Search

Experience of abnormal pains and unusual sensations in the mouth without a somatic base, for example abnormal mucus secretion, pulling sensation on the jaw or teeth, or a vibrating sensation, is termed 'oral cenesthopathy'. Psychological factors were investigated in terms of cognitive functions and personality tendencies, using Rorschach test in 28 patients with this condition (three men and 25 women). In oral cenesthopathy patients (i) the processing of new information is inefficient; (ii) the necessary resources for social adaptation are lacking, emotional control is inadequate, and uncomfortable emotions are expressed less; and (iii) with regard to interpersonal interaction, less interest is shown in others, trust in others is diminished, and they tend to have a higher Coping Deficit Index.

1998年1月1日～2000年12月31日の3年間に日本医科大学付属病院高度救命救急センターに搬送された患者で,精神科医が関与した自殺企図症例を対象に,その実態,転出先の変化さらに救命救急センター転出後の精神科継続治療状況についてレトロスペクティブに調査し,再自殺予防といった観点からその問題点と対応について検討した。自殺企図症例の実態としては,精神科診断分類でF4が最も多く認められ,企図手段では薬物・毒物によるものが最も多かった。救命救急センターからの転出先について,当院精神科への転科,および精神科医が勤務する一般病院への転院は,年を追って増加し,逆に精神科医が勤務していない一般病院への転院は減少していた。一方,救命救急センターから転出時に当院精神科外来受診を勧められた患者のうち1年以内に受診したのは36%にすぎなかった。診断別の受診率はF3, F2のうつ病圏,分裂病圏の患者で高かったのに対し,F4, F6の神経症圏,人格障害の患者では低く,これらの患者の精神科治療継続の困難さが伺えた。しかしながら,当院精神科へ転科入院した患者の98%と精神科医が勤務する一般病院へ転院した患者の78%は当院精神科の外来を受診していた。そのなかでも治療継続が困難とされるF4, F6症例の受診率が高かったことより,救命救急センターから引き続き行う精神科入院治療は,継続した精神科外来通院に対するmotivationを高めるための,効果的な方法のひとつであると思われた。よって,再自殺企図を防止するうえで,心身ともに治療のできる総合病院精神科で,自殺企図後の患者を積極的に引き受けることは大学病院をはじめとする総合病院精神科の役割のひとつであると考えられた。

Objective: As the prevalence of white matter hyperintensities detected on T 2 weighted MRI scans in patients with late‑onset depression is higher than that in nondepressed patients the concept of“vascular depression” （VDep）was introduced in 1997. However the pathology of vascular depression has not been clarified. This study examined the differences in functional imaging between vascular and non‑vascular depression（non‑VDep） . Methods: We utilized 123 I‑ IMP single photon emission computed tomography （SPECT） to compare regional cerebral blood flows（rCBF）between 9 patients with VDep（Krishnan criteria）and 11 age‑ and sex‑matched patients with non‑VDep in both depressed and remitted states. Results: In both VDep and non‑ VDep patients mean rCBF increased significantly as depression improved partially aided by changes in left anterior temporal blood flow. In addition compared to non‑VDep patients the left anterior frontal rCBF for VDep patients was significantly lower in both depressed and remitted states. Conclusions: Left anterior temporal rCBF therefore appears to represent a state marker that increases as symptoms associated with late‑onset depression improve regardless of vascular changes. Furthermore in VDep patients left anterior frontal rCBF was low in both states compared to non‑VDep patients and might not only represent a trait marker but also correlated with the duration of disease and likelihood of recurrence and relapse.（J Nippon Med Sch 2003; 70: 321―326）

