Tatsuhisa Yamashita

Regional cerebral blood flow changes associated with interoceptive awareness in the recovery process of anorexia nervosa.

BACKGROUND An abnormality in regional cerebral blood flow (rCBF) in anorexia nervosa (AN) patients has been reported. There are very few studies that have investigated the rCBF changes in the recovery process of AN. METHODS For eight female AN patients, we performed (123)I-IMP single photon emission computed tomography (SPECT) and four psychological assessments (Eating Disorder Inventory (EDI), Eating Attitude Test (EAT), Self-Rating Depression Scale (SDS) and State-Trait Anxiety Inventory (STAI)) both before and after inpatient-behavioral therapy. SPECT images were analyzed using statistical parametric mapping software. We also performed correlational analysis between rCBF and clinical variables. RESULTS Following treatment, the patients showed significant body weight recovery. They showed significant improvement in EAT, SDS, STAI and a subscale of EDI - interoceptive awareness (IA) - but not in total EDI or other EDI subscales. Significant rCBF increases were observed in the precuneus, posterior cingulate cortex (PCC), right dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC) and medial prefrontal cortex (MPFC) by the treatment. Significant correlation was observed between rCBF of right DLPFC and IA score before treatment. CONCLUSIONS Changes of rCBF in right DLPFC, ACC, MPFC, PCC and precuneus were related to the AN recovery process and might be associated with improvement of IA following treatment.

Parental bonding in patients with eating disorders and self-injurious behavior.

Aim:  The goal of the study was to investigate the correlations among parental bonding patterns, eating disorders (ED) and self‐injurious behavior (SIB).

Regional cerebral blood flow changes in a patient with delusional parasitosis before and after successful treatment with risperidone: A case report

The pathophysiology and appropriate pharmacological interventions for delusional parasitosis (DP) remain unknown. Here, we present a case of DP following brain infarction of the right temporoparietal region. Pharmacotherapy with risperidone resulted in a dramatic therapeutic response over a short period. In a sequential N-isopropyl-p-[(123)I]-iodoamphetamine single photon emission computed tomography ([(123)I]-IMP SPECT) study, post-treatment SPECT images revealed a marked increase of rCBF in the large areas including the bilateral frontal and left temporoparietal regions, the right parietal operculum and the bilateral basal ganglia, in contrast to pre-treatment SPECT images showing a global decrease of rCBF. Our clinical outcome suggests the efficacy and safety of risperidone for treatment of DP and that both dopaminergic and serotonergic dysfunction may play a role in DP. Our sequential SPECT findings suggest that psychiatric improvement of DP is associated with increased rCBF.

A tract-based spatial statistics study in anorexia nervosa: abnormality in the fornix and the cerebellum.

There has been an increasing interest in white matter abnormalities in patients with anorexia nervosa (AN). However, to date, there have been only a few diffusion tensor imaging (DTI) studies investigating AN, and the results are inconsistent. In this study, we employed tract-based spatial statistics (TBSS), a robust technique for whole-brain analysis of DTI data, to detect white matter abnormalities in AN patients compared with healthy controls. Seventeen women with AN and 18 age matched healthy women were included. The mean body mass index of patients was 13.6 kg/m(2) (controls: 19.9 kg/m(2)). DTI data were acquired on a 3-Tesla magnetic resonance imaging system. Fractional anisotropy (FA) and mean diffusivity (MD) maps were calculated from the DTI data of each patient, and voxel-wise group comparisons of FA and MD were performed using TBSS. Compared with the healthy comparisons, the patients showed a significantly higher MD value in the fornix and lower FA value in the left cerebellum. We also found significant positive correlations between the mean FA value of the left cerebellar hemisphere cluster and BMI, as well as between the mean MD value of the cluster in the anterior body of the fornix and the duration of illness. The results suggest that the white matter abnormalities in the fornix and the cerebellum may be related to the pathophysiology of AN.

Factors associated with postpartum depression and abusive behavior in mothers with infants

Aims:  This study was conducted to examine factors associated with postpartum depression and abusive behavior in mothers with infants.

