Aran Tajika

EEG Global Field Power Spectrum Changes After a Single Dose of Atypical Antipsychotics in Healthy Volunteers

Effects of four novel atypical antipsychotic drugs (olanzapine, perospirone, quetiapine, and risperidone) on scalp-recorded multi-channel EEGs were compared with two conventional antipsychotic drugs (chlorpromazine and haloperidol) and placebo in 14 healthy male volunteers. All subjects went through seven sessions. In each session, EEGs were recorded before and 2, 4 and 6 hours after drug administration. Global Field Power (GFP) in delta frequency band (1.5-6 Hz) increased around the time of peak serum concentration of quetiapine and risperidone compared to baseline. The increase of GFP in delta activity after quetiapine was significantly prominent in comparison to two other atypical antipsychotic drugs, perospirone and olanzapine, as well as to typical antipsychotic drugs, chlorpromazine and haloperidol (p<0.05). The increase in GFP of delta after risperidone was more prominent in comparison to after haloperidol (p<0.05). The greater sedative effects after quetiapine and risperidone may reflect the high affinity to A1 and H1 receptor bindings of these drugs. According to Low Resolution Electromagnetic Tomography (LORETA), olanzapine increased the delta in the posterior region indicating a frontal shift of brain activity, suggesting that olanzapine may be useful against negative symptoms in schizophrenics.

Psychological characteristics of Japanese patients with chronic pain assessed by the Rorschach test

BackgroundThe increasing number of patients with chronic pain in Japan has become a major issue in terms of the patients quality of life, medical costs, and related social problems. Pain is a multi-dimensional experience with physiological, affective, cognitive, behavioral and social components, and recommended to be managed via a combination of bio-psycho-social aspects. However, a biomedical approach is still the dominant method of pain treatment in Japan. The current study aimed to evaluate comprehensive psychological functions and processes in Japanese chronic pain patients.MethodsThe Rorschach Comprehensive System was administered to 49 in-patients with non-malignant chronic pain. Major variables and frequencies from the test were then compared to normative data from non-patient Japanese adults by way of the t-test and chi-square test.ResultsPatients exhibited high levels of emotional distress with a sense of helplessness with regard to situational stress, confusion, and ambivalent feelings. These emotions were managed by the patients in an inappropriate manner. Cognitive functions resulted in moderate dysfunction in all stages. Information processing tended to focus upon minute features in an inflexible manner. Mediational dysfunction was likely to occur with unstable affective conditions. Ideation was marked by pessimistic and less effective thinking. Since patients exhibited negative self-perception, their interpersonal relationship skills tended to be ineffective. Originally, our patients displayed average psychological resources for control, stress tolerance, and social skills for interpersonal relationships. However, patient coping styles were either situation- or emotion-dependent, and patients were more likely to exhibit emotional instability influenced by external stimuli, resulting in increased vulnerability to pain.ConclusionsData gathered from the Rorschach test suggested psychological approaches to support chronic pain patients that are likely to be highly beneficial, and we thus recommend their incorporation into the course of current pain treatments.

Syndrome of inappropriate secretion of anti-diuretic hormone in an elderly depressive patient receiving paroxetine: a case report

Paroxetine is a selective serotonin reuptake inhibiter (SSRI) widely used to treat depression. SSRI can also be prescribed to elderly patients with comparative safely because there are fewer serious side-effects of SSRIs compared with those of tricyclic anti-depressants. However, fatal side-effects induced by SSRIs have sometimes been observed. Jacob and Spinler (2006) reported hyponatremia associated with SSRI with an incidence varying from 0.5–32% (Jacob and Spinler, 2006). This case report describes a case of syndrome inappropriate secretion of anti-diuretic hormone (SIADH) in association with paroxetine therapy in an elderly patient. In SIADH, ADH stimulates the retention of water in the absence of appropriate physiological stimuli. The cardinal signs are as follows: (a) hyponatremia (serum sodium concentration< 135mmol/L) with corresponding hypo-osmolarity of the serum and extracellular fluid (osmolarity< 280mOsm/L); (b) if the urine is hypertonic relative to the plasma; (c) the absence of clinical evidence of fluid volume depletion; (d) normal renal function; and (e) normal adrenal function. Common symptoms include lethargy, fatigue, anorexia, sleep disturbance, muscle cramps and headaches. These symptoms may progress as the hyponatremia worsens to include nausea and vomiting, confusion, seizure, coma and ultimately death because of cerebral edema (Kirby and Ames, 2001).

