Comparison of metabolic parameters between oral and total parenteral nutrition in children with severe eating disorders

BACKGROUND

This study investigated changes of lipid parameters in children with severe eating disorders during refeeding in order to explore the optimal timing for lipid preparation administration.

METHODS

We prospectively assessed the physical conditions of patients with eating disorders after the start of nutrition therapy. The assessments were performed at admission and at 2 and 4 weeks. Lipid metabolism was assessed based on triglyceride (TG), total cholesterol (TC), and free carnitine (FC) levels, as well as acylcarnitine/free carnitine (AC/FC) ratio.

RESULTS

A total of 18 patients were included. Of these, 12 and 6 received an oral diet (OD group) and total parenteral nutrition (TPN group), respectively. The mean body mass indexes at hospital admission were 12.8 kg/m2 in the OD group and 12.7 kg/m2 in the TPN group. At 2 weeks after the start of refeeding, TC, TG, and AC/FC levels were significantly lower in the TPN group than in the OD group. Other blood test results did not show any significant differences between the two groups.

CONCLUSIONS

Fat-free glucose-based nutrition promoted lipid metabolism over a 2-week period after the start of refeeding, suggesting that balanced energy and lipid intake are essential, even in TPN.

Comparison of metabolic parameters between oral and total parenteral nutrition in children with severe eating disorders

BACKGROUND

This study investigated changes of lipid parameters in children with severe eating disorders during refeeding in order to explore the optimal timing for lipid preparation administration.

METHODS

We prospectively assessed the physical conditions of patients with eating disorders after the start of nutrition therapy. The assessments were performed at admission and at 2 and 4 weeks. Lipid metabolism was assessed based on triglyceride (TG), total cholesterol (TC), and free carnitine (FC) levels, as well as acylcarnitine/free carnitine (AC/FC) ratio.

RESULTS

A total of 18 patients were included. Of these, 12 and 6 received an oral diet (OD group) and total parenteral nutrition (TPN group), respectively. The mean body mass indexes at hospital admission were 12.8 kg/m2 in the OD group and 12.7 kg/m2 in the TPN group. At 2 weeks after the start of refeeding, TC, TG, and AC/FC levels were significantly lower in the TPN group than in the OD group. Other blood test results did not show any significant differences between the two groups.

CONCLUSIONS

Fat-free glucose-based nutrition promoted lipid metabolism over a 2-week period after the start of refeeding, suggesting that balanced energy and lipid intake are essential, even in TPN.

Effect of the Temporal Window of Integration of Speech Sound on Mismatch Negativity

Speech-sound stimuli have a complex structure, and it is unclear how the brain processes them. An event-related potential (ERP), known as mismatch negativity (MMN), is elicited when an individual's brain detects a rare sound. In this study, MMNs were measured in response to an omitted segment of a complex sound consisting of a Japanese vowel. The results indicated that the latency from onset in the right hemisphere was significantly shorter than that in the frontal midline and left hemispheres during left ear stimulation. Additionally, the results of latency from omission showed that the latency of stimuli omitted in the latter part of the temporal window of integration (TWI) was longer than that of stimuli omitted in the first part of the TWI. The mean peak amplitude was found to be higher in the right hemisphere than in the frontal midline and left hemispheres in response to left ear stimulation. In conclusion, the results of this study suggest that would be incorrect to believe that the stimuli have strictly the characteristics of speech-sound. However. the results of the interaction effect in the latencies from omission were insignificant. These results suggest that the detection time for deviance may not be related to the stimulus ear. However, the type of deviant stimuli on latencies was found to be significant. This is because the detection of the deviants was delayed when a deviation occurred in the latter part of the TWI, regardless of the stimulation of the ear.

Prediction of the prognosis of somatoform disorders using the Minnesota Multiphasic Personality Inventory

BACKGROUND

Somatoform disorders are frequently resistant to treatment. This study aimed to determine the utility of the Minnesota Multifaceted Personality Inventory (MMPI) in predicting the prognosis of somatoform disorders.

METHODS

Overall, 125 patients diagnosed with somatoform disorders between January 1, 2013 and December 31, 2017 in the psychiatric department of Fukushima Medical University Hospital were included. Patients with positive outcomes were identified based on a subjective estimation regarding (1) pain and (2) social functions, including activities of daily living. They were divided into the improved group (IG) and the non-improved group (NIG). Each factor was then descriptively compared between the two groups, and the sensitivity and specificity were determined.

RESULTS

The NIG had significantly higher scores but only on the Hy scale. Thus, the optimal Hy scale cutoff score was calculated. The cutoff point was 73.5, with a sensitivity of 55.7% and a specificity of 71.7%.

CONCLUSION

An MMPI Hy scale score higher than a cutoff value of 73.5 predicts a poor response to conventional supportive psychotherapy or drug therapy in patients with somatoform disorders. This cutoff point may be used as an important index for selecting treatment for somatoform disorders.

