Gaku Yamanaka

Comorbidity of Irritable Bowel Syndrome, Panic Disorder, and Agoraphobia in a Japanese Representative Sample

OBJECTIVES:Irritable bowel syndrome (IBS) is considered to be a transcultural functional bowel disorder with high comorbidity and psychiatric disorders; but well-designed epidemiologic studies have never been performed in Japan. The purpose of this study was to establish the prevalence of IBS, together with the comorbidity rates of panic disorder (PD) and agoraphobia, employing a large-scale survey based on stratified random sampling.METHOD:A total of 4,000 subjects aged 20–69 years completed a questionnaire and the results were weighted to ensure representativeness of the Japanese general population. The questionnaire covered key symptoms of IBS, PD, and agoraphobia. The prevalence of IBS and its subtypes was calculated by gender. The comorbidity of PD and agoraphobia with IBS was compared with morbidity in non-IBS subjects; and comorbidity in IBS subjects who had consulted medical practitioners regarding their symptoms and in those who had not was also compared.RESULTS:The prevalence of IBS was 6.1% in total. It was significantly higher in females than in males. Diarrhea-predominant IBS was more prevalent in males and constipation-predominant IBS in females. The morbidity rates of PD and agoraphobia were significantly higher in IBS than in non-IBS subjects. Comorbidity did not differ between female and male IBS subjects, while morbidity was significantly higher in female than in male non-IBS subjects; and comorbidity did not differ between consulter and nonconsulter subjects.CONCLUSIONS:The prevalence of IBS and its comorbidity with PD and agoraphobia in Japan were demonstrated to be similar to those reported in Western industrialized countries.

Major Depression and Somatic Symptoms in a Mind/Body Medicine Clinic

This study examined the prevalence of somatic symptoms and psychiatric characteristics of major depression in a Japanese psychosomatic outpatient clinic. A total of 2,215 outpatients referred for mind/body complaints were assessed by DSM-III-R or DSM-IV. Somatic symptoms were rated using the Cornell Medical Index Questionnaire. Ninety-one outpatients (4.1%) were diagnosed with major depression. Prevalence of fatigue (86%), insomnia (79%), nausea/vomiting (50%), and back pain (36%) as well as degrees of psychosocial stress (DSM-III-R axis IV) were higher (all p < 0.05) and scores of global assessment of psychosocial functioning (DSM-III-R/DSM-IV axis V) were lower (p < 0.001) in the major depressive patients compared to the remaining outpatients. Among the major depressive patients, the total number of somatic symptoms was larger (p < 0.05) in patients with ‘severe’ major depressive episodes than in those with ‘mild’ depressive episodes. These findings suggest that the level of depression is closely linked to the reporting of somatic symptoms in a psychosomatic medicine population.

Assessment of Patients by DSM-III-R and DSM-IV in a Japanese Psychosomatic Clinic

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9–95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview. Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was ‘somatoform disorders not otherwise specified’, followed by bulimia nervosa, ‘depressive disorder not otherwise specified’, anorexia nervosa, conversion disorder, major depression or depressive disorder, ‘panic disorder with agoraphobia‘, and ‘psychological factors affecting physical or medical condition’. On axis II, 11–17% of the patients met the criteria for personality disorder. On axis IV, 78–80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.

QT interval and QT dispersion in eating disorders

Background: Eating disorders are thought to be risk factors for cardiac sudden death secondary to arrhythmia. Results in previous studies on QT interval and QT dispersion, markers of fatal arrhythmia, have been inconsistent. Methods: We prospectively examined 179 female eating disorder patients, being over 18 years old and diagnosed according to the DSM-IV criteria between January 1995 and December 2002, and 52 healthy women. Patients with abnormal plasma electrolytes or taking medications that might influence the electrocardiogram (ECG) were excluded from the study. QT intervals were corrected for heart rate using Bazett’s formula and the nomogram method, which is more reliable at extremely low heart rates than Bazett’s formula. QT dispersion was measured as the difference between the longest and shortest QT intervals. QT intervals and QT dispersion in each patient group were compared with those in the control group. Results: The 164 eligible patients consisted of 43 patients with anorexia nervosa restricting type, 35 with anorexia nervosa binge eating/purging type, 63 with bulimia nervosa purging type, and 23 with bulimia nervosa nonpurging type. There was no significant difference in age between eating disorder patients and controls. QT interval and QT dispersion were significantly longer in all eating disorder subtypes than in the control group. QT interval and QT dispersion were significantly correlated with the rate of body weight loss in bulimia nervosa. Conclusions: QT interval and QT dispersion were prolonged in both anorexia nervosa and bulimia nervosa. Examination of ECG in eating disorder patients without extremely low body weight also appears to be clinically important.

