The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident:results from the Fukushima health management survey.

INTRODUCTION: We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children's experience of the nuclear disaster. METHODS: We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the "Strengths and Difficulties Questionnaire (SDQ)" scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster - "nuclear disaster (+)" and "nuclear disaster (-)" - were also compared. RESULTS: Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between "elementary school" and "junior high school" or "nuclear disaster" (+) and (-). There was no significant difference between these items. CONCLUSIONS: We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.

Mental health literacy regarding eating disorders in female Japanese university students.

Mental health literacy (MHL) refers to one's knowledge and beliefs about mental disorders. MHL is necessary for the prevention and early detection of eating disorders, but little research exists on the MHL of Japanese people. This paper aims to reveal the degree of MHL about eating disorders in the Japanese individuals most susceptible to them (namely, female university students). Female Japanese university students were surveyed with a self-report questionnaire, using the Japanese versions of anorexia nervosa and bulimia nervosa vignettes. Most participants responded that the main problem described in each vignette were "eating disorders" and tended to suggest medical care for the treatment. However, many still believed these issues to be simple problems of eating behavior. Overall, the participants demonstrated inadequate MHL about eating disorders. Initiatives to improve this population's knowledge and understanding of eating disorders are necessary.

Neonatal behavior and social behavior and sensory issues in 18-month toddlers.

BACKGROUND: There has long existed a need for early detection and early intervention for children with autism spectrum disorder. Accordingly, the aim of this study was to demonstrate, in a prospective manner, the relationship between behavioral features during the neonatal period and social behavior and sensory issues at 18 months. METHODS: Participants were 105 full-term infants considered "healthy" by an obstetrician. The behavioral features of the infants were evaluated using the Neonatal Behavioral Assessment Scale (NBAS) between 2 and 7 days after birth. Follow-up assessments were conducted 18 months later using a Japanese version of the Modified Checklist for Autism in Toddlers (M-CHAT-JV) and the Infant / Toddler Sensory Profile (ITSP). RESULTS: Sixteen (15.2%) of the 105 infants were M-CHAT-JV-positive. There were significant differences between the M-CHAT-JV-positive and M-CHAT-JV-negative groups in two of the NBAS clusters: orientation and motor. We observed a significant negative correlation between the NBAS orientation cluster and the ITSP "low registration" and "auditory processing" sections, as well as between the NBAS motor cluster and the ITSP "sensation avoiding" and "tactile processing" sections. Logistic regression analysis showed that the NBAS orientation cluster and ITSP low registration were significantly associated with the M-CHAT-JV at 18 months. CONCLUSIONS: The results suggest a relationship between the NBAS orientation cluster in full-term neonates and their social behavior and sensory features at 18 months.

Relationship between parenting stress and children's behavioral characteristics in Japan.

BACKGROUND: The evaluation of a child tends to differ between the mother and father regardless of whether the child has a disability or not, although parents have key information about the behavioral characteristics of the child. The number of reports in Japan, however, is limited. We, therefore, investigated the relationship between the parenting stress experienced by parents of non-clinical preschool children and the children's behavioral characteristics. METHOD: The subjects were 83 pairs of mothers and fathers with non-clinical children in kindergarten and nursery school (average age, 59.1 ± 13.0 months; 36 boys, 47 girls). The study was conducted using the Parenting Stress Index-Short Form (PSI-SF) and the Strengths and Difficulties Questionnaire (SDQ). RESULTS: There was no difference in the PSI-SF scores between mothers and fathers, but hyperactivity/inattention, peer relationship problems, and the total score of the SDQ were significantly higher in fathers. On multiple regression analysis, parenting stress experienced by fathers was significantly related to hyperactivity/inattention, while parenting stress experienced by mothers was significantly related to peer relationship problems and emotional symptoms. CONCLUSION: Children's behavioral characteristics related to parenting stress differ between mothers and fathers.

