Folia psychiatrica et neurologica japonica最新文献

A total of 164 (47%) out of 350 new psychiatric patients in a general hospital in Japan were those referred to psychiatric consultation. In 47% of the cases, concurrent physical and psychiatric disorders were reported. In the referred patients, neurosis (38%) was the most common psychiatric disorder, followed by other nonorganic psychoses (9%), schizophrenic psychoses (8%), alcoholic psychoses (8%), transient organic psychotic conditions (7%), affective psychoses (6%) and others. The high frequency of psychiatric emergency cases (23%) including cases with suicide attempts (12%) indicated that psychiatrists play an important role in psychiatric emergency crisis intervention in the general hospital emergency service. In suicide attempts, depression was most prominent, but schizophrenic psychoses were also involved in a third of the cases.

The Tokyo Child Development Schedule (TCDS) consisting of 140 items divided into seven areas--gross motor, fine motor, self-help, play, socialization, speech and comprehension-cognition--was developed. Each item is checked by a caretaker of a child with a three-point scale: pass, sometimes pass and fail. All of the seven areas and the entire portion of the TCDS exhibited a high grade of test-retest reliability. All but two of the items showed good agreement between the results of the two-time ratings. In 53 children with or without autistic features, the total scores on the TCDS and mental ages on the Japanese version of the Stanford-Binet Intelligence Scale demonstrated the value of correlation coefficient (r) of 0.779.

Five trained psychiatrists evaluated 330 first-visit patients aged from 12 to 30 at a psychiatric outpatient facility using the DSM-III criteria (Axis-I and Axis-II). Seven cases were diagnosed as definite Borderline Personality Disorder and six cases as definite Schizotypal Personality Disorder. Hence, we had a total of 13 criteria-defined borderline patients (3.9%). Discussions were held on some methodological problems involved in collecting information and making diagnostic judgments.

This is a report concerning 13 autistic children who have been followed up from their early infancy to adulthood. Some intake variables, such as speech development at the age of 5, were correlated with the outcome status. As a result, we showed that a higher level of speech development at age 5 did not necessarily lead to a better outcome in social adaptability. We showed also that any of the variables we examined, such as the presence of brain organic abnormality, the duration of schooling and the duration of medical treatment, were not factors in determining a good or poor prognosis. We concluded that a rather poor outcome seen in our subjects might be due to the particular situation in Japan throughout this study period, and not a reflection of the real natural history of early infantile autism.

In order to examine the cranial CT of autistic children and investigate the etiological significance of CT scan findings, the CT of the brain was surveyed in 24 children with early infantile autism (3 to 17 years with a mean age of 7.6), and 179 children with the normal CT despite their medical histories such as headaches or febrile convulsions. According to their ages, the autistic and normal children were divided into the following three groups: Group I (age ranging from 3 to 5), Group II (age: 6 to 9) and Group III (age: 10 to 17). There was no significant difference between the bifrontal CVI of the autistic children and that of the normal children. However, in Group III, the bifrontal CVI of the autistic children was significantly higher than that of the normal children. There was no significant difference between the bicaudate CVI of the autistic children and that of the normal children. However, in Groups I and II, the bicaudate CVI of the autistic children was significantly lower than that of the normal children. The maximum widths of the third ventricle showed no significant difference between the autistic and normal children. However, in Groups II and III, those of the autistic children were wider than those of the normal children. In the autistic children, as the age increases, the difference becomes significantly wider. A positive correlation was observed between the width of the third ventricle and ages of the autistic children. An examination of the right-left ratio of maximum transverse diameter of the brain showed that there was no significant difference between the autistic and normal children. The above-mentioned results (1)-4)) might suggest a progressive disorder of the brain structure surrounding the third ventricle or lateral ventricles in the autistic children.

