFPDD children are more likely to have non-psychotic delusions than non-HFPDD children, and to test the hypothesis that non-psychotic delusions are associated with depression and anxiety. METHODS: This is a cross-sectional and case-control study. The participants were 45 HFPDD children (cases) and 51 children without HFPDD (controls). Semi-structured interviews were conducted to assess the presence of non-psychotic delusions. We used the Child Behavior Checklist (CBCL) to assess levels of anxiety and depression. RESULTS: Of the cases, 62.2% had non-psychotic delusions, which was significantly higher than controls (25.5%, p<0.001, OR: 4.81, 95% CI: 2.01-11.51). Cases tended to score higher for internalizing problems (including anxiety and depression) on the CBCL than controls (69.8±9.4 vs 65.9±10.4, t= 1.9, p=0.062). Cases with non-psychotic delusions scored significantly higher for internalizing problems in CBCL than children without non-psychotic delusions (72.2±7.7 vs 65.7±10.7, t=2.4, p= 0.022). CONCLUSIONS: More than half of the HFPDD children were suffering from non-psychotic delusions, and these delusions were associated with anxiety and depression. Therefore, accurate diagnoses of non-psychotic delusions should be conducted for appropriate treatments to be prescribed.

Aggression in Teachers is Related to Role Conflict and Role Ambiguity as Occupational Stress.

BACKGROUND: Aggression in the workplace is increasingly recognized as a serious problem, but there are few studies about worker aggression toward outsiders in the workplace. We investigated the association between aggression and occupational stress among teachers. METHODS: This was a cross-sectional study of 1583 teachers, principals, and vice-principals. Aggression was measured using the Japanese version of the Buss-Perry Aggression Questionnaire (BAQ). The survey respondents were classified into tertiles according to the BAQ score. The high BAQ group was defined as the upper tertile for the BAQ total score (BAQ total score 625). Occupational stress was measured using the Japanese version of the Generic Job Stress Questionnaire. Comparisons among the groups were performed using multiple logistic regression analysis. RESULTS: Of the 1583 respondents, 488 were included in the high BAQ group. After adjusting for demographic and occupational variables, high role conflict and role ambiguity were significantly associated with belonging to the high BAQ group. In subscales of the BAQ, high role conflict and role ambiguity related to high levels of hostility, and physical aggression. CONCLUSIONS: Occupational stress such as role conflict and role ambiguity was associated with aggression among teachers. It is necessary to reduce problems which relates to role conflict and role ambiguity for preventing teachers' aggression.

Psychiatric comorbidity in children with high-functioning pervasive developmental disorder.

BACKGROUND: In previous studies for children with pervasive developmental disorder (PDD), the prevalence for psychiatric comorbidities has varied because of their methodological differences. In this research, our PDD subjects were strictly limited by age and IQ scores, and we utilized a semi-structured interview to diagnose their coexisting disorders. The purpose of this study is to identify reliable prevalence and types of psychiatric comorbidities in children with high-functioning PDD (HFPDD). METHODS: The subjects were 49 children aged 6-15 years with HFPDD. In order to diagnose the comorbidities among them, we used the Japanese version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version. RESULTS: Forty-eight cases (98%) met the criteria for at least one comorbidity. The median number of the present comorbidities per child was 2, and the mode was 2. Depression (37%), attention deficit hyperactivity disorder (49%), and oppositional defiant disorder (45%) were frequently observed. CONCLUSIONS: Our finding indicates the high prevalence of comorbidities and the variety of the comorbid disorders in children with HFPDD. It is important to be aware of those comorbid disorders to provide the children with effective treatments.

Sensory hypersensitivity in children with high-functioning pervasive developmental disorder.

BACKGROUND: Studies have shown that children with pervasive developmental disorder (PDD) have high rates of sensory hypersensitivity. In addition, a few recent studies suggested that sensory hypersensitivity was related to anxiety or depression. However, most studies had methodological limitations because they included children with mental retardation and did not examine broadband psychopathology. Therefore, the purpose of this study was to examine the prevalence of sensory hypersensitivity in children with high-functioning PDD (HFPDD) and the correlation among sensory hypersensitivity, various characteristics, and broadband psychopathology. METHODS: We assessed 132 children with HFPDD (aged 6-15 years, 75% male) that were divided into sensory hypersensitivity (HS) and sensory non-hypersensitivity (non-HS) groups. A logistic regression model was used to examine correlations among sensory hypersensitivity, age, gender, PDD subtypes, socioeconomic status, and broadband psychopathology, including symptoms of anxiety and depression. RESULTS: Of the 132 children with HFPDD, 65.9% (n = 87) were categorized as HS and 34.1% (n = 45) as non-HS. The most common sensory hypersensitivity was auditory. Logistic regression analyses revealed that sensory hypersensitivity in HFPDD was significantly associated with autistic disorder and symptoms of anxiety and depression. CONCLUSIONS: Majority of children with HFPDD exhibited sensory hypersensitivity. Our findings suggested that sensory hypersensitivity may be a core feature of HFPDD and is possibly correlated to symptoms of anxiety and depression. We propose that sensory hypersensitivity in children with PDD should be aggressively assessed.

Correlation between right medial temporal lobe atrophy and persecutory delusions in patients with dementia of the Alzheimer's type demonstrated on VSRAD advance.

BACKGROUND: The relationship between focal brain atrophy and delusions in patients with Dementia of the Alzheimer's Type (DAT) is not well understood. Few studies have been reported on the association between medial temporal atrophy (MTA) and persecutory delusions in patients with DAT. We investigated the relationship between MTA and persecutory delusions in patients with DAT using voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) advance software, which allows us to quantify the laterality and the degree of MTA on magnetic resonance imaging (MRI) scans. METHODS: Thirty-one patients diagnosed with DAT were recruited and scanned with a 1.5 tesla MRI scanner. All MRI data were analyzed using VSRAD advance. The target volume of interest (VOI) included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of MTA was obtained from the averaged positive z score (Z-score) on the target VOI, with higher scores indicating more severe. These DAT patients were divided into a group with (D group: n = 13) and without (ND group: n = 18) persecutory delusions. RESULTS: In the D group, the mean the bilateral, right, and left Z-scores were 2.45, 2.69, and 2.19, respectively. These mean Z-scores of the ND group were 2.00, 2.00, and 1.95, respectively. The right Z-scores for the D group were significantly higher than those for the ND group (p < 0.05). CONCLUSIONS: These findings suggest that right MTA could contribute to the development of persecutory delusions in patients with DAT.

[What psychiatrists can contribute in the workplace].

With the rapid changing of the social structure, the possibility and limitations of the principal psychiatrist cooperation in the workplace need to be considered. A principal psychiatrist treats patients from the viewpoint of "illness", while the workplace treats patients from the viewpoint of "caseness" with a consideration of the balance between the obligation of security and risk management. The principal psychiatrist has rights to prescribe or write a medical certificate; on the other hand, an occupational physician orders workers and the workplace to create appropriate working conditions in accordance with the relevant and various laws, guidelines, or guidance. The principal psychiatrist can treat "illness" associated with mental health disorders in the workplace, but there are limitations for them to intervene in the workplace. It is important for principal psychiatrists to first understand that occupational health staff including occupational physicians have different standpoints and criteria for judgment, and they must cooperate with the workplace by means of national guidelines or guidance, so that workers with mental health disorders can work while maximizing health.