Deep sequencing reveals variations in somatic cell mosaic mutations between monozygotic twins with discordant psychiatric disease.

Monozygotic (MZ) twins have been thought to be genetically identical. However, recent studies have shown discordant variants between them. We performed whole-exome sequencing (WES) in five MZ twin pairs with discordant neurodevelopmental disorders and one healthy control MZ twin to detect discordant variants. We identified three discordant variants confirmed by deep sequencing after analysis by personalized next-generation sequencing (NGS). Three mutations in FBXO38 (chr5:147774428;T>G), SMOC2 (chr6:169051385;A>G) and TDRP (chr8:442616;A>G), were detected with low allele frequency of mutant alleles on deep sequencing, suggesting that these loci are mosaic due to somatic mutations in a developmental stage. Our results suggest that deep sequencing analysis would be an adequate method to detect discordant mutations in candidate genes responsible for heritable diseases.

Primary Motor Cortex Activation during Action Observation of Tasks at Different Video Speeds Is Dependent on Movement Task and Muscle Properties.

The aim of the present study was to investigate how the video speed of observed action affects the excitability of the primary motor cortex (M1), as assessed by the size of motor-evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS). Twelve healthy subjects observed a video clip of a person catching a ball (Experiment 1: rapid movement) and another 12 healthy subjects observed a video clip of a person reaching to lift a ball (Experiment 2: slow movement task). We played each video at three different speeds (slow, normal and fast). The stimulus was given at two points of timing in each experiment. These stimulus points were locked to specific frames of the video rather than occurring at specific absolute times, for ease of comparison across different speeds. We recorded MEPs from the first dorsal interosseous muscle (FDI) and abductor digiti minimi muscle (ADM) of the right hand. MEPs were significantly different for different video speeds only in the rapid movement task. MEPs for the rapid movement task were higher when subjects observed an action played at slow speed than normal or fast speed condition. There was no significant change for the slow movement task. Video speed was effective only in the ADM. Moreover, MEPs in the ADM were significantly higher than in the FDI in a rapid movement task under the slow speed condition. Our findings suggest that the M1 becomes more excitable when subjects observe the video clip at the slow speed in a rapid movement, because they could recognize the elements of movement in others. Our results suggest the effects of manipulating the speed of the viewed task on the excitability of the M1 during passive observation differ depending on the type of movement task observed. It is likely that rehabilitation in the clinical setting will be more efficient if the video speed is changed to match the task's characteristics.

Relationship between Motor Coordination, Cognitive Abilities, and Academic Achievement in Japanese Children with Neurodevelopmental Disorders.

BACKGROUND/OBJECTIVE: Motor coordination impairment is common in children with neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (AD/HD). The purpose of this study was to investigate the relationship between motor coordination, cognitive ability, and academic achievement in Japanese children with neurodevelopmental disorders. METHODS: Thirty-four school-age (6-12 years old) children with neurodevelopmental disorders and 34 age-matched typically developing (TD) children were recruited in this study. Correlations between the scores of the Movement Assessment Battery for Children-2 (M-ABC2) and the Kaufman Assessment Battery for Children - Second Edition (K-ABCII) that assesses cognitive abilities, and academic achievement were analyzed. RESULTS: The children with neurodevelopmental disorders obtained a lower total score and all component scores on M-ABC2 compared to the TD children. In children with neurodevelopmental disorders, M-ABC2 Manual Dexterity score was significantly correlated with K-ABCII Simultaneous Processing (r = .345, p = .046), Knowledge (r = .422, p = .013), Reading (r = .342, p = .048), Writing (r = .414, p = .017), and Arithmetic (r = .443, p = .009) scores. In addition, M-ABC2 Balance score was significantly correlated with K-ABCII Learning (r = .341, p = .048), Writing (r = .493, p = .004), and Arithmetic (r = .386, p = .024) scores. CONCLUSION: These findings stress that it is essential to accurately identify motor coordination impairments and the interventions that would consider motor coordination problems related to cognitive abilities and academic achievement in Japanese children with neurodevelopmental disorders.