Zotepine (ZTP), synthesized by Fujisawa Pharmaceutical Co., Ltd. for possible use as an antipsychotic drug, clinically features a very rapid and potent antimanic effect. To elucidate the psychopharmacological mechanisms of zotepine, we have attempted to measure the potency of ZTP compared with other neuroleptic drugs in competing for binding sites in the brain associated with dopamine, serotonin (5-HT1, 5-HT2), noradrenaline (NA) and acetylcholine. Zotepine was found to have the most potent activity to the 5HT1 receptor among the test drugs. Chlorpromazine and thioridazine, which belong to phenothiazines and clinically have less potent antimanic effect, shared ZTP's potent activity to the NA receptor, while they were less potent than ZTP in activity to the 5HT1 receptor. These results show that the activity of the drugs to the 5HT1 receptor may be associated with the antimanic effect.

Bromperidol (4 or 12 mg per day) was administered to 18 newly admitted schizophrenics and 29 chronic schizophrenic inpatients once or four times a day and the two dose schedules were compared. The bromperidol levels in the four-times-a-day group were significantly higher than those in the once-a-day group and the daily variation in the serum level of the agent was markedly wider in the latter than in the former patients. The incidence and severity of extrapyramidal symptoms were not significantly different between the two. A clear relationship was not present between the serum levels and the development of extrapyramidal symptoms. The bromperidol serum values were not correlated with the therapeutic response but, at more than 5 ng per ml, there might be a positive correlation between the bromperidol levels and clinical efficacy in the newly admitted schizophrenics. As for concomitant medication, levomepromazine may raise the bromperidol serum level. An anti-parkinson drug failed to depress the bromperidol level.

An experiment was conducted on 150 subjects; 100 schizophrenic and 50 control subjects. Each subject was given 56 or 57 word-cards, which consisted of 5 Cards selves (I, me, myself, etc.), 4 or 6 Cards families (father, mother, etc.), 7 Cards bodies (head, eyes, etc.), 11 Cards detestable (snake, etc.) and others. These cards were to be distributed in three concentric circles according to the standard of importance for the subjects. The results for the schizophrenic group in comparison with those for the control group were: Fewer cards were distributed in the central circle. The number of the distributed Cards important was smaller for the central and larger for the outward circle, etc. The discussion on the results was carried out with regard to the inner structure of ego, the boundary between ego and the outer world and the flexibility of ego. The conclusion of the discussion is as follows: In schizophrenics, The boundaries among the inner region of ego diminish. The boundary between ego and the outer world diminishes. Ego loses its flexibility. Ego contracts.

The effects of adolescent group psychotherapy were studied on 253 adolescent patients and 98 parents who participated in a camping marathon group psychotherapy (MGT) conducted every summer from 1972 to 1982 by the staff of the psychiatry division of Fukuoka University Hospital. Among the factors examined were the relations of the present therapy with age, individual therapy, types of disorders, the nature of conflicts of the patients, the attitudes of the patients and their parents toward the therapy and countertransference of the therapists. The objects and adjustment patterns of patients in the group therapy are considered to be dependent on these and other interrelated factors. Some of the patients adjusted to their psychological trauma resulting from their past human relations through re-experiencing identity crisis in the group as a transitional object. They did not maintain their enhanced self-esteem through the group experience, but apparently utilized the transitional object they identified with as a model in overcoming their crises when they returned to the real life situation and confronted their actual problems. The actual effect of the camping MGT, therefore, may be evaluated when the nature of the disorders and therapeutic goals of individual patients, revealed during the present therapy, are further dealt with in the family, individual and regular group therapy following the camping MGT.

The serial EEGs on 10 cases of neuro-Behcet's syndrome have been investigated and were compared with the clinical symptomatology and autopsy findings in 4 cases. In 8 cases, the EEGs showed a mild to moderate increase in slowed alpha and theta waves and in 5 cases diffuse alpha patterns. In 2 cases, large slow wave patterns were observed and in Case 10, large slow waves changed into low voltage fast dominant patterns following the status epilepticus. In all the cases, the EEG changes seemed to be well correlated with the clinical symptoms. Our present study suggested that the diffuse alpha patterns were only seen in cases with the least affected brain stem diffuse projection system. From the investigation of the sequential alterations of large slow waves in Case 10, it was suggested that a synchronization mechanism would lie in the medulla oblongata.