Volume Reduction of the Dorsal Lateral Prefrontal Cortex Prior to the Onset of Frank Psychosis in Individuals with an At-Risk Mental State.

Although some individuals with at-risk mental states (ARMS) develop overt psychosis, surrogate markers which can reliably predict a future onset of psychosis are not well established. The dorsal lateral prefrontal cortex (DLPFC) is thought to be involved in psychotic disorders such as schizophrenia. In this study, 73 ARMS patients and 74 healthy controls underwent 1.5-T 3D magnetic resonance imaging scans at three sites. Using labeled cortical distance mapping, cortical thickness, gray matter (GM) volume, and surface area of DLPFC were estimated. These measures were compared across the diagnostic groups. We also evaluated cognitive function among 36 ARMS subjects to clarify the relationships between the DLPFC morphology and cognitive performance. The GM volume of the right DLPFC was significantly reduced in ARMS subjects who later developed frank psychosis (ARMS-P) relative to those who did not (P = 0.042). There was a positive relationship between the right DLPFC volume and the duration prior to the onset of frank psychosis in ARMS-P subjects (r = 0.58, P = 0.018). Our data may suggest that GM reduction of the DLPFC might be a potential marker of future onset of psychosis in individuals with ARMS.

Surface morphology of the orbitofrontal cortex in individuals at risk of psychosis: a multicenter study.

Changes in the surface morphology of the orbitofrontal cortex (OFC), such as a fewer orbital sulci and altered sulcogyral pattern of the 'H-shaped' orbital sulcus, have been reported in schizophrenia, possibly reflecting abnormal neurodevelopment during gestation. However, whether high-risk subjects for developing psychosis also exhibit these gross morphologic anomalies is not well documented. This multicenter MRI study from four scanning sites in Japan investigated the distribution of the number of intermediate and posterior orbital sulci, as well as the OFC sulcogyral pattern, in 125 individuals with an at-risk mental state (ARMS) [of whom 22 later developed psychosis (ARMS-P) and 89 did not (ARMS-NP)] and 110 healthy controls. The ARMS group as a whole had a significantly lower number of intermediate and posterior orbital sulci compared with the controls, which was associated with prodromal symptomatology. However, there was no group difference in OFC pattern distribution. The ARMS-P and -NP groups did not differ in OFC surface morphology. These results suggest that gross morphology of the OFC in high-risk subjects may at least partly reflect neurodevelopmental pathology related to vulnerability to psychosis.

Disaster preparation: Survey of patients with food allergies in Kobe, Japan.

BACKGROUND: Securing food for patients with food allergies may be more difficult during disasters, but reports on the status of household allergen-free food reserves in preparation for disasters are limited. This study investigated the household stock status of allergen-free foods in preparation for disasters in Kobe City after the Great Hanshin-Awaji Earthquake. METHODS: The survey targets were 172 parents of patients with a food allergy who underwent in-hospital oral food challenge test for allergies at four hospitals from October 2016 to March 2017. Of these, 158 patients with allergies to eggs, milk and wheat were included in the analysis. The first survey was performed to investigate patient characteristics and stockpiling status of allergen-free foods in parallel with oral food challenge tests. The second survey was performed on the follow-up visit to investigate any changes in behavior. RESULTS: Median patient age was 3 years, with boys comprising 68.4% of the patients. Eggs were the most eliminated food, and the median number of foods avoided was 2. A total of 82.3% of parents had experienced disasters. The proportion of households that stockpiled allergy-free meals was 42.4%, and the median amount was 3 days. The stockpiling situation did not differ according to the parents' disaster experience. In the second survey, 45.3% had modified their stockpiling practice. CONCLUSIONS: Even in this area where the Great Hanshin-Awaji Earthquake occurred, household stockpiles of allergen-free foods are inadequate; therefore, all medical staff should educate families about the necessity of stocking allergen-free food for disasters.

Design, synthesis, and evaluation of novel inhibitors for wild-type human serine racemase.

