Depression among adolescents : Clinical features and interventions

Depression often first develops during adolescence, with its rate sharply increasing after puberty and often running a chronic, recurring course thereafter. The development of depression is associated with difficulties in the lives of adolescents and their families, reduced academic achievement, suicide, and increased socio-economic disadvantage in adulthood. Earlier and more effective interventions for depression in adolescents are required. This review describes the updated etiology and clinical features of adolescent depression, and focuses on appropriate therapeutic strategies to adopt in clinical practice

Depression among adolescents and young adults

Depression is commonly known as frequent occurred status. Depressive disorder also has a rapid increase in prevalence after puberty, and has become a major problem for the mental health of adolescents and young adults. Depression in adolescents and young adults varies from those that require treatment for mood disorders, especially major depressive disorders, to those that are responses to worries or stress and are the effects of lifestyle. Therefore, for interventions it is required a multifaceted approach based on careful evaluation. It is necessary to further study the early intervention centered on depression in the future

Acceptability in subjects undergoing EGD

Esophagogastroduodenoscopy (EGD) has become an indispensable examination to discover upper gastrointestinal diseases, including cancer, and perform endoscopic treatment. However, many individuals who undergo the procedure have feelings of anxiety and fear regarding EGD. Although the use of medication for sedation during EGD is useful for reducing anxiety and the stability of hemodynamics, sedation may increase the likelihood of complications. Several noninvasive distractions have been introduced to decrease pain and anxiety during endoscopic examinations ; however, most assessments of these distractions evaluated subjective items such as impression. We herein add the results of our studies using objective items and review the effectiveness of distractions for EGD

The effect of odors of lavender and peppermint on the human SEP (Somatosensory Evoked Potential) and EEG

The effects of the odor, peppermint and lavender, on the human SEP (Somatosensory Evoked Potential) were studied with 15 healthy male subjects, aged 22~39 years. EEGs containing SEPs evoked by electric stimuli were recorded, together with EEGs, from the two derivations (monopolar : C 3'→A 1+2,bipolar : C 3'→F 3'), averaging 100 responses with 1024 msec of analysis time. In each experimental session, EEGs containing SEPs were recorded before, during and 15, 30 minutes after the inhalation of air and the odor. Consecutive changes on group mean SEPs were studied. Indivisual SEPs were subjected to the component analysis, and to the statistical assessment together with EEG . The following results were obtained. 1. During and after inhalation of peppermint, the latencies of long latency components of SEPdecreased, and the peak-to-peak amplitudes of middle and long latency components decreased significantly. In EEG, α1 power % increased during inhalation and then β2 power % decreased significantly after inhalation. 2. During and after inhalation of lavender, the latencies of middle and long latency components of SEP increased, and the peak-to-peak amplitude of middle latency components increased, and that of long latency components decreased significantly. After inhalation, in EEG, δ, θand α power % increased and β2 power % decreased. 3. These findings indicate that peppermint might activate cerebral whtite matter, lavender might release the activity in thalamocortical tract, in consequence of cerebral inhibition, besides inhibitory effects of peppermint and lavender through GABA neuron system

VEP シカクセイ ユウハツ デンイ オヨビ ノウハ エノ ラベンダー オヨビ ペパーミント ノ ニオイ ノ コウカ

匂いの情報は嘆覚伝導路を通じて大脳辺縁系，視床下部に入力され，本能的行動や感情 に影響を与える.近年，匂いの脳機能に及ぼす影響については，脳波，事象関連電位， PETなどによる研究がある.しかし，匂いの大脳誘発電位ヘ及ぼす効果についての研究 は当教室の聴覚性誘発電位(AEP) による研究しかない.木研究では健常成人男性15名 を対象として，ラベンダーおよびペパーミントの匂いを含む空気を吸入させ，視覚性誘発 電位(VEP)を含む脳波を，単極誘導(O1→A1+2)および双極誘導(O1→ Cz) から， 匂い刺激前，刺激中および刺激後2回にわたって計4回記録し，各VEP成分の潜時，振幅お よび脳波パワー%について統計的に検討して以下の結果を得た. 1.ラベンダーの匂い刺激中から後にかけ，両記録誘導で短潜時VEP成分P3，N3潜時が 有意なものも含めて延長し，長潜時成分では， P4～P7潜時で概ねすべての成分が有意に 延長した.振幅は，短～長潜時成分において有意な変化はすべて減少であった.本研究で は70msecまでの短潜時成分を皮質下反応とし，それ以降を皮質視中枢における反応とと らえ，前記の短～長潜時成分における潜時延長，振幅減少から，ラベンダーの匂い刺激に より視床(外側膝状体)から後頭葉および広範囲の皮質視中枢での興奮伝達が抑制された ものと理解した.脳波パワー%では，匂い刺激中にはα2波帯域では増加したが，刺激後 はθ波帯域では有意に増加した。すなわちラベンダーの匂い刺激は脳波上，緊張抑制効果 を示した後時間経過とともに鎮静催眠効果を示したものと考えられた. 2. ペパーミントの匂い刺激中から後にかけ，両記録誘導で短潜時VEP成分潜時には有 意な変化がなく，長潜時成分ではP5潜時が有意に延長し，振幅は短～長潜時成分におい て有意に減少した.このことから，ペパーミントの匂い刺激もラベンダーの匂いと同様に 潜時延長，振幅減少を示しVEPに対して抑制的に作用したが，有意な変化をきたした成分 が少なく，短潜時成分潜時に有意な変化がないことから，その作用は弱く，皮質下におけ る視覚神経伝達にはほとんど影響を及ぼさないものと理解した.脳波パワー%では，匂い 刺激中にα2波帯域では有意な減少，β2波帯域では有意な増加，およびô波帯域では有意 でない増加を認め，これらの変化は刺激後は消失したが，匂い刺激中の変化は，抗うつ薬 の示す脳波変化のパターンに該当することから，ペパーミントの匂いが抗うつ薬に類似し た作用をもつ可能性が示された. 3.本研究での匂いによるVEPへの影響は，皮質下では嗅覚系から視床網様核を介して 外側膝状体での神経伝達に作用を及ぼしたものとして理解した.ラベンダーおよびペパー ミントの匂いのVEPへの抑制作用は.その強さおよび作用部位は異なるが，いずれも外側 膝状体および皮質視中枢の抑制性神経伝達物質GABAを介する抑制作用によるものとして 理解できた

