Junya Fujino

Impaired empathic abilities and reduced white matter integrity in schizophrenia.

Empathic abilities are impaired in schizophrenia. Although the pathology of schizophrenia is thought to involve disrupted white matter integrity, the relationship between empathic disabilities and altered white matter in the disorder remains unclear. The present study tested associations between empathic disabilities and white matter integrity in order to investigate the neural basis of impaired empathy in schizophrenia. Sixty-nine patients with schizophrenia and 69 age-, gender-, handedness-, education- and IQ level-matched healthy controls underwent diffusion-weighted imaging. Empathic abilities were assessed using the Interpersonal Reactivity Index (IRI). Using tract-based spatial statistics (TBSS), the associations between empathic abilities and white matter fractional anisotropy (FA), a measure of white matter integrity, were examined in the patient group within brain areas that showed a significant FA reduction compared with the controls. The patients with schizophrenia reported lower perspective taking and higher personal distress according to the IRI. The patients showed a significant FA reduction in bilateral deep white matter in the frontal, temporal, parietal and occipital lobes, a large portion of the corpus callosum, and the corona radiata. In schizophrenia patients, fantasy subscales positively correlated with FA in the left inferior fronto-occipital fasciculi and anterior thalamic radiation, and personal distress subscales negatively correlated with FA in the splenium of the corpus callosum. These results suggest that disrupted white matter integrity in these regions constitutes a pathology underpinning specific components of empathic disabilities in schizophrenia, highlighting that different aspects of empathic impairments in the disorder would have, at least partially, distinct neuropathological bases.

Can we predict burnout severity from empathy-related brain activity?

Empathy cultivates deeper interpersonal relationships and is important for socialization. However, frequent exposure to emotionally-demanding situations may put people at risk for burnout. Burnout has become a pervasive problem among medical professionals because occupational burnout may be highly sensitive to empathy levels. To better understand empathy-induced burnout among medical professionals, exploring the relationship between burnout severity and strength of empathy-related brain activity may be key. However, to our knowledge, this relationship has not yet been explored. We studied the relationship between self-reported burnout severity scores and psychological measures of empathic disposition, emotional dissonance and alexithymia in medical professionals to test two contradictory hypotheses: Burnout is explained by (1) ‘compassion fatigue’; that is, individuals become emotionally over involved; and (2) ‘emotional dissonance’; that is, a gap between felt and expressed emotion, together with reduced emotional regulation. Then, we tested whether increased or decreased empathy-related brain activity measured by fMRI was associated with burnout severity scores and psychological measures. The results showed that burnout severity of medical professionals is explained by ‘reduced’ empathy-related brain activity. Moreover, this reduced brain activity is correlated with stronger emotional dissonance and alexithymia scores and also greater empathic disposition. We speculate that reduced emotion recognition (that is, alexithymia) might potentially link with stronger emotional dissonance and greater burnout severity alongside empathy-related brain activity. In this view, greater empathic disposition in individuals with higher burnout levels might be due to greater difficulty identifying their own emotional reactions. Our study sheds new light on the ability to predict empathy-induced burnout.

Altered brain response to others׳ pain in major depressive disorder

BACKGROUND Empathy has a central role in successful interpersonal engagement. Several studies have reported altered empathy in major depressive disorder (MDD), which could lead to interpersonal difficulties. However, the neural basis of altered empathy in the disorder is still largely unknown. To address this, we performed functional magnetic resonance imaging that tested empathy for others׳ pain in MDD patients. METHODS Eleven patients with MDD and 11 age-, gender-, handedness-, and education level-matched healthy control subjects were studied. We compared MDD patients and healthy controls for their regional hemodynamic responses to visual perception of videos showing human hands in painful situations. We also assessed subjective pain ratings of the videos in each group. RESULTS The MDD patients showed lower pain ratings for the painful videos compared with the healthy controls. In addition, the MDD patients showed reduced cerebral activation in the left middle cingulate cortex, and the right somatosensory-related cortices, whereas they showed greater cerebral activation in the left inferior frontal gyrus. LIMITATIONS We relied on a relatively small sample size and could not exclude effects of medications. CONCLUSIONS These results suggest that in MDD patients the altered neural activations in these regions may be associated with a deficit in the identification of pain in others. This study adds to our understanding of the neural mechanism involved in empathy in MDD.

