A Seven-Year-Old Girl With Dysphagia Due to Fear of Swallowing: A Favorable Outcome With Cognitive Behavioral Therapy Using an Anxiety Hierarchy Chart.

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance and aversion to food and eating. Food restriction is not due to a body image disturbance but rather to an anxiety or phobia of food and eating or abnormal hypersensitivity to food, such as its texture, taste, or smell, or a lack of interest in food/eating. We herein report a seven-year-old girl with dysphagia due to a fear of swallowing with a favorable outcome thanks to cognitive behavioral therapy using an anxiety hierarchy chart. After a scary experience of seeing her bother choking on a sausage, the patient struggled with a strong fear of eating, especially swallowing, and was diagnosed with ARFID. We constructed a hierarchical chart of food insecurity, listing her favorite sweets in order, from soft to hard. She picked out daily sweets and snacks from the list. She gradually learned to eat hard-shaped food, achieved an adequate oral calorie intake, and was discharged on the twenty-second hospital day. This case indicates that cognitive behavioral therapy using the anxiety hierarchy chart can be applied to the treatment of school-age children with ARFID.

Relationship between the experience of being a bully/victim and mental health in preadolescence and adolescence: a cross-sectional study.

BACKGROUND: Several studies have proven that the experiences of being bullied or bullying others are associated with poor mental health among adolescent youths. Our study aims to investigate the relationship between the experience of the bully/victim and mental health among preadolescents and adolescents. METHODS: Subjects were the Japanese fifth and sixth grade elementary school students (preadolescents: mean age = 11.3 years; n = 338) and junior high school students (adolescents: mean age = 13.8 years; n = 486). A self-report questionnaire was administered containing items concerning the experience of being a bully/victim and the Youth Self Report (YSR). RESULTS: Four groups relating to the experience of being a bully/victim were formed: "Victim Only," "Bully Only," "Victim and Bully," and "Neither." Approximately 65% of preadolescents and approximately 25% of adolescents engaged in bullying behaviors. Of these, the rate of participants in the "Bully Only" group was low, and that in the "Victim and Bully" group was high. Regarding the relationship between the experience of being a bully/victim and mental health, both preadolescents and adolescents of the "Victim Only" group had significantly higher scores on the YSR's internalizing problems compared with the "Neither" group. Moreover, both preadolescents and adolescents of the "Bully Only" group had significantly higher scores on the YSR's externalizing problems compared with the "Neither" group. Regarding the relationship between the experience of being a bully/victim and suicidal ideation for both preadolescent and adolescent girls, the relative risks of suicidal ideation were significantly higher in the "Victim and Bully" group than in the "Neither" group. CONCLUSIONS: Preadolescents indicated a higher rate of bullying behaviors than adolescents. In both preadolescents and adolescents, different effect patterns on mental health were found for the "Victim Only," "Bully Only," and "Victim and Bully" groups. The prevention and intervention methods for mental health should be tailored according to the type of experience associated with being a bully/victim and according to the developmental stages of preadolescence or adolescence.

Predicting efficacy of electroconvulsive therapy in major depressive disorder.

The aim of this study was to investigate methods for predicting the efficacy of electroconvulsive therapy (ECT) in patients with major depressive disorder. Subjects comprised 24 inpatients with major depressive disorder diagnosed according to DSM-IV criteria who were resistant to antidepressant therapy or who, due to adverse reactions, could not undergo pharmacotherapy at adequate doses for sufficient durations. ECT was generally performed 12 times using a sinusoidal-wave device. Efficacy of ECT was evaluated using the 17-item Hamilton Rating Scale for Depression (HRSD). Multiple regression analysis was performed, using the final rate of improvement with ECT as the dependent variable, and improvement rate at completion of three ECT sessions and adequacy of pharmacotherapy before ECT as independent variables. Significant positive correlations were seen between final improvement rate with ECT and improvement rate at completion of three ECT sessions (partial correlation coefficient, 0.50, P<0.02), and significant negative correlations were seen between final improvement rate and adequacy of pharmacotherapy before ECT (partial correlation coefficient, -0.51, P<0.02). No significant differences were identified between responders and non-responders with respect to age, sex, duration of index episode, number of previous depressive episodes, whether depression was melancholia-type, whether depression was accompanied by psychotic features, total HRSD score immediately before ECT, and HRSD retardation or agitation scores. These results suggest that history of pharmacotherapy prior to ECT and improvement rate at completion of three ECT sessions may offer predictors for the final rate of improvement with ECT.

Simultaneous use of thyrotropin-releasing hormone test and combined dexamethasone/corticotropine-releasing hormone test for severity evaluation and outcome prediction in patients with major depressive disorder.

We performed a prospective study designed to examine whether or not evaluation of the severity and prediction of treatment outcome in major depressive disorder would be enabled by simultaneous use of the thyrotropin-releasing hormone (TRH) test and the combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) test. We studied consecutive patients hospitalized for major depressive disorder. The patients received the TRH test and the DEX/CRH test on the 4th through the 7th hospital days and at the time of improvement. None of the indices in these tests at the time of admission correlated with the Hamilton rating scale for depression (HRSD) or the Global Assessment for Function (GAF). However, since the DeltaMAXACTH, ACTHAUC, DeltaMAXcortisol, and CortisolAUC showed significant decreases at the time of improvement compared with the time of admission, suggesting that the DEX/CRH test can be a state marker. DeltaMAXTSH showed no significant change. Prediction of improvement within 3 months after admission was not possible with either test alone. However, the quotient which divided DeltaMAXACTH by DeltaMAXTSH was predictive of clinical improvement with a sensitivity of 50% and a specificity of 100%. The simultaneous use of the TRH test and the DEX/CRH test seems to provide a more useful biological marker than the separate use of either test alone in patients with major depressive disorder.