Most of the endogenous free d-serine (about 90%) in the brain is produced by serine racemase (SR). d-Serine in the brain is involved in neurodegenerative disorders and epileptic states as an endogenous co-agonist of the NMDA-type glutamate receptor. Thus, SR inhibitors are expected to be novel therapeutic candidates for the treatment of these disorders. In this study, we solved the crystal structure of wild-type SR, and tried to identify a new inhibitor of SR by in silico screening using the structural information. As a result, we identified two hit compounds by their in vitro evaluations using wild-type SR. Based on the structure of the more potent hit compound 1, we synthesized 15 derivatives and evaluated their inhibitory activities against wild-type SR. Among them, the compound 9C showed relatively high inhibitory potency for wild-type SR. Compound 9C was a more potent inhibitor than compound 24, which was synthesized by our group based upon the structural information of the mutant-type SR.

Psychological trauma after the Great East Japan Earthquake.

The Great East Japan Earthquake (GEJE) struck the northeastern part of Japan on 11 March 2011 and triggered a devastating tsunami, causing widespread destruction along the coast of northeastern Japan. The tsunami also led to an accident at the Fukushima Daiichi nuclear power plant. Incidents occurring in such major disasters are known to lead to psychological trauma. This paper has summarized English-language documentation regarding GEJE-related psychological trauma or post-traumatic stress disorder (PTSD). Research thus far has reported the possibility of higher probable PTSD prevalence among residents of the GEJE areas than in the average Japanese population during normal times. At the very least, many people have experienced trauma symptoms at self-recognition levels 1 year or longer after the disaster. It appears that the percentage of persons with high PTSD risk was higher in regions with radiation-related impacts than in regions where the main damage was caused by the earthquake and tsunami. Results have not been limited to showing relations between severe exposure to a traumatic event and PTSD symptoms but also show that a variety of factors, including social factors, has been shown to interact with PTSD symptoms. The fact that Japanese society as a whole united against the trauma of the GEJE may have worked to minimize the effects of trauma. To grasp a full picture of the effects of psychological trauma due to the GEJE, further surveys and research are necessary. It will be necessary to continue engagements related to these problems and issues into the future.

Post-traumatic stress disorder and depression prevalence and associated risk factors among local disaster relief and reconstruction workers fourteen months after the Great East Japan Earthquake: a cross-sectional study.

BACKGROUND: Many local workers have been involved in rescue and reconstruction duties since the Great East Japan Earthquake (GEJE) on March 11, 2011. These workers continuously confront diverse stressors as both survivors and relief and reconstruction workers. However, little is known about the psychological sequelae among these workers. Thus, we assessed the prevalence of and personal/workplace risk factors for probable post-traumatic stress disorder (PTSD), probable depression, and high general psychological distress in this population. METHODS: Participants (N = 1294; overall response rate, 82.9%) were workers (firefighters, n = 327; local municipality workers, n = 610; hospital medical workers, n = 357) in coastal areas of Miyagi prefecture. The study was cross-sectional and conducted 14 months after the GEJE using a self-administered questionnaire which included the PTSD Checklist-Specific Version, the Patient Health Questionnaire-9, and the K6 scale. Significant risk factors from bivariate analysis, such as displacement, dead or missing family member(s), near-death experience, disaster related work, lack of communication, and lack of rest were considered potential factors in probable PTSD, probable depression, and high general psychological distress, and were entered into the multivariable logistic regression model. RESULTS: The prevalence of probable PTSD, probable depression, and high general psychological distress was higher among municipality (6.6%, 15.9%, and 14.9%, respectively) and medical (6.6%, 14.3%, and 14.5%, respectively) workers than among firefighters (1.6%, 3.8%, and 2.6%, respectively). Lack of rest was associated with increased risk of PTSD and depression in municipality and medical workers; lack of communication was linked to increased PTSD risk in medical workers and depression in municipality and medical workers; and involvement in disaster-related work was associated with increased PTSD and depression risk in municipality workers. CONCLUSIONS: The present results indicate that at 14 months after the GEJE, mental health consequences differed between occupations. High preparedness, early mental health interventions, and the return of ordinary working conditions might have contributed to the relative mental health resilience of the firefighters. Unlike the direct effects of disasters, workplace risk factors can be modified after disasters; thus, we should develop countermeasures to improve the working conditions of local disaster relief and reconstruction workers.

