Selective deficit of autobiographical incident memory in subjects with bipolar disorder.

BACKGROUND: Previous studies have suggested that episodic memory impairment is one of the trait-like markers of bipolar disorder (BD), and is also associated with the course of the illness. Autobiographical memory (AM) is a special type of episodic memory, and disruption of AM causes severe psychosocial dysfunctions in patients with various neuropsychiatric disorders. However, little is known about possible deficits in AM in BD. This study investigated AM performance of BD patients and the effect of aging on their memory function. SAMPLING AND METHODS: We assessed AM of particular incidents (incident AM) and AM of personal facts (semantic AM), focusing on 4 time periods in 31 BD patients and 38 normal controls. Each group was divided into younger and older subgroups. General episodic memory functioning was also assessed by a word list learning task. RESULTS: While there were no impairments in semantic AM throughout the lifetime in either group, both the younger and older BD groups exhibited impairments in incident AM compared to controls, and this effect was more profound in the recent period in the older BD group. Performance on the word list learning test was not impaired in either subgroup of BD patients, indicating that general episodic memory function was preserved. CONCLUSIONS: We are the first group to report relatively selective AM impairments in BD, which have severer effects upon recent incident memory, and seemed to worsen with aging and/or clinical course.

Cost-effectiveness of gargling for the prevention of upper respiratory tract infections.

BACKGROUND: In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective. METHODS: Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping. RESULTS: After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence. CONCLUSION: This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.

Smoking and small, dense low-density lipoprotein particles: cross-sectional study.

All forms of tobacco cause cardiovascular disease, and tobacco-related disease is a leading cause of death worldwide. Smoking oxidizes low-density lipoprotein (LDL) particles, and oxidized LDL particles are thought to play an early and critical role in atherosclerogenesis. Hyper-low-density lipoproteinemia is one of the risk factors for cardiovascular disease, but small, dense LDL particles have been associated with an increased risk for cardiovascular disease. Small, dense LDL correlates with some cardiovascular risk factors such as diabetes mellitus, hypertriglyceridemia, hypo-high-density lipoproteinemia, and hypertension. Although smoking is also a major risk factor for cardiovascular disease, the relationship between smoking and small, dense LDL particles has not been described previously. Our cross-sectional study examined this relationship in a population of 18 healthy young adult men (9 smokers and 9 never-smokers, aged 21-24 years) from the same college. Concentrations of blood lipids and the LDL migration index (LDL-MI) were examined. Although concentrations of blood lipids did not differ between smokers and never-smokers, the LDL-MI had a strong tendency to be lower in smokers. The LDL-MI is larger in the presence of a greater proportion of small, dense LDL particles. These results indicate that tobacco smoking is associated with a decrease in the proportion of small, dense LDL particles. Regardless of these surprising results, we do not recommend smoking, given that it is a major cause of cardiovascular disease.

Folie à deux and shared psychotic disorder.

Folie à deux (FAD) was first described in 19th century France. Since then, the concept has been elaborated, and several subtypes of FAD have been successively reported in France. In contrast, studies in German-speaking psychiatry mainly focused on the conceptual boundary between reactive/endogenous psychosis and etiological hypothesis (ie, psychogenesis vs genetic predisposition). In North America, Gralnick wrote a seminal review and redefined four subtypes of FAD by adopting the European classical concepts. More recently, "shared psychotic disorder" in DSM or "induced delusional disorder" in ICD-10 was branched off from FAD. However, several classical subcategories of FAD were not included in these recent definitions, the nosological significance of which should not be underestimated. We examined demographic data of FAD case reports published from the 19th to the 21st century and found that some of the earlier hypotheses, such as females being more susceptible, older and more intelligent individuals being more likely to be inducers, and sister-sister pairs being the most common relationship, were not supported. The controversial issue of the etiology of FAD-association of subjects or genetically driven psychosis-was re-examined in light of recent studies.

Analysis of delusional statements from 15 Japanese cases of 'Folie à Deux'.

