Makio Iimori

Caffeic acid produces antidepressive- and/or anxiolytic-like effects through indirect modulation of the alpha 1A-adrenoceptor system in mice.

&NA; We previously reported that caffeic acid produce antidepressiveand/or anxiolytic‐like effects in two different types of stress models. It has recently been reported that caffeic acid affects the &agr;1A‐adrenoceptor system. The present study examined whether the &agr;1A‐adrenoceptor system is involved in the antidepressive‐ and/or anxiolytic‐like effects of caffeic acid. Caffeic acid reduced the duration of immobility and freezing of mice produced by forced swimming and conditioned fear stress, respectively. These effects of caffeic acid were suppressed by the &agr;1‐ and &agr;1A‐adrenoceptor antagonists. However, caffeic acid did not alter the binding of [3H]prazosin to &agr;1A‐adrenoceptor in mouse cortical membranes. These results suggest that indirect modulation of the &agr;1A‐adrenoceptor system may be involved in the antidepressive‐ and/or anxiolytic‐like effects of caffeic acid.

Effects of nasal continuous positive airway pressure on panic disorder comorbid with obstructive sleep apnea syndrome

BACKGROUNDS Both obstructive sleep apnea syndrome (OSAS) and panic disorder (PD) are common disorders that often coexist. Continuous positive airway pressure (CPAP) has been established as the first-line treatment for OSAS. In this study, we examined the efficacy of CPAP on PD comorbid with OSAS by conducting a randomized crossover study using sham CPAP as control. METHODS PD patients (n=12) with an apnea hypopnea index (AHI) of 20/h or higher completed the study. At baseline, the subjects were asked to write their own records pertaining to the frequency of attacks and their score on the panic disorder severity scale (PDSS), and then they participated in the randomized crossover trial period, which measured optimal CPAP and sham CPAP set at 4cmH(2)O during nighttime sleep for each 4-week assignment. RESULTS The frequency of panic attacks, total PDSS score, and the frequency of alprazolam use for alleviating the attack symptoms were significantly decreased during the optimal CPAP period than during the baseline period and the sham CPAP period. Among the PDSS subitems, the frequency of attacks, panic distress, work impairment, and social impairment showed significant improvements during the optimal pressure period. CONCLUSION Our results suggest that OSAS contributes to PD aggravation, and a combination of pharmaceutical treatment for PD and OSAS-specific treatments such as CPAP could be recommended for patients with PD comorbid with OSAS.

Schizo‐nomenclature: A new condition?

Some psychiatric diagnoses are stigmatic. In August of 2002, at the annual congress of the Japanese Society of Psychiatry and Neurology, the Society decided to change the name of schizophrenia in Japanese from seishinbunretsu‐byo (‘split mind disease’) to togoshitcho‐sho (‘loss of coordination disorder’). In 2006 a survey was carried out among the 80 members of the Section on Classification, Diagnostic Assessment and Nomenclature of the World Psychiatric Association. Of the 21 responding, nine (45%) did not think that ‘schizophrenia’ was an appropriate term for the disease and half thought that the term ‘schizophrenia’ had a stigmatic meaning.

Should schizophrenia still be named so

9. If you answered “Yes” to No. 6, please mark when it should be changed. a) As soon as possible 5 – b) By the publication of ICD-11 12 – c) Later 3 – d) Did not answer “Yes” to Q.6 1 – 10. If you answered “Yes” to No. 6, what term do you think is more appropriate than the current term, i.e., “schizophrenia”? Please provide your suggestions below. (Space was provided for suggestions.) 11. Should the new name convey an acceptable scientific concept or concepts? 27 4

Prevalence of Substance Abuse among Patients with Physical Diseases Seen in an Emergency Room in Japan

According to a nationwide general population survey on drug use in Japan, the lifetime prevalence of methamphetamine is low when compared to the United States. To confirm the hypothesis of a lower point prevalence of methamphetamine in an emergency room (ER) in Japan than in the United States, we collected blood specimens from an urban area of heavy methamphetamine prevalence in Tokyo, Japan, and analyzed the sera using REMEDi-HS based on an unlinked anonymity. Twenty kinds of drugs other than psychotropics were detected in 55 of 279 subjects (19.7%). Nineteen kinds of psychotropics were detected in twenty (7.2%) subjects. Psychotropics were detected in eleven patients with physical diseases and no acute intoxication. Methamphetamines were detected in three subjects (1.09%, 95% confidence interval 1.073-1.088) and in one of 46 subjects with injury (2.2%). It is necessary to look at the methodological differences between this study and previous studies; however, this finding supports the lower point prevalence of methamphetamine in an ER in Japan than in an ER in the United States.

