Tadashi Sasaki

Comorbidity of Irritable Bowel Syndrome, Panic Disorder, and Agoraphobia in a Japanese Representative Sample

OBJECTIVES:Irritable bowel syndrome (IBS) is considered to be a transcultural functional bowel disorder with high comorbidity and psychiatric disorders; but well-designed epidemiologic studies have never been performed in Japan. The purpose of this study was to establish the prevalence of IBS, together with the comorbidity rates of panic disorder (PD) and agoraphobia, employing a large-scale survey based on stratified random sampling.METHOD:A total of 4,000 subjects aged 20–69 years completed a questionnaire and the results were weighted to ensure representativeness of the Japanese general population. The questionnaire covered key symptoms of IBS, PD, and agoraphobia. The prevalence of IBS and its subtypes was calculated by gender. The comorbidity of PD and agoraphobia with IBS was compared with morbidity in non-IBS subjects; and comorbidity in IBS subjects who had consulted medical practitioners regarding their symptoms and in those who had not was also compared.RESULTS:The prevalence of IBS was 6.1% in total. It was significantly higher in females than in males. Diarrhea-predominant IBS was more prevalent in males and constipation-predominant IBS in females. The morbidity rates of PD and agoraphobia were significantly higher in IBS than in non-IBS subjects. Comorbidity did not differ between female and male IBS subjects, while morbidity was significantly higher in female than in male non-IBS subjects; and comorbidity did not differ between consulter and nonconsulter subjects.CONCLUSIONS:The prevalence of IBS and its comorbidity with PD and agoraphobia in Japan were demonstrated to be similar to those reported in Western industrialized countries.

QT interval and QT dispersion in eating disorders

Background: Eating disorders are thought to be risk factors for cardiac sudden death secondary to arrhythmia. Results in previous studies on QT interval and QT dispersion, markers of fatal arrhythmia, have been inconsistent. Methods: We prospectively examined 179 female eating disorder patients, being over 18 years old and diagnosed according to the DSM-IV criteria between January 1995 and December 2002, and 52 healthy women. Patients with abnormal plasma electrolytes or taking medications that might influence the electrocardiogram (ECG) were excluded from the study. QT intervals were corrected for heart rate using Bazett’s formula and the nomogram method, which is more reliable at extremely low heart rates than Bazett’s formula. QT dispersion was measured as the difference between the longest and shortest QT intervals. QT intervals and QT dispersion in each patient group were compared with those in the control group. Results: The 164 eligible patients consisted of 43 patients with anorexia nervosa restricting type, 35 with anorexia nervosa binge eating/purging type, 63 with bulimia nervosa purging type, and 23 with bulimia nervosa nonpurging type. There was no significant difference in age between eating disorder patients and controls. QT interval and QT dispersion were significantly longer in all eating disorder subtypes than in the control group. QT interval and QT dispersion were significantly correlated with the rate of body weight loss in bulimia nervosa. Conclusions: QT interval and QT dispersion were prolonged in both anorexia nervosa and bulimia nervosa. Examination of ECG in eating disorder patients without extremely low body weight also appears to be clinically important.

Possible variances of blood urea nitrogen, serum potassium and phosphorus levels and interdialytic weight gain accounted for compliance of hemodialysis patients

OBJECTIVES The aim of this study was to assess the possible variances of blood urea nitrogen (BUN), serum potassium (SK) and serum phosphorus (SPO(4)) levels and interdialytic weight gain (IWG) accounted for compliance of uremic patients on hemodialysis (HD). METHODS BUN, SK and SPO(4) levels and IWG of uremic patients (n=310) regularly undergoing three HD sessions per week for more than 1 year in Japan were assessed. Patients suffering from problems influencing dietary intake and those with malnutrition were excluded. The variances accounted for self-efficacy for health-related behavior and avoidance-oriented coping (AOC) with stress were assessed by hierarchical multiple regression analyses. RESULTS BUN and SPO(4) levels were not significantly (P<.05) associated with self-efficacy or AOC. SK levels and IWG were significantly (P<.05) associated with self-efficacy and/or AOC. The variances of SK levels and IWG accounted for self-efficacy and/or AOC, independent of age, sex, duration of HD and facilities, were 1.6% and 5.0%, respectively. CONCLUSIONS Although the variances of SK levels and IWG accounted for self-efficacy and/or AOC were rather small, the significance of their relationships may suggest that intervention for self-efficacy or AOC could improve compliance and reduce SK levels and IWG of uremic patients on HD.

Coping skills in Japanese women with eating disorders.

The aim of this study was to investigate coping skills in the different types of eating disorders in Japan. Groups of patients with eating disorders diagnosed with DSM-IV and 22 controls were studied. Coping skills were assessed with the Stress Coping Inventory. The mean Problem-focused coping score tended to be lower in the bulimia nervosa purging-type group (n = 20) than in the control group. The former group and the bulimia nervosa nonpurging-type group (n = 6) used significantly less planful problem solving and less positive reappraisal coping than the control group, while the anorexia nervosa restricting-type group of 11 tended to use less positive reappraisal, and the anorexia nervosa binge-eating/purging-type (n = 11) tended to use less planful problem solving and less positive reappraisal than the control group. As some uses of coping skills by patients with eating disorders were lower than those of the control group, developing coping skills may be useful in treatment for eating disorders in Japan.

Relations among premorbid weight, referral weight, and psychological test scores for patients with anorexia nervosa.

The purpose of this study was to test the hypothesis that, in anorexia nervosa, patients with a low premorbid weight are associated with a low weight at referral and that premorbid weight, referral weight, and weight loss are associated with mood states. The changes of Body Mass Index from premorbid to referral, the duration of illness, and the psychological scores on the Profile of Mood States and the Cornell Medical Index-Health Questionnaire were examined in 49 anorexia nervous patients. Body Mass Index at referral of patients with lower premorbid Body Mass Index was significantly lower than that of patients with higher premorbid level. For patients with a larger relative decrease, scores on depressive mood were lower. These findings suggested that in anorexia nervosa patients, lower premorbid Body Mass Index was associated with lower Body Mass Index at referral, and that the patients with higher relative decrease in Body Mass Index might be satisfied with their weight loss.

Increased double product on Monday morning during work

It has been reported that cardiovascular events often occur on Monday morning, especially in the young working population. Because hypertension is a major cardiovascular risk, we examined whether blood pressure was elevated on Monday, especially in the morning during work. However, there were no weekly rhythms in blood pressure itself. Instead, we found significant interactions between the double product (systolic blood pressure × heart rate) and weekly (high on Monday) and circadian (high in the morning) rhythms. Further studies are required to determine whether Monday morning preference in cardiovascular events is caused by increased double product.