Naotaka Shinfuku

Stomach regulates energy balance via acylated ghrelin and desacyl ghrelin

Background/Aims: The gastric peptide ghrelin, an endogenous ligand for growth-hormone secretagogue receptor, has two major molecular forms: acylated ghrelin and desacyl ghrelin. Acylated ghrelin induces a positive energy balance, while desacyl ghrelin has been reported to be devoid of any endocrine activities. The authors examined the effects of desacyl ghrelin on energy balance. Methods: The authors measured food intake, gastric emptying, c-Fos expression in the hypothalamus, and gene expression of hypothalamic neuropeptides in mice after administration of desacyl ghrelin. To explore the effects of long term overexpression of desacyl ghrelin, transgenic mice that overexpressed desacyl ghrelin were created. Results: Administration of desacyl ghrelin decreased food intake and gastric emptying rate through an action on the paraventricular nucleus and the arcuate nucleus in the hypothalamus. Gene expression of anorexigenic cocaine and amphetamine regulated transcript and urocortin in the hypothalamus was increased by desacyl ghrelin. Desacyl ghrelin overexpressing mice exhibited a decrease in body weight, food intake, and fat pad mass weight accompanied by moderately decreased linear growth. Gastric emptying was also decreased in desacyl ghrelin overexpressing mice. Conclusions: These findings indicate that in contrast to acylated ghrelin, desacyl ghrelin induces a negative energy balance by decreasing food intake and delaying gastric emptying. The effect is mediated via the hypothalamus. Although derived from the same precursor, the inverse effects of these two peptides suggest that the stomach might be involved as an endocrine organ in the regulation of the energy balance.

Nutritional knowledge, food habits and health attitude of Chinese university students--a cross sectional study.

BackgroundWe have previously shown that irregular lifestyle of young Japanese female students are significantly related to their desire to be thinner. In the present study, we examined the nutritional knowledge and food habits of Chinese university students and compared them with those of other Asian populations.MethodsA self-reported questionnaire was administered to 540 students, ranging in age from 19-24 years. Medical students from Beijing University (135 men and 150 women) in Northern China and Kunming Medical College in southern China (95 men and 160 women) participated in this study. The parametric variables were analyzed using the Students t-test. Chi-square analyses were conducted for non-parametric variablesResultsOur results showed that 80.5% of students had a normal BMI and 16.6 % of students were underweight with the prevalence of BMI>30 obesity being very low in this study sample. Young Chinese female students had a greater desire to be thinner (62.0%) than males (47.4%). Habits involving regular eating patterns and vegetable intake were reported and represent practices that ought to be encouraged.ConclusionsThe university and college arenas represent the final opportunity for the health and nutritional education of a large number of students from the educators perspective. Our findings suggest the need for strategies designed to improve competence in the area of nutrition.

Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change

Abstract  The purpose of this international collaborative study was to investigate the prescription patterns of antipsychotic drugs for schizophrenia in East Asia and to analyze factors that affect these patterns. Prescription patterns for patients admitted for treatment of schizophrenia were surveyed using a standardized protocol from six East‐Asian region/countries: China, Hong Kong, Japan, Korea, Singapore and Taiwan. Patients’ social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications were systematically assessed and recorded. Prescriptions of the first‐ and second‐generation antipsychotic drugs were compared. A total of 2399 patients were recruited. The second‐generation drugs comprised 28.1% of all prescribed antipsychotics, and 46% of the antipsychotic prescriptions were in the context of polypharmacy. The mean dosage of antipsychotics for the whole sample was 675.3 + 645.1 mg chlorpromazine equivalents. Japan had a high frequency of prescribing high doses and polypharmacy; Singapore had a high utilization of depot injections while China had a higher prescription of clozapine. Using multiple logistic regression analysis, distinctions in the prescription patterns of antipsychotic drugs were found: first‐generation drugs were mainly for controlling aggressive behavior, while second‐generation drugs were targeted at the alleviation of positive, negative psychotic symptoms as well as disruptive behavior in schizophrenia. The present collaborative study highlighted differences in the prescription patterns, especially the under‐utilization of second‐generation antipsychotic drugs in East Asia. The pattern of antipsychotic medication use varied from country to country and is likely to be influenced by the prevailing health‐care system, the availability and cost of the drugs.