[Mental health care systems and provisions in the immediate and acute phase of the Great East Japan Earthquake: situational and support activities in Miyagi Prefecture].

The Great East Japan Earthquake on March 11, 2011, which measured 9.0 on the Richter scale, was followed by a huge tsunami that caused catastrophic damage to the area extending from the Tohoku to Kanto regions. It was also accompanied by the meltdown of the Fukushima Daiichi Nuclear Power Station. Mental health service provisions were hit equally hard by the disaster, with a wide range of support and relief activities being implemented. This article reviews damage that was inflicted and support activities that were carried out in the mental health field in Miyagi Prefecture in the immediate aftermath and acute phase of the disaster, and also examines future challenges. Almost all mental health institutions in Miyagi Prefecture were affected by the disaster, and experienced difficulties such as feeding inpatients and securing necessary medication. Mental health institutions in the coastal area, in particular, were severely hit. Three hospitals-were seriously damaged by the tsunami, which forced them to make arrangements for the transfer of 300 inpatients. In the aftermath of the earthquake, it became difficult to access medical institutions, and confusion ensued regarding the provision of mental health services. Many municipalities in Miyagi Prefecture were seriously affected by the disaster, and information-gathering was crippled due to the disruption of communication and transport networks. Consequently, the administrative function regarding mental health service provisions was significantly impaired. Through official, private, and academic channels, volunteers in the field of mental health were sent to the affected areas in the immediate aftermath of the disaster. It was very difficult to coordinate these volunteers because of the confusion in gathering-information and in the chain of command for support activities. The number of support teams working in the affected areas peaked one to two months after the earthquake, but it became clear that continuous and long-term support in mental health service provisions by external support teams was necessary in some remote areas. Measures were taken to care for the elderly and children, to tackle alcohol-related problems, and provide support for volunteers, but many challenges remain. When a disaster hits, measures appropriate to the nature and size of the disaster become necessary, and the need arises to construct a model to facilitate such responses. It is now necessary to integrate mental health measures with a municipality's plan for medical care in a disaster, along with develop a permanent system to provide support for mental health care at the time of a disaster.

[Activity to prevent mental diseases after the Great East Japan Earthquake].

Following the Great East Japan Earthquake, we have been supporting psychiatric hospitals and mental health and welfare centers in Miyagi Prefecture. In October 2011, with a grant from Miyagi Prefecture, the Department of Preventive Psychiatry was established in Tohoku University Graduate School of Medicine. The institute aims to promote the prevention of and early intervention for mental diseases. As its members, we carry out our duties in collaboration with the Miyagi Disaster Mental Health Care Center. We refer to our activities as the Great East Japan Earthquake Mental Health Support and Research (GEMS) project. The GEMS project includes both practices and research in the affected areas in Miyagi Prefecture. The focus is on supporting those who provide services for survivors long-term, such as municipal employees, nurses, fire fighters, and staff of the social welfare council. We investigated how much the disaster impaired the functioning of psychiatric hospitals and clinics in Miyagi Prefecture. We also conduct mental health surveys in public organizations. Based on the results, we arrange workshops, consultation, or counseling. Moreover, we promote improvement of the mental health skills of mental health professionals, which are essential for mid and long-term support after the disaster. One of them is "Skills for Psychological Recovery". As members of the support organization in the region, we keep working toward the recovery and development of mental health systems in Miyagi Prefecture.

Physicochemical properties as indicators of sensory characteristics of jidori and broiler chicken meat.

