Association between bullying behavior, perceived school safety, and self-cutting: a Japanese population-based school survey.

BACKGROUND: No previous population-based studies have examined associations between self-cutting, perceived school safety, and bullying behavior among East Asian adolescents. METHOD: We examined whether bullying, victimization, and perceived school safety were associated with self-cutting by getting 1865 students with a mean age of 13.9 years (standard deviation 0.2 years) to complete questions on these variables. Psychiatric problems were assessed with the Strengths and Difficulties Questionnaire. RESULTS: About 5.6% of males and 11.9% females had practiced self-cutting and when we controlled these results for psychiatric symptoms, self-cutting was associated with being both a bully and a victim among males and females. In addition, self-cutting was independently associated with perceived school safety among females. Those who felt unsafe at school and were victimized were much more likely to engage in self-cutting. CONCLUSIONS: Self-cutting among Japanese adolescents was linked with bullying behavior and feeling unsafe at school. Secure school environments and school-based antibullying programs could help to prevent adolescent self-injurious behavior.

The Japanese version of the Postpartum Bonding Questionnaire: Examination of the reliability, validity, and scale structure.

OBJECTIVE: The purpose of this study was to develop the Japanese version of the Postpartum Bonding Questionnaire (PBQ) to gather data on Japanese mothers for comparison with other cultures and to examine the scale structure of the PBQ among Japanese mothers. METHODS: We administered the PBQ to a cross-section of 244 mothers 4 weeks after delivery and again 2 weeks later to 199 mothers as a retest to examine reliability. We used exploratory factor analysis to evaluate the factor structure of the PBQ. Correlations with the Mother-to-Infant Bonding Scale (MIBS), the Maternal Attachment Inventory (MAI), Edinburgh Postnatal Depression Scale (EPDS), and sociodemographic variables were calculated for validation. RESULTS: The 14-item version of the PBQ extracted by exploratory analysis consisted of four factors: 'impaired bonding', 'rejection and anger', 'anxiety about care', and 'lack of affection'. We found significant correlations of the total scores of the PBQ and the 14-item version of the PBQ positively with the MIBS and negatively with the MAI. Moderate significant correlations with total scores were also found with the EPDS. Total scores for primiparous and depressed mothers were higher than those for multiparous mothers and mothers without depression. CONCLUSION: The results of this study demonstrated the reliability and validity of the PBQ and the 14-item version of the PBQ in Japanese mothers 4 weeks after delivery.

Executive Dysfunction among Children with Antipsychotic Treated Schizophrenia.

OBJECTIVE: To investigate the executive function among adolescents with antipsychotic-treated schizophrenia in Child and Adolescent Outpatient Clinic at Cipto Mangunkusumo General Hospital, Jakarta. METHODS: This was a cross sectional study with control group. Case was defined as adolescents with antipsychotic-treated schizophrenia without any mental retardation or other physical illnesses (n=45). The control group consisted of healthy and age-matched adolescents (n=135). Executive function is determined by using Indonesian version of Behavior Rating Inventory of Executive Function (BRIEF-Indonesian version). We used SPSS 16.0 program for windows to calculate the prevalence risk ratio (PRR) and set up the p value <0.05. RESULTS: Mean of age was 16.27 (standard deviation 1.86) year-old. Most of the case group (95%) has been treated with atypical antipsychotic such as risperidone, aripipripazole, olanzapine, and clozapine. Duration of having antipsychotic medication was ranged from one to 36 months. Adolescents with antipsychotic treated-schizophrenia had higher BRIEF T-score, except for inhibit scale, shift scale and behavior regulation index. The prevalence risk ratio on several clinical scales were higher in children with antipsychotic-treated schizophrenia compared to control group, such as on emotional state (PRR=7.43, 95% confidence interval [CI]=2.38-23.15), initiate scale (PRR=6.32, 95% CI=2.51-15.95), monitor scale (PRR=8.11, 95% CI=2.0-32.86), and behavior regulation index (PRR=4.09, 95% CI=1.05-15.98). CONCLUSION: In general, the results showed that adolescents with atypical antipsychotic treated-schizophrenia had higher BRIEF T-score compared, and comparable with their normal group control.

[The neurotic disorders].