Disrupted structural connectivity and less efficient network system in patients with the treatment-naive adult attention-deficit/hyperactivity disorder

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder whose primary symptoms are hyperactivity, impulsivity, and inattention. Historically, ADHD was recognized as a disease of childhood and adolescence. However, many patients are known to have persistent symptoms into adulthood. Many researchers consider the neuropathology of ADHD to be based on abnormalities in multiple parallel and intersecting pathways rather than a single anatomical area, but such alterations remain to be clarified.

Methods

Using diffusion tensor imaging, we investigated differences in the global network metrics estimated by graph theory and the degree of connectivity between adjacent voxels within a white matter (WM) fascicle defined by the density of the diffusing spins (connectometry) between 19 drug-naive Japanese patients with adult ADHD and 19 matched healthy controls (HCs). In adult patients with ADHD, we examined the relationships between the symptomatology of ADHD and global network metrics and WM abnormalities.

Results

Compared with HCs, adult patients with ADHD showed a reduced rich-club coefficient and decreased connectivity in widely distributed WMs such as the corpus callosum, the forceps, and the cingulum bundle. Correlational analyses demonstrated that the general severity of ADHD symptoms was associated with several global network metrics, such as lower global efficiency, clustering coefficient, small worldness, and longer characteristic path length. The connectometry revealed that the severity of hyperactive/impulsive symptoms was associated with overconnectivity in the corticostriatal, corticospinal, and corticopontine tracts, the inferior fronto-occipital fasciculus, and the extreme capsule but dysconnectivity in the cerebellum. The severity of inattentive symptoms was associated with dysconnectivity in the intracerebellar circuit and some other fibers.

Conclusion

The results of the present study indicated that patients with treatment-naive adult ADHD showed disrupted structural connectivity, which contributes to less efficient information transfer in the ADHD brain and pathophysiology of ADHD.

Trial registration

UMIN Clinical Trials Registry (UMIN-CTR) UMIN000025183, Registered: 5 January 2017.

A Six-Year Prospective Study on Problem Drinking among Evacuees of the Great East Japan Earthquake: The Fukushima Health Management Survey

Evacuees of the Great East Japan Earthquake have experienced adverse, long-term physical and psychological effects, including problem drinking. This study examined the risk and recovery factors for problem drinking among evacuees between fiscal years (FY) 2012 and 2017 using data on residents in the evacuation area from the Mental Health and Lifestyle Survey. With the FY 2012 survey as a baseline, a survey comprising 15,976 men and women was conducted in the evacuation area from FY 2013 to FY 2017, examining the risk and protective factors for problem drinking. Particularly, the Cutting down, Annoyed by criticism, Guilty feeling, and Eye-opener (CAGE) questionnaire was used to evaluate problem drinking. Univariate and multivariate Cox proportional hazard models were constructed to identify the risk and recovery factors of problem drinking. The findings indicated that the male gender, insufficient sleep, job change, trauma symptoms, mental illness, family financial issues, and heavy drinking (≥4 drinks per day) were significant risk factors for the incidence of problem drinking among the evacuees. Furthermore, a high blood pressure diagnosis could exacerbate problem drinking among men, while younger age and a diabetes mellitus diagnosis could increase problem drinking among women. Trauma symptoms and heavy drinking inhibited recovery from problem drinking after the disaster. Understanding these factors can shape effective long-term intervention strategies to physically and psychologically support evacuees.

Associations Between External Radiation Doses and the Risk of Psychological Distress or Post-traumatic Stress After the Fukushima Daiichi Nuclear Power Plant Accident: the Fukushima Health Management Survey

BACKGROUND

The relationship between radiation levels and mental health status after a nuclear disaster is unknown. We examined the association between individual external radiation doses and psychological distress or post-traumatic stress after the Fukushima Daiichi nuclear power plant accident in March 2011 in Japan.

METHODS

The Mental Health and Lifestyle Survey was conducted from January 2012. Based on the estimated external radiation doses for the first 4 months, a total of 64,184 subjects were classified into <1 mSv, 1 to <2 mSv, and ≥2 mSv groups. Odds ratios (ORs) and 95% confidence intervals (CIs) of psychological distress and post-traumatic stress, with the <1 mSv group as the reference, were calculated using logistic regression analysis adjusted for age, sex, evacuation, perception of radiation risk, and subjective health status.

RESULTS

The prevalence of psychological distress/post-traumatic stress in the <1 mSv, 1 to <2 mSv, and ≥2 mSv groups was 15.1%/22.1%, 14.0%/20.1%, and 15.0%/21.7%, respectively. In women, although the ≥2 mSv group tended to have a higher risk of psychological distress with the age-adjusted OR of 1.13 (95% CI, 0.99-1.30), the adjusted OR decreased to 1.00 (95% CI, 0.86-1.16) after controlling for all variables. On the other hand, there were no dose-dependent associations between radiation dose and post-traumatic stress.

