Yoshiharu Kim

Estimation of premorbid IQ in individuals with Alzheimer’s disease using Japanese ideographic script (Kanji) compound words: Japanese version of National Adult Reading Test

Abstract  The National Adult Reading Test (NART) is widely used as a measure of premorbid IQ of the English‐speaking patients with dementia. The purpose of the present study was to develop a Japanese version of the NART (JART), using 50 Japanese irregular words, all of which are Kanji (ideographic script) compound words. Reading performance based on JART and IQ as measured by the Wechsler Adult Intelligence Scale–Revised (WAIS‐R) was examined in a sample of 100 normal elderly (NE) persons and in 70 age‐, sex‐, and education‐matched patients with Alzheimer’s disease (AD). The NE group was randomly divided into the NE calculation group (n = 50) and the NE validation group (n = 50). Using the NE calculation group, a linear regression equation was obtained in which the observed full‐scale IQ (FSIQ) was regressed on the reading errors of the JART. When the regressed equation computed from the NE calculation group was applied to the NE validation group, the predicted FSIQ adequately fit the observed FSIQ (R2 = 0.78). Further, independent t‐tests showed that the JART‐predicted IQs were not significantly different between the NE and AD groups, whereas the AD group performed worse in the observed IQs. The reading ability of Kanji compound words is well‐preserved in Japanese patients with AD. The JART is a valid scale for evaluating premorbid IQ in patients with AD.

Prevalence and determinants of complicated grief in general population

BACKGROUND Few epidemiological studies have examined complicated grief in the general population, especially in Asian countries. Therefore, this study aimed to explore the prevalence and predictors of complicated grief among community dwelling individuals in Japan. METHODS A questionnaire survey regarding grief and related issues was conducted on community dwelling individuals aged 40-79 who were randomly sampled from census tracts. Complicated grief was assessed using the Brief Grief Questionnaire. Stepwise logistic regression analysis was conducted in order to identify predictors of complicated grief. RESULTS Data from 969 responses (response rate, 39.9%) were subjected to analysis. The analysis revealed 22 (2.4%) respondents with complicated grief and 272 (22.7%) with subthreshold complicated grief. Respondents who were found to be at a higher risk for developing complicated grief had lost their spouse, lost a loved one unexpectedly, lost a loved one due to stroke or cardiac disease, lost a loved one at a hospice, care facility or at home, or spent time with the deceased everyday in the last week of life. LIMITATIONS Limitations of this study include the small sample size, the use of self-administered questionnaire, and the fact that the diagnoses of complicated grief were not based on robust diagnostic criteria. CONCLUSIONS The point prevalence of complicated grief within 10years of bereavement was 2.4%. Complicated grief was maintained without significant decrease up to 10years after bereavement. When subthreshold complicated grief is included, the prevalence of complicated grief boosts up to a quarter of the sample, therefore, routine screening for complicated grief among the bereaved is desired. Clinicians should pay particular attention to the bereaved families with abovementioned risk factors in order to identify people at risk for future development of complicated grief.

Insight and clinical correlates in schizophrenia

It is not clear to what extent poor insight is inherent in schizophrenic psychopathology or is related to clinical factors. It is clinically important to elucidate this point to know how some insight remains intact in schizophrenia. Sixty-three ICD-10 schizophrenics were recruited. Insight was measured by Davids three-dimensional scale, which deals with the awareness of the need for treatment, of the illness, and of psychotic experiences. Clinical factors that may influence insight were grouped into objective psychopathology, subjective experience, and treatment settings, according to the normal development of insight starting from objective illness, through subjective perception of it, to seeking treatment. Psychopathology was measured by the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and the subjective experience was measured by a checklist of our own. Positive symptoms, especially disordered thought, hallucinations, and delusions, had a modest inverse correlation with awareness of illness and of psychotic experiences, but these were not correlated with alogia or other negative symptoms. Later age at the first onset was significantly correlated with poor awareness of psychotic experience, but no correlation of subjective experience with insight emerged. Awareness of the need for treatment was significantly higher in outpatient than in inpatient groups, and was not correlated with any other variables. Poor awareness of illness and of psychotic experience seems to be a trait of the acute rather than the chronic psychopathology of schizophrenia. Poor awareness of psychotic experience was related to later onset. Awareness of the need for treatment seems to improve, even in the absence of awareness of illness or of psychotic experience, in outpatient settings--the effects of social interaction may be relevant to this.