Previously, we reported that morning bright light therapy improved sleep time and cognitive function in Alzheimer type of dementia. We conducted a double blind study to examine the effects of melatonin on the sleep-wake rhythm, cognitive and non-cognitive functions in Alzheimer type of dementia. The subjects were 9 persons given a placebo (PLA), and 11 given melatonin ( 3 mg)(MLT). The mean age was 79.2+/-6.4 (17 females and 3 males). The drugs were given at 20: 30 each day for 4 weeks. We checked sleep time and activity by Actigraph through one week before and the 4th week after drug administration. Cognitive and non-cognitive functions were evaluated with the clinical dementia rating scale (CDR), and Mini Mental State Examination (MMSE), and the Alzheimer's Disease Assessment Scale (ADAS). We successfully recorded Actigraph data from 18 patients (PLA8, MLT10). The mean sleep time change ratio and SD of the administration of PLA in the night was-0.2+/-13.7%, and MLT was 33.2+/-37.6%. The mean activity counts and SD of the administration of PLA in the night was 29.8+/-77.0%; in MLT it was-44.9+/-21.9%. Melatonin significantly prolonged the sleep time (p=0.017) and decreased activity (p=0.014) in the night (21: 00-6: 00) in the MLT group, although no significant difference in sleep time or activity in the daytime (6: 00-21: 00) was recognized between the two groups. In comparison with ADAS cognition score changes, the mean change and SD in the PLA was 0.3+/-3.7; in MLT it was-4.3+/-3.6 points. In comparison with ADAS non-cognition score, the mean change and SD in the PLA group was-0.8+/-1.0, in the MLT group it was-4.1+/-2.2 points. There were also significant differences between the PLA and the MLT groups in the comparison with the score improvement of ADAS cognition (p=0.017) and non-cognition (p=0.002), otherwise there was no significant difference in improvement of MMSE between both groups. Melatonin administration had effect to improve sleep time and night activity, but no significant effect to improve daytime naps and activity. Although melatonin administration might has less strong effect on circadian rhythm than morning bright light therapy we previously reported, cognitive and non-cognitive functions were improved. Melatonin seemed to be useful for care of the Alzheimer type of dementia patients.

We studied the sleep effect, the carry over effect (sleepiness) on polysomnography (PSG), the sleep propensity test (SPT), the subjective sleep rating scale for the ultra short acting hypnotics triazolam and short acting hypnotics brotizolam. Ten healthy male volunteers were used for double blind crossover design by randomized allocation with a single oral administration. Informed consent was obtained from all subjects. Placebo (PL), triazolam (TL, 0.125 mg), triazolam (TH, 0.25 mg) and brotizolam (BR, 0.25 mg) were administered at 11 p.m. PSG was recorded from 11 p.m. to 7 a.m. in the next morning. Then, Stanford Sleepiness Scale (SSS) and Kwansei Gakuin Sleepiness Scale (KSS) were checked before 8 a.m., and SPT was recorded at 8:00–8:20 a.m. In PSG of total sleep, TH decreased the frequency of stage shifts significantly ( p p p p

Cerebrovascular or vascular change is frequent in elderly patients with depression. The concept of vascular depression (VD) has been a topic of interest in neuropsychiatry. During the last decade, functional neuroimaging studies have reported that recovery from depression was associated with increased regional cerebral blood flow (rCBF) in specific regions. However, the majority of studies have been confined to depression without cerebrovascular changes. Therefore, this study was undertaken to examine changes in rCBF on recovery from vascular depression. We measured rCBF in nine patients with ‘vascular depression’ and 11 patients with ‘non-vascular depression’ using 123I-IMP single photon emission computed tomography (SPECT) during illness and after recovery. The results showed that VD has significantly lower mean rCBF than non-VD during both depressed and remitted state, localized to the left anterior frontal region. This suggested that persisting left frontal hypoperfusion may lead to longer duration or higher frequency of relapse. Both VD and non-VD showed significantly higher mean rCBF in remitted state than in depressed state, especially left anterior temporal rCBF correlated with recovery from depression. This suggested that left temporal activity might be a state or episode-dependent marker for both VD and non-VD

Objective: Psychiatric patients presenting with polydipsia are often difficult to treat with standard psychiatric interventions. Pharmacological intervention was attempted in these patients based on the hypothesis that angiotensin II, a potent dipsinogen, may be involved in the drinking behavior of patients with polydipsia. Beta-blockers inhibit renin release (and thus indirectly angiotensin II) by blocking beta receptors in the kidney. Methods: Three patients were identified as excessive water drinkers during their hospital admissions. All three patients were eunatremic but polydipsic at the time of study. Two of the three had histories of hyponatremia and required emergency medical treatment on more than one occasion. No patients had been controlled by strict fluid restriction. Trials of propranolol were initiated to control their water drinking. Results: After starting propranolol, two patients responded quickly. In one patient, fluid intake decreased from 2650 ± 647 to 1577 ± 361, p < .001. In the other, fluid intake decreased from over 7000 ml before starting propranolol to around 3000 ml. The mean noon body weight of the third patient, in whom it was not possible to document fluid intake or urine volume before and after administering beta-blocker, was 72.6 ± 2.6 Kg and 66.0 ± 1.0 Kg, respectively ( p < .0001). Conclusions: These results suggest that propranolol may be useful for the treatment of polydipsia in patients with schizophrenia. Its efficacy could be related to inhibition of the renin-angiotensin system. Additional research using the controlled pharmacotherapeutic trials is required to confirm these findings.