CONCLUSION

Although external radiation doses were not associated with psychological distress, evacuation and perception of radiation risk may increase the risk of psychological distress in women in the higher dose group.

Long-Term, Community-based Approach for Affected People Having Problems With Mental Health and Lifestyle Issues After the 2011 Fukushima Disaster: the Fukushima Health Management Survey

A Mental Health and Lifestyle Survey (MHLS) has been conducted yearly as part of the Fukushima Health Management Survey since 2012, in order to monitor different health issues related to long-term evacuation of affected people after the 2011 Fukushima disaster. This survey is a mail-based one of nearly 210,000 affected people living in the evacuation zone at the time of the disaster. Another purpose of the MHLS is to provide efficient interventions by telephone based on the results of the survey. Significant findings contributing to understanding of non-radiological health effects caused by long-term evacuation were obtained from the MHLS, directly connecting to telephone-based interventions for over 3,000 respondents per year. In this article, the mental health outcomes of the MHLS, including depressive symptoms and posttraumatic responses, are reviewed, and the usefulness of telephone-based interventions is discussed. The evidence showed that, despite improvement of core mental health outcomes, the prevalence of respondents at high risk of some psychiatric problems remained high compared to that among the general population in Japan. In particular, several mental health consequences of respondents staying outside of Fukushima Prefecture were higher than those staying inside Fukushima. Along with further efforts to increase the response rate, we need to continue and modify the MHLS to meet the requirements of the affected people and communities.

The Association between Parenting Confidence and Later Child Mental Health in the Area Affected by the Fukushima Nuclear Disaster: The Fukushima Health Management Survey

After the 2011 Fukushima Daiichi Nuclear Power Station accident, the Fukushima Health Management Survey was conducted to assess children's lifestyle and mental health conditions. The participants in this study were 1126 children, aged 0 to 3 years, living in the evacuation zone at the time of the disaster. The parenting confidence of their mothers was assessed using a self-administered questionnaire as a baseline in 2013. We examined the association of parenting confidence level at baseline, using a total difficulty score of the Strengths and Difficulties Questionnaire (SDQ) and reluctance to attend school among children in a follow-up study in 2016 and 2017. As a result, no confidence was reported by 178 (15.8%) mothers, while 477 (42.4%) responded with "not sure" and 471 (41.8%) were confident. In the multiple logistic analysis, after adjusting for covariates such as the child's sex, age, and current health condition, the group lacking parenting confidence demonstrated a significantly higher risk level for SDQ total difficulties (OR, 2.8; 95% CI, 1.59-4.93) and reluctance to attend school (OR = 1.98, 95% CI: 1.24-3.18) than the confident mothers. After a major disaster, which can have long-term effects on communities, intensive psychological care for mothers with young children is needed to prevent various mental health problems in their children.

Trajectories of peer relationship problems and emotional symptoms in children 5 years after a nuclear disaster: Fukushima Health Management Survey

The Fukushima Daiichi Nuclear Power Station (NPS) accident, which occurred in March 2011, is having long-term effects on children. About 3 years after the accident, we identified three patterns of peer relationship problems and four patterns of emotional symptoms using group-based trajectory modeling. As a result, we reported that different factors might be related to very severe trajectories of peer relationship problems and emotional symptoms. In this study, we used five waves of data from fiscal year (FY) 2011 to FY2015 from the Mental Health and Lifestyle Survey, a detailed survey of the Fukushima Health Management Survey started in FY2011. We analyzed 7013 residents within the government-designated evacuation zone (aged 6-12 years old as of 11 March 2011) with responses to all items of psychological distress in at least one wave from FY2011 and FY2015. We planned this study to describe the trajectories of peer relationship problems and emotional symptoms in children and to examine potential risks and protective factors over the 5 years following the NPS accident. We identified four patterns of peer relationship problems and five patterns of emotional symptoms using latent class growth analysis. For peer relationship problems, male sex, experiencing the NPS explosion and lack of exercise habits were associated with the severe trajectory group. For emotional symptoms, experiencing the NPS explosion, experiencing the tsunami disaster and lack of exercise habits were associated with the severe trajectory group. Exercise habits are very important for the mental health of evacuees after a nuclear disaster.

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident:results from the Fukushima health management survey

INTRODUCTION

We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children's experience of the nuclear disaster.

METHODS

We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the "Strengths and Difficulties Questionnaire (SDQ)" scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster - "nuclear disaster (+)" and "nuclear disaster (-)" - were also compared.

RESULTS

Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between "elementary school" and "junior high school" or "nuclear disaster" (+) and (-). There was no significant difference between these items.

CONCLUSIONS

We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.