Visual cognitive function in dementia of Alzheimer’s type: a comparison of visual event‐related potentials and Stroop test

Background:  Many published studies on dementia of Alzheimer’s type (DAT) have utilized event‐related potentials (ERP) and the Stroop test. However, most of this research has performed these analyses separately. Therefore, in the present research, these two examinations were carried out together following the same paradigm in order to clarify the characteristics of visual dysfunction in DAT patients.

The Japanese version of the Screen for Cognitive Impairment in Psychiatry: a preliminary study

The equivalence of three alternative forms of the Screen for Cognitive Impairment in Psychiatry for Japan (SCIP-J), and the gains associated with repeated testing, were examined in 72 samples including university students and hospital staffs administered two forms of the SCIP-J separated by 48 h delay. The Screen for Cognitive Impairment in Psychiatry (SCIP) is a brief assessment tool designed for the bedside evaluation of key features of cognitive impairment common in psychiatric illnesses, including immediate and delayed verbal learning, working memory, verbal fluency, and psychomotor speed. The SCIP requires less than 20 min and it has three alternative forms to minimize practice effects from repeated testing. Multivariate analysis supported the equivalence of the three forms of the SCIP-J. Practice effects were not observed for immediate verbal learning, delayed verbal learning, or verbal fluency, but small reliable practice effects were observed for working memory and psychomotor speed. Re-test reliability of the composite score was high (Cronbach’s alpha 0.87). The three forms of the SCIP-J are equivalent and may prove useful for the rapid screening of common cognitive impairments in psychiatric samples. A conservative estimate of practice effects is provided to allow a benchmark against which alleged therapeutic benefits can be evaluated.

Successful treatment with maintenance electroconvulsive therapy for a patient with medication-resistant rapid cycling bipolar disorder.

ACETYLCHOLINESTERASE (ACHE) INHIBITORS are recommended as a first-line therapy for dementia with Lewy bodies (DLB); however, they occasionally cause motor side-effects. Pisa syndrome is characterized by abnormally sustained posturing with a flexion of the body and head to one side and a slight axial rotation of the trunk. Here we report the first case of a patient with DLB who experienced Pisa syndrome following treatment with an AChE inhibitor, donepezil. A 71-year-old Japanese woman who did not have any history of psychiatric illness visited our hospital to seek treatment for visual hallucination that she started to suffer 1 month before. According to her family, she had gradual, but progressive cognitive decline over the previous 1 year. The score in the Hasegawa Dementia Rating Scale – Revised was 22 out of 30, and her full scale of the Intelligence Quotient of the Wechsler Adult Intelligence Scale – Revised was 65. She also presented bradykinesia while rigidity and tremor were not observed. A decline in blood flow in the parietal, occipital, and temporal lobes was observed in single photon emission computed tomography. A magnetic resonance imaging (MRI) scan revealed brain atrophy in the frontal and temporal lobes while medial temporal structures were preserved. She was therefore diagnosed with possible DLB, according to the consensus guidelines. Following the treatment with donepezil (5 mg/day), the hallucination disappeared. She was then maintained on the same regimen. One year later, she gradually developed right laterocollis with right axial deviation and right side flexion of the body with backward axial rotation. Dystonic spasm of the right sternocleidomastoid muscles and slight rigidity of the upper arms were also observed. There was no abnormal finding in the MRI scan, hematological laboratory tests, electromyographic examination, manual muscle test, sensory perception, or reflexes. Although donepezil was subsequently discontinued, laterocollis has still persisted for 6 months at the time of submission. An imbalance in cholinergic-dopaminergic central pathways has been claimed as a potential mechanism of Pisa syndrome. Discontinuing donepezil did not diminish Pisa syndrome in the present case, which is compatible with the irreversibility of this syndrome reported in the literature. Anticholinergic or dopamine agonists were not administered in this case because of potential cognitive decline or worsening of the hallucination, respectively. Botulinum toxin type-A or deep brain stimulation may need to be considered, instead. Given the widespread use of AChE inhibitors for DLB, thorough attention should be paid to this potentially serious side-effect, irrespective of diagnosis. REFERENCES