Polysomnography was performed on eight healthy men with trazodone hydrochloride, imipramine and placebo. Trazodone hydrochloride increased slow wave sleep significantly. Imipramine prolonged rapid eye movement (REM) latency and decreased the percentage of REM sleep significantly. Trazodone decreased stages 1 and 2 sleep, while imipramine increased it. These findings suggest that the antidepressive effect of trazodone might be different from that of imipramine with the suppression of REM sleep.

Two hundred thirty-eight patients admitted consecutively to a critical care unit through an emergency room were assessed prospectively for the presence of delirium. Thirty-eight patients (16%) developed delirium. Delirium occurred with equal frequency in all disease categories. The presence of abnormal head imaging which required medical intervention did not predict the development of delirium. The median delay between admission and the development of delirious was 4 days, however, one-fourth of the patients were delirious on the day of admission. The patients with abnormal head imaging who required medical intervention had a higher frequency of onset of delirium on the first day compared with patients without. The delirium lasted a median of 5 days and resolved within a week in over 70% of patients. These results confirm that delirium is frequently present in patients who require acute critical care after emergency room evaluation. In this population, serious medical disease is a better predictor of the development of delirium than the presence of abnormal brain imaging which required medical intervention. Although delirious patients have longer lengths of stay, the presence of delirium does not predict higher mortality, as has been reported in other populations. This could be because delirious patients admitted to the critical care unit through the emergency room have fewer premorbid medical problems predisposing them to poor outcome.

Polysomnography, blood concentration and core body temperature recordings were performed on 12 healthy volunteers with administration of trazodone and placebo. Trazodone increased slow wave sleep (SWS), and decreased the average, the highest and lowest core body temperature significantly compared to placebo. The blood concentration of trazodone correlated positively with amplitude (the difference between the highest and lowest temperature) and %SWS during the first period of a sleep phase divided into three periods, and negatively with the lowest temperature. The appearance time of the lowest temperature correlated negatively with %SWS.

Background: The present study investigated the efficacy and safety of milnacipran a serotonin noradrenalin reuptake inhibitor（SNRI） for the treatment of depression following mild and moderate traumatic brain injury（MMTBI）. While other reports have been published on the use of antidepressants such as selective serotonin reuptake inhibitors（SSRIs）and tricyclics for the treatment of depression following MMTBI no previous study has examined the use of a SNRI for this condition. Methods: A six‑week open study was conducted using 10 patients（4 males and 6 females）of ages ranging from 28 to 74 years. DSM‑IV（diagnostic statistical manual of mental disorders 4 th Ed. American psychiatric association 1994）was used to diagnose mood disorders. The severity of depression was measured with the 21‑item Hamil ton rating scale for depression（HAM‑D） . The cognitive state of the patients was assessed using the mini‑mental state examination（MMSE） . Results: The maximum daily milnacipran dosage for the patients ranged from 30 to 150 mg. One patient experienced side effects but none of the side effects were serious. On the basis of having a decrease in a final HAM‑D score of more than 50％ the response rate for the nine patients was 66.7％ while in a final score of 7 or less the remission rate for the nine patients was 44.4％. Furthermore significantly greater improvement in cognitive function was seen in patients treated with milnacipran. Conclusion: The results demonstrated that milnacipran is a safe and effective drug for depression following mild and moderate TBI and could be the first choice drug for the treatment of this condition.（J Nippon Med Sch 2003; 70: 313―320）

This study examined the characteristics of Japanese patients who required psychiatric intervention through the Consulate-General Japan in New York. The findings show that 61.5% of cases were tourists in contrast with 38.5% who were residents. Seventy three point one percent of all cases had psychiatric disorders prior to traveling to the United States. Seventy one point two had schizophrenia, and 48.1% required intervention within one week stay in the United States. The study indicated cultural elements had little influence on their psychiatric crises. The dominant cases, which were schizophrenics who traveled because of their delusional symptoms, were consistent with cases of "voyage pathologique". It was also suggested that cases with personality disorders are increasing in number. And we inferred that cases with substance-related disorders, particularly among young illegal residents, must be present in greater numbers.