Differential diagnosis of memory impairment in areas affected by a natural disaster:a case report

We treated a man with a chief complaint of memory impairment after the Great East Japan Earthquake. Initially, he was diagnosed with dementia. However, after several tests, neither could a definitive diagnosis of dementia be reached, nor was there any apparent evidence for depression, epilepsy, delirium, or internal medicine diseases. During the earthquake, the patient experienced the severe trauma of watching his wife being swept away by a tsunami. Furthermore, he experienced separation from his family. Because of this traumatic experience, we suspected that dissociative disorder was involved in the development of the memory impairment and thus, we switched to treatments focusing on emotional support. Subsequently, the patient’s memory impairment gradually improved. The present case demonstrates the importance of considering dissociative disorders when examining a patient with memory impairment in areas affected by disasters.

Omission mismatch negativity of speech sounds reveals a functionally impaired temporal window of integration in schizophrenia

OBJECTIVE

We hypothesized that sensory memory associated with the temporal window of integration (TWI) would be impaired in patients with schizophrenia, an issue that had not been evaluated using omission mismatch negativity (MMN) of complex speech sounds. We aimed to assess the functional changes in auditory sensory memory associated with the TWI in patients with schizophrenia by investigating the effect of omission of complex speech stimuli on the MMN.

METHODS

In total, 17 patients with schizophrenia and 15 control individuals participated in the study. The MMN in response to omission deviants of complex speech sounds was recorded, while the participants were instructed to ignore the series of speech sounds.

RESULTS

The MMN latency in patients with schizophrenia was significantly prolonged by deviant stimuli to omissions corresponding to the early and late parts of the temporal TWI. There were no significant group differences in the amplitude of the MMN to omissions at different time points across the TWI.

CONCLUSIONS

Our results suggested that sensory tracing function in patients with schizophrenia is impaired in the early and the later half of the TWI.

SIGNIFICANCE

We showed that certain MMN abnormalities in patients with schizophrenia may be caused by an impaired TWI.

The association between body mass index and recovery from post-traumatic stress disorder after the nuclear accident in Fukushima

Post-traumatic stress disorder (PTSD) and obesity share common risk factors; however, the effect of obesity on recovery from PTSD has not been assessed. We examined the association between body mass index (BMI) and recovery from PTSD after the Great East Japan Earthquake. We analyzed 4356 men and women with probable PTSD aged ≥ 16 years who were living in evacuation zones owing to the radiation accident in Fukushima, Japan. Recovery from probable PTSD was defined as Post-traumatic Stress Disorder Checklist-specific scores < 44. Using Poisson regression with robust error variance adjusted for confounders, we compared the prevalence ratios (PRs) and 95% confidence intervals (CIs) for this outcome in 2013 and 2014. Compared with point estimates for normal weight (BMI: 18.5-24.9 kg/m2), especially in 2013, those for underweight (BMI: < 18.5 kg/m2) and obesity (BMI: ≥ 30.0 kg/m2) tended to slightly increase and decrease, respectively, for recovery from probable PTSD. The multivariate-adjusted PRs (95% CIs) for underweight and obesity were 1.08 (0.88-1.33) and 0.85 (0.68-1.06), respectively, in 2013 and 1.02 (0.82-1.26) and 0.87 (0.69-1.09), respectively, in 2014. The results of the present study showed that obesity may be a useful predictor for probable PTSD recovery. Obese victims with PTSD would require more intensive support and careful follow-up for recovery.

Plasma levels of dopamine metabolite correlate with mismatch negativity in patients with schizophrenia

AIM

Mismatch negativity (MMN) deficit is one of the most robust and replicable findings in schizophrenia, and primarily reflects deficient functioning of the N-methyl-D-aspartate (NMDA) receptor system. Although the dopamine receptor is known not to modulate MMN over the short term, it is unclear whether the dopamine system affects MMN in the long term.

METHODS

We explored correlations between MMN and levels of plasma dopamine and serotonin metabolites in 18 patients with schizophrenia psychiatrically evaluated with the Positive and Negative Syndrome Scale (PANSS).

RESULTS

A significant negative correlation exists between MMN amplitude and plasma levels of dopamine metabolites. Plasma serotonin metabolite levels were not correlated with MMN. The PANSS total score and Negative score also showed negative correlations with MMN amplitude.

CONCLUSION

The usual strong therapeutic blockade of dopamine receptors applied in cases of schizophrenia may reduce MMN over the long term.

