Noa Tsujii

Association between activity level and situational factors in children with attention deficit/hyperactivity disorder in elementary school

Abstract  The aim of this study was to determine whether the objective activity level of children with attention deficit/hyperactivity disorder (AD/HD) is associated with situational factors in elementary school. A total of 16 children with combined‐type AD/HD (13 boys, 3 girls) and 20 controls matched for age and gender participated in the study. All the participants wore the objective measurement of activity level for 1 week while attending elementary school. The average activity levels were calculated for the morning and afternoon classes. The classes were categorized into four types: (i) in‐seat classes, in which the participants were expected to learn quietly while sitting in their own seats; (ii) not‐in‐seat classes, in which the participants were not expected to sit in their seats; (iii) physical education classes; and (iv) lunch/recess periods. During the afternoon in‐seat classes, the children with AD/HD were significantly more active than the controls. However, no significant differences based on the group (children with AD/HD or controls) were observed during the other morning or afternoon classes. These findings indicate that in naturalistic settings where the effects of situational demands involving inhibition and the effect of fatigue overlapped, the children with AD/HD exhibited an activity level that was different from that exhibited by the controls. Differences in the activity levels of children with AD/HD and normal controls were identified using an objective measurement of activity level when two situational factors overlapped.

Regional cerebral blood flow in the assessment of major depression and Alzheimer's disease in the early elderly.

BackgroundAlzheimers disease and major depression are representative diseases that present forgetfulness and a depressive mood. It is often difficult to make a differential diagnosis between the two in the initial phase. AimTo evaluate the differential diagnosis method using regional cerebral blood flow patterns with a three-dimensional stereotactic surface projection technique. MethodsTwenty early-elderly patients with mild and moderate forgetfulness were studied. Among them, 10 were diagnosed as having major depression (the MD group) and the other 10 as having Alzheimers disease (the AD group). All patients underwent cerebral perfusion single photon emission computed tomography (SPECT) with [123I]iodoamphetamine. A z-score was calculated for each pixel of the cerebral surface. Twenty-one circular regions of interest (ROIs) were placed on the z-score map. The significance of the statistical difference in ROI values between the two groups was determined by using the two-sided Mann–Whitney U-test. ResultsThe z-scores for the lateral parietal, lateral temporal, bilateral precuneus and bilateral posterior cingulate gyrus were significantly reduced in the AD group compared with those in the MD group. The z-scores for the lateral frontal, left thalamus and bilateral medial frontal regions were significantly lower in the MD group than in the AD group. ConclusionOur study demonstrated a difference in regional cerebral blood flow patterns between the early elderly with Alzheimers disease and those with major depression. All patients were classified into the appropriate categories using discriminant analysis and z-scores of frontal and parietal regions. Brain perfusion SPECT was a useful tool for the differential diagnosis between Alzheimers disease and major depression.

Prefrontal cortex activation is associated with a discrepancy between self- and observer-rated depression severities of major depressive disorder: A multichannel near-infrared spectroscopy study

BACKGROUND Studies on major depressive disorder (MDD) show that the degree of correlation between the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAMD) varies widely. We aimed to determine whether this discrepancy reflects specific functional abnormalities in the frontotemporal cortex. METHODS Mildly depressed or euthymic patients with MDD (n=52), including 21 patients with MDD with the discrepancy, i.e., those with low HAMD17 scores (≤13) but high BDI-II scores (>28), and 31 patients without the discrepancy, i.e., those with low HAMD17 scores and low BDI-II scores (≤28), participated in the study along with 48 control subjects. Regional changes of oxygenated hemoglobin (oxy-Hb) levels during a verbal fluency task (VFT) were monitored using a 52-channel near-infrared spectroscopy (NIRS) device. RESULTS In the frontotemporal regions, mean oxy-Hb changes induced by the VFT were significantly smaller in patients with MDD than in control subjects. In 5 channels within frontal regions, the increase in mean oxy-Hb levels was significantly greater in MDD patients with the BDI-HAMD discrepancy than in those without the discrepancy. In 6 channels within the frontal region of the patients with MDD, significant positive correlations were observed between mean oxy-Hb changes and BDI total scores (ρ=0.38-0.59; P<0.05, false discovery rate corrected). LIMITATIONS Our findings required replication in severely depressed patients, particularly those with melancholia. CONCLUSIONS The distinct pattern of activation of the prefrontal cortex suggests that MDD with the BDI-HAMD discrepancy is pathophysiologically different from MDD without the discrepancy.