The clinical practice of child and adolescent psychiatry includes encounters with disorders not particular to childhood and adolescence, but seen in adulthood as well. For example, among the neurotic disorders, obsessive-compulsive disorder can be seen from around 3 years of age, with rapid rise in prevalence from around age 10. Increase is also seen in cases of anorexia nervosa from around age 11. This report examines the association between disorders in childhood and adolescence, in comparison to that in adulthood, with focus on obsessive-compulsive disorder. To start with, the characteristics of childhood onset cases with onset under age 7 were reviewed, revealing a relatively large proportion of subjects with experience of separation anxiety. Analyses revealed the possibility of anticipating obsessional tendencies in the parents of such subjects. Further clarification of the features of such early onset cases is hoped for in future. Next, we conducted a literature review comparing the characteristics of child and adolescent obsessive-compulsive disorder with that in adulthood. It has been determined that obsessive-compulsive symptoms in childhood and adolescence have a relatively unyielding 4-factor construct that persists through life, namely: 1) symmetry factor, 2) forbidden thoughts factor, 3) cleaning factor, and 4) hoarding factor. Of these, children with primary symptoms of hoarding are said to have poorer long-term diagnoses than children with other symptoms. Another point of note is the presence of large disparity regarding the prognosis of cases with concomitant tics. While the prognosis of childhood-obsessive compulsive disorder is generally favorable in many reports, the need for caution has also been noted regarding the possibility of transition on to schizophrenia in more than just a few cases.

Prefrontal overactivation, autonomic arousal, and task performance under evaluative pressure: a near-infrared spectroscopy (NIRS) study.

To study the mechanism underlying the influence of psychological pressure on task performance, we investigated the relationship between prefrontal activation, autonomic arousal, and performance in an n-back working memory task with 3 load levels (l-, 2-, and 3-back tasks) under evaluative pressure. The tasks were performed by 32 university students with or without evaluative observation by experimenters. The error rate and prefrontal activation were found to increase with pressure only in the highest load task (3-back). In contrast, autonomic arousal increased with pressure regardless of the task condition. Correlation analysis showed a positive correlation of the error rate with prefrontal activation in the 3-back task and no consistent correlation with autonomic arousal. We concluded that the inhibitory effect of evaluative pressure on task performance is mediated by prefrontal overactivation rather than autonomic arousal.

Hemodynamic changes in the prefrontal cortex during digit span task: a near-infrared spectroscopy study.

BACKGROUND/AIMS: In this study, we examined changes in the concentrations of oxygenated and deoxygenated hemoglobin (oxy- and deoxy-Hb, respectively) in the prefrontal cortex (PFC) during the digit span task by using near-infrared spectroscopy (NIRS). METHODS: The digit span task consists of the digit span forward and backward tasks. The tasks were performed by 22 healthy undergraduate students who participated in this study. Differences in the mean concentrations of oxy-Hb and deoxy-Hb between the baseline and task intervals were evaluated. RESULTS: In digit span backward, oxy-Hb was significantly higher during the task interval than during the baseline. Further, deoxy-Hb was significantly lower during the task interval than during the baseline in both digit span forward and digit span backward. Digit span forward performance was significantly higher for the right-PFC-dominant group than for the left-PFC-dominant group. CONCLUSION: These results suggest that the digit span backward task is more demanding and requires greater activation of the prefrontal cortex than the digit span forward task. Our NIRS findings suggest that the digit span backward task involves executive functioning.

Ijime in Japan.

This paper reviews the problem of ijime in Japan from a variety of perspectives, primarily through studies conducted in this country. The term ijime is not uniform in concept, open to different interpretations given the disparity in definitions among different circles, making precise assessment of the actual conditions difficult. Such being the case, what is needed is further study on the mechanisms and actual state of ijime accounting for the flow of the times, and compilation of research to enable the creation of ever more effective modes of prevention and intervention.

Personality and defense mechanisms in late adulthood.

OBJECTIVE: Current understanding of the use of psychological defense mechanisms (DMs) in older adults is limited. This study set out to examine individual differences in DMs and Cloninger's biosocial model of personality in two age groups (50-64, 65-93), as well as their influence on health. METHODS: A Japanese community sample (N = 330) completed the Temperament and Character Inventory (TCI-125), the Defense Style Questionnaire (DSQ-40), and the General Health Questionnaire (GHQ-28). RESULTS: Across age groups, psychological well-being was related to lower levels of harm avoidance and higher levels of self-directedness. In addition, older age was related to decreases in reward dependence, cooperativeness, and increases in self-transcendence, DMs of isolation, denial, and splitting. DISCUSSION: An Age X Gender interaction revealed that men and women varied in their pattern of age differences for some specific DMs. Results further suggest that image-distortion defense may function to compensate resource loss.

Application of the Revised Infant Temperament Questionnaire for evaluating temperament in the Japanese infant: creation of an abridged Japanese version.

The Japanese version of the Revised Infant Temperament Questionnaire (RITQ) was implemented to re-evaluate factor structure of the temperament scale with the objective of simplification. The questionnaire was conducted on 1099 mothers of Japanese infants visiting health centers for their children's health examinations at 6 or 7 months. As a result, a 57-item abridged version was constructed consisting of the seven subscales: 'fear of strangers and strange situations', 'insensitivity to food', 'regularity of rhythm', 'manageability', 'activity level', 'persistence of attention', and 'insensitivity to touch'. Although the items did not break down into the traditional nine temperament dimensions extracted by Carey et al., a certain commonality was seen in factor structure compared with the results of factor analysis using the RITQ in studies in Japan and abroad.