In the present study, the effects of short-acting benzodiazepines on nocturnal sleep and the carryover effects of these drugs were studied. The study involved 10 young, healthy male subjects who had given their written informed consent to participate. Either a placebo (PLA), 0.125 mg triazolam (TRZ), 0.25 mg TRZ or 0.25 mg brotizolam (BRZ) was administered to the subjects in a double-blind crossover design by randomized allocation with a single oral administration at 23.00 h. A polysomnography (PSG) was recorded for each subject from 23.00 to 07.00 h the following day. Then, the Stanford Sleepiness Scale (SSS) and Kwansei Gakuin Sleepiness Scale (KSS) were checked between 07.55 and 08.00 h, and the sleep latency test (SLT) was performed between 08.00 and 08.20 h. Event-related potentials (ERPs) were then recorded with an oddball paradigm; the reaction time (RT) was measured simultaneously. According to the PSG, treatment with 0.25 mg TRZ resulted in a statistically significant increase in the percentage of stage 2 sleep (p < 0.05) and a reduction in the percentage of rapid eye movement sleep (p < 0.05) compared with PLA. None of the drugs had any effect on the percentage of slow-wave sleep compared with PLA. With regard to carryover effects, although none of the drugs had any effect on SSS, KSS, RT or ERPs, BRZ did cause a statistically significant decrease in sleep latency (p < 0.05) compared with PLA. TRZ (0.125 and 0.25 mg) and 0.25 mg BRZ exerted different effects on SLT. We suggest that these different effects are attributable to differences in the half-life of these hypnotics.

Depression commonly involves abnormalities of the sleep-wake rhythm, the temperature rhythm, and other biological rhythms. The changes of these biological rhythms are caused in remission by medications. However, it has yet to be clarified whether the biological rhythms are changed as a result of recovery from depression or from the direct pharmacological effects of the antidepressants. Therefore, we have undertaken a study on the direct effects of the antidepressants trazodone and imipramine on the biological rhythms of healthy volunteers. The study involved 12 healthy male volunteers (ages 21 approximately 28 years, mean age 23.9+/-1.7 years) who had given written informed consent. Placebo, trazodone, and imipramine were each administered in a single blind manner four times a day, during the three-day study period. The total daily dosage of trazodone was 100 mg (50 mg in one subject), and of imipramine 40 mg (20 mg in one subject). Subjects were submitted to polysomnography (PSG) and body core temperature (rectal temperature) measurements during the study period. We compared the data concerning the antidepressants to those of the placebo. The results show that, with regard to the sleep rhythm, trazodone significantly increased slow wave sleep (SWS), but no changes were observed in REM (rapid eye movement) sleep. Imipramine significantly decreased REM sleep and prolonged the REM cycle. With regard to the temperature rhythm, trazodone showed a tendency to advance the appearance time of the minimal temperature. Imipramine significantly lowered the maximal temperature and decreased the difference between the maximal and the minimal temperature, but no changes in the phases were observed. Neither antidepressant had any effect on the temperature cycle. Trazodone and imipramine showed different effects on PSG. Furthermore, they had different effects on the temperature rhythm. The changes of the sleep-wake rhythm were greater than those of the temperature rhythm. Although the two antidepressants had different mechanisms of action, it is worthy of note that both directly influenced the biological rhythms of healthy volunteers.

The effects of the antidepressant drugs trazodone and imipramine on the circadian rhythm were studied by means of the sleep propensity test (SPT; sleep latency was examined by 35-minute EEG records at 09:00, 11:00, 13:00, 15:00, 17:00). The subjects were 11 healthy male volunteers (mean age, 23.6 years old). The drugs were administered 4 times a day with single blind trials using an inactive placebo as a control. The dosages of the drugs were trazodone 50-100 mg/day and imipramine 20-40 mg/day. We discussed the circadian rhythm referring to previous polysomnograhy (PSG) studies using the same drugs and dosages with most of the same subjects. As a result, the mean sleep latency of SPT was the shortest at 09:00 (p

Twenty-seven patients with Alzheimer-type dementia (ATD) were treated with bright light therapy in the morning for four consecutive weeks. The cognitive state of each patient was evaluated with the Mini-Mental-State Examination (MMSE) and circadian rhythm with actigram before and after therapy for all of the patients and those of two groups divided by the severity criteria of the Clinical Dementia Rating. The therapy improved the circadian rhythm disturbances. Although the therapy caused no remarkable effects on dementia severity, it improved the MMSE scores, especially in the early stages of ATD. These results suggest that bright light therapy improved the circadian rhythm disturbances and then bettered the cognitive state in early-stage ATD.

We investigated the effectiveness of bright light therapy on cognitive disturbances and its effect on circadian (sleep-wake) rhythm in Alzheimer-type dementia (ATD). Twenty-seven patients with ATD were treated with bright light therapy in the morning for 4 consecutive weeks. We evaluated the cognitive functions and circadian rhythms of the patients as a whale, and as members of two groups (one: questionable and mild dementia: the other: moderate and severe dementia; both groups classified by the severity criteria of Clinical Dementia Rating). We assessed circadian rhythms by actigraphy and cognitive states by Mini-Mental-State Examination (MMSE) and Alzheimer's Disease Assessment Scale (ADAS) before and after light therapy. Bright light therapy improved circadian rhythm. Although bright light therapy had no Significant effect on the Severity of dementia, it improved the MMSE scores, cognitive functions of ADAS scores (memory > language) and non-cognitive functions of ADAS scores (behavior = mood), especially in the questionable and mild dementia group. These results suggest that bright light therapy improves cognitive functions with the modification of circadian rhythm, especially in the early stages of ATD.