Estimation of frequency difference at which stream segregation precedes temporal integration as reflected by omission mismatch negativity

Both stream segregation and temporal integration are considered important for auditory scene analysis in the brain. Several previous studies have indicated that stream segregation may precede temporal integration when both processes are required. In the present study, we utilized mismatch negativity (MMN)-which reflects automatic change detection-to systematically estimate the threshold of the frequency difference at which stream segregation occurs prior to temporal integration when these functions occur together during a state of inattention. Electroencephalography (EEG) data were recorded from 22 healthy Japanese men presented with six blocks of alternating high pure tones (high tones) and low pure tones (low tones). Only high tones were omitted with 5 % probability in all blocks. Our results indicated that stream segregation should cancel temporal integration of close sounds, as indicated by omission-MMN elicitation, when the frequency difference is 1000 Hz or larger.

Do tone duration changes that elicit the mismatch negativity also affect the preceding middle latency responses?

The human brain can automatically detect sound changes. Previous studies have reported that rare sounds presented within a sequence of repetitive sounds elicit the mismatch negativity (MMN) in the absence of attention in the latency range of 100-250 ms. On the other hand, a previous study discovered that occasional changes in sound location enhance the middle latency response (MLR) elicited in the latency range of 10-50 ms. Several studies have reported an increase in the amplitude of the MLR within the frame of oddball paradigms such as frequency and location changes. However, few studies have been conducted on paradigms employing a duration change. The purpose of the present study was to examine whether the peak amplitudes of the MLR components are enhanced by a change in duration. Twenty healthy Japanese men (age: 23.9 ± 2.9 years) participated in the present study. We used an oddball paradigm that contained standard stimuli with a duration of 10 ms and deviant stimuli with a duration of 5 ms. The peak amplitudes of the MLR for the deviant stimuli were then compared with those for the standard stimuli. No changes were observed in the peak amplitude of the MLR resulting from a duration change, whereas a definite MMN was elicited. The amplitude of the MLR was increased within the frame of oddball paradigms such as frequency and location changes. By contrast, the amplitude of the MLR was not changed within the duration change oddball paradigm that elicited the MMN.

Study of developmental disorders among newborns in Fukushima City after the Great East Japan Earthquake and nuclear power plant accident; an adjunct study of the Fukushima Regional Center of the Japan Environmental and Children's Study (JECS)

This is based on a survey of two-year-old but not three-year-old cohorts. Therefore, we cannot state anything about the incidence of autism spectrum disorder (ASD) in over three-years-old children. We submit corrections in the following errata, because the original sentences might mislead the readers without evidence from three-year-old children. Also, we would like to exclude the phrase of "low-dose radiation" from the sections of Key word, Abstract, and Conclusion, because this study did not cover its influence.Author Shuntaro ItagakiAugust 05, 2019.

Young patient with treatment-resistant schizophrenia drastically improved by combination of clozapine and maintenance electroconvulsive therapy: a case report

Objectives: Although clozapine is considered the only effective pharmacological option for patients with treatment-resistant schizophrenia (TRS), around 30–40% of patients show clozapine resistance. Modified electroconvulsive therapy augmentation is reportedly clinically effective for clozapine-resistant schizophrenia, but few case reports have described the efficacy of combining clozapine and continuous/maintenance ECT for patients with TRS.

Methods: We present the case of a young patient with TRS who was treated using combination therapy with clozapine and maintenance ECT (m-ECT).

Results: The patient achieved drastic improvement under combination therapy with clozapine and m-ECT. Total Positive and Negative Syndrome Scale (PANSS) score fell markedly by 36 (from 108 to 72) using the combination of clozapine and m-ECT. Behaviors not reflected directly by PANSS score also improved. For example, the problem of being unable to take oral drugs stably because of delusions of poisoning was resolved. Furthermore, the patient maintained improvement under m-ECT, and long-term homestays became possible.

Conclusion: Combination therapy with clozapine and m-ECT proved greatly effective in this case. Further clinical trials of this combination therapy for TRS are needed to confirm the effectiveness. Further studies are also expected to examine effective periods for this therapy.

Parental Recognition of Bullying and Associated Factors Among Children After the Fukushima Nuclear Disaster: A 3-Year Follow-Up Study From the Fukushima Health Management Survey

This study examined parental recognition of bullying victimization and associated factors among evacuated children after the 2011 Fukushima Daiichi Nuclear Power Plant accident, using a 3-year follow-up data (wave 1: January 2012; wave 2: January 2013; wave 3: February 2014). The sample included the caregivers of 2,616 children in the first-sixth grades of elementary school, who lived in one of the 13 municipalities that were the target areas of the Mental Health and Lifestyle Survey, conducted as part of the Fukushima Mental Health Management Survey. Across 3 years, around 80% of caregivers responded "not true," 15% responded "somewhat true," and 5% responded "certainly true" in response to a question about bullying victimization of their children. Being male was significantly associated with the parental recognition of bullying victimization at wave 1 and wave 3. At wave 1, experiencing the nuclear plant explosion was significantly associated with parental recognition of bullying victimization. Moreover, age at wave 3 was negatively associated with parental recognition of bullying victimization. Our findings will be helpful for establishing community- and school-based mental health care for children, parents, and teachers.

