Psychiatric Features of Children with Chronic Functional Constipation: Focusing on Individuals with Autism Spectrum Disorder.

PURPOSE: The present study aimed to assess the psychiatric characteristics of children with chronic functional constipation using the Aberrant Behavior Checklist-Japanese version and the Pervasive Developmental Disorders/Autism Society Japan Rating Scale, and to examine the frequency of autism spectrum disorder in children with chronic functional constipation. We also investigated differences in treatment duration between children with and without autism spectrum disorder. METHODS: Treatment outcomes were examined retrospectively for 55 participants (chronic functional constipation group: n = 30, mean age 3.4 years; control group: n = 25, mean age, 4.5 years). The association between chronic functional constipation and autism spectrum disorder was evaluated using multivariable logistic regression analysis. RESULTS: The mean Aberrant Behavior Checklist score and frequency of individuals with autism spectrum disorder were significantly higher in the chronic functional constipation group. After adjusting for age and sex, chronic functional constipation was significantly associated with autism spectrum disorder. In the chronic functional constipation group, the frequency of onset was significantly higher in children with autism spectrum disorder under 1 year of age. When treated, the mean duration of constipation was significantly longer in children with autism spectrum disorder. CONCLUSION: Pediatricians, pediatric surgeons, and child psychiatrists should work closely to ensure appropriate treatment of chronic functional constipation in children with autism spectrum disorder.

Prescribing Patterns in Child and Adolescent Outpatient Psychiatry: A Retrospective Cohort Study of Prescriptions in the First Year.

OBJECTIVE: Recently, excessive and off-label prescribing of psychotropic drugs for children and adolescents have become a problem. Child and adolescent psychiatric patients receive treatment in many departments and department-specific psychotropic drug use has not been analyzed. We surveyed prescriptions for child and adolescent psychiatric outpatients during their first year of treatment. METHODS: The participants were 302 patients, 15 years or younger, who made their first visit to the outpatient psychiatry department of Tokai University Hospital from September 1, 2015 to September 1, 2016. Prescription details and patient profiles were retrospectively investigated using medical records. RESULTS: Medication was prescribed for 20.9% of patients (63/302) with the prescription rate increasing with age. Psychotropic drugs were prescribed for 15.6% of patients (48/302), with attention-deficit/hyperactivity disorder (ADHD) medications being most frequently prescribed (20 cases). Other than psychotropic drugs, iron pills (25 cases) and herbal medicines (21 cases) were prescribed frequently. CONCLUSIONS: The pharmacotherapy and psychotropic prescription rates were low. This may be due to the use of non-pharmacological interventions and the lack of inpatient facilities. With the publication of guidelines for pharmacotherapy in child psychiatry in Japan, measuring the patterns of psychotropic drug prescription in children and adolescents is important, and would make treatment more transparent.

Impact of Gut Microbiota on Host Aggression: Potential Applications for Therapeutic Interventions Early in Development.

Aggression in the animal kingdom is a necessary component of life; however, certain forms of aggression, especially in humans, are pathological behaviors that are detrimental to society. Animal models have been used to study a number of factors, including brain morphology, neuropeptides, alcohol consumption, and early life circumstances, to unravel the mechanisms underlying aggression. These animal models have shown validity as experimental models. Moreover, recent studies using mouse, dog, hamster, and drosophila models have indicated that aggression may be affected by the "microbiota-gut-brain axis." Disturbing the gut microbiota of pregnant animals increases aggression in their offspring. In addition, behavioral analyses using germ-free mice have shown that manipulating the intestinal microbiota during early development suppresses aggression. These studies suggest that treating the host gut microbiota during early development is critical. However, few clinical studies have investigated gut-microbiota-targeted treatments with aggression as a primary endpoint. This review aims to clarify the effects of gut microbiota on aggression and discusses the therapeutic potential of regulating human aggression by intervening in gut microbiota.

Iron Supplementation for Hypoferritinemia-Related Psychological Symptoms in Children and Adolescents.

BACKGROUND: Although some studies have described the association between serum ferritin levels and specific disorders in child and adolescent psychiatry, few have focused on mental status per se with low serum ferritin levels in children and adolescents. This study examined the effects of iron administration on psychological status of children and adolescents with reduced serum ferritin concentration. METHODS: This prospective study evaluated 19 participants aged 6-15 years with serum ferritin levels <30 ng/mL who visited a mental health clinic and received oral iron administration for 12 weeks. The participants were assessed using the Clinical Global Impression Severity (CGI-S), Profile of Mood States 2nd Edition Youth-Short (POMS), Center for Epidemiologic Studies Depression Scale (CES-D), and Pittsburgh Sleep Quality Index (PSQI). In addition to serum ferritin, blood biochemical values such as hemoglobin (Hb) and mean corpuscular volume (MCV) were examined. School attendance was recorded. RESULTS: The most prevalent physical symptoms were fatigability and insomnia. The CGI-S, PSQI, and CES-D scores decreased significantly following iron supplementation, whereas the scores of almost all POMS subscales improved significantly at week 12. No participant had hemoglobin levels <12 g/dL. Serum ferritin concentration increased significantly, whereas Hb and MCV remained unchanged. At baseline, 74% of the participants did not attend school regularly; this number improved to varying degrees by week 12. CONCLUSIONS: Serum ferritin levels would be preferable to be measured in children and adolescents with insomnia and/or fatigability regardless of psychiatric diagnoses or gender. Iron supplementation can improve the hypoferritinemia-related psychological symptoms of children and adolescents, such as poor concentration, anxiety, depression, low energy and/or irritability.

