Sadanobu Ushijima

Schizophrenia: Is it time to replace the term?

The attitudes of Japanese psychiatrists toward their patients who suffer from schizophrenia were investigated. We were concerned specifically with whether the psychiatrists inform their patients of the suspected diagnosis. We discuss how the term ‘schizophrenia’ may influence a psychiatrist’s decision to inform his patients of the diagnosis. A self‐reported questionnaire was distributed to 150 executive board members of the Japanese Society of Psychiatry and Neurology and analysis of the data obtained from 110 respondents was carried out. The results showed that the concepts that psychiatrists use when they give a diagnosis of schizophrenia vary considerably. Fifty‐nine per cent of the respondents informed their patients of a diagnosis of schizophrenia on a case‐by‐case basis, while 37% informed only the patients’ families. A tree analysis showed that the most important predictors for informing the patients of the diagnosis were assumptions about the public image of schizophrenia and a negative impression of the term schizophrenia, translated as ‘Seishin Bunretsu Byou’ in Japanese. The results revealed that the Japanese term for schizophrenia influences a psychiatrist’s decision to inform patients of the diagnosis and that, by changing the term to a less stigmatized one, the disclosure of information about schizophrenia to patients would be promoted.

Alcohol dementia and alcohol delirium in aged alcoholics.

Abstract In the present study, 126 alcoholics aged 60 years or older were compared with 104 alcoholics aged 35–45 years. No dementia was found in the younger group, whereas 62.7% of the aged patients had dementia; the dementia being irreversible in 32.9% of such patients. Cases of so‐called alcohol dementia excluding organic brain diseases accounted for 42.1%. The percentage of aged alcoholics having dementia increased with age, being far beyond the frequency of senile dementia in the general aged. Among various physical complications, hepatic injury and myocardiopathy were more frequent in the aged alcoholics than in general aged people, suggesting that hypertension, myocardiopathy and hepatic injury underlie the manifestation of dementia. There was no case of dementia attributable to the direct effect of alcohol distinctly exceeding the effects of various physical factors. Problem behaviors characteristic of the aged group included ‘being soaked in drink’ and being inebriated, showing no correlation with the presence or absence of dementia. There was no significant difference in frequency of delirium between the aged group and the younger group. However, in aged alcoholics delirium tended to continue for a longer period during abstinence and was more likely to occur even during non‐abstinence. A similar trend was found in aged alcoholics with dementia compared with those without dementia.

Diurnal Rhythm in Body Temperature in Different Phases of the Menstrual Cycle

The biorhythm that is peculiar to the fair sex due to its menstrual cycle is presumed to affect in no small way the diurnal rhythm in body temperature. In order to substantiate this presumption, an investigation has been conducted into the diurnal rhythm in body temperature in different phases of the menstrual cycle in healthy women and a patient with menstrual-associated syndrome. This paper discusses the results of a part of this investigation, that is, findings obtained in healthy women and a patient with periodic hypersomnia as a kind of menstrual-associated synSubjects and Methods

Clinical features of circadian rhythm sleep disorders in outpatients

The clinical data of 86 cases of primary circadian rhythm sleep disorder (primary CRSD) were retrospectively examined and compared to 40 cases of secondary circadian rhythm sleep disorder (secondary CRSD), who had presented with some kind of psychiatric or medical disorder, and had exhibited sleep‐wake rhythm disorders that were judged to be secondary CRSD based on sleep logs. The comparison of cases found that: (i) the mean age at first presentation to the clinic was significantly younger for primary CRSD compared to secondary CRSD; (ii) more secondary CRSD cases were unemployed than were Primary CRSD cases; (iii) more cases in the secondary CRSD group had a clear trigger for sleep‐wake rhythm disorder onset than cases in the primary CRSD group; and (iv) the types of sleep‐wake rhythm disorders in the primary CRSD group consisted of delayed sleep phase syndrome (DSPS), 72 (83.7%), non‐24 pattern, 11 (12.8%), and irregular, 3 (3.5%). In the secondary CRSD group there were 25 (62.5%) cases of DSPS pattern, 1 (2.5%) of non‐24 pattern and 14 (35.0%) with irregular pattern. The 56 (65.1%) cases with primary CRSD showed good response to vitamin B12 and bright light therapy; however, 28 (70.0%) cases with secondary CRSD did not respond to such therapies.

Clinical features of nicotine dependence compared with those of alcohol, methamphetamine, and inhalant dependence.

Abstract: A new clinical evaluation form was developed to compare the clinical features of nicotine dependence with those associated with other abused drugs. A new scoring system for clinical evaluation was developed. The form consisted of five scoring items: subjective effects, liking (of drug), withdrawal syndrome, acute psychic and physical disorders, and social disturbance. A preliminary clinical investigation was performed to test the validity of the evaluation form. Study subjects were those showing dependence on nicotine (cigarette smoking, n= 40), alcohol (n= 39), methamphetamine (n= 31), and inhalants (n= 30), who fulfilled the DSM‐IV‐TR criteria for drug dependence disregarding the state of “a maladaptive pattern of substance use, leading to clinically significant impairment or distress,” and gave written informed consent for participation in the study. Nicotine caused a mild or the least degree of subjective effects, liking, and psychic and physical withdrawal symptoms, without any significant social disturbance or acute disorders. With alcohol, liking, withdrawal syndrome, and acute physical disorders were prominent. Methamphetamine produced the most serious acute psychic disorders, with intensive acute physical disorders and psychic withdrawal symptoms. Inhalants were characterized by an intensive degree of acute psychic disorders. As for social disturbance, alcohol, methamphetamine, and inhalants showed more significant influence than nicotine. Our study findings revealed that the clinical features of drug dependence could be evaluated by using the new clinical evaluation form. Further study is required to clarify the clinical features of nicotine dependence compared with those of other drugs of dependence.

