Pediatric myxopapillary ependymoma treated with subtotal resection and radiation therapy: a case report and review of the literature.

STUDY DESIGN: Case report and review of the literature. OBJECTIVES: Myxopapillary ependymoma (MPE) is a relatively rare glioma that develops from the spinal part of the filum terminale, usually in adulthood. While it is generally benign, MPE can disseminate intraspinally, and this malignant behavior requires a multidisciplinary response with surgery and radiotherapy. We report here a case of MPE occurring in the lumbosacral spine area of an 8-year-old boy. SETTING: Japan, Tokyo. METHODS: We report here a case of MPE, treated with subtotal surgical resection followed by craniospinal irradiation (CSI), in an 8-year-old boy. The patient was referred to our hospital with a 6-month history of severe pain in the lower back and legs, paralysis of the legs and dysuria. Magnetic resonance imaging images showed a large tumor that filled the entire spinal canal below L1. After subtotal resection of the tumor, the pathological findings established a diagnosis of MPE. Since the tumor had perforated its capsule, increasing the risk of intraspinal dissemination, the patient underwent radiotherapy and CSI after surgery. RESULTS: Magnetic resonance images obtained 3 years after the surgery did not show any recurrence of MPE. CONCLUSION: Although tumor resection followed by CSI can be considered an effective strategy for treating a child with MPE, long-term follow-up is necessary to ensure early detection of any local recurrence or dissemination of the tumor, or of post-radiotherapy scoliosis.

Factors Associated With Physical Restraints in a Psychiatric Unit in Japan: a Retrospective Study.

OBJECTIVE: To identify factors associated with the use and duration of physical restraint (PR) in a psychiatric unit in Japan. METHODS: Medical records of 1308 patients admitted first time to the psychiatric emergency unit of Showa University Northern Yokohama Hospital between 1 January 2014 and 31 December 2021 were retrospectively reviewed. Data collected included patient age, sex, outpatient treatment, living arrangements, disability pension status, diagnosis (based on ICD-10), and psychotropic medication use at admission (chlorpromazine equivalent dose, imipramine equivalent dose, diazepam equivalent dose, and number of mood stabilisers administered). Logistic regression analysis and multiple regression analysis were used to identify factors associated with the use and duration of PR, respectively. RESULTS: Of 1308 patients, 399 (30.5%) were subjected to PR and 909 (69.5%) were not. Among the 399 patients subjected to PR, 54 were excluded from the multiple regression analysis for duration of PR as they remained subject to PR on the day of discharge. The remaining 345 patients were subject to PR for a median of 10 days. PR utilisation was associated with male sex (odds ratio [OR] = 1.420), treatment at our hospital (OR = 0.260), treatment at other hospitals (OR = 0.645), F3 diagnosis (depression) [OR = 0.290], F4-9 diagnosis (OR = 0.309), and imipramine equivalent dose at admission (unit OR = 0.994). The log-transformed duration of PR was independently associated with the age group of 50 to 69 years (ß = 0.248), the age group of ≥70 years (ß = 0.274), receiving a disability pension (ß = 0.153), an F1 diagnosis (ß = -0.187), an F4-9 diagnosis (ß = -0.182), chlorpromazine equivalent dose at admission (ß = 0.0004), and number of mood stabilisers administered at admission (ß = -0.270). CONCLUSION: Identifying factors associated with the use and duration of PR may lead to reduction in the use and duration of PR.

Impaired suppression of processing in schizophrenic patients suggested by ERPs obtained in a selective attention task.

In the present study, we focused on the ability of suppression of processing in schizophrenic patients, using event-related potentials (ERPs) recorded during a selective attention task. During the task, subjects were required to focus on one ear, counting deviant stimuli, those deviating in duration from a sequence of standard stimuli. We compared amplitude data of two positive components differing in latency elicited by standard stimuli, which reflect suppression of stimulus processing, between schizophrenic patients and normal controls. Significant between-group differences were obtained specifically in the right ear attended condition, suggesting impaired suppression of processing in schizophrenics mediated in the left hemisphere.

Behavioral and P3 amplitude enhancement in schizophrenia following feedback training.