Effect of gut microbiota early in life on aggressive behavior in mice.

Recent reports have indicated that gut microbiota modulates the responses to stress through the microbiota-gut-brain axis in mice, suggesting a connection between gut microbiota and brain function. We hypothesized that the gut microbiota early in life would have an effect on aggressiveness, and examined how gut microbiota affect aggressive behaviors in mice. BALB/c mice were housed in germ-free (GF) and ex-germ-free (Ex-GF) isolators. An aggression test was performed between castrated and a non-castrated mice at 8 weeks of age; the mice were allowed to confront each other for 10 min in strictly contamination-free environments. To evaluate aggressive behavior related to gut microbiota, we orally administered diluted Ex-GF mouse feces to the offspring of GF mice at 0, 6, and 10 weeks. GF mice showed more aggression than Ex-GF mice. Furthermore, GF mice who were administered feces of the Ex-GF group at 0-week-old were less aggressive than the GF mice. These findings suggested that the gut microbiota in the early stages of development was likely to have an effect on aggressiveness. Maintenance of healthy gut microbiota early in life can affect the mitigation of aggressive behavioral characteristics throughout the lifetime.

Second-Generation Antipsychotic Drugs for Children and Adolescents.

The effectiveness and safety of antipsychotics have not been fully established in children and adolescents. Many antipsychotics approved for use in adults are prescribed off-label to children and adolescents. We investigated the effectiveness and tolerability of antipsychotics for children and adolescents with schizophrenia and bipolar disorder. A literature review of the empirical evidence regarding the use of antipsychotics, particularly second-generation antipsychotics, in children and adolescents showed that these drugs were safe and effective for this population. Antipsychotics were similarly effective for treatment of schizophrenia and bipolar disorder in children and adolescents. When prescribing antipsychotics to this population, clinicians should consider adverse events and the discontinuation rate in treated patients. However, the current evidence shows a lack of consensus regarding the use of antipsychotics in children and adolescents.

Suicide Leap of an 11-Year-Old Girl with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) has been linked with risk of suicide, and several cases of suicide attempts by adolescents with ASD have been reported. However, there is scant research on therapeutic approaches to prevent suicide re-attempts by children with ASD who have already attempted suicide. We report our experience of treating an 11-year-old girl with adjustment disorder comorbid with ASD who was transported to our hospital after sustaining injuries from the suicide leap. Initially, she was diagnosed with adjustment disorder brought on by poor interpersonal relationships at school, and, upon reviewing the patient's personal history, her underlying ASD characteristics became apparent. To prevent a re-attempt, it was crucial to reduce her risk factors and enhance her protective factors. To reduce her risk factors, we manipulated the environmental factor that triggered the patient's suicide attempt. In addition, to reinforce her protective factors, we intervened in the parent-child relationship and addressed her hesitation to ask for help, which we identified as a predisposing factor since early childhood. Over the course of her treatment, she did not exhibit suicidal ideation or re-attempt suicide.

Reconsideration of Periodic Psychosis of Adolescence.

The condition of periodic psychosis of adolescence based on the clinical features of recurrent depressive symptoms, sub-stupor, and psychotic symptoms whose features return to a normal state within 2 weeks with no residual symptoms has been often seen during adolescence. However, international recognition of periodic psychosis of adolescence is low and the condition is not recognized as an independent disease in ICD-10 or DSM-5. We presented a case report of a depressive episode central to periodic psychosis of adolescence in a 16-year old female. The symptoms presented in the case correspond to the DSM-5 classification of premenstrual dysphoric disorder. However, a diagnosis of periodic psychosis of adolescence was made due to the presence of clinical features of victim mentality, increased irritability, suicidal ideations, and changes in consciousness over short periods of time and sub-stupor. This report was focused on the medical treatment of the episode of periodic psychosis of adolescence with the aim of verifying its current significance.

Efficacy of Mirtazapine on Irritable Bowel Syndrome with Anxiety and Depression: A Case Study.

