Yoshihiko Hoshino

Phenomenology and classification of the childhood psychoses

Two hundred and twenty-eight cases of children with final clinical diagnoses of childhood psychosis were reviewed using a standard coding scheme; cases were grouped in three broad categories on the basis of clinical diagnosis (autistic, atypical and schizophreniform). These three groups differed significantly in many respects, although the atypical group more closely resembled the autistic group. While it was possible meaningfully to differentiate diagnostic groups using DSM-III criteria, some cases were difficult to classify. Childhood schizophrenia, as strictly defined, was far less common than childhood autism. The development of diagnostic schemes for those children whose disorders are difficult to classify is an important topic for future research.

Hypothalamic-pituitary-adrenal axis function in children with attention-deficit hyperactivity disorder

Examined hypothalamic-pituitary-adrenal axis (HPA axis) function in 30 children with attention-deficit hyperactivity disorder (ADHD) by measuring the diurnal variation and response to the dexamethasone suppression test (DST) of saliva cortisol. Normal diurnal saliva cortisol rhythm was found in only 43.3% of the ADHD children. DST showed suppression in 46.7% of the ADHD children. An abnormal diurnal rhythm and nonsuppression to the DST were more frequent in the severely hyperactive group than in the mildly hyperactive group of children with ADHD. These results suggest abnormalities in HPA axis function in some children with ADHD, especially those exhibiting severe hyperactivity.

Hypothalamic-pituitary-adrenal axis function in chronic schizophrenia: association with clinical features.

The function of the hypothalamic-pituitary-adrenal axis (HPA-axis) and its association with clinical features in chronic schizophrenia were investigated. Twenty of 33 chronic schizophrenics exhibited an abnormal diurnal variation of the saliva cortisol level. The patients with abnormal diurnal variation gave higher scores for some negative symptoms than those with normal diurnal variation. On the dexamethasone suppression test (DST) of saliva samples, 13 of 34 chronic schizophrenics were abnormal. The patients with DST nonsuppression were more frequently classified into disorganized type and exhibited low scores of anxiety compared with the patients with normal suppression. The 9 patients who showed abnormal diurnal variation and DST nonsuppression were more frequently classified into disorganized type and showed higher scores of negative symptoms than the 9 patients who did not show any abnormal cortisol data. These results suggest that there might be some disturbance in the function of the HPA-axis in a group of chronic schizophrenics and that these patients might have severe negative symptoms.

The Diurnal Variation and Response to Dexamethasone Suppression Test of Saliva Cortisol Level in Autistic Children

Abstract: In order to examine the function of hypothalamic‐pituitary‐adrenal axis (HPA‐axis) in autistic children, the diurnal rhythm of saliva Cortisol and the response of Cortisol to the DST was investigated using saliva samples.

The Application of DSM‐III Diagnostic Criteria to School Refusal

Abstract: The DSM‐III diagnostic criteria were applied to school refusal cases, and the possibility of a subclassification of school refusal through the DSM‐III was studied. The subjects were 50 cases diagnosed as school refusal following the criteria defined by Sumi and Tatara.

Dexamethasone Suppression Test in Schizophrenia: Its Relation to Monoamine Metabolism in Hypothalamic-Pituitary-Adrenal Axis

The metabolic disturbances of monoamine in the hypothalamic-pituitary-adrenal axis (HPA axis) was examined in patients with chronic schizophrenia showing nonsuppression of the dexamethasone suppression test (DST). Subjects were 16 male chronic schizophrenics consisting of 8 DST suppressors and 8 nonsuppressors. All the patients were orally given the 5HT precursor, L-5-hydroxytryptophan (L-5HTP, 3 mg/kg) and the alpha 2-adrenergic agonist, clonidine (3 micrograms/kg), and the concentrations of plasma prolactin, cortisol, human growth hormone, and blood 5HT were measured chronologically. As a result, all of the DST nonsuppressors showed no increased response of prolactin after L-5HTP loading. Moreover, in the DST nonsuppressors, the secretion response of cortisol after L-5HTP loading was delayed compared with that of the suppressors. However, no different response between the DST suppressors and the nonsuppressors was observed after a loading dose of clonidine. These results suggest that there might be a metabolic disturbance of 5HT in the HPA axis of chronic schizophrenics showing DST nonsuppression.