In order to clarify the remediability of behavioral and electrophysiological abnormalities in schizophrenia, hit rate, reaction time, and P3 amplitude from auditory event-related potentials were evaluated before and after feedback training of a task in 14 schizophrenics and 12 age-matched normal controls. Although mean changes in the three indices due to the training were nonsignificant in both schizophrenic and normal control groups as a whole, the changes in hit rate and reaction time correlated significantly with the P3 amplitude change in the schizophrenic (r = 0.60 and -0.58, respectively) but not in the normal control group. The P3 amplitude change also correlated with the P3 amplitude before the training only in the schizophrenic group (r = -0.68), suggesting that the training was more effective for the schizophrenic patients with marked P3 amplitude reduction. The observed P3 amplitude increase due to training may represent an electrophysiological correlate of a remediable aspect of behavioral deficits in schizophrenics, which may underlie the effectiveness of nonpharmacological treatments.

Event-related potentials and thought disorder in schizophrenia.

We examined the relationship between event-related potentials and thought disorder in schizophrenia. The subjects were 29 chronic schizophrenic patients. Thought disorder was assessed using the Comprehensive Index of Positive Thought Disorder developed by Harrow and colleagues (Harrow and Quinlan, 1985; Marengo et al., 1986). Auditory event-related potentials were recorded during a standard oddball task. The P300 amplitude correlated negatively with the severity of the thought disorder. The P300 amplitude in the patients with thought disorder was significantly smaller than in the patients without thought disorder. These results suggest that a reduction in P300 amplitude is associated with a fundamental impairment of information processing in schizophrenic patients.

Brain lateralization for mismatch response to across- and within-category change of vowels.

Differences in hemispheric predominance between across- and within-category change perception of vowels were assessed using a whole-head magnetoencephalography. The magnetic mismatch responses (MMNm) to pure-tone and vowel within-category changes were significantly predominant in the right hemisphere; on the other hand, vowel across-category MMNm did not differ in power between hemispheres. The results suggest that both hemispheres are symmetrically activated in the preattentive across-category change perception of vowels, while the within-category change of a vowel is analyzed as the change in physical features of the stimuli, thus predominantly activating the right hemisphere. Thus, the relative contribution of the left auditory cortex in the preattentive speech processing may occur only at the level of perception of the vowel across-category change.

Multiple generators in the auditory automatic discrimination process in humans.

To reveal the spatiotemporal characteristics of the auditory automatic discrimination process, mismatch negativity (MMN) generators were assessed with a high-resolution EEG system (128ch) and scalp current density (SCD) analysis. Ten normal volunteers participated in the study. Event-related potentials were recorded during a selective attention task. Sequential SCD mappings revealed that a current sink/source combination in the left temporal regions and a current sink in the right frontotemporal regions appeared around 200 msec irrespective of the ear of stimulation. Moreover, a parietal sink/source combination was demonstrated on the right hemisphere around 240 ms irrespective of the ear of stimulation. These findings demonstrate that the auditory automatic change detection process is, both spatially and temporally, a multiple-generated system.

Electrophysiological evidence for sequential activation of multiple brain regions during the auditory selective attention process in humans.

In an attempt to examine dynamic involvement of multiple brain regions in the auditory selective attention process, negative difference wave (Nd) generators were assessed using a high-resolution EEG system (128ch) and scalp current density (SCD) analysis. Ten normal volunteers participated in the study. Event-related potentials were recorded during a selective attention task. Sequential SCD mappings revealed that current sinks were located in the bilateral temporal regions at 160 ms subsequent to the onset of stimuli, shifting the dipole orientation more tangentially to the scalp at around 220 ms. Moreover, a current sink was demonstrated in the midfrontal region at around 320 ms. These findings confirm that different cortical regions are sequentially involved in the auditory selective attention process.

1H-MR spectroscopy and gray matter volume of the anterior cingulate cortex in schizophrenia.

Schizophrenic and normal control subjects were examined using both H-magnetic resonance spectroscopy (MRS) and structural MR imaging, in order to accurately assess the partial volume within the spectroscopic volume of interest (VOI) in the anterior cingulate cortex. The gray matter volume within VOI correlated positively with the N-acetyl-aspartate (NAA) to choline (Cho) ratio in schizophrenics only, not in controls. Schizophrenic patients had a reduced NAA/Cho ratio and an elevated Cho/creatine ratio compared to controls after the partial volume effect was eliminated. There was a significant negative correlation between the NAA/Cho ratio and the severity of blunted affect symptom in schizophrenics. These results provide further support to the idea that the measures of H-MRS indicate not only neuronal loss but also neuronal dysfunction in schizophrenia.

Event-related potentials during an auditory discrimination task in rats.

