Naomi Hara

Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12-15 years

Nishida A, Sasaki T, Nishimura Y, Tanii H, Hara N, Inoue K, Yamada T, Takami T, Shimodera S, Itokawa M, Asukai N, Okazaki Y. Psychotic‐like experiences are associated with suicidal feelings and deliberate self‐harm behaviors in adolescents aged 12–15 years.

Intrasubject reproducibility of prefrontal cortex activities during a verbal fluency task over two repeated sessions using multi‐channel near‐infrared spectroscopy

Aim:  To determine whether intrasubject reproducibility could be observed in the frontal cortex and to assess the mental‐health status of subjects in each session.

Relationship between the prefrontal function during a cognitive task and the severity of the symptoms in patients with panic disorder: A multi-channel NIRS study

To investigate whether prefrontal function during a cognitive task reflects the severity of panic disorder, the prefrontal function during a word fluency task in 109 panic disorder patients with or without agoraphobia was measured by multi-channel near-infrared spectroscopy (NIRS). [Oxy-Hb] changes in the left inferior prefrontal cortex were significantly associated with the frequency of panic attacks, and, in addition, [deoxy-Hb] changes in the anterior area of the right prefrontal cortex were significantly associated with the severity of agoraphobia. These results suggest that the prefrontal function in patients with panic disorder is associated with the disease state of disease in patients with panic disorder.

Dysfunction of ventrolateral prefrontal cortex underlying social anxiety disorder: A multi-channel NIRS study

Social anxiety disorder (SAD) is characterized by strong fear and anxiety during social interactions. Although ventrolateral prefrontal cortex (VLPFC) activity in response to emotional stimuli is related to pathological anxiety, little is known about the relationship between VLPFC activity and social anxiety. This study aimed to investigate whether VLPFC activity was involved in SAD and whether VLPFC activity was related to the level of social anxiety. Twenty-four drug-naïve patients with SAD and 35 healthy controls underwent near-infrared spectroscopy (NIRS) scanning while performing a verbal fluency task (VFT). Results indicated that, compared to the healthy controls, the SAD patients exhibited smaller changes of oxygenated hemoglobin (oxy-Hb) concentrations in the VLPFC during the VFT. Furthermore, the right VLPFC activation was negatively correlated with social avoidance. In contrast to the latter, the healthy controls exhibited a positive correlation between changes of oxy-Hb concentrations in the bilateral VLPFC and social fear. Our findings provide evidence for VLPFC dysfunction in SAD, and indicate that the VLPFC dysfunction may contribute to the difference between normal and abnormal social anxiety.

Asymmetry of prefrontal cortex activities and catechol-O-methyltransferase Val158Met genotype in patients with panic disorder during a verbal fluency task: Near-infrared spectroscopy study

We examined the relationship between the catechol-O-methyltransferase (COMT) Val158Met genotype and frontal lobe function by using multi-channel near-infrared spectroscopy (NIRS). The present study investigated oxygenated ([oxy-Hb]) and deoxygenated ([deoxy-Hb]) hemoglobin concentration changes during the performance of a verbal fluency task in the frontal region of 71 patients with panic disorder (PD). The activation of [oxy-Hb] on the right lateral prefrontal cortex was observed in the Met/Met genotype of the COMT gene polymorphism of PD patient groups in the analysis of NIRS, which seems to be related to the autonomic dysfunction in the pathogenesis of PD.

A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia

OBJECTIVE The quality of life of individuals with panic disorder and agoraphobia can be improved by the alleviation of agoraphobia. In other words, examining panic disorder in terms of whether agoraphobia is present is crucial. The current study examined panic disorder from this perspective. METHODS Subjects were 253 patients who met the diagnostic criteria for panic disorder (lifetime) according to the Mini International Neuropsychiatric Interview (MINI). Of those patients, 179 had agoraphobia and 74 did not. Statistical analysis was used to examine gender differences in the presence (or absence) of agoraphobia, comorbidities, and the effects of the presence of agoraphobia (severity, assessment of depression, assessment of anxiety, and personality) in these patients. RESULTS Results indicated gender differences in the presence (or absence) of agoraphobia. Compared to patients without agoraphobia, significantly more patients with agoraphobia were female (p<.001), and had a higher prevalence of comorbidities. Patients with agoraphobia had a higher suicide risk (p<.05), more hypomanic episodes (current) (p<.05), and more frequent episodes of social phobia (p<.05). In addition, patients with agoraphobia had more severe panic disorder and a higher level of neuroticism, sensitivity to anxiety, and trait anxiety [PDSS-J, P&A, NEO-N: p<.01, ASI, STAI (Trait Anxiety): p<.05]. CONCLUSIONS The current findings suggest that when treating a panic disorder, diagnosing the presence of agoraphobia is extremely important.

Discussion of preventive measures against the increase of suicide among males in Japan.