Donepezil-induced nightmares in mild cognitive impairment

Donepezil is a selective and long-acting acetylcholinesterase inhibitor that is currently approved in many countries for the treatment of mild-to-moderate Alzheimer’s disease (AD). Its safety and tolerability are well established, but sleep problems including nightmares have been identified as adverse events of donepezil in AD. 1 Recent studies also indicate the use of donepezil in mild cognitive impairment (MCI), based on evidence of a high rate of conversion from MCI to AD. 2 However, the efficacy and safety of donepezil in MCI remains ambiguous. Here, we report the case of a patient with MCI who experienced frequent frightening nightmares following donepezil treatment. The patient was a 79-year-old Japanese woman who had no history of sleep and psychiatric disorders. She was referred to our clinic in June 2002, because of difficulty in remembering the names of her friends. Her Mini-Mental State Examination (MMSE) score was 26/ 30 (calculation: − 2; delayed recall: − 2), MRI and 123 IIMP SPECT showed no abnormalities, and she was completely independent in her activities of daily living. She was diagnosed as having MCI, and her status remained unchanged for the next 16 months. From October 2003, daily morning administration of donepezil was initiated. After taking donepezil (5 mg/day) for a few days, she began to experience nightmares about ‘fierce animals and dead people pursuing her in a dark forest’. These nightmares caused her to wake in the middle of the night and she was very afraid of going back to sleep. She also became anxious and depressed because of the frequent nightmares. Co-use of a benzodiazepine (flunitrazepam, 1 mg/day) and a decrease of donepezil to 3 mg/day did not eliminate the nightmares, and so she stopped the treatment. Shortly after discontinuation of donepezil, the nightmares completely disappeared and they have not subsequently recurred. After this episode, no remarkable change in cognitive status was observed. From the end of 2004, her memory disturbance worsened. She began to ask the same questions repeatedly and her emotional balance became unstable. In February 2005, her MMSE score was 25/30 (calculation: − 2; delayed recall: − 3), and SPECT revealed a decrease in regional cerebral blood flow (rCBF) in the posterior cingulate and bilateral parietal cortex. She was diagnosed with probable AD according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association criteria. After diagnosis of AD, re-administration of donepezil at 5 mg/day did not cause nightmares. Informed consent for the study and the neuroimaging investigation was obtained from the patient and her family. This case was initially diagnosed as MCI based on evidence of mild memory impairment and the absence of both social dysfunction and imaging abnormalities. During the MCI stage, the patient experienced frequent nightmares following donepezil treatment, after which she stopped taking donepezil. About 2 years later, her diagnosis was changed from MCI to AD, because of deterioration of memory and social function and the appearance of decreased rCBF in the cingulate and parietal cortex. After the occurrence of AD, donepezil administration no longer caused nightmares. Activation of the cholinergic nervous system by donepezil increases REM sleep, REM density and the duration of the first REM period, and also reduces REM latency. 3 Previous studies have reported sleep problems, including nightmares, as adverse events associated with donepezil treatment in AD patients, 1

A behavior therapy program combined with liquid nutrition designed for anorexia nervosa

We have introduced behavior therapy as standard in‐patient treatment for anorexia nervosa and have modified the treatment program. At first, we used Fukamachis activity restriction therapy (FT), followed by Token economy therapy (TET), which combined token economy with FT. Finally, we have developed Kyoto Prefectural University of Medicine Behavior Therapy (KPT). According to KPT, only liquid formula is given in the early stages of hospitalization and a target weight is not set at admission. We examined the effect of these three programs with respect to bodyweight gain. Thirty‐five anorexic patients participated in these three programs in our hospital: seven completed FT, seven completed TET and 21 coompleted KPT. We compared the effects of these three programs on body mass index (BMI). Furthermore, the effects of these three programs on BMI were compared at admission, 1 month after admission and at discharge, 6 months after discharge. In addition, the rate of increase of BMI for the following three periods was investigated: 1 month after admission, total hospitalization (from admission to discharge) and from admission to 6 months after discharge. The result is that KPT was the most effective of the three programs with regard to both the amount and the rate of increase of BMI at all points and there is a significant difference between KPT and FT. This effectiveness may be attributable to the use of an oral liquid formula, the setting of target weight at a later stage of hospitalization and the release of activity restriction based on weight gain.