Coping skills in Japanese women with eating disorders.

The aim of this study was to investigate coping skills in the different types of eating disorders in Japan. Groups of patients with eating disorders diagnosed with DSM-IV and 22 controls were studied. Coping skills were assessed with the Stress Coping Inventory. The mean Problem-focused coping score tended to be lower in the bulimia nervosa purging-type group (n = 20) than in the control group. The former group and the bulimia nervosa nonpurging-type group (n = 6) used significantly less planful problem solving and less positive reappraisal coping than the control group, while the anorexia nervosa restricting-type group of 11 tended to use less positive reappraisal, and the anorexia nervosa binge-eating/purging-type (n = 11) tended to use less planful problem solving and less positive reappraisal than the control group. As some uses of coping skills by patients with eating disorders were lower than those of the control group, developing coping skills may be useful in treatment for eating disorders in Japan.

Relations among premorbid weight, referral weight, and psychological test scores for patients with anorexia nervosa.

The purpose of this study was to test the hypothesis that, in anorexia nervosa, patients with a low premorbid weight are associated with a low weight at referral and that premorbid weight, referral weight, and weight loss are associated with mood states. The changes of Body Mass Index from premorbid to referral, the duration of illness, and the psychological scores on the Profile of Mood States and the Cornell Medical Index-Health Questionnaire were examined in 49 anorexia nervous patients. Body Mass Index at referral of patients with lower premorbid Body Mass Index was significantly lower than that of patients with higher premorbid level. For patients with a larger relative decrease, scores on depressive mood were lower. These findings suggested that in anorexia nervosa patients, lower premorbid Body Mass Index was associated with lower Body Mass Index at referral, and that the patients with higher relative decrease in Body Mass Index might be satisfied with their weight loss.

Efficacy of media in motivating patients with panic disorder to visit specialists

In 97 patients who visited Akasaka Clinic, their chief complaints, the form of media which motivated patients to visit the clinic, and their DSM‐IV diagnoses were examined. The media which most frequently motivated the patients were books (35%), TV programs (23%), and the Internet (16%). While many of patients complained of panic attacks, 74.2% were diagnosed as having anxiety disorder, 12% had somatoform disorder and 8% did not have any mental illness. The rate of panic disorder tended to be higher in patients motivated by TV programs (70%) and significantly lower in those motivated by the reading of books (48%). These results suggest that enlightenment of panic disorder using the media, especially that by TV programs, effectively motivates patients with panic disorder.

Approaches to the Treatment of Somatoform Disorders in Internal Medicine

This chapter discusses the prevalence of somatoform disorders and their treatment approaches in internal medical settings. The subjects of this study were 424 new outpatients in 1997 on our department. In the diagnosis distribution by Axis I of DSM-IV, eating disorders were the largest in number (19.4%), followed by somatoform disorders (18.2%). The number of somatoform disorder patients was 77 (male 28, female 49). In somatoform disorders, somatoform disorder not otherwise specified (NOS) was seen most often (32.5%), followed by pain disorder (22.1%), conversion disorder (19.5%), hypochondriasis (14.3%), and undifferentiated somatoform disorder (11.7%). The treatment for somatoform disorders included mainly supportive psychotherapy and pharmacological treatment. Other therapies included autogenic training and behavior therapy. The pharmacological treatments for somatoform disorders were mainly antianxiety drugs, partial antidepressants, and sleep inducers. In the management of somatoform disorders, both physiological and psychological approaches should be considered. Medication such as antianxiety drugs may be effective in alleviating patients’ symptoms. In addition, a psychotherapeutic approach might be necessary to resolve their complaints.

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