Event-related potentials (ERPs) during an auditory discrimination task were recorded both on the surface and at a depth of the auditory cortex in rats. Ten-kilohertz rare and 5-kHz frequent tones were used with the probabilities of 0.2 and 0.8. Lever pressing within 2 s, following the onset of the rare tone, was rewarded with food paste. In the performing condition, the surface ERPs for the rare tones consisted of P30, N50, P80, N130, and P290 components. Only the surface P30 and N50 showed a polarity reversal at the intracortical electrode, suggesting that these components are generated in the auditory cortex. The P290 was elicited in the performing condition but not in the resting condition, showing its task-relevancy. These results suggest that auditory ERPs similar to those in humans can be recorded in rats during an active discrimination task.

P300 and disability of daily life in schizophrenia.

1. The relationship between the P300 component of event-related potentials and disability of daily life was examined in schizophrenia. The subjects were 26 chronic schizophrenic patients. 2. Disability of daily life was assessed by using the Life Assessment Scale for Mental Illness (LASMI). 3. Auditory event-related potentials were recorded during a standard oddball task. 3. P300 amplitude correlated negatively with general psychopathology scale of PANSS (r = -0.416) and Work of LASMI (r = -0.417). P300 latency did not correlate with any of PANSS or LASMI score. 4. These results indicate that P300 amplitude can be an index for disability of daily life in schizophrenia.

P300 component of event-related potentials in methamphetamine psychosis and schizophrenia.

To examine psychophysiological features of MAP psychosis and schizophrenia, P300 component of event-related potentials during an oddball paradigm were recorded in 25 MAP psychotics and 25 schizophrenics. P300 component was evaluated using baseline-to-peak measurement and principal component analysis. P300 amplitude in MAP psychotics was smaller at Fz and Cz region than in the controls. Unlike schizophrenics, P300 amplitude in MAP psychotics was not smaller at Pz region than in the controls. P300 latency in MAP psychotics and schizophrenics were delayed. These results indicated that MAP psychotics have some biological changes in their central nervous system after the remission of acute psychotic state.

Decreased plasma cortisol level during alprazolam treatment of panic disorder: a case report.

1. Changes in the plasma cortisol level were reported in a male patient with panic disorder during the period of low-dose alprazolam treatment (mean 0.62 +/- 0.15 mg/day) compared with during the period of high-dose period (mean 1.08 +/- 0.28 mg/day). 2. The plasma cortisol level was significantly higher in the low-dose period (mean 13.90 +/- 3.35 micrograms/ml) than in the high-dose period (mean 9.06 +/- 2.75 micrograms/ml) although, paradoxically, the panic attack frequency was significantly lower in the low-dose period (mean 1.35 +/- 0.29/day) than in the high-dose period (mean 2.09 +/- 0.66/day). 3. Thus, the decreased plasma cortisol level during alprazolam treatment of panic disorder was suggested to be caused not by symptom alleviation due to alprazolam but by alprazolam administration itself.

Effects of metamfetamine on auditory P3 component of event-related potentials in rats.

Three rats were trained with an oddball paradigm, in which 5 kHz frequent and 10 kHz target rare tones were presented with a probability of 0.8 and 0.2. Pressing the lever within 2 s following the onset of the target tones was rewarded with a drop of food paste. Long latency event-related potentials (ERPs) corresponding to those in humans could be recorded in rats. After the administration of metamfetamine (0.2 mg/kg), the amplitude of surface and intracortical N1 increased, indicating an augmentation of the primary cortical response. Surface P3 showed a decrease of amplitude, accompanied by an increase of intracortical negativity. These alterations of ERPs may be caused by the dysregulation of central noradrenergic system.

Increased neuronal firing in the rat auditory cortex associated with preparatory set.

Extracellular single neuronal firings were recorded in the auditory cortex of rats (n = 4) performing a visual reaction-time task with a warning tone (10 kHz, 10 ms duration), which preceded the imperative light stimulus by an interstimulus interval (ISI) of 1.4 s. Thirty-six neuronal firings were evoked by the warning tone, with the peak latency being between 15 and 55 ms. Among them, nine neurons (25%) showed an increased firing frequency following the evoked response during the ISI, which was, in average, 2.5 times as high as the firing frequency during the baseline period. When the tones were presented independent of the imperative stimulus, such sustained increase in neuronal firing was not observed. Activation of the sensory cortex during the ISI may constitute one of the neuronal modulations related to preparatory set.

Plasma vanillylmandelic acid level as an index of psychological stress response in normal subjects.