To improve the eating quality of chicken, the physicochemical properties were examined, which serve as indicators for breeding. Thigh meat was collected from 384 chickens from seven and nine types of the jidori (free-range local traditional pedigree chickens) or broiler chickens, respectively. The principal component analysis of the physicochemical values of the jidori and broilers were arranged as different groups in the score plot. The results of multiple regression analysis of the sensory characteristics and physicochemical properties of thigh meat indicated that the tenderness decreased with the higher crude protein content and cooking loss in the jidori and increased with lower cooking loss and higher moisture and ether extract content in the broiler. The juiciness of the jidori decreased as the moisture content decreased, and that of the broiler decreased as the cooking loss and crude protein content increased. The umami of both the jidori and broiler was improved by increasing the 5'-inosinic acid content. Therefore, it was suggested that the physicochemical properties, which serve as indicators of the eating quality of chicken, differed between the jidori and broiler, and that the general biochemical components, cooking loss and 5'-inosinic acid content may serve as breeding indicators.

Emotional processing during speech communication and positive symptoms in schizophrenia.

AIMS: The recognition of emotion is often impaired in patients with schizophrenia. The relationship of this deficit with symptoms of psychosis remains unclear. In the current study, we investigated the relationship between emotional processing and positive psychotic symptoms in schizophrenia. METHODS: Twenty-eight patients with schizophrenia and 37 healthy participants were included in the study. They were instructed to listen to a set of sentences and judge whether the emotional valence expressed verbally and that expressed by affective prosody were congruous or incongruous. RESULTS: Overall, the patients with schizophrenia had more inaccurate responses than the healthy participants and the poor performance was prominent when the patients processed affectively negative scenarios. The percentage of accurate responses negatively correlated with the severity of positive symptoms when the scenarios and/or the affective prosody had a negative valence. CONCLUSION: Patients with schizophrenia appear to have impaired function in the processing of negative verbal information. Impaired processing of negative verbal and prosodic information seems to be associated with positive symptoms in schizophrenia.

[Application of cognitive behavioral therapy to early phase of psychosis].

Attempts to apply cognitive-behavioral therapy (CBT) to treat patients in the early stage of psychosis, including those with First-Episode Psychosis (FEP) and those with an At-Risk Mental State (ARMS), have recently attracted considerable attention. Such CBT for FEP focuses on promoting the recovery process and relapse prevention, although evidence on its efficacy is currently limited. Further, studies on CBT for ARMS have not consistently demonstrated its effectiveness. Some reports affirm the effectiveness of CBT in FEP prevention, while others claim that the treatment leads to no compelling difference in comparison to nonspecific treatment such as supportive therapy and treatment as usual. It is evident that psychosocial interventions play a fundamental role in the treatment of early stages of psychosis. Therapeutic approaches based on CBT have been applied to various cases: however, further research is necessary in order to produce more concrete results and obtain the evidence needed to approve this method.

[Natori EI project: the early intervention project for psychiatric disorders by the Miyagi Psychiatric Center].

Attempts to promote early intervention (EI) for psychiatric disorders are becoming accepted worldwide. Although several attempts at EI have begun in Japan, this movement is still limited, and the development of concrete EI services suited to individual regions is required. At the Miyagi Psychiatric Center, the "Natori EI project" is being carried out with the aim of improving the mental health of young people. This project involves three activities: consultation and mental health promotion in high schools, specialized outpatient clinics for young people, and psychosocial intervention for first-episode psychosis. There are many difficulties in building a system to support this kind of EI within the framework of the conventional medical care system; it is necessary to sort out issues such as collaboration with government and educational institutions, sharing the basic principle of EI, medical economic problems, ensuring manpower, and staff training system.

[Challenges faced by psychiatric services in Miyagi Prefecture after the Great East Japan Earthquake].

