Hirohisa Kinoshita

Effects of cellular phone email use on the mental health of junior high school students in Japan

IN RECENT YEARS, cellular phone (CP) email has become a major communication method among young people in Japan. Furthermore, ‘cyberbullying’ via email, chat and message board postings on the Internet and CP is becoming an important issue. In the present study we conducted a largescale survey of junior high school students in Japan to investigate the effects of CP email on emotional status. The subjects consisted of a total of 10 709 junior high school students in grades 7–9 from Tsu City (5335 students) and Nagasaki City (5374 students). An anonymous 50-item self-completed questionnaire survey was conducted in July 2006 (Tsu) and January 2008 (Nagasaki). Students absent on the day of the survey and those whose questionnaires were left blank were excluded; 4894 and 4864 valid responses were obtained for Tsu and Nagasaki, respectively (total, 9758; boys, 4952; girls, 4806). Overall, 49.9% of students possessed a CP. The rate of possession increased with year in school; 39.6% of 7th graders, 50.2% of 8th graders and 59.3% of 9th graders possessed CP. In response to the question ‘Have you experienced stress during email exchange using your CP in the past week?’, 8.4% of students reported ‘once’, 2.6% reported ‘twice’, 5.5% reported ‘three times or more’ ( 3 times), and the remainder reported ‘never’. Logistic regression analysis was conducted controlling for grade and sex; odds ratios (OR) of the 12-item General Health Questionnaire (GHQ-12) poor mental health status (GHQ-12 score 4) were 1.83 (95% confidence interval [CI]: 1.57–2.12; once), 2.36 (95%CI: 1.81–3.07; twice), and 3.97 (95%CI: 3.25–4.85; 3 times) as compared to ‘never’. Thus, the number of occurrences of email-related stress was associated with poor mental health status. A significant association was also observed between subjects who answered ‘yes’ to the item ‘Have you been the victim of bullying within the past year?’ and those who reported ‘ 3 times’ to the email question (OR, 2.02; 95%CI: 1.65–2.49). The OR of the GHQ-12 poor mental health status for subjects who met the two aforementioned criteria was markedly high (19.30; 95%CI: 10.60–35.15) compared to those who answered ‘no’ to the bullying question and ‘never’ to the email question. Thus, a marked decline in mental health was observed in subjects who were experiencing both stress due to CP email use and bullying. These findings suggest that problems with CP email may have a considerable effect on the emotional status of young teens. CP email stress should be a new focus of mental health intervention in young people in Japan.

Could subclinical hypothyroidism cause periodic catatonia with delusional misidentification syndrome

PERIODIC CATATONIA IS a subtype of schizophrenia involving the repetition of two phases: catatonic excitement; and stupor. Delusional misidentification syndrome (DMS) is a relatively rare complex of symptoms that includes Capgras syndrome and Fregoli syndrome. We describe herein a case in which DMS during the course of refractory periodic catatonia improved dramatically with a low-dose thyroid preparation. The patient was a 29-year-old woman whose illness began with catatonic symptoms at 15 years of age. Catatonic periods occurred abruptly approximately once a month and the patient repeatedly exhibited a variety of psychotic symptoms, such as visual hallucinations and delusions. Each episode of excitement lasted 1–2 weeks, and the main symptoms during the remission period were blunted affect and thought disturbance. Auditory hallucinations worsened at 28 years old and she was admitted to Nagasaki University Hospital. No marked abnormalities were identified on electroencephalography or brain magnetic resonance imaging, ruling out organic disease. Although thyroid-stimulating hormone (TSH) was elevated (6.750 mU/mL), levels of T3 and T4 were within normal limits. The patient was sequentially given sufficient doses of risperidone, olanzapine, haloperidol, sodium valproate, and so on, but catatonic symptoms remained unimproved. Beginning around 12 months after admission, she exhibited Capgras syndrome, one of the forms of DMS, with respect to her father during catatonic periods. She repeatedly claimed that her father was an impostor and demonstrated extreme aggression and violence toward him. Moreover, DMS was refractory, with symptoms remaining present during remission periods. After 17 months of hospitalization, because it was considered that TSH was elevated and T4 was normal, a state of subclinical hypothyroidism (SCH) was indicated. Levothyroxine was initiated at 25 mg/day and increased to 75 mg/day for 2 weeks. Surprisingly, no periodic excitement occurred at all from that month onward. Furthermore, DMS improved within 1 week and was not seen again during the catatonic or remission periods. The patient was discharged 4 weeks later, and no exacerbation of catatonic symptoms has been seen in 4 years. Thyroid function has been maintained within the normal range. We are unaware of any reports of a thyroid preparation showing efficacy for DMS with SCH. DMS is often seen in diseases associated with cognitive dysfunction, such as schizophrenia and dementia with Lewy bodies, and cognitive dysfunction has been reported in patients with SCH, suggesting that DMS in the present case was essentially cognitive dysfunction with underlying SCH. Levothyroxine has been reported to decrease dopamine levels in cerebrospinal fluid. Levothyroxine administration could have improved the cognitive dysfunction resulting from SCH in the present case, and also to have improved the DMS by correcting excessive dopamine levels. The relationship between SCH and psychiatric disorders with cognitive dysfunction should be reconsidered.