Tokuzo Matsui

Personality disorders in patients with obsessive‐compulsive disorder in Japan

A total of 75 patients with obsessive‐compulsive disorder (OCD) were studied in order to investigate the characteristics of OCD symptoms and the comorbidity of personality disorders (PD). Contamination obsessions and checking compulsions were most commonly found in patients, of whom 53% met the criteria for at least one PD. Among comorbid PD, the anxious‐fearful (cluster C) PDs, such as avoidant, obsessive‐compulsive and dependent PD, were most prevalent, followed by the odd‐eccentric (cluster A) PDs, such as paranoid and schizotypal PD. The patients with PD had more severe social maladaptation and concurrent depressive and anxious symptoms than the patients without any PD, despite the similar severity of OCD symptoms. These results are consistent with those reported in the Western world, and are considered to be relatively stable cross‐culturally.

Multi-impulsivity among bulimic patients in Japan

OBJECTIVE Studies in Western world patients suggest the possible existence of a subgroup of patients with bulimia nervosa (BN) who display multiple problems with impulsivity, such as suicidal attempts. We assessed impulsive behaviors among BN patients in Japan to discuss them crossculturally. METHOD Impulsive behaviors in 64 BN patients were assessed and multi-impulsivity (MI) was defined according to the definition proposed by Fichter, Quadflieg, and Rief (Psychological Medicine, 24, 591-604,1994). RESULTS Nineteen patients (30%) met the definition of MI. BN patients with MI had more severe clinical features, such as concurrent depressive and anxious symptoms, global functioning, and higher prevalence of borderline personality disorder than BN patients without MI. DISCUSSION These results showed the similarities between BN patients with MI in Japan and those patients in the Western world in clinical and psychopathological characteristics and a life-time incidence of each impulsive behavior. These findings may suggest culturally free bases for linkage between BN and MI.

Scheduled feeding caused activation of dopamine metabolism in the striatum of rats.

The effects of a time-restricted feeding schedule on dopamine (DA) release and its metabolites output in the striatum of freely moving rats were studied. Rats had access to food for only 2 h daily for 7 successive days. On the 1st or 7th day, the extracellular concentrations of DA, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) in the ventrolateral striatum were measured by in vivo brain microdialysis during 2 h of exposure to food-related stimuli followed by 2 h of access to food. Extracellular concentrations of DA and its metabolites did not change during the period of exposure to food-related stimuli or during feeding on the 1st day. On the 7th day, extracellular DOPAC and HVA concentrations increased significantly during 2 h of feeding, but not during exposure to food-related stimuli, compared with basal levels. Extracellular DA concentration did not change significantly. These results indicate that scheduled feeding caused activation of DA metabolism in the ventrolateral striatum and facilitate feeding-related motor activity in feeding behavior.

Prevalence and symptomatology of comorbid obsessive–compulsive disorder among bulimic patients

This study sought to assess the prevalence and symptomatology of comorbid obsessive– compulsive disorder (OCD) among Japanese subjects who met the DSM‐III‐R criteria for bulimia nervosa (BN). The Structured Clinical Interview for DSM‐III‐R Patient Version was used to distinguish 26 BN patients with concurrent OCD from 52 BN patients without OCD. Obsessive–compulsive symptoms in BN subjects with concurrent OCD were evaluated using the Japanese version of the Yale‐Brown Obsessive–Compulsive Scale. There were no differences in the prevalence of concurrent OCD between BN subjects with and without a lifetime history of anorexia nervosa. Among BN subjects with concurrent OCD, symptoms related to symmetry and order were most frequently identified, followed by contamination and aggressive obsessions, and checking and cleaning/washing compulsions. Bulimia nervosa subjects with concurrent OCD were more likely than subjects without OCD to have more severe mood and core eating disorder psychopathology. Comorbid OCD is a common phenomenon in Japanese bulimics (33%) similar to that suggested in BN subjects in the Western countries. Obsessive– compulsive symptoms related to symmetry and order were most frequently observed in BN subjects with concurrent OCD, which was a similar finding to that reported among restricting anorexic subjects.

A comparison of clinical features among Japanese eating-disordered women with obsessive-compulsive disorder.

Clinical features, such as obsessive-compulsive disorder (OCD) symptoms, were investigated in Japanese women with DSM-III-R eating disorders (EDs) and concurrent OCD in comparison to age-matched women with OCD. Sixteen women with restricting anorexia nervosa (AN), 16 with bulimia nervosa (BN), and 16 with both AN and BN (BAN) showed commonality in a more elevated prevalence of OCD symptoms of symmetry and order compared with 18 OCD women. Among the personality disorders (PDs), likewise, obsessive-compulsive PD (OCPD) was more prevalent in each ED group compared with the OCD group. However, aggressive obsessions were more common in both BN and BAN subjects compared with AN subjects. Subjects with bulimic symptoms were also distinguished from AN subjects by impulsive features in behavior and personality. Thus, an elevated prevalence of aggressive obsessions along with an admixture of impulsive and compulsive features specifically characterized the clinical features of bulimic subjects with OCD.

