Hiroyuki Suematsu

Statistical Studies on Anorexia nervosa in Japan: Detailed Clinical Data on 1,011 Patients

Statistical studies on anorexia nervosa in Japan were carried out by our research group. Questionnaires were sent to physicians at 1,030 representative institutions throughout Japan and data were collected from 315 institutions. The total number of patients with anorexia nervosa in 1981 was 940 outpatients and 372 inpatients. The number of patients in 1981 was twice as high as in 1976. Detailed data on 1,011 patients were investigated. As most of the patients had certain endocrinological abnormalities which improved after weight gain, indications are that at least a part of the endocrinological abnormalities might be secondary changes due to weight loss.

Epidemiological data on anorexia nervosa in Japan

An epidemiological survey on anorexia nervosa was performed in Japanese hospitals in 1985 and 1992 using a questionnaire. The reported number of patients with anorexia nervosa was 2391 from 732 institutions. From these data, the total number of anorexia nervosa patients treated in 1985 in Japanese hospitals was estimated to be about 3500-4500. In 1992, the reported number of patients with AN was 2247. The total number of AN patients treated in 1992 was estimated to be about 4500-4600, which is a little higher than that in 1985 (3500-4500). The prevalence was 3.6-4.5 per 100000 among the general population, 6.3-9.7 per 10(5) among the female population, and 25.2-30.7 per 10(5) among the 13-29 year-old female population.

Dissociation and child abuse histories in an eating disorder cohort in Japan

Dissociation and childhood abuse were studied in female eating disorder outpatients in Japan. A self‐report version of the Dissociative Disorders Interview Schedule (DDIS), which includes data on physical and sexual abuse, and the Dissociative Experiences Scale (DES) were used. Nine of 41 subjects who completed the DDIS reported symptoms suggesting DSM‐III‐R multiple personality, and 6 of the 39 subjects who completed the DES scored over 30 (reflecting a high likelihood of posttraumatic stress or multiple personality). Subjects’ sexual abuse history rates were considerably greater then those in the Japanese general population. Though physical abuse history was associated with high dissociation, no difference was seen between the high and low dissociators in sexual abuse histories.

Clinical effects of blood pressure biofeedback treatment on hypertension by auto-shaping

Objective Although biofeedback has been reported to be efficacious in the treatment of hypertension, the degree of response has varied. This study investigated the mechanisms of blood pressure reduction by biofeedback. Method: Thirty outpatients with essential hypertension (10 men and 20 women) aged 38 to 65 years were studied. Subjects were randomly assigned to group A or B. Subjects in group A underwent biofeedback treatment once a week for a total of four sessions. Those in group B self-monitored their blood pressure during the sessions as the control period and later underwent the same biofeedback treatment. Results: Blood pressure measured by doctor was reduced by 17 +/- 18/8 +/- 7 (p <.01) and elevation of pressure induced by mental stress testing was suppressed by 8 +/- 9 (p <.05)/4 +/- 8 during the treatment period in group A (mm Hg). In group B, both blood pressure measured by doctor and elevation of pressure by mental stress testing remained unchanged during the control period and they were later suppressed by 20 +/- 15/9 +/- 7 (p <.01) and 11 +/- 10 (p <.05)/5 +/- 9 by the biofeedback treatment. Self-monitored pressure in both groups tended to decrease by the biofeedback treatment. Systolic and diastolic pressures as well as pulse rate decreased, skin temperature increased, and alpha-wave amplitude on electroencephalography increased during the therapy (p <.05). Conclusion: This treatment was effective in suppressing the pressor response to stress. Patients whose blood pressure increases with stress may be suited for biofeedback intervention.

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.

Relationship of parental bonding to child abuse and dissociation in eating disorders in Japan

Parental bonding patterns were studied in 52 female Japanese eating disorder outpatients with and without histories of sexual or physical abuse and with dissociation. Instruments included the Parental Bonding Instrument (PBI), the Dissociative Experiences Scale (DES) and the Dissociative Disorders Interview Schedule (DDIS). Those with physical abuse history, but not sexual abuse history, had significantly different parental bonding scores and higher DES scores compared with subjects without physical abuse. DES scores and PBI scores were not correlated. Although the PBI was useful in discriminating between those with and those without abuse histories, it did not detect differences in degree of dissociation. Lack of association of sexual abuse to PBI and DES scores may have been due to mild abuse.

Hemodynamic and Endocrine Responsiveness to Mental Arithmetic Task and Mirror Drawing Test in Patients With Essential Hypertension

To evaluate the reactivity to psychological stress in patients with essential hypertension we investigated hemodynamic and endocrinologic changes during a mental arithmetic task (MAT) and a mirror drawing test (MDT) in 10 hypertensive subjects. Hemodynamic changes were assessed continuously using an ambulatory radionuclide cardiac detector. There were significant increases in systolic blood pressure (deltaSBP: +37.8 +/- 11.1 and +41.0 +/- 9.4 mm Hg during MAT and MDT, respectively, P < .01) and diastolic blood pressure (deltaDBP: +17.5 +/- 3.1 and +21.2 +/- 3.9 mm Hg, P < .01) and in heart rate (deltaHR: +17.1 +/- 5.3 and +12.5 +/- 2.9 beats/min, P < .01) during both tasks in association with an increase in cardiac output (CO). The plasma levels of norepinephrine and epinephrine increased during both the MAT (deltaNE: +0.074 +/- 0.022 ng/mL, P < .01; deltaEP: +0.068 +/- 0.025 ng/mL, P < .01) and the MDT (deltaNE: +0.067 +/- 0.034 ng/mL, P < .01; deltaEP: +0.030 +/- 0.011 ng/mL, .05 < P < .1). Although the deltaNE was similar in response to the MAT and MDT, the deltaEP during the MDT tended to be less than half the deltaEP during the MAT (.05 < P < .10). The deltaEP was positively correlated with the deltaDBP and the deltaCO during both tasks and with the deltaSBP and the deltaHR during the MAT. These findings suggest that MAT- and MDT-induced increases in BP were attributable mainly to an increase in CO, possibly as the result of stimulation of the sympathoadrenomedullary system. However, the sympathoadrenomedullary system appeared to be more closely associated with the hemodynamic responses during the MAT than during the MDT.

Treatment of a depressive disorder patient with EEG-driven photic stimulation

This study examined the effects of electroencephalographic-(EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subjects own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression, and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment. Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression, or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patients depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.

Reliability and validity of a Japanese version of the Eating Disorder Inventory.

The rapid increase of patients with eating disorders in Japan has made necessary the reliable and valid measurement of psychological factors in eating disorders. The purpose of this study was to examine the reliability and validity of the Japanese version of the Eating Disorder Inventory. 766 females without eating disorders and 139 female patients with eating disorders responded to the Eating Attitude Test and the Eating Disorder Inventory. Principal factor extraction with promax rotation isolated 9 interpretable factors with satisfactory internal consistency (Cronbach alpha range = .74–.90). Compared with controls, patients scored significantly higher on all factors after minimizing the influence of Body Mass Index. There were strong correlations among factor scores and scores on the Eating Attitudes Test, particularly among patients. These results indicate the Eating Disorder Inventory as showing psychometrically sound internal consistency and concurrent validity.

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.