Study of developmental disorders among newborns in Fukushima City after the Great East Japan Earthquake and nuclear power plant accident; an adjunct study of the Fukushima Regional Center of the Japan Environmental and Children's Study (JECS)

The present adjunct study of the Japan Environment and Children's Study (JECS) aimed to determine the occurrence of developmental disorders in Fukushima Prefecture, which was exposed to low-dose radiation. At two medical institutions in Fukushima City, we enrolled 339 pregnant women from September 2013 through May 31, 2014, who delivered 335 neonates (174 male, including one set of twins) between November 4, 2013 and November 11, 2014. The parents of four neonates declined to participate in the present study and one neonate died. Therefore, 334 families agreed to participate in additional surveys until March 2017. Child Behavior Checklists (CBCL) were mailed to all 334 families during the month of their infant's second birthday and we received 236 responses (response rate, 70%). All responses were below the 69^th percentile in the CBCL, and no responses indicated significant problem behaviors. Boys tended to have higher values for items associated with developmental problems, but symptoms of autism were not evident. The mental health of the mothers indicated in the previous study might not have influenced the children. Autism spectrum disorder (ASD) is not obvious by the age of three years and thus it might become apparent as the children grow older.

Psychiatric Outpatients After the 3.11 Complex Disaster in Fukushima, Japan

BACKGROUND

After the 3.11 complex disaster, fear of radioactive contamination and forced evacuation influenced a number of residents to seek psychiatric care.

OBJECTIVES

This study assessed the sequential changes in the number of new outpatients and patients with acute stress disorder (ASD), post-traumatic stress disorder (PTSD), adjustment disorder, and depression after the Fukushima disaster.

METHODS

We distributed questionnaires to 77 psychiatric institutions to determine the number of new outpatients between March and June in 2010, 2011, and 2012.

FINDINGS

There were 771, 1000, and 733 new patients in 2010, 2011, and 2012, respectively. We observed a statistically significant increase in new patients with ASD or PTSD and a significant decrease in patients with depression in 2011, which returned to predisaster levels in 2012.

CONCLUSIONS

There were time- and disease-dependent changes in the numbers of psychiatric care-seeking individuals after the 3.11 complex disaster in Fukushima.

The Relationship between Sleep Time and Mental Health Problems According to the Strengths and Difficulties Questionnaire in Children after an Earthquake Disaster: The Fukushima Health Management Survey

A cross-sectional study was performed on the adverse effects of sleep time on the mental health of children after the Great East Japan Earthquake and subsequent nuclear reactor accident in March 2011. The target participants were children aged 4–15 years living inside the government-designated evacuation zone as of 11 March 2011 (n = 29,585). The participants’ parents/guardians completed the Strengths and Difficulties Questionnaire (SDQ) and sleep time data were obtained from the 2011 Fukushima Health Management Survey. A total of 18,745 valid responses were returned. We excluded questionnaires with incomplete answers leaving 13,272 responses for the final analysis. First, we divided the children into three age groups for analysis. Second, we divided each age group into four or five groups based on sleep time per day. We used SDQ scores ≥16 to indicate a high risk of mental health problems. In the 4–6-year-old group, those with a sleep time of <9 h had a higher risk. In the 7–12-year-old group, those with ≥10 h of sleep time had a higher risk. In the 13–15-year-old group, those with ≥9 h of sleep time had a higher risk. Shorter sleep time was associated with a higher risk of mental health in 4–6-year-olds. On the other hand, oversleeping was associated with a high risk of mental health in 7–15-year-olds.

Dynamic changes in near-infrared spectroscopy (NIRS) findings in first-episode schizophrenia: a case report

The clinical course of schizophrenia is characterized by recurrence and chronicity and has a large burden on society.　Nevertheless, diagnosis of schizophrenia is based only on distinctive symptoms and the disease course.　Near-infrared spectroscopy (NIRS) is a useful method for measuring changes in the hemoglobin concentration in the cortical surface area and reflects brain function.　We measured NIRS four times during the clinical course in a patient with first-episode schizophrenia.A 17-year-old woman admitted to our hospital because of hallucinations, delusions and appetite loss. After treatment with low-dose antipsychotics, NIRS findings showed a prompt increase in the cerebral blood volume in the frontal region.　On the basis of the clinical course of this patient, we introduce a new point of view, namely, that NIRS findings may be useful as a state marker that indicates the severity of schizophrenia in some cases.