Effectiveness of Earmuffs and Noise-cancelling Headphones for Coping with Hyper-reactivity to Auditory Stimuli in Children with Autism Spectrum Disorder: A Preliminary Study.

OBJECTIVE/BACKGROUND: The purpose of this pilot study was to examine the effectiveness of standard earmuffs and noise-cancelling (NC) headphones in controlling behavioural problems related to hyper-reactivity to auditory stimuli in children with autism spectrum disorder (ASD). METHODS: Twenty-one children with ASD aged 4-16 years (16 boys and 5 girls), after a 2-week nonwearing baseline period, were asked to use standard earmuffs and NC headphones for 2 weeks, in a random order. Parents or teachers rated participants' behaviours that were related to their reaction to auditory stimuli. RESULTS: Four participants refused to wear either the earmuffs or the NC headphones. It was found that the T-score on the Goal Attainment Scaling was significantly higher during the earmuff period than that in the baseline period (Z = 2.726, p = .006). The behaviours of 5 children with ASD improved during the NC headphone period as compared with those in the baseline period; there were no differences in the T-scores on the Goal Attainment Scaling between the NC headphone period and the baseline period (Z = 1.689, p = .091) and between the earmuff and NC headphone periods (Z = -0.451, p = .678). CONCLUSION: This study demonstrated the effectiveness of standard earmuffs and NC headphones in helping children with ASD to cope with problem behaviours related to hyperreactivity to auditory stimuli, therefore, children with ASD could use earmuffs to help to deal with unpleasant sensory auditory stimuli.

Factors affecting medication adherence in children receiving outpatient pharmacotherapy and parental adherence.

PROBLEM: Although pharmacotherapy is an effective treatment for many psychiatric disorders in children and adolescents, medication adherence rates among children are low. This study clarifies factors affecting children's medication adherence and the role of parental involvement. METHOD: Patients aged 7-17 years with a history of psychotropic medication treatment and their mothers were included in this study. Each mother and child completed self-administered questionnaires. Thirty mother-child pairs who fully completed the questionnaires were included in the analysis. RESULTS: Medication adherence was greater in children and mothers when mothers felt that "children's symptoms improved with treatment and medication." Medication adherence in children and mothers significantly correlated with the child's reported trust in their parent. CONCLUSIONS: The results suggest the need for psychosocial support that considers the influence of mothers on medication adherence in children treated in child psychiatry departments.

Relationship between Sympathetic Skin Responses and Auditory Hypersensitivity to Different Auditory Stimuli.

[Purpose] Auditory hypersensitivity has been widely reported in patients with autism spectrum disorders. However, the neurological background of auditory hypersensitivity is currently not clear. The present study examined the relationship between sympathetic nervous system responses and auditory hypersensitivity induced by different types of auditory stimuli. [Methods] We exposed 20 healthy young adults to six different types of auditory stimuli. The amounts of palmar sweating resulting from the auditory stimuli were compared between groups with (hypersensitive) and without (non-hypersensitive) auditory hypersensitivity. [Results] Although no group × type of stimulus × first stimulus interaction was observed for the extent of reaction, significant type of stimulus × first stimulus interaction was noted for the extent of reaction. For an 80 dB-6,000 Hz stimulus, the trends for palmar sweating differed between the groups. For the first stimulus, the variance became larger in the hypersensitive group than in the non-hypersensitive group. [Conclusion] Subjects who regularly felt excessive reactions to auditory stimuli tended to have excessive sympathetic responses to repeated loud noises compared with subjects who did not feel excessive reactions. People with auditory hypersensitivity may be classified into several subtypes depending on their reaction patterns to auditory stimuli.

[Trend in ICD-11 primary health care version--possibility of introducing new psychiatric diagnosis categories].