Anterior cingulate volume predicts response to cognitive behavioral therapy in major depressive disorder

BACKGROUND Cognitive behavioral therapy (CBT) is widely used to treat major depressive disorder (MDD). Although improved response prediction could facilitate the development of individualized treatment plans, few studies have investigated whether underlying brain structure is related to CBT response in MDD. METHODS Ten MDD patients who received individual CBT were studied in this study. We investigated the relationship between the regional gray matter (GM) volume and subsequent responses to CBT using voxel-based morphometry. RESULTS The degree of improvement in depressive symptoms was positively correlated with GM volume in the caudal portion of the anterior cingulate cortex. LIMITATIONS The sample size was small, and the effects of medication on the results could not be excluded. CONCLUSIONS Our results, although preliminary, suggest that the anterior cingulate cortex is a key structure whose volume can be used to predict responses to CBT and is thus a potential prognostic marker in MDD.

Attitudes toward risk and ambiguity in patients with autism spectrum disorder

Although the ability to make optimal decisions under uncertainty is an integral part of everyday life, individuals with autism spectrum disorder (ASD) frequently report that they experience difficulties with this skill. In behavioral economics, researchers distinguish two types of uncertainty to understand decision-making in this setting: risk (known probabilities) and ambiguity (unknown probabilities). However, it remains unclear how individuals with ASD behave under risk and ambiguity, despite growing evidence of their altered decision-making under uncertainty. We therefore extended previous research by studying the attitudes of those with ASD toward risk and ambiguity in both positive and negative contexts (i.e., gain and loss). In gain contexts, no significant difference was observed between the groups in risk attitudes, but ambiguity aversion was attenuated in ASD. In loss contexts, ambiguity attitudes did not significantly differ between the groups, but the ASD participants were less risk-seeking compared with the controls. In addition, insensitivity to the context change under risk and ambiguity in ASD was both significantly associated with poor social skills. These results improve our understanding of altered decision-making under uncertainty by disentangling the attitudes toward risk and ambiguity in ASD individuals. Applying behavioral economic tools may provide insights into the mechanisms underlying behavioral disturbances in ASD.

Neural mechanisms and personality correlates of the sunk cost effect

The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect.

Are ambiguity aversion and ambiguity intolerance identical? A neuroeconomics investigation.

In recent years, there has been growing interest in understanding a persons reaction to ambiguous situations, and two similar constructs related to ambiguity, “ambiguity aversion” and “ambiguity intolerance,” are defined in different disciplines. In the field of economic decision-making research, “ambiguity aversion” represents a preference for known risks relative to unknown risks. On the other hand, in clinical psychology, “ambiguity intolerance” describes the tendency to perceive ambiguous situations as undesirable. However, it remains unclear whether these two notions derived from different disciplines are identical or not. To clarify this issue, we combined an economic task, psychological questionnaires, and voxel-based morphometry (VBM) of structural brain magnetic resonance imaging (MRI) in a sample of healthy volunteers. The individual ambiguity aversion tendency parameter, as measured by our economic task, was negatively correlated with agreeableness scores on the self-reported version of the Revised NEO Personality Inventory. However, it was not correlated with scores of discomfort with ambiguity, one of the subscales of the Need for Closure Scale. Furthermore, the ambiguity aversion tendency parameter was negatively correlated with gray matter (GM) volume of areas in the lateral prefrontal cortex and parietal cortex, whereas ambiguity intolerance was not correlated with GM volume in any region. Our results suggest that ambiguity aversion, described in decision theory, may not necessarily be identical to ambiguity intolerance, referred to in clinical psychology. Cautious applications of decision theory to clinical neuropsychiatry are recommended.