Following the Great East Japan Earthquake and Tsunami, the number of patients with onset, relapse, and exacerbation of mental disorders was expected to increase in Miyagi Prefecture, one of the worst affected areas. The functioning of almost all psychiatric hospitals sharply declined or even ceased. This situation worsened with traffic congestion and crippled public transportation, hindering many patients with psychiatric disorders from accessing mental health services. Among them, patients with schizophrenia and related disorders were affected the most; some could not reach the hospitals and clinics they had regularly visited and had to become new patients of another hospital or clinic. Moreover, an increasing number of patients with schizophrenia needed to be hospitalized because of acute exacerbations of their disorder, due to the experience of the disaster and the consequent drastic changes in their living environment Unfortunately, the support system for psychiatric institutions after disasters is not yet well structured; the system needs to be rebuilt and strengthened in anticipation of future disasters.

Relationship between refractive index and fatty acid composition by gas chromatography and near-infrared fiber-optic method in bovine fat.

The causes of the difference in fatty acid composition between gas chromatography (GC) and near-infrared fiber-optic method (NIR) in bovine fat and their countermeasures were studied using absolute values of refractive index. Using intermuscular fat from 45 crossbreeds, refractive index was measured by using a refractometer, and saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) were measured by NIR and GC. The correlation coefficients between GC and NIR in SFA and MUFA, as well as those between refractive index and GC or NIR (in SFA and MUFA), were all greater than or equal to 0.8 (p < 0.01). In samples with 3% or more difference between GC and NIR in SFA and MUFA, GC and NIR values were often located in opposite directions to the regression lines with regard to refractive index. GC reanalysis on these samples slightly increased the correlation coefficient between GC and refractive index and reduced the difference between GC and NIR by 1%-2%. Results indicate that measurement errors in GC and NIR are related to their more than 3% difference, and GC reanalysis based on refractive index may improve its accuracy.

Laparoscopic Nephroureterectomy with Heminephrectomy for Urothelial Carcinoma of the Upper Renal Pelvis on the Left Side of the Horseshoe Kidney.

A 70-year-old male was diagnosed with urothelial carcinoma of the upper renal pelvis on the left side of the horseshoe kidney. Preoperative thin-slice contrast-enhanced CT with three-dimensional reconstruction of the images revealed that two arteries arising from the aorta supplied the left moiety of the horseshoe kidney. He underwent laparoscopic transperitoneal nephroureterectomy with heminephrectomy on the left side of the horseshoe kidney visualized by indocyanine green fluorescence system. The histopathological findings of the renal pelvic tumor revealed invasive urothelial carcinoma with squamous differentiation, high grade, and pT3.

It's not what you say but the way that you say it: an fMRI study of differential lexical and non-lexical prosodic pitch processing.

BACKGROUND: This study aims to identify the neural substrate involved in prosodic pitch processing. Functional magnetic resonance imaging was used to test the premise that prosody pitch processing is primarily subserved by the right cortical hemisphere.Two experimental paradigms were used, firstly pairs of spoken sentences, where the only variation was a single internal phrase pitch change, and secondly, a matched condition utilizing pitch changes within analogous tone-sequence phrases. This removed the potential confounder of lexical evaluation. fMRI images were obtained using these paradigms. RESULTS: Activation was significantly greater within the right frontal and temporal cortices during the tone-sequence stimuli relative to the sentence stimuli. CONCLUSION: This study showed that pitch changes, stripped of lexical information, are mainly processed by the right cerebral hemisphere, whilst the processing of analogous, matched, lexical pitch change is preferentially left sided. These findings, showing hemispherical differentiation of processing based on stimulus complexity, are in accord with a 'task dependent' hypothesis of pitch processing.

Innovative approach to adolescent mental health in Japan: School-based education about mental health literacy.