Revision of ICD-11 will be submitted for approval at the general assembly in 2015. The influence of the ICD revision will be marked in the field of psychiatry. The trend in developing ICD-11-PHC is promoting cooperation with primary carers. The goals of the revision of ICD-11-PHC are as follows: 1) To produce a classification system that corresponds more closely to common mental disorders encountered in general medical practice; 2) The "co-morbidity" we want practitioners to recognize is that between physical and psychological disorders; 3) To allow dimensions of severity of some common disorders to be recognized, rather than case/non-case distinctions. The ICD-11-PHC draft consists of 28 categories and detailed clinical descriptions. The number of categories has increased in the ICD-11-PHC draft in comparison with ICD-10-PHC. Anxiety disorders such as neurasthenia, and phobic disorders and panic disorder have been deleted. On the other hand, new diagnostic categories such as autistic spectrum disorder, PTSD, and personality disorder have been introduced. Furthermore, name changes such as anxious depression, bodily stress syndrome, health anxiety, and persistent psychotic disorders have been suggested. We should be aware of such new diagnostic concepts. In addition, it is thought that it is necessary for us to deepen our understanding of ICD-11, which will be important in the future.

Pilot study: efficacy of sensory integration therapy for Japanese children with high-functioning autism spectrum disorder.

This study's objective was to investigate the efficacy of sensory integration therapy (SIT) for children with high-functioning autism spectrum disorder (HFASD). The subjects were 20 HFASD children with IQs above 70 selected from previously collected data. Eight participated in individual SIT sessions, and 12 participated in group therapy (GT) including social skill training, communication training, kinetic activities, and child-parent play for 8-10 months. Changes in Total score and five Index scores on the Japanese version of the Miller Assessment for Preschoolers before and after therapy between children in the SIT and GT groups were compared. The results showed that Total score and all Index scores except for Verbal Index increased significantly in the SIT group, while only Total score increased in the GT group. Furthermore, the SIT group showed more improvement compared with the GT group in Total score and on Coordination, Non-verbal, and Complex Index scores. SIT might have a more positive effect on motor coordination abilities, non-verbal cognitive abilities, and combined abilities of sensory motor and cognition in children with HFASD when compared with GT. This study has limitations such as being an analysis of previously collected data. Further study should be conducted with a randomized control trial.

[Epidemiology of schizophrenia].

Schizophrenia exhibits wide variation in epidemiological characteristics. Through the past few decades, we have learned much about schizophrenia epidemiology, providing important findings for etiological research, clinical care and public health. In this article, we provide overview of current research on incidence, prevalence, risk factors, mortality and outcome of schizophrenia. Contrary to traditional understanding, the incidence and prevalence of schizophrenia show prominent variation between locations. Risk factors for schizophrenia include urbanicity, migration, sex, season of birth and pregnancy and birth complications. Schizophrenia patients have an increased mortality risk compared with the general population. Recent studies about outcome show not so tragic, especially in regard to social functioning. Over the recent decades, circumstances have been changing around schizophrenia. As to treatment, for example, 'the second generation antipsychotics' have replaced conventional ones and 'early intervention' is developing. However, we have only limited evidences of current schizophrenia. Further epidemiological development is needed.

[Trends in primary health version of ICD-11].

The WHO recognizes the importance of a psychiatric diagnostic system in primary care. Regarding the revision of ICD-11 primary health care (ICD-11-PHC), a working group is organized and acts positively. The WG makes the draft of ICD-11-PHC. Some new and interesting disease names, such as ANXIOUS DEPRESSION and BODILY STRESS SYNDROME (BSS), are incorporated in ICD-11-PHC. Revision to ICD-11 continues, and an international Field Trial of ICD-11-PHC by the WHO is planned. Participation in the Field Trial of Japanese researchers is expected. We psychiatrists should closely follow trends in interesting new knowledge in ICD-11-PHC.

Usefulness of near-infrared spectroscopy to detect brain dysfunction in children with autism spectrum disorder when inferring the mental state of others.