Hemodialysis for lithium intoxication: preliminary guidelines for emergency

Abstract: In Japan, 9 cases of severe lithium intoxication have been treated by hemodialysis so far, and the usefulness and indications of this procedure are not yet understood fully. We have recently experienced a case of lithium intoxication treated by hemodialysis. Considering this case together with those reported previously, we have prepared some preliminary guidelines for the application of hemodialysis to patients with lithium intoxication. The blood concentration of lithium, renal function, the severity of consciousness disturbance and clinical symptoms such as somatic complications are, of course, important indices for the application of this therapy. We think that the signs of intoxication and the time interval between the onset and the beginning of treatment also serve as useful indices for application of hemodialysis.

The effects of flumazenil on sleepiness, task performance and nocturnal sleep after anesthesia with midazolam.

The purpose of the present study was to clarify the changes in psychophysiological functions after anesthesia with midazolam (intravenous (i.v.) benzodiazepine anesthetic) and to examine the ability of flumazenil (benzodiazepine antagonist) to prevent the adverse effects of anesthesia with midazolam. Clinical dose of midazolam (0.1 mg/kg i.v.) was administered to seven healthy volunteers and either flumazenil (0.3 mg i.v.) or saline was injected at the end of the anesthesia. After anesthesia with midazolam, subjective sleepiness and euphoria increased significantly, but these changes were not observed when flumazenil was administered. In addition, sleep latency was prolonged and sleep efficiency decreased significantly after midazolam anesthesia with and without flumazenil. Slow wave sleep decreased significantly only by co‐administration of flumazenil.

Psychological distress of family members with cancer patients in Japan.

BACKGROUND: There were no previous studies in Japan on the psychological distress of members of families with cancer patients which focussed on the disclosure of the diagnosis of cancer. This study was designed to investigate factors that may have an effect on the psychological distress of family members. METHODS: The subjects were 95 members of families of cancer patients in the surgical ward; one member was recruited from each patients family. The psychiatrist investigated the demographic factors of both the patient and the family member: for the patient - gender, age, occupation, cancer site, disclosure (or not) of cancer diagnosis, cancer stage and performance status (PS); for the family member - gender, age, occupation, relationship to the patient, physical illness, frequency of visiting the ward, the period from when the family member was informed of the diagnosis, and any past experience of the loss of close relatives due to cancer. Furthermore, we conducted a survey on the family members anxiety and depression by using the Spielberger State - Trait Anxiety Inventory (STAI) and the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: A multiple regression analysis indicated that the factors which were associated with the STAI scores independently were the lack of disclosure of the diagnosis to the patient (P=0.01), and advanced or recurrent cancer (P=0.01). The factors which were associated with the CES-D scores independently were the lack of disclosure of the diagnosis to the patient (P=0.03), advanced or recurrent cancer (P=0.01), and the family members past history of psychiatric disorders (P=0.01). CONCLUSIONS: The results suggested that the psychological distress of a family member increases when the patient is not informed of the cancer diagnosis, when the cancer is advanced or recurrent, and when the family member has a past history of psychiatric disorders. (Int J Psych Clin Pract 2002; 6: 205-210 )

Present status and prospect of psychotherapy in Japan.

The author will describe the changing trend of psychotherapy since the 1960s. The main theme in the 1960s was to establish psychotherapy for schizophrenics, although the school of Morita therapy had been continuing to treat the neurotic patients, particularly obsessional areas of neuroses. When social therapy came to dominate the clinical situation of schizophrenia in the course of time, the dynamic psychotherapists turned their attention to borderline patients. It was during this time that the borderline patients had been becoming the main theme in the clinical practices and the new theories and techniques had been successively imported. This situation is continuing even now. The rapid change of family structure had changed the personality structures and had given rise to the necessity for the family therapy. It is also emphasized that the new personality with ego splitting, who were likely to involve many people in the course of psychotherapy, has been asking us not only for individual psychotherapy but also a team approach.

Diurnal Rhythm of 5HIAA Release Determined by In Vivo Microdialysis in Freely Moving Rats

Changes in brain neurotransmitters measured by microdialysis have not yet been utilized sufficiently to determine the presence of circadian rhythms, such as those modulating sleep-wakefulness, hormonal secretion, and body temperature. There are some reports of a circadian rhythm governing the release of brain neurotransmitters, but these studies were chiefly performed in vitro.” Microdialysis has the twin advantages that the influence of individual variations between animals and problematic postmortem changes can be avoided. Furthermore, the changes in neurotransmitters actually released into the synaptic cleft can be evaluated directly. Some recent reports3 concerning the diurnal changes in brain neurotransmitters measured by microdialysis have been presented, but general agreement on the changes occurring has not yet been Furthermore, the duration of measurement was 24 hrs or less in most of these studies. It is necessary to conduct a longer study than this to confirm the presence of a circadian rhythm. Taking these problems into consideration, we performed microdialysis for 6 days in rats and measured brain monoamines and their metabolite levels. As a result, SHIAA, dopamine, DOPAC and HVA were found to show a clear circadian rhythm.