AIMS: Improving mental health literacy through school-based education may encourage mental health promotion, prevention and care and reduce stigma in adolescents. In Japan, instruction about mental illness has been formulated in a Course of Study that reflects governmental curriculum guidelines, which will be enforced from 2022 to promote an understanding of current issues of adolescent health. Educational resources available to schoolteachers have been developed. This article describes the development processes and contents of these resources. METHODS: Our collaborating team, consisting of mental health professionals and schoolteachers, developed educational resources, based on feedback from high school students in general and young people who had experienced mental health problems. RESULTS: The new Course of Study covers: (1) mechanisms of mental illness, prevalence, age at onset, risk factors and treatability; (2) typical symptoms of mental health problems and illnesses; (3) self-help strategies for prevention of and recovery from mental illness; (4) enhancing help-seeking and helping behaviour and (5) decreasing stigma associated with people with mental health problems. The educational strategy is targeted at high school students (grades 10-12) and is conducted by teachers of health and physical education. The educational resources include short story animated films, filmed social contact and educators' manuals, which are freely available through the internet and open to all concerned including schoolteachers in Japan. CONCLUSIONS: Our efforts are expected to help implement mental health education of the public throughout Japan and other countries and promote the practice of early intervention and prevention of mental illnesses in adolescents.

Reduced cortical thickness of the paracentral lobule in at-risk mental state individuals with poor 1-year functional outcomes.

Although widespread cortical thinning centered on the fronto-temporal regions in schizophrenia has been reported, the findings in at-risk mental state (ARMS) patients have been inconsistent. In addition, it remains unclear whether abnormalities of cortical thickness (CT) in ARMS individuals, if present, are related to their functional decline irrespective of future psychosis onset. In this multicenter study in Japan, T1-weighted magnetic resonance imaging was performed at baseline in 107 individuals with ARMS, who were subdivided into resilient (77, good functional outcome) and non-resilient (13, poor functional outcome) groups based on the change in Global Assessment of Functioning scores during 1-year follow-up, and 104 age- and sex-matched healthy controls recruited at four scanning sites. We measured the CT of the entire cortex and performed group comparisons using FreeSurfer software. The relationship between the CT and cognitive functioning was examined in an ARMS subsample (n = 70). ARMS individuals as a whole relative to healthy controls exhibited a significantly reduced CT, predominantly in the fronto-temporal regions, which was partly associated with cognitive impairments, and an increased CT in the left parietal and right occipital regions. Compared with resilient ARMS individuals, non-resilient ARMS individuals exhibited a significantly reduced CT of the right paracentral lobule. These findings suggest that ARMS individuals partly share CT abnormalities with patients with overt schizophrenia, potentially representing general vulnerability to psychopathology, and also support the role of cortical thinning in the paracentral lobule as a predictive biomarker for short-term functional decline in the ARMS population.

Trajectories for Post-traumatic Stress Disorder Symptoms Among Local Disaster Recovery Workers Following the Great East Japan Earthquake: Group-based Trajectory Modeling.

BACKGROUND: As many local municipality and medical workers were involved in disaster recovery duties following the Great East Japan Earthquake (GEJE) on March 11, 2011, the aim of this work was to elucidate the distinct trajectories for post-traumatic stress disorder (PTSD) symptoms and associated factors among these personnel. They confronted a diverse range of stressors both as survivors and as relief workers; however, little is known about their longitudinal PTSD symptoms. METHODS: The participants were 745 local municipality and hospital medical workers [average age: 43.6 ± 9.5 years, range: 20 - 66 years; 306 (59%) women] involved in disaster recovery duties following the GEJE. PTSD symptoms were measured using the Japanese version of the PTSD Checklist Specific Version (PCL-S) at four time points: 14, 30, 43, and 54 months after the GEJE. Using group-based trajectory modeling, distinct trajectories were elucidated. RESULTS: We identified five distinct PTSD symptoms profiles: resistance (n = 467, 62.7%), subsyndromal (n = 181, 24.3%), recovery (n = 47, 6.3%), fluctuating (n = 26, 3.5%), and chronic (n = 24, 3.2%). The trajectories differed according to the post-disaster working conditions and personal disaster experiences. LIMITATIONS: Potential selection bias resulting from the limited number of participants who completed all waves. The survey was conducted in one region of the disaster area. CONCLUSIONS: The majority of participants remained stable, with a relatively small group classified as chronic and fluctuating. Our results highlight the importance of improved working conditions and sustained monitoring of workers responding to natural disasters.