Irritable bowel syndrome (IBS) is a disease in which gastrointestinal symptoms-primarily abdominal pain or discomfort and abnormal bowel movements persist chronically. For patients with IBS, mental illness, especially depression and/or anxiety, leads to a further lower quality of life. The purpose of this case study was to investigate the effects of mirtazapine (MIR) on mental health and IBS symptoms in a case of IBS accompanied by anxiety and a depressive state. This case report suggests that MIR is efficacious for the treatment of IBS with predominant diarrhea accompanied by depression and anxiety.

Frequency and clinical features of suicide attempts in elderly patients in Japan.

The objective of this study was to investigate the clinical features of suicide attempts in elderly patients (≥65 years) in Japan. We enrolled 546 patients who attempted suicide and were hospitalized for inpatient treatment. Characteristics were compared between the elderly and non-elderly patients. Compared with the non-elderly group, the incidence of mood disorders was significantly higher and the average length of stay in the intensive care unit and the duration of hospitalization were significantly longer in the elderly group. Elderly patients hospitalized for attempted suicide were more likely to have mood disorders than the non-elderly.

Frequency and clinical features of patients who attempted suicide by charcoal burning in Japan.

BACKGROUND: To date, the clinical features between patients in Japan who have attempted suicide by charcoal burning and those who have attempted suicide by other methods in the context of a mental disorder diagnosis as assessed by structured interviews have not been reported. METHODS: We enrolled 647 consecutive patients who attempted suicide and were hospitalized for inpatient treatment. Psychiatric diagnoses, frequency of suicide attempts, and clinical features were compared between charcoal burning and other suicide methods. RESULTS: Twenty of the 647 patients (3.1%) had attempted suicide by charcoal burning. The ratio of men to women was significantly higher by this method compared with that of other methods. The proportion of patients with mood disorders was significantly higher in the charcoal burning group than that in the other methods group. The occurrence of a psychiatric history in patients in the charcoal burning group was significantly lower than that in the other methods group. LIMITATIONS: The study sample was limited to a single hospital. CONCLUSIONS: The results demonstrate the clinical characteristics of patients who attempted suicide by charcoal burning. Therefore, it is necessary to identify the clinical features of patients who have attempted suicide by charcoal burning in Japan.

Clinical features of suicide attempts in adults with autism spectrum disorders.

OBJECTIVE: The objective of this study was to investigate the frequency and clinical features of suicide attempts in adults with autism spectrum disorders (ASDs). METHODS: We enrolled 587 consecutive patients aged 18 or over who attempted suicide and were hospitalized for inpatient treatment. Psychiatric diagnoses, suicide attempt frequency and clinical features were compared between ASD and non-ASD patients. RESULTS: Forty-three (7.3%) of the 587 subjects who attempted suicide had ASDs. The incidence of patients with mood disorders was significantly lower (Fisher's Exact Test, P=.043) and that of those with an adjustment disorder was significantly higher (Fisher's Exact Test, P<.001) in the ASD group than in the non-ASD group. The average length of stay at both the hospital and intensive care unit in the ASD group was longer than that in the non-ASD group (z=-2.031, P=.042; z=-2.322, P=.020, respectively). CONCLUSIONS: ASDs should always be a consideration when dealing with suicide attempts in adults at the emergency room.

Blonanserin in the treatment of delirium.

The purpose of the present study was to provide preliminary data on the usefulness and safety of blonanserin for patients with delirium in the intensive care unit (ICU). The charts of 32 consecutive patients with delirium in the ICU were retrospectively reviewed. These patients were treated with blonanserin. A total of 96.6% had reduction in Memorial Delirium Assessment Scale score. The proportion of patients with side-effects was 24.1%. Blonanserin may be effective and safe in the treatment of delirium in the ICU.

The effect of probiotics on gastric mucosal permeability in humans administered with aspirin.

OBJECTIVE: To examine whether a probiotic strain, Lactobacillus gasseri OLL2716 (LG21), can protect the gastric mucosal integrity from aspirin using urinary sucrose excretion (USE) test. MATERIALS AND METHODS: In the study using high-dose aspirin, the USE tests were carried out in 29 volunteers before and after LG21 treatment for 4 weeks. In the study using patients undergoing low-dose aspirin therapy, USE tests were performed in 37 subjects who took LG21 for 16 weeks. Stool occult blood was examined by the guaiac method. RESULTS: In the former study, the elevation in the USE value after aspirin loading significantly decreased after LG21 treatment (Median ± SD; 0.244 ± 0.237 vs. 0.208 ± 0.112%, p = 0.018). In the latter study, the USE value significantly decreased in the period with LG21 treatment (p = 0.033), while no significant difference was found in the period without LG21 (p = 0.113). The number of positive occult blood tests decreased during LG21 treatment. CONCLUSIONS: The regular ingestion of LG21 may protect the integrity of the gastric mucosal permeability against aspirin.