A Critical Review of DSM‐III in the Developmental Disorder of Childhood

Abstract: This paper presents a summary and critical review of the DSM‐III diagnostic system for childhood psychiatric disorders with particular reference to developmental disorders. The rational for a multiaxial system, explicit diagnostic criteria, and a phenomenologicalapproach are outlined. Criteria for mental retardation, infantile autism, and specific developmental disorders are reviewed. While this system is an advance over previous schemesmany problems are also evident. These include a lack of specificity of the criteria, inconsistencies in criteria, and placement on the axes of mental disorders.

Sleep Rhythm Disturbances in School Refusers

Two subjects diagnosed as schizophrenia and two others without data on the history of sleep rhythm disturbances were excluded from the examinations. Of the remaining 26 subjects, 9 (34.6%) subjects reported no sleep rhythm disturbance, while 11 (42.3%) and 6 (23.1 %) reported disturbed and reversed sleep rhythms, respectively. Sleep rhythm disturbances were observed in over 60% of the school refusers. Sleep rhythm disturbance occurs as a symptom in the development of other major features of school refusal. So, we examined several variables concerning the amount of absence. We eliminated again two more subjects without data on the total amount of absence which finally left 24 subjects. First, we calculated the total amount of absence since the onset of school refusal (TAA) in each subject. The averaged TAA was 142.14 days for the school refusers with intact sleep rhythm, 187.27 days for disturbed sleep rhythm, and 279.33 days for reversed sleep rhythm (Fig. 1 1 . Then, we examined the period of school refusal (PSR; years passed since the onset of school refusal) in each subgroup of school refusers. The averaged PSR for the patients with intact sleep rhythm was 2.55 years, for those with disturbed sleep rhythm was 2.09 years, and for those with reversed sleep rhythm was 3.33 years (Fig. 1 ) . The above-mentioned results were summarized, school refusers with intact sleep rhythm were characterized by a relatively small TAA in spite of a moderately long PSR, while those with disturbed sleep rhythm showed a rather large TAA during a relatively shorter PSR, and school refusers with reversed sleep rhythm showed the largest TAA and longest PSR. These results suggest that their severity of sleep rhythm disturbance is determined at least partly by TAA and PSR, reducing an amount of social interaction as a synchronizer. We examined the period of school refusal and whether their sleep rhythm disturbances were present or past symptoms, to know when the disturbance of sleep rhythm occurred

The Problems on the Application of DSM-III-R and ICD-10 (DCR) Criteria in Learning Disability (Minimal Brain Dysfunction)

The utility of the “International Classification of Epilepsies, Epileptic Syndromes, and Related Seizure Disorders,” recognized by the International League against Epilepsy in 1989, was investigated in a neuropsychiatric clinic with a patient population numbering 300. Two hundred and three patients (67.7%) had localization-related epilepsies (LRE), including one idiopathic case. Sixty-six patients (22%) had generalized epilepsies, 50 idiopathic, 2 LennoxGastaut syndrome, and 14 symptomatic. Thirty-one patients (10.3%) with generalized tonic-clonic seizures occurring only during sleep had the epilepsies undetermined whether they are focal or generalized. In the symptomatic LRE cases, 56 had frontal lobe epilepsies, 86 had temporal lobe epilepsies, 8 had parietal lobe epilepsies, 7 had occipital lobe epilepsies, and 34 cases (1 1.4%) could not be classified. Furthermore, seven of the cases with frontal lobe epilepsies were difficult to subtype. Eleven of the symptomatic LRE cases had some independent seizures, multiple foci in surface EEGs and were intractable. These cases may be defined as “multifocal epilepsies” as a new group. The Problems on the Application of DSM-111-R and ICD-10 (DCR) Criteria in Learning Disability (Minimal Brain Dysfunction)