Using polysomnography, sleep effect was studied, then the sleep latency test (SLT), Stanford Sleepiness Scale (SSS), and Kwansei Gakuin Sleepiness Scale (KSS) were studied the next morning after administration of either an inactive placebo (PL), 0.125 mg triazolam (TL), 0.25 mg triazolam (TH), or 0.25 mg brotizolam (BR). Ten healthy male volunteers were used for the double-blind crossover design. TL increased the percentage of stage 2 sleep significantly compared with PL, whereas TH decreased the number of stage shifts significantly. TH and BR increased the percentage of stage 2 sleep significantly and decreased the percentage of rapid eye movement sleep significantly. Although no drug had any effect on SSS and KSS, BR decreased the sleep latency in SLT significantly.

The present study investigated the effects of vitamin B12 (VB12) on circadian rhythm in Alzheimer-type dementia (ATD). Twenty-eight ATD patients were treated with bright light therapy (BLT) for 8 weeks. For the latter 4 weeks, half were treated with VB12 with BLT (BLT + VB12). We evaluated the cognitive state with Mini-Mental State Examination and the circadian rhythm with actigraphy after the fourth and eighth week. After the first 4 weeks BLT improved the circadian rhythm disturbances and cognitive state especially in the early stage of ATD. Although the latter 4 week-BLT caused no significant effects on the circadian rhythm; BLT + VB12 improved the vigilance level during the daytime. These results suggest that VB12 has some efficiency to enhance vigilance for ATD patients.

One bias inherent in calculating dimension for limited time-series data is investigated. The bias is derived from the fluctuation of the distribution of measures in the phase space and distorts the scaling with respect to each reference point to be concave up or down. These distortions are pronounced for the experimental data whose number of points is not sufficient and whose scaling region is restricted to a relatively small interval. It is possible that the Grassberger–Procaccia algorithm and all its modified ones are affected by the bias. We evaluate the distortion quantitatively and show the procedure required for the correction of the bias taking the case of an electroencephalogram (EEG).

Quantitative EEG analysis was done on 29 medicated right-handed depressive patients at age over 45 and age and sex matched right-handed 20 normal controls. The patients were all diagnosed as major depression with melancholia by DSM-III-R and were divided into anxiety type (n = 17) and retardation type (n = 12) evaluated with the Hamilton rating scale for depression. Eye closed resting EEGs were recorded on a data recorder from the 16 electrode leads (10-20 system). Artifact rejected 3 minutes EEGs were analyzed by off-line with Fast Fourier Transform from the bilateral frontal (F3, F4), parietal (P3, P4) and occipital (O1, O2) regions. The mean values of absolute amplitude power (microV) and the mean Z scores of inter-, and intrahemispheric coherence were obtained in theta 1 (4.0-6.0 Hz), theta 2 (6.0-8.0 Hz), alpha 1 (8.0-10.5 Hz), alpha 2 (10.5-13.0 Hz), beta 1 (13.0-20.0 Hz), and beta 2 (20.0-40.0 Hz) frequency bands respectively. The main findings were: 1) Beta 1 and beta 2 power were greater in patients with anxiety type depression than in normal controls, and the differences were statistically significant over the parietal and occipital regions in beta 1 and the frontal region in beta 2. The anxiety type was distinguished from the retardation type with the increase of beta 2 power. The retardation type showed higher alpha 1 power over the frontal region and lower alpha 2 power over the occipital region than normal controls. 2) Both types showed greater frontal predominant ratio to the parietal in beta 2 power than did normal controls. The retardation type was distinguished from the anxiety type with the right predominance in beta 1 power over the frontal region. 3) Both groups of patients showed lower frontal interhemispheric coherences than normal controls in each band. In particular, the anxiety type showed significantly lower alpha 2 band and lower beta 1 and beta 2 bands. The parietal interhemispheric coherence was lower in the anxiety type but higher in the retardation type than in normal controls in each band, and this difference was prominent in theta 2 band. 4) The two groups of patients showed higher fronto-parietal intrahemispheric coherences in both hemispheres than the normal controls in each band. Especially, the anxiety type showed higher in theta two and alpha 1 bands.(ABSTRACT TRUNCATED AT 400 WORDS)