Neuropsychological Evaluation and Cerebral Blood Flow Effects of Apolipoprotein E4 in Alzheimer's Disease Patients after One Year of Treatment: An Exploratory Study.

Background: Alzheimers disease (AD) is affected by apolipoprotein E (ApoE); however, its effects assessed by means of cognitive tests and by neuroimaging have not been sufficiently studied. Methods: We administered the Alzheimers Disease Assessment Scale (ADAS) and single-photon emission computed tomography imaging in patients with AD medicated with donepezil at baseline and after 1 year. Patients were classified as with or without ApoE4 and we evaluated the progress of AD. Results: Analysis of covariance showed that cerebral blood flow after 1 year in subjects with ApoE4 is significantly reduced in some areas including the left lenticular nucleus, left thalamus, and right hippocampus compared with subjects without ApoE4. Paired t tests showed significantly reduced blood flow in several regions including the right hippocampus in subjects with ApoE4 and significant deterioration of ideational praxis in subjects without ApoE4. Conclusion: This study provides evidence that supports the notion of ApoE4 playing an important role in the progress of AD.

Olfactory reference syndrome treated by blonanserin augmentation

IN PATIENTS WITH coronary heart disease (CHD), depression following myocardial infarction (MI) is associated with a 2–2.5-fold increased risk for severe adverse cardiovascular events and we have highly effective treatments for major depressive disorder (MDD). Why have large-scale studies of patients with depression and comorbid CHD repeatedly failed to show that effective treatment of depression improves cardiac outcome? We believe that the mismatch between instruments used in depression and those used in CHD is the most likely explanation. Using the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial as an example of this mismatch, the method used to assess depression was based on modified DSM-IV-TR criteria for either current MDD, minor depressive disorder with a history of past MDD, or dysthymia. The principle modification was that current symptoms of depression must be present for 7 days instead of 14 days to facilitate enrollment and start treatment early. A structured version of the 17-item Hamilton Depression Rating Scale (HDRS) was integrated with the National Institute of Mental Health Diagnostic Interview Scale as modified for cardiac patients to form a new instrument: the Depression Interview and Structured Hamilton (DISH). According to the ENRICHD authors, the DISH produces accurate DSM-IV diagnoses, assesses the longitudinal course of the depressive disorder, and provides a reliable HDRS. The method used to assess CHD in the ENRICHD study focused on acute MI and required a characteristic increase in creatine kinase cardiac isoenzyme above the upper limits of the reference or an increase in other biomarkers to more than twice the upper limit. When cardiac isoenzyme values were less than twice the reference range, there was a mandatory review by the onsite cardiologist. Also, at least one of the following must have been present: (i) symptoms compatible with acute MI; or (ii) characteristic evolutionary electrocardiographic ST-T wave changes or new Q waves. Thus, instruments used in depression are less rigorous than those used in CHD. Depression instruments largely employ scales of categorical variables, when most depressive symptoms/behaviors are better described on ordinal scales. During instrument development, subjects with comorbid medical illness were excluded during field-testing. Parametric statistics were often used to analyze non-Gaussian data. These factors may explain why treatment of depression has not been found to improve cardiovascular conditions. We propose using the objectivity of CHD parameters to assess the efficacy of psychiatric interventions in patients with comorbid depression and to define the link between depression and CHD. REFERENCES

Comparative research between Australia and Japan : A comparison of the quality of health care in nursing facilities using actigraphy

Aim:u2003 Aging in Japan is advancing at a globally unprecedented rate. In Japan, the provision of high quality nursing care for aged people is needed. In the present study, we clarify the effect of different environments and nursing care service on the life rhythm of aged people in Japan and Australia.