Brief measure for screening complicated grief: reliability and discriminant validity.

Background Complicated grief, which is often under-recognized and under-treated, can lead to substantial impairment in functioning. The Brief Grief Questionnaire (BGQ) is a 5-item self-report or interview instrument for screening complicated grief. Although investigations with help-seeking samples suggest that the BGQ is valid and reliable, it has not been validated in a broader population. Methodology/Principal Findings A questionnaire was mailed to a randomly selected sample (n = 5000) residing in one of 4 areas of Japan. The BCQ was examined for responders who were bereaved more than 6 months and less than 10 years (n = 915). Non-specific psychological distress was assessed with the K6 screening scale. Multiple group confirmatory factor analysis supported a uni-dimensional factor structure and the invariance of parameters across gender and age. Cronbachs alpha was sufficiently high (alpha = .75) to confirm internal consistency. Average Variance Extracted (0.39) was higher than the shared covariance (0.14) between BGQ and K6, suggesting discriminant validity. Conclusions The results of this study support the reliability and validity of the BGQ in the Japanese population. Future studies should examine predictive validity by using structured interviews or more detailed scales for complicated grief.

Prevalence of Mental Disorders and Suicidal Thoughts Among Community-Dwelling Elderly Adults 3 Years After the Niigata-Chuetsu Earthquake

Background Japan is located in an area prone to natural disasters, and major earthquakes have occurred recently in rural areas where the proportion of elderly adults is high. Although elderly persons are vulnerable members of communities at a time of disaster, the prevalence of mental disorders among this population has yet to be reported in Japan. This study aimed to determine the prevalence of mental disorders and suicidal thoughts among community-dwelling elderly persons 3 years after an earthquake and to identify risk factors associated with their quality of life (QOL). Methods Face-to-face interviews were conducted with 496 community-dwelling persons aged 65 years or older in areas of Japan where 2 major earthquakes had occurred during a 3-year period. The main outcome was diagnosis of a mental disorder or suicidality. Results During the 3-year period after the earthquake, 1.6% of men and 5.5% of women had received a diagnosis of major depression. There were no cases of posttraumatic stress disorder. Women were more likely than men to report suicidality (7.8% vs 3.8%, P = 0.075). Conclusions The prevalence of mental disorders was lower than that reported in previous studies. Despite the low prevalence of mental disorders, the percentage of community-dwelling elderly persons with subclinical mental health symptoms was high. The results indicate that appropriate public health and medical interventions are warranted after a natural disaster.

Peritraumatic Distress Inventory as a predictor of post-traumatic stress disorder after a severe motor vehicle accident

Aim:  The aim of this study was to examine the utility of the Peritraumatic Distress Inventory (PDI) as a predictor of subsequent post‐traumatic stress disorder (PTSD) in severe motor vehicle accident survivors.

Incidence and prediction of psychiatric morbidity after a motor vehicle accident in Japan: the Tachikawa Cohort of Motor Vehicle Accident Study.