Regional brain cerebral glucose metabolism and temperament: a positron emission tomography study.

Personality, and in particular temperament, is thought to have a biological basis. In the present study, the relationships between regional brain glucose metabolism and temperament have been investigated. Regional brain glucose metabolism was measured using [18F] fluorodeoxyglucose positron emission tomography in 31 healthy subjects. Temperament was assessed using the Temperament and Character Inventory. Temperament dimensions were observed to be significantly correlated with specific brain regions. In particular, novelty seeking was significantly correlated with the superior temporal gyrus, inferior parietal lobule, and the precuneus, which have been reported to be related with impulsiveness, while reward dependence was significantly correlated with the caudate head, which has been shown to be associated with reward processing. The various aspects of temperament may have biological bases in the specific brain regions. The accumulation of results from studies of this kind should provide further evidence connecting personality traits with their biological bases.

No association between monoamine oxidase A promoter polymorphism and personality traits in Japanese females.

Monoamine oxidase A (MAO-A) is an enzyme involved in the metabolism of monoamine neurotransmitters such as dopamine, serotonin, and noradrenaline in the brain. Previous studies have demonstrated a significant association between MAO-A gene polymorphism and personality traits in males. The purpose of the present study was to examine this association in females. The subjects were 219 healthy Japanese females. We genotyped a variable number of tandem repeats located upstream of the MAO-A gene. Personality traits were assessed using the Temperament and Character Inventory (TCI). There was no association between any personality trait and MAO-A genotype. The present results do not support the hypothesis that MAO-A gene polymorphism is related to certain personality traits in females.

Transient eating disorder in early childhood--a case report.

Although children in infancy present eating problems of multifarious nature, the diagnostic classification of infant eating disorders remains markedly deficient. The authors present a case exhibiting transient eating disorder in early childhood, alongside discussion of some considerations relevant to this age group. The subject was a boy aged 5 years 6 months at first presentation. Starting with an inability to swallow "sushi" at dinner, he was brought to the clinic for inability to ingest food or liquids. Treatment was planned as play therapy for the patient, and psychological interviews for the mother. The child's symptoms were improved in five sessions, but interviews of the mother revealed eating disorders such as bulimia and vomiting, and sexual problems in the marital relationship, necessitating long-term therapy.

Hallucinatory experiences in a community sample of Japanese children.

OBJECTIVE: Hallucinatory experiences in children are often thought to indicate serious psychopathology. However, they have also been reported in normally developing children and in association with temporary psychological reactions to acute stress. The aim of this study was to investigate the prevalence of hallucinatory experiences in a nonclinical population of children and to examine the relationship between the modality and content of hallucinations and psychopathology. METHOD: Seven hundred sixty-one Japanese children, 11 to 12 years old, completed a battery of four measures: (1) a questionnaire about the type of hallucinatory experience, (2) the Children's Depression Inventory, (3) the State-Trait Anxiety Inventory for Children, and (4) the Adolescent Dissociative Experiences Scale. RESULTS: Approximately 21% of the subjects had experienced hallucinations. Subjects who had experienced hallucinations, in particular, hallucinations characterized by combined modalities, closely self-related auditory content, or concrete visual content, had more significant psychopathology than did those who had never experienced hallucinations. CONCLUSIONS: Therapeutic intervention should be considered for children who experience hallucinations in association with depression, anxiety, or dissociation.

[Support for the family from infancy].

A rising tendency has been reported for child abuse in our country in recent years, and the need to provide support for child-care capabilities in the home has been raised. In this context, attention has turned to the mother-child relationship and the mother's mental health from early on, in pregnancy and the antenatal period. In particular, it has become clear that the incidence of post-partum maternity blues and puerperal depression is higher than hitherto believed, drawing focus upon the effects of the mother's depression on the mother-child relationship. This report outlines the research and clinical intervention we have been undertaking for the mother's depression in pregnancy and the puerperium in relation to maternal attachment. 1) Results from studies in the puerperium on a group of mothers with children admitted to the NICU and a control group of mothers, and a 1-year follow-up study on the control group of mothers have revealed a relationship between a mother's depression and maternal attachment in the puerperium with depression and maternal attachment after 1 year, indicating the importance of focusing on the mother's depression and maternal attachment from the puerperium in thinking about maternal mental health and the mother-child relationship. 2) We have been attempting clinical intervention for the mother's psychological problems through the obstetric clinic, obstetric ward, and NICU, since 1998. The number of subjects, interviews, interview content, and other such data are reported. 3) A borderline personality disorder case we have been involved with clinically from age 19 is presented, for discussion of problems arising in the mother-child relationship from pregnancy through the child-rearing years.