AIMS: The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for identifying abnormalities in prefrontal brain activity in children with autism spectrum disorders (ASD) as they inferred the mental states of others. METHODS: The subjects were 16 children with ASD aged between 8 and 14 years and 16 age-matched healthy control children. Oxygenated hemoglobin concentration was measured in the subject's prefrontal brain region on NIRS during tasks expressing a person's mental state (MS task) and expressing an object's characteristics (OC task). RESULTS: There was a significant main effect of group (ASD vs control), with the control group having more activity than the ASD group. But there was no significant main effect of task (MS task vs OC task) or hemisphere (right vs left). Significant interactions of task and group were found, with the control group showing more activity than the ASD group during the MS task relative to the OC task. CONCLUSIONS: NIRS showed that there was lower activity in the prefrontal brain area when children with ASD performed MS tasks. Therefore, clinicians might be able to use NIRS and these tasks for conveniently detecting brain dysfunction in children with ASD related to inferring mental states, in the clinical setting.

Psychological impact on caregivers traumatized by the violent behavior of a family member with schizophrenia.

BACKGROUND: A combination of factors such as substance abuse problems, medication noncompliance, and insufficient insight are generally known to increase the risk of violent behavior. However, little is known regarding the psychological impact on caregivers who are traumatized by the violent behavior of a family member with schizophrenia. Therefore, we carried out an investigation to measure this impact. METHOD: A questionnaire was given to 116 caregivers of individuals with schizophrenia in family support groups in Seoul and Daegu, Korea. Their responses were then evaluated using the 22-item version of the Impact of Event Scale-Revised (IES-R), the 8-item short version of the Zarit Caregiver Burden Interview (ZBI-8), and the 15-item version of the Mental Illness and Disorder Understanding Scale (MIDUS). RESULTS: The mean (SD) IES-R score was 26.69 (17.83) (range, 1-84). Multiple regression analysis showed that the psychological impact of traumatic experiences was significantly associated with the following factors: medical non-adherence (P<0.01), living without the patient (P<0.01), and caregiver burden (P<0.05). CONCLUSION: Our results from the present study suggest that even when family caregivers live apart from the patient, they still experience the harmful psychological impact of trauma from the patient's violent behavior. The psychological impact continued as a result of the huge caregiver burden and the medication non-adherence of the family member with schizophrenia in spite of receiving long-term treatment and multiple hospitalizations. The present findings suggest the need for improved community-based service for preventive long-term care, including medication adherence, for outpatients with schizophrenia instead of multiple hospitalizations.

Utilization of bar and izakaya-pub establishments among middle-aged and elderly Japanese men to mitigate stress.

Japanese suicide rate is one of the highest among industrialized nations, especially following the economic crisis of the 1990s, with more than 30000 suicides every year since 1998. Previous studies have pointed out to relationships between overwork and/or job stress, and death and other health risks, and suggested several possible avenues for releasing stress and emotional burden, including suicidal ideation, through talking with intimate friends, family, and specialists, such as counselors and physicians. The present study was performed to explore the potential role of owners and managers of bars and izakaya-pub establishments in mitigating stress of middle-aged and elderly Japanese men by having informal conversations with them. A self-administered questionnaire was posted to all bars and izakaya-pubs registered in Ohmura-city, Nagasaki prefecture, in December 2009. Among 260 bars and izakaya-pubs, a total of 103 owners and managers completed the questionnaire. More than half of the respondents experienced engaging in conversations with their customers regarding customers' various personal and private issues. The most frequently talked about problem was that regarding work (56.3%). Regardless of sex and age of the respondents, those with longer working experience in bar and izakaya-pub establishments were more likely to have had customers confiding in them financial problems including debts/loans (adjusted odds ratio: 5.48, p = 0.033). Owners and managers of bars and izakaya-pubs may be in a position to act as "listeners", to whom middle-aged and elderly men can talk about their personal problems casually and without having to worry about conflict of interests, and direct those in need to professional counseling.