Effectiveness of aripiprazole in a patient with presumed idiopathic Parkinson's disease and chronic paranoid schizophrenia

population such as Chinese, Japanese, and Korean, reflecting cultural differences?’ We believe we should not bundle discussions on east-Asian countries together as if dealing with one homogenous group. But although suicide is indeed a complex phenomenon, it does consists of two elements: a universal element and a specific element. As for the universal element, livelihood issues and mental ill-health are always key issues in suicidal individuals irrespective of time and country. Therefore, availability and accessibility to livelihood support as well as primary and mental health-care services play important roles. In urban areas where such resources could be sufficiently provided, our case management intervention system, which is an integration of the medical model with the community model, might be effective. But education and enlightenment on mental illness and suicide prevention are also necessary. The universal health-care system that has developed in Japan means that Japanese people who live in urban areas should have easy access to psychiatrists, although we do not think that they are used to doing so. And this situation has contributed to the current high suicide rate in Japan. We suggest that the firstand second-line interveners, such as family members, colleagues at work and physicians, should be gatekeepers for suicide prevention. In rural areas where medical and social resources are often insufficient, there is a greater need for community intervention targeted at citizens and workers. Primary healthcare workers, officers, and general practitioners are expected to be knowledgeable about suicide prevention intervention. As a whole, education on the awareness of mental illness is a pressing need. Suicide has been regarded as taboo everywhere, but possibly especially so in Asian countries. Regarding Professor Pae’s second question, ‘Did the authors find any meaningful differences in the clinical outcome in accordance with clinical variables in this study?’, we reply as follows. Our case management intervention is always highly individualized, and our research protocol was not suitable to test the effects of individual interventions precisely. We would say, however, that our case intervention model might be effective especially for patients with mood disorders because these patients, who made up approximately 25% of all suicide attempters in our study, did not reattempt suicide. To examine in detail the effectiveness of continuous follow-up care by case management after suicide attempt, a randomized, controlled, multicenter trial (ACTION-J) was launched in 2005 in Japan. We hope that the results of that trial will be useful in developing effective strategies to prevent further suicide attempters.

Inflexible daily behaviour is associated with the ability to control an automatic reaction in autism spectrum disorder

Inflexible behaviours in people with autism spectrum disorder (ASD) broadly obstruct social communication. Meanwhile, flexibility implicates cognitive control to resolve socially conflicting situations; however, it remains unclear how people with ASD behave in the face of these conflicts in this respect. We used the ultimatum game (UG) and the implicit-association test (IAT) to examine goal-directed/economic flexibility, both of which involve conflict and cognitive control. In addition, we used the Detail and Flexibility Questionnaire (DFlex) to measure inflexible everyday behaviour with diminished cognitive control and attention shifting. We observed the decreased flexibility in participants with ASD (DFlex and IAT); further, their IAT scores positively correlated with DFlex. However, in the UG, contrary to our prediction, participants with ASD accepted unfair offers more frequently than TD. These results suggest that assessing the automatic/attention processing level with the IAT could be a useful approach to study behavioural flexibility among ASD compared with the UG, which might comprise multiple response strategies besides economic rationality. Overall, the severity of inflexible daily behaviours in people with ASD may be associated with a reduced flexible attitude at an automatic level, altered attention processing and decreased cognitive control.

Sense of meaning in work and risk of burnout among medical professionals.

tic and visual stimulation, and a CRS-Score of 11. Thus, we decided to increase Zp dosage up to 30 mg (administered for around 3 weeks), with a further improvement of CRS-R score (i.e. 13) and EEG (presence of theta-beta rhythm over both the temporal areas), and without relevant side-effects. Our case further supports the hypothesis of a positive effect of Zp, although at higher dosage, in improving consciousness in VS. After brain injury or cerebral anoxic damage there is a change either in the levels of glutamate (resulting in neurotoxicity) or GABA neurotransmission, with reduced cell metabolism and blood flow in brain areas adjacent to the damaged area. By binding to modified GABAA receptors of the ‘neurodormant cells’, Zp may cause reversal of the abnormal state and associated metabolic inhibition, with a consequent arousal. For the first time, we used a higher dose of Zp (30 mg) to evaluate whether the drug’s response could be dose-dependent. Indeed, our patient’s improvement was strictly related to the increase in Zp dosage, with a relatively good response at 30 mg. We are not able to explain this interesting finding, although a more effective action of high-dose Zp on the centrothalamic activity (by potentiating the ‘mesocircuit’), could be taken into account. Zp may be a valuable treatment in improving consciousness, although further studies should be fostered to confirm its efficacy, the proper dosage, and long-term safety.