Exercise Habits Are Important for the Mental Health of Children in Fukushima After the Fukushima Daiichi Disaster

After the Great East Japan Earthquake and the subsequent nuclear reactor accident, the outdoor activities of children greatly decreased. We investigated adverse effects on the exercise habits and mental health of children after the disaster. The target subjects were children aged 6 to 15 years living inside the government-designated evacuation zone as of March 11, 2011 (n = 29  585). The subjects’ parents/guardians completed the Strengths and Difficulties Questionnaire (SDQ) and exercise habit data were obtained from the 2011 Fukushima Health Management Survey. A total of 18  745 valid responses were returned. We excluded questionnaires with incomplete answers leaving 10  824 responses for the final analysis. SDQ scores ≥16 indicated high risk of mental health. Children in the evacuation zone who did not get regular exercise had a higher risk of mental problems as evaluated by SDQ (multivariate-adjusted prevalence ratio [PR] = 1.49; 95% CI 1.38-1.62). When stratified by sex, age, place of residence, treatment for illnesses and experienced the nuclear reactor accident the associations were essentially the same. Regular exercise is important for maintaining children’s mental health after a disaster. This is the first large-scale report to examine the impact of outdoor exercise limitations among children in a nuclear accident.

The Relationship Between Functional Independence and Psychological Distress in Elderly Adults Following the Fukushima Daiichi Nuclear Power Plant Accident

This study aimed to explore the relationship between psychological distress and degree of functional independence among elderly adults following the Great East Japan Earthquake. Participants were 20 282 adults aged 65 and older who lived in the Great East Japan Earthquake evacuation zone specified by the government on March 31, 2011. This study is a part of a detailed survey on mental health and lifestyle, the Fukushima Health Management Survey, which was conducted in 2012. Psychological distress was assessed using the Kessler 6 scale. Functional independence in different daily activities was assessed by asking participants whether they could independently perform activities: eating, dressing, toileting, and shopping. According to the multiple logistic regression analysis, psychological distress was significantly associated with independence in all models: without adjustment (Model 1), adjusting for demographic characteristics (Model 2), and adjusting for demographic characteristics and disaster-related factors (Model 3), with an adjusted odds ratio of 2.32 (95% confidence interval = 1.97-2.73). High psychological distress was associated with low functional independence, after controlling for demographic characteristics and disaster-related factors. Thus, using psychological distress as the dependent variable, we examined the relationship between low functional independence and psychological distress among elderly adults who were evacuated.

Storage stability of serum formulations containing ofloxacin for autologous serum eardrop therapy

OBJECTIVE

The storage stability of serum formulations containing ofloxacin for autologous serum eardrop therapy was evaluated for microbiological quality and component stability.

METHODS

Sterile serum formulations were prepared by mixing human serum and ofloxacin otic solution (1:1, v/v). To simulate eardrop contamination with external ear surface substances, prepared serum formulations were contaminated with a cotton swab that was rubbed sufficiently on the human external ear. Formulations were stored at 4 °C or room temperature in the dark. Colony forming units (CFUs), ofloxacin, and basic fibroblast growth factor (bFGF) concentrations in the stored serum formulations were determined.

RESULTS

The growth of microorganisms derived from the external ear was not detected in serum formulations after storage for 14 days, regardless of temperature. However, microbial growth was detected in serum formulations stored without ofloxacin, indicating that this is necessary for storage. In addition, concentrations of ofloxacin and bFGF did not decrease over 14 days, indicating that ofloxacin and bFGF in serum formulations are stable for this time period.

CONCLUSION

The present study indicates that the efficacy and safety of serum formulations used as a therapy for perforated eardrums are stable and safe for at least 14 days.

The efficacy of antipsychotics for prolonged delirium with renal dysfunction

AIM

Delirium is commonly encountered in daily clinical practice. To identify predictors influencing outcomes, we retrospectively examined the characteristics of inpatients with delirium who required psychiatric medication during hospitalization.

METHODS

We extracted all new inpatients (n=523) consulted for psychiatric symptoms at Fukushima Medical University Hospital between October 2011 and September 2013. We selected 203 inpatients with delirium diagnosed by psychiatrists. We analyzed data from 177 inpatients with delirium who received psychiatric medication. We defined an "early improvement group" in which delirium resolved in ≤3 days after starting psychiatric medication, and a "prolonged group" with delirium lasting for >3 days. Among the 83 inpatients with renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m²), we defined an "early improvement group with renal dysfunction" in which delirium resolved in ≤3 days after starting psychiatric medication and a "prolonged group with renal dysfunction" with delirium lasting for >3 days. We then examined differences between groups for different categorical variables.

RESULTS

Dose of antipsychotic medication at end point was significantly lower in the prolonged group with renal dysfunction than in the early improvement group with renal dysfunction.

CONCLUSION

The results suggest that maintaining a sufficient dose of antipsychotics from an early stage may prevent prolongation of delirium even in inpatients with renal dysfunction.