Differentiation between attention-deficit/hyperactivity disorder and pervasive developmental disorders with hyperactivity on objective activity levels using actigraphs

Aims:  To clarify differences in objective activity levels between children with attention‐deficit/hyperactivity disorder (ADHD) and those with pervasive developmental disorders (PDD) and hyperactivity.

Left temporal activation associated with depression severity during a verbal fluency task in patients with bipolar disorder: A multichannel near-infrared spectroscopy study

BACKGROUND Neuroimaging studies using multichannel near-infrared spectroscopy (NIRS) have provided compelling evidence about the dysfunction of the frontotemporal cortices in patients with bipolar disorder (BD). However, it remains unclear whether the dysfunction is associated with mood state or symptom severity. Using NIRS, we aimed to clarify differences in oxygenated hemoglobin (oxy-Hb) activation between depressive and euthymic states as well as regional brain dysfunction in relation to symptom severity in BD. METHODS Fifty-five patients with BD, including 30 with bipolar depression (BPD) and 25 with euthymic bipolar disorder (BPE), and 28 healthy controls (HCs) participated in the study. Regional hemodynamic changes during a verbal fluency task (VFT) were monitored using a 52-channel NIRS apparatus. RESULTS The mean oxy-Hb changes induced by VFT were significantly smaller in the BD patients than in the HCs in 18 channels in the frontotemporal regions (false-discovery rate p<0.05, p=0.000-0.011). The BPD group exhibited significantly smaller changes in mean oxy-Hb compared with the BPE group in three channels of the left temporal region (p=0.005-0.014). In the BD patients, significant negative correlations were observed between mean oxy-Hb changes in the left temporal regions and the severity of depression. LIMITATIONS Our sample size was small, making the results susceptible to type II errors. CONCLUSIONS BD patients have persistent hypofunction of the frontotemporal cortical regions. Moreover, the hemodynamic response in the left temporal regions is associated with symptom severity.

Reduced left precentral regional responses in patients with major depressive disorder and history of suicide attempts

Previous neuroimaging studies have revealed frontal and temporal functional abnormalities in patients with major depressive disorder (MDD) and a history of suicidal behavior. However, it is unknown whether multi-channel near-infrared spectroscopy (NIRS) signal changes among individuals with MDD are associated with a history of suicide attempts and a diathesis for suicidal behavior (impulsivity, hopelessness, and aggression). Therefore, we aimed to explore frontotemporal hemodynamic responses in depressed patients with a history of suicide attempts using 52-channel NIRS. We recruited 30 patients with MDD and a history of suicidal behavior (suicide attempters; SAs), 38 patient controls without suicidal behavior (non-attempters; NAs), and 40 healthy controls (HCs) matched by age, gender ratio, and estimated IQ. Regional hemodynamic responses during a verbal fluency task (VFT) were monitored using NIRS. Our results showed that severities of depression, impulsivity, aggression, and hopelessness were similar between SAs and NAs. Both patient groups had significantly reduced activation compared with HCs in the bilateral frontotemporal regions. Post hoc analyses revealed that SAs exhibited a smaller hemodynamic response in the left precentral gyrus than NAs and HCs. Furthermore, the reduced response in the left inferior frontal gyrus was negatively correlated with impulsivity level and hemodynamic responses in the right middle frontal gyrus were negatively associated with hopelessness and aggression in SAs but not in NAs and HCs. Our findings suggest that MDD patients with a history of suicide attempts demonstrate patterns of VFT-induced NIRS signal changes different from those demonstrated by individuals without a history of suicidal behaviors, even in cases where clinical symptoms are similar. NIRS has a relatively high time resolution, which may help visually differentiate SAs from NAs.