AEPおよび脳波に対するcaffeineの効果

We studied the effects of caffeine on the central nervous system by auditory evoked potentials (AEP) with 25 healthy male subjects (T-group: 24-44 y.o., mean caffeine consumption: 251.4 mg/day). According to the DSM-IV criteria for caffeine intoxication, T-group were devided into the light (L-group: 11 subjects, ≦250 mg/ day) and heavy consumer group (H-group: 14 subjects, >250 mg/ day), and into caffeine (CAF-group) and placebo administration group (PLA-group) according to a double-blind cross-over design. EEG containing AEP was recorded through the two deviations (monopolar : Cz→A1+2, bipolar : Cz→T5); before and 30, 60 and 90 min after the oral administration of caffeine or placebo (3 mg/kg of B.W.). Consecutive changes of the latencies and amplitudes in group mean AEP were studied. Those of individual AEP were subjected to the component analysis, and to the statistical assessment with reference to the EEG power % changes. 1. After the administration of caffeine, CAF-group had a significant decrease in N 4 (= N 1, latency : 95-125 msec) and P 5 (=P 2, latency : 160-200 msec) latencies of long latency components, followed by a decrease in N 4-P 5 amplitudes of AEP, which indicated that there was a post-exciting inhibitory effect in CAF(H)-group. In EEG, α power % significantly increased, whereas δ, θ and β power % significantly decreased. These findings indicated that caffeine might have a sedative effect as well as the exciting effects on the primary and secondary auditory cortex. 2. CAF(H)-group had significant changes in latencies of AEP and EEG only 30 min after the administration of caffeine, whereas CAF(L)-group had these changes over 60 min after that, suggesting the hypersensitivity to caffeine by the interruption of caffeine consumption. 3. These changes seemed to be assciated with the effects of caffeine as an adenosine A1 receptor antagonist in the cerebral cortex, although further investigation on the neurotransmitters related to caffeine should be expected

The effects of odors of lavender and peppermint on the human AEP (Auditory Evoked Potential) and EEG

The effects of odors (Lavender and Peppermint) on AEP (Auditory Evoked Potential) were studied with 15 healthy male subjects aged 22~39 y. o. (mean : 29.1 ± 4.8 y. o.). EEGs containing AEPs evoked by click stimuli once every 5 seconds were derived from the two derivations (3 ch : Cz→A1 +2, 6 ch : Cz→T5) , and recorded into magnetic tape. Reproducing the tape, AEPs with 1024 msec of analysis time were obtained by averaging 100 responses, and EEGs were subjected to the frequency analysis. In the experimental session, EEGs containing AEPs were recorded before, during and 15 and 30 minutes after the inhalation of odors of Lavender and Peppermint. Consecutive changes of group mean AEP were studied. Indivisual AEPs were subjected to the component analysis, and to the statistical assessment together with EEG. The following results were obtained. 1. Subjective assessment for the intensity and pleasantness of odors was not only so much different between Lavender and Peppermint, but close similar among the subjects. 2. During and after the inhalation of Lavender, latencies of the middle latency AEP including P2 latency, and latencies of long latency components (P6~) significantly or not significantly increased. Peak-to-peak amplitudes including P2-N2 of the middle latecy AEP significantly or not significantly decreased. During and after the inhalation of the odor of Peppermint, latencies of the middle latency AEP including P2 latency decreased but not significant, and peak-to-peak amplitudes including P2-N2 significantly or not significantly increased. Amplitudes of long latency component (P6~) did not change significantly. In conclusion, sedative effect of Lavender and a kind of stimulating effect of Peppermint on the middle latecy component were confirmed by AEP. 3. From the changes of P2, which derived from the brainstem reticular formation, it was said that Lavender inhibited, and Peppermint activated the reticular formation. Increased latencies of the long latency component of AEP during and after Lavender indicated the secondary inhibition of cortex succeeding to inhibition of the brainstem reticular formation. 4. Although the mechanism of olfactory system is not clarified, the odors of Lavender and Peppermint were might be differentiated in olfactory systems below neocortical olfactory area, and act on the reticular formation respectively inhibitorily or excitedly through the medial forebrain bundle. 5. It has been generally said that olfactory stimuli activate the CNS through the brainstem reticular formation, but inhibitory effect of Lavender similar to that of minor traquilizer, besides activating effect of Peppermint was verified for the first time by AEP