Effects of rat medial prefrontal cortex lesions on olfactory serial reversal and delayed alternation tasks

When reward reinforcement in a two-choice discrimination task is regularly changed from one stimulus to another immediately after one learning acquisition session, the learning efficiency of a rat increases as if the rat has come to recognize this regularity of reversal. To investigate how the rat medial prefrontal cortex (mPFC) is involved in such improvement, we examined the performance of mPFC-lesioned rats in a serial reversal task of olfactory discrimination. The performance of other mPFC-lesioned rats in a delayed alternation task was also analyzed using the same apparatus to evaluate the contribution of the mPFC to working memory. The mPFC-lesioned rats demonstrated selective difficulty in the second reversal session in the serial reversal task and also showed performance impairment in the delayed alternation task. These results suggest that the rat mPFC mediating working memory is involved in early progress in learning efficiency during experiences of multiple reversals, which may be relevant to cognitive operations in reversal learning beyond a one-time reversal of stimulus response associations.

Japanese version of the Body Attitude Test: Its reliability and validity

The Body Attitude Test (BAT) was developed by Probst et al. (1995) for female patients with eating disorders (ED). This test measures the subjective body experience and attitudes toward ones body. The present authors have developed the Japanese version of the BAT and the purpose of the present paper was to investigate its reliability and validity in control (CON, n = 599) and ED patients (n = 46). The ED patients consisted of 21 anorexia nervosa, restricting type (AN‐R) patients and 25 bulimia nervosa (BN) patients. Internal consistency was determined with Cronbachs α coefficient in CON. Factor analysis was conducted on BAT ratings given by CON. Factor analysis indicated that BAT was composed of two factors. These were body dissatisfaction (factor 1) and lack of familiarity with ones body (factor 2). A comparison was made among AN‐R, BN, and CON. Bulimia nervosa had a significantly higher score than the other two groups. The BAT scores of ED patients correlated significantly with the Self ‐rating Depression Scale, and State–Trait Anxiety Inventory. These results show that ED patients have negative feelings toward their own body, similar to the findings in the original report. On factor analysis, however, it was not possible to distinguish between negative appreciation of body size and general body dissatisfaction as described in the original report. The authors also examine influences on this difference from a cross‐cultural view point.

Predictors for exacerbation/improvement of postpartum depression—A focus on anxiety, the mothers' experiences of being cared for by their parents in childhood and borderline personality: A perspective study in Japan

OBJECTIVE To investigate the course and influencing factors of postpartum depression in women during the child rearing period. METHODS Data were collected during 0-year-old baby check-ups and a follow-up investigation. 262 participants were included in the analysis. Both surveys employed the Zung Self-Rating Depression Scale (ZSDS). The first also comprised the State Trait Anxiety Inventory, Parental Bonding Instrument (PBI), and Borderline Scale Index, enabling sub-division of participating subjects into healthy/pathological groups. ZSDS group and survey scores were compared using the t-test. RESULTS The average ages of the children and the ZSDS scores in both surveys were 7.0±3.2 and 21.8±2.4 months, 40.6±7.9 and 40.1±8.7, respectively, with no significant differences among depression scores. When subjects were divided according to individual scale scores, and survey scores compared, depression significantly improved in the high trait/state anxiety group, high PBI maternal care score group, nonborderline personality (BP) trait group, and breast feeding group, whereas depression was significantly exacerbated in the low PBI maternal care score group. DISCUSSION Postpartum depression characterized by strong anxiety and a depressive state in mothers with favorable psychological backgrounds showed gradual improvement. We noted an exacerbation of depression during the separation period in mothers who had received poor maternal care. We assume that the feeling of abandonment induced by individuation of their children is a major factor. LIMITATIONS There is concern that some depressive women may have dropped out due to a performance bias. CONCLUSIONS Sharing our findings about exacerbation/improvement of depression among medical staff may be beneficial for postpartum mothers.