Objectives:To assess both the incidence of new-onset psychiatric illness after involvement in a motor vehicle accident in Japan for comparison with Western data and the predictors of psychiatric morbidity and posttraumatic stress disorder (PTSD) evaluated immediately after the accident. Design:Prospective cohort study of injured patients assessed immediately and 4–6 wks after involvement in a motor vehicle accident. Setting:Intensive care unit in a teaching hospital in Tokyo, Japan. Patients:Total of 100 consecutive patients with motor vehicle accident–related injuries (mean Injury Severity Score, 11.2; mean Glasgow Coma Scale, 14.5; age, 18–69 yrs) admitted to the intensive care unit. Patients with traumatic brain injury, suicidality, current psychiatric or neurologic illness, or cognitive impairment were excluded. Measurements:An extensive clinical interview and evaluation of vital signs, sociodemographic variables, previous traumatic events, family history of psychopathology, Impact of Event Scale–Revised, Hospital Anxiety and Depression Scale, Clinician-Administered PTSD Scale, and Mini-International Neuropsychiatric Interview. Results:A total of 31 patients showed some form of new-onset psychiatric illness at the 4- to 6-wk follow-up. The majority of illnesses consisted of depression (major depression, n = 16; minor depression, n = 7) and PTSD (full PTSD, n = 8; partial PTSD, n = 16). Other illnesses included alcohol dependence (n = 3), obsessive–compulsive disorder (n = 2), agoraphobia (n = 2), and social phobia (n = 1). Both psychiatric morbidity and PTSD were predicted by a sense of life threat (odds ratio, 4.2 and 6.2, respectively), elevated heart rate (odds ratio, 1.6 and 1.7), and higher Impact of Event Scale–Revised intrusion subscale score (odds ratio, 1.1 and 1.1). Conclusion:This study showed that psychopathology and PTSD after a motor vehicle accident in Japan is common and that the incidence is within the range of that in Western countries. A combination of a sense of life threat, heart rate, and Impact of Event Scale–Revised intrusion subscale allowed for significant prediction of psychiatric morbidity and PTSD.

Sleep Deprivation Facilitates Extinction of Implicit Fear Generalization and Physiological Response to Fear

BACKGROUND Neuroendocrine hormones, which regulate both homeostasis and stress responses, provide homeostatic recovery and sleep suppression to brains under stress. We examined the effects of total sleep deprivation on subsequent enhancement of aversive event memory, implicit fear recognition, and fear conditioning in healthy humans. METHODS Three different recognitions (explicit event, implicit emotion, and physiological response) were assessed in two groups of 14 healthy young volunteers (sleep control and sleep deprived) with aversive (motor vehicle accident films) and nonaversive episodic memory stimuli. Both groups were tested on Day 1 of the experiment and again on Days 3 and 10; the sleep-deprived group was totally deprived of initial nocturnal sleep after the first trial on Day 1. RESULTS Event recognition performances were similar in both groups throughout the study. Implicit fear recognition remained high for aversive stimuli, with generalization of implicit fear recognition occurring for nonaversive stimuli on Day 3 in the sleep control group. Physiological fear and generalized fear responses were observed for every episode, and delayed enhancement of physiological response was only observed for misidentified aversive episodes in the sleep control group on Day 3. However, in the sleep-deprived group, generalization of implicit fear recognition for nonaversive stimuli on Day 3 and all physiological and generalized fear responses on Days 3 and 10 were comprehensively extinguished. CONCLUSIONS Clinically, trauma-exposed victims often experience acute insomnia, indicating that such insomnia might provide prophylactic benefits in reducing the development of posttraumatic stress disorder via extinction of the fear-magnifying effects of memory.

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.

Reliability and validity of the Japanese version of the Peritraumatic Distress Inventory

OBJECTIVE To assess the reliability and validity of the Japanese version of the Peritraumatic Distress Inventory (PDI). METHOD One hundred thirty-five participants with physical injury resulting from motor vehicle accidents were consecutively recruited in this cross-sectional study, from Aug. 18, 2005, to Jan. 8, 2008. A subsample (n=71) were retested on the PDI an average of 96.4 days after initial measure completion. RESULTS Correlational analyses revealed an overall Cronbachs alpha coefficient of 0.83. The item-total correlations for the 13 items ranged from 0.29 to 0.75. The test-retest correlation coefficient was 0.61. The PDI was significantly correlated with the external validators such as peritraumatic dissociation as measured by the Peritraumatic Dissociative Experiences Questionnaire (PDEQ); the intrusion, avoidance and hyperarousal scores of the Impact of Events Scale-Revised (IES-R); and the depression and anxiety subscales of the Hospital Anxiety Depression Scale (HADS) (P<.01). CONCLUSION The present study indicated that the Japanese version of the PDI has a high degree of internal consistency, acceptable reliability and a high degree of concurrent validity with measures of peritraumatic dissociation and posttraumatic symptoms. The Japanese version of the PDI can be used as a validated instrument in future research.