The effect of odors of lavender and peppermint on the human VEP (Visual Evoked Potential) and EEG

The effects of the two kind of odors, Lavender and Peppermint, on the human VEP (Visual Evoked Potential) were studied with 15 healthy male subjects aged 22~39 years. EEGs containing VEPs evoked by flash stimuli once every 5 sec were derived from the two derivations (2 ch : O1→A1+2, 5 ch : O1→Cz) and recorded on magnetic tapes. Reproducing the tapes, VEPs with 1024 msec of analysis time were obtained by averaging 100 responses, and EEGs were subjected to the frequency analysis. In each experimental session, EEGs containing VEPs were recorded before, during and 15 and 30 minutes after the inhalation of air containing odor. Consecutive changes were observed with group mean VEP. Indivisual VEPs were subjected to the component analysis, and to the statistical assessment together with EEG frequency analysis. The following results were obtained. 1. During and after inhalation of Lavender, latencies of the short and long latency components increased, and peak-to-peak amplitudes decreased significantly. In EEG, the power % of α2 frequency band increased, and then that of θ increased significantly with EEG slowing. These findings indicate that Lavender inhibits the visual system on the lateral geniculate body and visual cortex, probably through GABA neuron system. The effect of Lavender on CNS might be relaxation at first, and then up to sedation. 2. During inhalation of Peppermint, the latencies significantly increased and the peak-to-peak amplitude significantly decreased with the long latency components of VEP, but not those of short latency components. These findings indicate that Peppermint does not inhibit the visual system at the subcortical level, and the inhibitory effect on CNS is mild, moreover it might have some effect of the thymoleptic

The effects of caffeine on the human Somatosensory evoked potential (SEP), visual evoked potential (VEP) and EEG

The effects of caffeine on central nervous system were investigated with SEP and VEP (EPs). The subjects were 25 healthy male volunteers aged 24-44 with a mean caffeine consumption of 251.4 mg/day, and were divided into the light and heavy consumer groups according to DSM-IV criteria for caffeine intoxication. They were given 3 mg/kg of body weight of caffeine or placebo in a double-blind cross-over design. EEGs containing SEPs evoked by electric stimuli to the right median nerve and VEPs by flash stimuli were recorded before, 30, 60, 90 minutes after dosing. The consecutive changes in EPs and EEG power% were studied and the following results were obtained. 1. Overall subjects had few components with significant changes in latencies and amplitudes of SEP and VEP after administration of caffeine. 2. EEGs recorded together with EPs showed a significant increase in α1 power% and a significant decrease in δ, θ and β２ power%. 3. There were also no significant differences in EPs measures and EEGs between the light and heavy consumer groups, except for EEG power% of VEP with the heavy costumer group showing an earlier appearance of changes. In conclusion, 3 mg/kg of body weight of caffeine administered in the present study did not effect on SEP and VEP as well as EEGs

Social and cognitive functions in schizophrenia

Purpose: The purpose of the present study was to examine clinical factors related to social function in people with schizophrenia. Patients and methods: The participants were 55 stabilized outpatients with schizophrenia. Their mean age was 39.36 (SD =10.65) years. Social function was assessed using the Quality of Life Scale (QLS). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. Results: Neither the MCCB cognitive domain score nor composite score was correlated with the QLS scores. However, of the 10 MCCB subtests, the Trail Making Test Part A and the Brief Assessment of Cognition in Schizophrenia-Symbol Coding (BACS-SC) scores were positively correlated with the QLS scores. Among clinical variables, especially the PANSS negative syndrome scale score had a strong negative correlation with the QLS scores. Stepwise regression analyses showed that the PANSS negative syndrome scale score was an independent predictor of the QLS scores, and although the BACS-SC score predicted the QLS common objects and activities subscale score, the association was not so strong compared to the PANSS negative syndrome scale score. Conclusion: These results indicate that speed of processing evaluated by BACS-SC could predict some aspect of social function but negative symptoms have a much stronger impact on global social function in people with schizophrenia