To the Editor: Suicide ranked seventh among the causes of death in Japan between 1977 and 1995 and has ranked sixth place since 1996. The number of people who committed suicide each year in Japan increased rapidly to more than 30,000 in 1998. Since then, the number of suicide victims has remained high, making suicide one of the most prevalent social problems in Japan. Researchers have reported that the maleto-female ratio of suicides in Japan has been approximately 2 or greater in recent years, suggesting the need to investigate descriptive features of suicide according to basic variables including age and year. It is critical to establish preventive measures against suicide in men immediately. In this report, we examine age-classified suicide rates among men in Japan in 1993, 1998, and 2003 as reported in the Journal of Health and Welfare Statistics. We discuss the change in suicide rates in each ageclass and the causative factors reported to the National Police Agency in 2003 and show the breakdown of causative factors in Table 1. Suicide rates among men by age group are shown in Figure 1, and the rates for 2003 show an increase over the rates in 1993 and 1998 for men aged 25 to 59 years (25Y29, 30Y34, 35Y39, 40Y44, 45Y49, 50Y54, and 55Y59 age groups, respectively). Fortunately, the rates in 2003 fell below those in 1998 for the age groups 10 to 14, 15 to 19, 20 to 24, 60 to 64, 65 to 69, 70 to 74, 75 to 79, and 80 years or older. Causative factors of each age group among men in 2003 are shown in Figure 2. The most prevalent factor was ‘‘economic and life problems’’ in the 20to 29-, 30to 39-, 40to 49-, and 50to 59-year-old age groups, whereas ‘‘health problems (including experiencing physical illness and mental health problems)’’ were the most prevalent factor in the age groups 60 years or older. The results show that it is necessary to take suicideprevention measures for ‘‘economic and life problems’’ among 25to 59-year-old males. Regarding such problems, an increased risk of death from external causes implies a need for support for those experiencing unemployment and particularly for individuals who need mentally supported care. When economic conditions become worse, people feel intense stress; therefore, following unemployment or bankruptcy of a company, it is important to take concrete follow-up measures in relation to individuals’ experiencing debt, financial difficulty in the home, existential suffering, appearance of mental symptoms, and deterioration of mental faculties. We would like to propose that such measures

Specific panic attack symptoms in panic disorder patients with putative genetic factor.

DESPITE THE FREQUENT comorbidity of obsessive– compulsive disorder (OCD) with pervasive developmental disorders (PDD), little evidence is available to guide treatment of such cases. We report a case of OCD comorbid with Asperger’s disorder, in which high-dose paroxetine treatment was effective in improving obsessive–compulsive behaviors. Written parental informed consent was obtained for publication of this report. A 15-year-old girl with severe contamination fears and contamination-related checking behaviors was admitted to hospital. She was diagnosed as having OCD according to DSMIV-TR. Several medication trials prior to hospitalization, including fluvoxamine 100 mg/day, risperidone 2 mg/day, haloperidol 6 mg/day, and paroxetine 20 mg/day, had been ineffective in reducing her symptoms. Upon admission the patient’s Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score was 40. A detailed review of her past history indicated socially inappropriate behaviors since early childhood, such as being uncooperative with other children in preschool. Her obsessive traits became prominent in her grade-school years, spending several hours on simple handwriting assignments to do it as neatly as possible. She was very specific about her dress, sometimes refusing to put anything on because she was unsatisfied with her clothing. Her impairment in social interaction without delay in language and her persistence since childhood led us to diagnose her as having Asperger’s disorder according to DSMIV-TR, in addition to previously diagnosed OCD. Although obsessive traits had been apparent since childhood, the onset of OCD, which was when contamination fears appeared, was at the age of 15. Paroxetine was started concurrently with behavioral therapy, and the dose was titrated to 60 mg/day. After 8 weeks her contamination fears began to lessen. During the course of treatment the patient experienced irritability and excess sweating, which diminished after the paroxetine dose was reduced to 40 mg/day in the third month. Her Y-BOCS score at 6 months after initiation of paroxetine was 14. Her obsessive tendencies remained even after her contamination fears almost completely disappeared. The important role of serotonin in OCD and PDD has been hypothesized from the efficacy of selective serotonin re-uptake inhibitors (SSRI). Results from a randomized, double-blind, placebo-controlled trial indicated that paroxetine is an effective treatment in pediatric OCD, and several other studies have suggested therapeutic benefit of SSRI in PDD. Studies investigating candidate genes related to serotonin regulation, however, such as serotonin transporter gene, have not found any associations in PDD or OCD. Whether obsessive–compulsive symptoms in OCD and PDD have overlapping etiologies remain unclear. Although concurrent behavioral therapy complicates the evaluation of pharmacotherapeutic effectiveness, it is inferred that paroxetine showed dose-dependent efficacy for OCD in a patient with Asperger’s disorder. Considering the evidence of efficacy in both disorders, pharmacotherapy with SSRI is recommended in such patients. There are no guidelines, however, for treatment of OCD symptoms in those diagnosed with PDD, and thus patients for whom the pharmacotherapy could be beneficial may not be receiving adequate treatment. We believe that clinical trials are warranted to clarify the benefits versus the risks of using SSRI in children and adolescents dually diagnosed with PDD and OCD. It is noteworthy that, in the present case, the contamination fears disappeared with paroxetine treatment while obsessive traits of PDD, which had been present since before the onset of OCD, remained. Further studies may clarify the difference between obsessive symptoms observed in PDD and OCD in regard to medication response, which may lead to the drawing of a distinction between the two disorders.

Clear Trends in Panic Disorder with a Possibility of Suicide Risk

In the Diagnostic and Statistical Manual of Mental Disorders (DSM), panic disorder is one type of anxiety disorder. There have been few detailed reports on the relationship between suicide and panic disorder. We examined the comorbidities and personality inventory tendencies in panic disorder with an increased suicide risk. Our participants were patients with panic disorder. We found that an increased risk of suicide must be kept in mind when treating patients with panic disorder that is accompanied by mood disorders or anxiety disorders. This study also found that such patients are thought to be “very sensitive and emotional and easily distracted”, “introverted, humble and serious”, and “hedonistic”. The risk of suicide must be ascertained during the treatment of panic disorder.