Post-earthquake quality of life and psychological well-being: Longitudinal evaluation in a rural community sample in northern China

Abstract This study aims to observe longitudinal change of quality of life (QOL) and psychological wellbeing in a community sample affected by an earthquake and to examine the relationship between QOL and disaster exposure, post‐disaster support and other related variables. The subjects, from two villages at different distances from the epicenter, were assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL‐BREF) and three subscales of a symptoms checklist at 3 months (n = 335) and 9 months (n = 253) after the earthquake, respectively. Exposure to the earthquake was associated with multidimensional impairment in QOL, including physical, psychological and environmental domains at 3 months, and psychological and environmental domains at 9 months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. At both assessment points the group that experienced lower initial exposure but then received less post‐disaster help reported poorer QOL and psychological well‐being. The two victim groups also differed significantly in changing trend along time. The group that received more support showed a general improvement in post‐disaster well‐being from 3 months to 9 months. The results confirm that post‐disaster variables could be as important to post‐disaster psychosocial outcomes as variables of predisaster vulnerability and disaster per se. A comprehensive and prospective assessment of disaster effects is imperative for the better organization of disaster relief programs and psychosocial interventions.

A comparative study of food habits and body shape perception of university students in Japan and Korea

BackgroundAbnormal body weight, dietary concerns, and unhealthy weight loss behaviors are increasingly being observed in young females in Japan. Our previous research has shown that the irregular lifestyles of female Japanese and Chinese students are significantly related to their desire to be thinner. In the present study, we compare the food habits and body shape preferences of female university students in South Korea and Japan to explore body shape perceptions in those populations.MethodsA total of 265 female university students aged 19 – 25 years participated in this study. University students in Korea (n = 141) and university students in Japan (n = 124) completed a self-reported questionnaire. Data were analyzed using SPSS statistical software. Descriptive statistics were used to identify the demographic characteristics of the students and parametric variables were analyzed using the Students t-test. Chi-square analyses were conducted for non-parametric variables.ResultsComparison of body mass index (BMI) distributions in Japan and Korea showed the highest value in the normal category (74%) together with a very low obesity rate (1.2%). Significant differences were observed between the two countries in terms of eating patterns, with more Japanese eating breakfast daily and with Japanese students eating meals more regularly than Korean students. A difference was also observed in frequency of meals, where Korean students reported eating meals two times per day (59%) and the majority of Japanese students reported eating meals three times per day (81%). Although most subjects belonged to the normal BMI category, their ideal BMI classification was the underweight category (BMI: 18.4 ± 3.4).ConclusionFew studies have compared the health related practices of Japanese and Korean university students. The present results suggest the necessity of nutrition and health promotion programs for university students, especially programs emphasizing weight management.

Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation

PurposeTo explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated.MethodsTwo hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome’s prevalence in their country, etiology, diagnosis, suicide risk, and treatment.ResultsOut of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization.ConclusionsPatients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.

Are Japan's hikikomori and depression in young people spreading abroad?

1 Watts J. Public health experts concerned about “hikikomori”. Lancet 2002; 359: 1131. 2 Kato TA, Shinfuku N, Fujisawa D, et al. Introducing the concept of modern depression in Japan; an international case vignette survey. J Aff ect Disord 2011; published online July 22. DOI:10.1016/j.jad.2011.06.030. 3 Koyama A, Miyake Y, Kawakami N, Tsuchiya M, Tachimori H, Takeshima T. Lifetime prevalence, psychiatric comorbidity and demographic correlates of “hikikomori” in a community population in Japan. Psychiatry Res 2010; 176: 69–74. 4 Teo AR, Gaw AC. Hikikomori, a Japanese culture-bound syndrome of social withdrawal? A proposal for DSM-5. J Nerv Ment Dis 2010; 198: 444–49. 5 Kato TA, Tateno M, Shinfuku N, et al. Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation. Soc Psych Psychiatr Epidemiol 2011; published online June 25.DOI:10.1007/ s00127-011-0411-7. omnipotence; and avoidance of eff ort and strenuous work. It seems to mainly aff ect those who were born after 1970—ie, the generation growing up with home video games in the era of Japan’s high economic growth. Young people with moderntype depression tend to feel depressed only when they are at work; at other times, they enjoy the virtual world of the internet, video games, and pachinko (similar to pinball). Therefore, people with modern-type depression have diffi culties in adapting to work or school and participating in the labour market, similarly to those with hikikomori. An epidemiological study of hikikomori indicated a lifetime prevalence of more than 1% in adults in Japan. However, the question arises: do these syndromes represent no more than a general response to Japan’s modernisation? In fact, several hikikomori-like cases have been reported from Korea, Oman, and Spain, leading to debate as to whether hikikomori is a culture-bound syndrome specifi c to Japan or a new form of maladjustment or psychiatric disorder. We did an international survey to investigate whether these syndromes exist beyond Japan. Psychiatrists’ responses to vignettes indicated that both hikikomori and moderntype depression are seen in various countries, and are more prevalent in urban areas, which might suggest that modernisation has an important role in the occurrence of these phenomena. Many respondents suggested that hikikomori and modern-type depression might not fi t into current international diagnostic categories, and some felt that hikikomori could be seen as a form of internet addiction. These reports provide a rational basis for epidemiological and ethnographic studies of hikikomori and modern-type depression in clinical and community populations in diff erent countries. They might not simply be Japanese cultural phenomena; rather, they We declare that we have no confl icts of interest.