Antenatal depression and maternal-fetal attachment.

BACKGROUND: In recent years, attention has been turned to maternal mental health in relation to the mother-child relationship accompanying a widening in focus, i.e. taking into account not only the puerperium, but also the stage of pregnancy. This applies to studies that have revealed a connection between depression and maternal attachment in the postpartum period and late pregnancy. This study, however, was designed to evaluate the maternal-fetal relationship in the first and second trimesters, being the first one to address this issue in these early stages. SAMPLING AND METHODS: Zung's Self-Rating Depression Scale (ZSDS), the original Antenatal Maternal Attachment Scale (AMAS), and a questionnaire addressing peripheral factors were given to 216 pregnant women (3-6 months of gestation) who visited the Nagoya University Hospital between September 1998 and June 2001. RESULTS: Contrary to reports on the latter stages of pregnancy, no direct association was observed between depression in mothers and maternal-fetal attachment before fetal movement was perceived. CONCLUSION: However, education, form of employment, planning of pregnancy, and premenstrual mood changes were found to be associated with the ZSDS score (mean: 41.9), while form of employment, feelings regarding pregnancy, and sources of support were extracted as factors associated with the AMAS, which are of interest in terms of the subsequent association between depression and maternal-fetal attachment in the peri- and postnatal periods.

Psychiatric features of seriously life-threatening suicide attempters: a clinical study from a general hospital in Japan.

OBJECTIVE: Although attempted suicide is one of the strongest predictors of completed suicide, few Japanese studies have described psychiatric differences between those who attempt suicide by overdose (OD) and those who use more violent methods (MV). METHODS: A total of 22 consecutively admitted MVs were compared to 78 ODs. All patients were referred for psychiatric evaluation during the same 3-year period. RESULTS: The MV group was predominantly male (68%), whereas the OD group was predominantly female (72%). Using DSM-IV criteria, depressive disorders were most common in both groups, followed by psychotic disorders. The OD group had significantly more borderline patients. Contrary to previous reports, prior psychiatric contact was low in the MV group. MVs were more likely to complain of financial problems and to retain a definite wish to die after the attempt. CONCLUSIONS: This study identified meaningful differences between the two groups of patients who attempted suicide.

Study on feelings of school avoidance, depression, and character tendencies among general junior high and high school students.

School refusal is a phenomenon that first drew attention in Japan around 1960 and it remains one of the major issues in child psychiatry today. Moreover, it is now said that there exists a large group of latent school refusers currently attending school but harboring feelings of school avoidance. To address this issue, a questionnaire survey was conducted on students enrolled in a junior high and high school affiliated with the Nagoya University School of Education. The questionnaire consisted of the Children's Depression Inventory (CDI), a scale for evaluating feelings of school avoidance (School Avoidance Scale), and a scale for assessment of personality characteristics associated with school refusal (School Refusal Personality Scale). The subjects were 425 first-year junior high to second-year high school students. Factor analysis of each scale revealed the CDI to consist of three factors: 'core depression', 'feelings of interpersonal maladaptation', and 'self-revulsion', and the School Avoidance Scale to consist of two factors: 'school dislike', and 'school avoidance'. The School Refusal Personality Scale consisted of three factors: 'obsessive-compulsive', 'passive/unsocial', and 'socially introverted'. Mean CDI score and standard deviation (SD) was 19.44 +/- 7.49, and that for 'feelings of school avoidance' was 20.18 +/- 5.61. The two subordinate factors of the School Avoidance Scale were intimately associated with both 'feelings of interpersonal maladaptation' and 'core depression' of the CDI, and negatively correlated with the 'obsessive-compulsive' factor of the School Refusal Personality Scale.

Depression in the mother and maternal attachment--results from a follow-up study at 1 year postpartum.

Although evidence exists pointing to the impact of maternal depression in puerperium upon mother-child interaction, longitudinal studies on this perspective are rare. Hence, this study was designed to examine the association between maternity blues and maternal attachment in the puerperium with depression in the mother and attachment after 1 year together with the factors involved. A questionnaire survey consisting of Zung's Self-Rating Depression Scale (ZSDS) and a 'maternal attachment' scale, comprised of subscales on 'core maternal attachment' and 'anxiety regarding children', was conducted on mothers who had participated in a previous puerperium survey. The mean ZSDS score of 42.1 +/- 7.45 after 1 year did not differ significantly from puerperium results. 'Maternity blues' was found to influence the maternal depression after 1 year, which was in turn associated with 'core maternal attachment' and 'anxiety regarding children', supporting the need for early intervention in maternity blues starting in the perinatal period for the mental health of mother and child.