The relationships between psychological stress responses and plasma levels of vanillylmandelic acid (VMA), 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 5-hydroxyindolacetic acid (5-HIAA) were investigated in normal volunteers. Two questionnaires were used to measure stress: the Psychological Stress Response Scale (PSRS) and the State-Trait Anxiety Inventory (STAI). Plasma levels of VMA--but not MHPG, HVA, and 5-HIAA--showed significant positive correlations with PSRS emotional and cognitive-behavioral stress and STAI state anxiety. Significant positive correlations were also found between plasma levels of VMA and MHPG and psychological stress responses measured repeatedly in a longitudinal study of an Olympic swimmer. Plasma VMA measurements, which reflect the level of activity of the peripheral sympathetic nervous system, may provide a useful biochemical index of psychological stress responses in normal subjects.

Psychophysiological correlates of social skills deficits in persons with schizophrenia.

Social skill deficits in schizophrenia profoundly affect patients' life-long outcome, although the profile of the underlying cognitive dysfunction still remains a matter of debate. In the present study, we investigated the relationship between social skills and event-related potentials (ERPs) in an auditory selective attention task, in addition to the neurocognitive indices obtained from the degraded-stimulus continuous performance test (CPT) and clinical indices, such as Brief Psychiatric Rating Scale (BRPS) and global assessment of function (GAF) scores. Social skills were assessed using a Japanese version of the structured role play test. Fourteen persons with schizophrenia participated in the study. Non-verbal skills showed a positive correlation with GAF, the performance level, N1 and N2b amplitude in the ERP task, and hit rate in the CPT, and a negative correlation with reaction time in the CPT. Verbal communication skills showed a positive correlation with GAF, the performance level and N2b amplitude in the ERP task, and hit rate in the CPT, and a negative correlation with reaction time in the CPT. Processing skills showed a positive correlation with the performance level and N1 amplitude in the ERP task and a negative correlation with reaction time in the CPT. These findings suggested that the social skill deficits of persons with schizophrenia were related to the vigilance level and controlled stimulus detection processing.

Distributions of the Nd and P300 in a normal sample.

To obtain objective criteria for assessing the attentional and cognitive functioning of psychiatric populations, we attempted to standardize values of two components in Event-Related Potentials (ERPs), namely the attention-related negative potential (Nd) and the P300, in normal populations. The study consisted of 100 healthy volunteers (50 females, 50 males) who were given the task of making dichotic syllable discriminations requiring key-press responses. Their ages ranged between 18 and 59 years (mean +/- S.D., 32.3 +/- 11.3 years). Nd was found to be maximum in the Fz region, P300 being maximum in the Pz region. The means and standard deviations of Nd and P300 areas in their maximum regions were 554.1 +/- 307.8 microV ms and 2148.5 +/- 1248.5 microV ms, respectively. The transformation plot for symmetry indicated the suitable power of transformation to be 1/2 for both Nd and P300 distributions. After being transformed into square-root values, the distribution patterns of Nd and P300 areas were examined. When the lower limit of normal values was tentatively assigned to mean -2 S.D. using square-root transformed data for both Nd and P300, 97% of the subjects were found to display values above the lower normal limit for Nd, and 98% for the P300. Neither, Nd nor P300 areas correlated with age, while P300 latencies displayed a weak positive correlation with age. Females displayed relatively larger values than males for Nd and P300 areas and P300-peak amplitudes. However, the differences between females and males were not statistically significant. Females and males showed nearly equal P300-peak latencies.

N1 component derived from the temporal region during an auditory passive event-related potential paradigm in schizophrenics.

Event-related potentials (ERPs) were recorded at the Cz, W1 (Wernicke's area), and W2 (contralateral to Wernicke's) regions in 27 schizophrenics during an auditory passive sequence paradigm similar to that employed by Polich. N1 component for frequent tones was analyzed. In schizophrenics, the difference between the ERP waveforms at W1 and W2 was larger than that in controls, and N1 latency at W1 was significantly shorter than that at W2. To examine the similarity between interhemispheric waveforms, Person product-moment correlation coefficient (Interhemispheric Correlation Coefficient, IHCC) was calculated, time point by time point, between the ERP waveforms at W1 and at W2. The mean IHCC for schizophrenics was significantly lower than that for controls. In schizophrenics, the low IHCC group had more severe psychopathology and a longer duration of illness. These results suggest that the hemispheric imbalance of the temporal lobe is characteristic of schizophrenia.

Relapse of panic disorder induced by a single intravenous methamphetamine injection.

The authors reports a case of a 33-year-old woman who had a relapse and worsening of panic disorder following a single injection of methamphetamine after a long period of remission. Her first panic attack had occurred when she was a 14-year-old high school student, but the course had persisted only for 1 month. Soon after an intravenous injection of methamphetamine, she had a relapse of panic disorder, and depression and agoraphobia developed. Psychotropic medication was not fully effective.