Teachers' knowledge, beliefs and attitudes concerning schizophrenia- a cross-cultural approach in Japan and Taiwan.

Abstract.Background:Mental health literacy of the general public is essential for the effective promotion of society’s mental health. However, there has been no investigation of the general public’s mental health literacy with Japanese and Taiwanese socio-cultural backgrounds.Methods:A total of 129 Japanese and 150 Taiwanese elementary school teachers were surveyed about knowledge, beliefs and attitudes concerning schizophrenia by means of a questionnaire with a vignette describing a case of the disease. Identification of the case, cause of the disease, coping behavior for the case, and perception of stigmatizing and supporting attitudes by parents and neighbors of the case were investigated.Results:As a common finding with the studies in Western countries, only small percentages of the Japanese and Taiwanese respondents were able to make a correct identification. A further common finding was the emphasis on psychosocial factors as a cause of schizophrenia, as was the rejection of psychotropic medication, although future study is required to determine to what extent the respondents know about therapeutic procedures utilized by psychiatrists. Significantly stronger stigma perception was shown in the Japanese respondents than in the Taiwanese, which may be attributable to the high institutionalization rate in Japan.Conclusions:Japanese and Taiwanese teachers’ knowledge, beliefs and attitudes regarding schizophrenia were similar to those found in the general public in Western societies. Although the present study is limited in sampling and the components of the mental health literacy investigated, several working hypotheses have been extracted from it to be tested in future investigations on the Japanese and Taiwanese and other Asian general public’s mental health literacy.

Natural disaster and mental health in Asia

Abstract  The purpose of the present article was to review the literature on disaster mental health in relation to natural disasters such as earthquakes, volcanic eruptions, typhoons and cyclones throughout Asia. Articles reviewed show that disaster psychiatry in Asia is beginning to emerge from and leave behind the stigma attached to mental health. The emergence of the acceptance of disaster mental health throughout Asia can be attributed in part to the acceptance of the notion of post‐traumatic stress disorder (PTSD). This has allowed greater involvement of mental health professionals in providing ongoing support to survivors of natural disasters as well as providing greater opportunities for further research. Also, articles reviewed in the present paper commonly suggested the need for using standardized diagnostic tools for PTSD to appropriately interpret the discrepancy of results among studies. The importance of post‐disaster support services and cultural differences is highlighted.

Pharmacotherapy for schizophrenic inpatients in East Asia – Changes and challenges

Objectives: (1) to review characteristics of prescription patterns of antipsychotic medication in China, Hong Kong, Japan, Korea, Singapore and Taiwan, (2) to examine the changes of prescriptions brought about by the introduction of second generation psychotropic drugs (SGA) in East Asia, (3) to analyse factors contributing to the characteristic use of antipsychotics, and (4) to suggest ways and means to improve the prescription practice of antipsychotics in East Asia. Methods: Authors of this study collaborated with psychiatrists in East Asia to undertake an international survey reviewing prescription patterns of psychotropic medications in East Asia. The REAP (Research on Asian psychotropic prescription patterns) study reviewed the prescription of a large number of schizophrenic inpatients in China, Hong Kong, Japan, Korea, Singapore and Taiwan in 2001 and 2004 using a unified research protocol and questionnaire. Results: Prescription patterns of antipsychotic drugs differ greatly country by country and have recently experienced rapid changes. Our survey shows second generation antipsychotics are frequently used in East Asia. The introduction of SGA resulted in the combined use of first generation psychotropic drugs (FGA) and SGA in East Asia. These changing prescription patterns have created many challenges for psychiatrists in East Asia.