Characteristics and outcomes of school refusal in Hiroshima, Japan: proposals for network therapy.

The authors conducted a study on children undergoing treatment at major school refusal treatment centers in Hiroshima Prefecture. On the whole, school refusal in the prefecture was found to peak between 13 and 14 years of age. By age group, the main reason for school refusal in elementary school group was parent-child relationship with separation anxiety. Given additional problems such as neglect at home and complicated social situations in their schools, junior high school students were found to present diverse symptoms from introversion and self-analysis to extroversion, neglect of studies, and delinquency. Among high school students, there were more cases suffering withdrawal and schizophrenia spectrum disorders. The major task regarding treatment seems to lie in how to treat complex cases combining different problems. We summarized herein the studies we have carried out and propose a model for a network therapy system based on functional liaisons between treatment centers. With this system, a child psychiatric medical facility plays the part of a liaison center for the overall network system.</p

Medial prefrontal cortex and anterior cingulate cortex in the generation of alpha activity induced by transcendental meditation: a magnetoencephalographic study.

Previous EEG studies have shown that transcendental meditation (TM) increases frontal and central alpha activity. The present study was aimed at identifying the source of this alpha activity using magnetoencephalography (MEG) and electroencephalography (EEG) simultaneously on eight TM practitioners before, during, and after TM. The magnetic field potentials corresponding to TM-induced alpha activities on EEG recordings were extracted, and we attempted to localize the dipole sources using the multiple signal classification (MUSIC) algorithm, equivalent current dipole source analysis, and the multiple spatio-temporal dipole model. Since the dipoles were mapped to both the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC), it is suggested that the mPFC and ACC play an important role in brain activity induced by TM.</p

Delirium in Elderly Patients Admitted to a Psychiatric Hospiral: Causative Factors and Treatment

We studied the causes and treatments of delirium in 43 patients admitted to the geriatric-psychiatric ward of a hospital in Japan. Patients studied were divided into three groups according to the type of factor responsible for their delirium. We termed these causal factors precipitating, facilitating and predisposing factors. Twenty-one patients exhibited precipitating factors, the most common of which were overmedication and poisoning. Almost all these cases were treated with psychotropic drugs. Facilitating factors were judged responsible in nine cases. In six of these, admission to a hospital was thought to be the facilitating factor. Thirteen patients who had only predisposing factors were treated with psychotropic drugs while 27% of patients without precipitating factors were successfully treated for delirium without the use of such drugs.</p

Diffuse Lewy Body Disease : An Autopsy Case

A 67-year-old male patient initially showed memory disturbance followed by tremors a year later. The symptoms rapidly aggravated to dementia and Parkinsonian symptoms, and the patient died 2 years and 6 months after the onset at the age of 69 years and 5 months. Autopsy revealed numerous senile plaques in the cerebral cortex and Alzheimer's neurofibrillary tangles in the inferior temporal lobe and hippocampus. A number of Lewy bodies were found in the cerebral cortex and brain stem. Lewy bodies were found abundantly in the third layer of the pyramidal cells in the gyrus parahippocamalis. The distribution of Lewy bodies in the cerebral cortex was similar to that of inflated cells in Pick's disease.</p

Metabolism of 14 C-iodochlorohydroxyquinoline (chinoform) in mice

In order to know the organ distribution of Chinoform, I4C.Chinoform was injected into the tail vein of the mice, and radioactivity was measured in the chloroform soluble fractions in some organs and tissues containing non.conjugated Chinoform. The results obtained are as follows. 1. Uptake of Chinoform by the visceral organs was found to be in the following ascending order: fat tissue, kidney, spleen, liver, small intestine, (blood), muscle and eye, and marked uptake by the fat tissue and kidney was observed. 2. The presence of radioactive Chinoform in the chloroform soluble fraction of the central nervous system was recognized and it was almost in the same degree of specific radioactivity as that of blood. 3. A higher uptake in the chloroform soluble fraction of the sciatic nerve than that of central nervous system was recognized, and the value of the former was about 3 to 8 times as high as that of the latter. 4. The presence of Chinoform in the chroloform soluble fraction of the bile, although it increased after incu bation of the bile with j9-glucuro. nidase was observed. High radiogctivity of chinoform in the total fraction of the bile suggests a possible presence of &#34;liver-intestine-circulation&#34; of the drug.</p

Familial spastic paraplegia with epilepsy.

We report a family whose members have familial spastic paraplegia (FSP) associated with epilepsy. A man and his sister initially had primary generalized epilepsy with tonic-clonic seizures, but they have had no seizures for years. However, they developed spastic paresis of the lower extremities and presently show features of FSP. Their mother seemed to have suffered from FSP. One son of the female patient has epilepsy. The clinical picture of this family suggests a close relationship between FSP and epilepsy.</p

Bunina bodies in dendrites of patients with amyotrophic lateral sclerosis.

We studied the brains of two cases of amyotrophic lateral sclerosis with dementia. Bunina bodies were found in the motor neurons of cranial nerve nuclei (trigeminal, facial and hypoglossal nerves) as well as in the spinal motoneurons. They appeared mostly in the cytoplasm and occasionally in the neuronal processes. However, the present electron microscopic study disclosed clearly that Bunina bodies were present not only in the cell body but also in the dendrites. No Bunina bodies were observed in the axons. It is inferred that the Bunina bodies were degenerative products formed as a result of a protein metabolism disorder.</p

A case of bulbospinal muscular atrophy with chief complaint of sensory disorder in the lower extremities.

A 56-year-old man was admitted to our department with a chief complaint of lower extremity dysesthesia. He described a dull numbness below the ankle and a dull pain in the nates for the past two years. Although the numbness extended to the thigh, he did not notice any muscular weakness or atrophy. Neurological examination revealed weakness and atrophy in the face, tongue and the proximal portions of all four extremities. Deep tendon reflexes were decreased. A moderate loss of vibratory sensation was noted below the knees. Electromyography showed neurogenic changes. Muscle biopsy revealed both myogenic and neurogenic changes. Sural nerve biopsy revealed a mild reduction of myelinated fibers, particularly the large-diameter fibers. Based on these findings, a diagnosis of bulbospinal muscular atrophy (BSMA) was made. In recent years, there have been some case reports of BSMA with sensory disturbances, or merely with subclinical manifestations of a sensory disturbance. This case is included in the same category as those reports, but it is interesting to note that the sensory disturbance in the lower extremities occurred as the chief complaint of the disease.</p

Depression in the early stages of Pick's disease.

To better understand the nature of the symptoms of depression in the early stages of Pick's disease, we performed a retrospective study of the medical records of eight patients who were originally treated for major depressive disorders before being clinically diagnosed with Pick's disease. Six of the eight manifested psychomotor retardation and social withdrawal, seven of the eight were agitated and five of the eight showed hyperbulia too. However, only two of the eight showed melancholia or physical symptoms such as insomnia or loss of appetite. All patients were treated with antidepressants but these were not effective in relieving the symptoms of depression. The data we gathered in this study will be useful in the future for distinguishing between Pick's disease-related depression (in the early stages of the disease) and major depression.</p