A comparative study of clinical features between pure checkers and pure washers categorized using a lifetime symptom rating method.

The current study assessed lifetime obsessive-compulsive disorder (OCD) symptoms in 156 Japanese patients with OCD in order to investigate clinical differences between pure lifetime checkers and pure lifetime washers. Fifty subjects (32%), who had no lifetime history of washing or checking compulsions, or who had a principal symptom other than washing or checking compulsions, were initially excluded. The remaining 106 subjects were divided into three groups: 43 pure lifetime washers (W), 33 pure lifetime checkers (C) and 30 subjects who had experienced both checking and washing compulsions over their lifetime (WC). No differences in clinical characteristics were observed between the W and C groups, suggesting that the lifetime washer-checker distinction may not be useful in subtyping OCD. However, subjects in the WC group differed from other subjects in a number of respects including poorer level of insight, more severe psychopathology and global dysfunction. Thus, they can be generally distinguished by more pervasive and severe psychopathological features, and may constitute a valid subgroup of OCD. Further work from a multidimensional perspective is required to verify the clinical significance of a typology based on lifetime symptoms.

Clinical features in two cases with musical obsessions who successfully responded to clomipramine

Abstract Clinical features in two cases with musical obsessions are presented to discuss phenomenological and psychopharmacological differences from those in patients with musical hallucinations. The present patients commonly experienced music as an internally generated cognitive product accompanied by full insight into the senselessness of the symptoms. They also attempted to suppress the musical symptoms or to neutralize them with other thoughts. Thus, despite no covert or systematic compulsive behaviors, the musical symptoms of the present cases are consistent with the phenomenological nature of obsessive–compulsive disorder defined in DSM‐IV. In addition, in contrast to previous case reports of musical hallucinations, the present patients failed to respond to neuroleptics, but showed significant response to an adequate trial of clomipramine. Thus, their symptoms appear to be phenomenologically and biologically distinct from musical hallucinations, especially those characteristic of schizophrenia.

A two-year follow-up study of chronic fatigue syndrome comorbid with psychiatric disorders.

Aims:  Chronic fatigue syndrome patients often have comorbid psychiatric disorders such as major depressive disorders and anxiety disorders. However, the outcomes of chronic fatigue syndrome and the comorbid psychiatric disorders and the interactions between them are unknown. Therefore, a two‐year prospective follow‐up study was carried out on chronic fatigue syndrome patients with comorbid psychiatric disorders.

A benzisothiazole derivative and antipsychotic agent, perospirone, for augmentation of selective serotonin reuptake inhibitors (SSRIs) in refractory obsessive-compulsive disorder (OCD): two patient case series

Even though selective serotonin reuptake inhibitors (SSRIs) are the mainstay of pharamacological treatment for obsessive-compulsive disorder (OCD), as many as 40% of patients do not have an adequate response to these medications. For such SSRI-refractory patients, the augmentation of SSRIs with new-generation antipsychotics that modulate both 5-HT and DA systems has recently been proven effective in controlled augmentation studies. The benzisothiazole derivative perospirone is a new serotonin 5-HT2 and dopamine D2 antagonist available in Japan for the treatment of schizophrenia. As its unique property, perospirone also exhibits 5-HT1A agonistic action. We present two SSRI-refractory OCD patients who showed little improvement with adequate trials of SSRI monotherapy, but exhibited significant improvement in their OCD symptoms after the addition of perospirone to ongoing SSRI treatment. The cases suggest that perospirone augmentation may be an effective and well-tolerated strategy for SSRI-refractory OCD patients. Controlled studies are required to further confirm the efficacy and tolerability of perospirone augmentation for treatment-resistant OCD.

Secondary obsessive‐compulsive disorder related to diaschisis after pontine infarction, successfully treated with paroxetine

Abstract  This report describes a case of secondary obsessive‐compulsive disorder related to diaschisis after pontine infarction. A 71‐year‐old male developed obsessive images, after a pontine infarction. A brain magnetic resonance imaging scan showed a low intensity area in the right pons on T1‐weighted image, while brain single photon emission computed tomography showed low cerebral blood flow in the temporal lobe as well as the pons. In this case, infarction in the pons appeared to cause dysfunction in the temporal lobe via the neural projection network, an example of so‐called ‘diaschisis’. This case suggests that brainstem infarction and decreased temporal lobe perfusion can lead to secondary obsessive‐compulsive disorder.