BACKGROUND: Although many studies have reported folie à deux (FAD) cases, there has not yet been a study systematically examining patients' delusional statements. In the present study, we analyzed the changes in patients' delusional statements across the clinical course from the perspective of discourse analysis. SAMPLING AND METHODS: First, we presented a case of FAD in a married Japanese couple. Second, we examined 14 other cases of FAD from Japanese literature and analyzed changes in subjective pronoun (SP) use in each patient's delusional statements. RESULTS: Observed delusions of FAD were classified into the following two categories, based on the SP: (1) We-type: 'We are persecuted', and (2) Non We-type: mostly 'I am persecuted'. Interestingly, We-type was generally observed in paranoid schizophrenia, paranoid disorder, and shared psychotic disorder. In contrast, Non We-type was predominantly observed in nonparanoid schizophrenia. CONCLUSIONS: The present classification might reflect two different mechanisms of delusional association in FAD. Possible mechanisms of delusional transmission in schizophrenia were discussed. The present study has a clear limitation in the small number of cases from only Japanese literature. Furthermore, the relatively high occurrence of FAD between married couples in the Japanese literature may have introduced some bias into the present results. Further studies on FAD are needed, however, the present method of examining the SP seems to be useful in order to investigate the psychological mechanism of delusion formation between plural subjects.

Heat shock protein 90 is required for increased DNA binding activity of activator protein-1, a heterodimer of Fos/JunD, in rheumatoid synovial cells under inflammatory stimuli.

We have studied the DNA binding profiles of activator protein-1 (AP-1) involved in synovial overgrowth and osteoporosis in rheumatoid arthritis (RA) in relation to the molecular chaperon heat shock protein 90 (HSP90). The AP-1 binding activity of the nuclear extracts of rheumatoid synovial cells was basically increased as compared with osteoarthritic synovial cells. Upon stimulation with inflammatory cytokines IL-1beta or TNFalpha, the AP-1 binding activity was further increased in rheumatoid synovial cells, and increased AP-1 protein was composed as heterodimers of Fos and JunD which was not known before as a major component of AP-1 in rheumatoid synovial cells. The increase of AP-1 binding activity as induced by inflammatory cytokines was specifically inhibited by geldanamycin, radicicol or herbimycin A, specific inhibitors of HSP90, while AP-1 protein was not decreased by geldanamycin. Further, HSP90 protein was not decreased by the inhibitors. The findings indicate that HSP90 is required for increased AP-1 binding activity of rheumatoid synovial cells under inflammatory stimuli and that AP-1 binding activity is inhibited by functionally inactivating HSP90 with the inhibitors.

A case of central nervous system lupus in succession to lupus peritonitis: a difficulty in the differential diagnosis between lupus psychosis and steroid-induced psychosis.

Abstract A 55-year-old woman with well-controlled systemic lupus erythematosus (SLE) suffered from the abrupt onset of massive intractable ascites, which did not respond to conventional diuretic therapy. While treatment with methylprednisolone pulse therapy ameliorated this lupus peritonitis, neuropsychiatric symptoms then appeared. After a diagnosis of the central nervous system (CNS) lupus, pulse therapy was continued and the patient recovered from the lupus psychosis. We discuss the differential diagnosis between CNS lupus and steroid-induced psychosis with particular references to recent diagnostic methods for CNS lupus.

Oncogenic ras induces gastrin/CCKB receptor gene expression in human colon cancer cell lines LoVo and Colo320HSR.

Gastrin has the ability to stimulate cell growth in some colorectal cancer cells and some of these cells also express gastrin/CCKB receptors, suggesting that gastrin and its autocrine loop are involved in their proliferation. We previously reported that oncogenic ras induced gastrin gene expression in colon cancer cells. The aim of this study was to investigate whether oncogenic ras also induces gastrin/CCKB receptor gene expression. A transiently transfected activated ras vector stimulated gastrin/CCKB receptor transcriptional activities in both Colo320HSR and LoVo cells, but these ras-increased activities were inhibited by a specific MEK inhibitor, PD98059. An RPA demonstrated that activated ras increased endogenous gastrin/CCKB receptor mRNA levels and PD98059 decreased them in LoVo cells. These findings suggest that oncogenic ras induces gastrin/CCKB receptor gene expression through some intracellular signaling pathways, including MEK, in colon cancer cell lines.