Changes in the condition of psychiatric inpatients after the complex Fukushima disaster

After the high magnitude earthquake and the subsequent tsunami in Japan on March 11, 2011, the residents of Fukushima Prefecture suffered not only from tremendous physical injury caused by the earthquake and tsunami but also from the effects of radiation contamination after a hydrogen explosion at the Fukushima Daiichi nuclear power plant on March 12, 2011. The complex Fukushima disaster is characterized by additional stress due to the fear of continued exposure to invisible radiation. We investigated whether there were any changes in the clinical mental state of patients in the inpatient ward of Fukushima Medical University Hospital, Japan, 7 days after the earthquake. There was no obvious change in the condition of two-thirds of the patients. Whereas one-third of patients had any change in their condition, several cases showed dramatic symptomatic improvement after the earthquake. Anxiety levels in the patients who originally showed coexisting anxiety disorders became exaggerated. The depressive state was improved after the earthquake in one patient with depression. One patient with restrictive-type anorexia nervosa resumed food consumption. These findings suggest that caregivers should be attentive to any symptomatic changes among patients with psychiatric disorders after sudden disasters.

Event-related potentials in patients with adult attention-deficit/hyperactivity disorder versus schizophrenia

Event-related potentials (ERPs) such as Nd, N2b, and P300 in an attentional task and an auditory oddball task were compared among 54 adult AD/HD patients, 43 schizophrenic patients (SZ), and 40 healthy age-matched volunteers (HC). It is known that Nd, N2b, and P300 reflect selective attention, voluntary attention, and cognitive context updating respectively. The peak amplitude of P300 was significantly lower in the adult AD/HD and SZ groups than in the HC group. The peak latencies of late Nd, N2b, and P300 were significantly longer in the SZ group than in the HC and adult AD/HD groups. Thus, attenuated amplitude and prolonged latency of various ERP components in the SZ group suggest the possibility of impairment of basic mechanisms underlying cognitive processing. Unlike the SZ group, the adult AD/HD group exhibited reduced amplitude of P300 but not prolonged latency. These findings suggest the existence of a different type of cognitive dysfunction in the adult AD/HD group, which might be closely related to attentional function.

Expression and role of SNAT3 in the placenta

Glutamine is the most versatile amino acid and its plasma concentration is the highest of all amino acid. Many transporters are therefore involved in glutamine uptake or efflux. Glutamine is actively released from the placenta into fetal circulation. In this study, we examined the alteration of transporters that transport glutamine into fetal circulation as gestation progresses. High expression levels of system A and y(+)L were found in the rat placenta in the late period of pregnancy and the expression levels of these transporters increased as gestation progressed (p<0.05). On the other hand, the expression of SNAT3, the system N transporter, was detected in the early period of pregnancy and its expression level decreased as gestation progressed (p<0.05). SNAT3 was also found to be expressed in isolated human primary cytotrophoblast cells and its expression level was decreased by their differentiation into syncytiotrophoblast cells (p<0.05). Since this regulation is closely related to glutamine synthetase expression, SNAT3 may play a key role in providing glutamine corresponding to glutamine synthetase function in the early period of gestation. This is the first report on the expression of SNAT3 in the placenta in the early stage of pregnancy.

Functional and molecular analysis of D-serine transport in retinal Müller cells

D-serine, an endogenous co-agonist of NMDA receptors in vertebrate retina, may modulate glutamate sensitivity of retinal neurons. This study determined at the functional and molecular level the transport process responsible for D-serine in retinal Müller cells. RT-PCR and immunoblotting showed that serine racemase (SR), the synthesizing enzyme for D-serine, is expressed in the rMC-1 Müller cell line and primary cultures of mouse Müller cells (1 degrees MCs). The relative contributions of different amino acid transport systems to d-serine uptake were determined based on differential substrate specificities and ion dependencies. D-serine uptake was obligatorily dependent on Na+, eliminating Na+-independent transporters (asc-1 and system L) for D-serine in Müller cells. The Na+:substrate stoichiometry for the transport process was 1:1. D-serine transport was inhibited by alanine, serine, cysteine, glutamine, and asparagine, but not anionic amino acids or cationic amino acids, suggesting that D-serine transport in Müller cells occurs via ASCT2 rather than ASCT1 or ATB0,+. The expression of mRNAs specific for ASCT1, ASCT2, and ATB0,+ was analyzed by RT-PCR confirming the expression of ASCT2 (and ASCT1) mRNA, but not ATB0,+, in Müller cells. Immunoblotting detected ASCT2 in neural retina and in 1 degrees MCs; immunohistochemistry confirmed these data in retinal sections and in cultures of 1 degrees MCs. The efflux of D-serine via ASCT2 by ASCT2 substrates was demonstrable using the Xenopus laevis oocyte heterologous expression system. These data provide the first molecular evidence for SR and ASCT2 expression in a Müller cell line and in 1 degrees MCs and suggest that D-serine, synthesized in Müller cells by SR, is effluxed via ASCT2 to regulate NMDA receptors in adjacent neurons.