Relationship between prefrontal hemodynamic responses and quality of life differs between melancholia and non-melancholic depression

This study aimed to determine whether quality of life (QOL) reflects specific functional abnormalities of frontotemporal hemodynamic responses in melancholia. We recruited 30 patients with major depressive disorder (MDD) with melancholic features (MDD-MF), 52 with non-melancholic features (MDD-NMF), and 68 healthy control subjects who were matched for age, sex ratio, and years of education. QOL was assessed using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and regional hemodynamic responses during a verbal fluency task were monitored with near-infrared spectroscopy (NIRS). Patients with MDD-MF scored significantly lower than those with MDD-NMF on the role emotional domain of SF-36. Both MDD patient groups exhibited lower hemodynamic responses in the frontotemporal regions than the control group. Hemodynamic responses in the frontotemporal regions were significantly smaller in patients with MDD-MF than in those with MDD-NMF. The role emotional domain of patients with MDD-MF was significantly and positively correlated with hemodynamic responses in the prefrontal region, whereas that of patients with MDD-NMF revealed no significant correlation. In conclusion, our results indicate that patients with MDD-MF exhibit qualitatively distinct prefrontal dysfunction patterns associated with emotional role functioning compared with patients with MDD-NMF.

Shared and differential cortical functional abnormalities associated with inhibitory control in patients with schizophrenia and bipolar disorder

Schizophrenia (SZ) and bipolar I disorder (BD-I) share genetic risk factors and cognitive impairments, but these conditions may exhibit differences in cortical functioning associated with inhibitory control. We measured hemodynamic responses during a stop-signal task using near-infrared spectroscopy (NIRS) in 20 patients with SZ, 21 patients with BD-I and 18 healthy controls (HCs). We used stop-signal reaction time (SSRT) to estimate behavioural inhibition. Compared with HCs, patients with either SZ or BD-I exhibited significantly reduced activation in the bilateral inferior, middle and superior frontal gyri. Furthermore, patients with BD-I showed inactivation of the right superior temporal gyri compared with patients with SZ or HCs. Patients with SZ or BD-I demonstrated significant negative correlations between SSRT and hemodynamic responses of the right inferior frontal gyrus. Moreover, patients with SZ exhibited correlations in the middle and superior frontal gyri. Our findings suggest that right inferior frontal abnormalities mediate behavioural inhibition impairments in individuals with SZ or BD-I. Differential patterns of orbitofrontal or superior temporal functional abnormalities may reflect important differences in psychopathological features between these disorders.

An open‐label extension long‐term study of the safety and efficacy of aripiprazole for irritability in children and adolescents with autistic disorder in Japan

The purpose of this study was to evaluate the long‐term safety and efficacy of aripiprazole in treating irritability in pediatric patients (6–17 years) with autistic disorder (AD) in Japan.

Delayed hemodynamic responses associated with a history of suicide attempts in bipolar disorder: a multichannel near-infrared spectroscopy study

Bipolar disorder (BD) is associated with a high risk of suicide compared with other psychiatric disorders. Recent studies using near-infrared spectroscopy (NIRS) reported frontotemporal functional abnormalities in BD. However, it remains unclear whether NIRS signal changes are associated with vulnerability toward suicide in BD. We recruited 20 patients with depressed BD with a history of suicide attempts (suicide attempters; SAs) and 28 control patients with BD who did not have a history of suicide attempts (non-attempters; NAs). Regional hemodynamic responses during a verbal fluency task were monitored using NIRS. Compared with the NA group, the SA group exhibited significantly reduced activation during VFT in the bilateral precentral and superior temporal gyri and left supramarginal, inferior frontal, postcentral, and middle temporal gyri. Furthermore, compared with the NA group, the SA group exhibited delayed activation timing of the NIRS signal in the prefrontal region. In BD patients, current suicide risk was noted to be significantly and positively associated with delayed activation timing of the NIRS signal in the prefrontal region. The findings of this study suggest that the observed specific NIRS signal pattern in BD patients is associated with vulnerability toward suicide.