[Case of bonding disorder effectively treated by Naikan therapy].

The perinatal period is important for establishing the mother-to-infant bond. Especially, psychiatric disorders during this period, such as postnatal depression, significantly affect mother-to-infant attachment. Recently, the concept of "Bonding Disorder" has been proposed to identify attachment disturbances between mothers and infants. Here, we report a case of bonding disorder effectively treated by Naikan therapy. The patient was a 28-year-old female. She suffered from depression and anxiety one week after giving birth, and then began to have negative feelings foward her child. First, she felt a lack of attachment, claiming for example, "I cannot feel my child is cute." Her negative feelings developed in to strong refusal, which made her say, "I want to give my child up for adoption." After admittance to our hospital, her depressive symptoms improved by adequate treatment with anti-depressants, but her attachment disturbances continued. Because of her character and inflexible child care, she tended to suffer from a mental conflict. She underwent treatment with intensive Naikan therapy and her attachment to her child improved. Mother-to-infant attachment is thought to be influenced by how the mother was brought up. Naikan therapy reflects the relationships with his/her relatives from childhood up to the present, providing an important element concerning attachment formation. Through Naikan therapy, mothers may recall that they themselves have received love from their parents, which strengthens the feeling of basic trust. Consequently, they are encouraged to love their children. Therefore, Nikan therapy is suggested to be one of the effective therapies to treat attachment disturbances between mothers and infants.

[Intensive Naikan therapy for generalized anxiety disorder and panic disorder: clinical outcomes and background].

OBJECT: Intensive Naikan therapy (INT) is used to treat irrational recognition, and to develop awareness of others and self-reflection. Several reports have also shown that INT is effective for treating anxiety disorders. The purpose of the present systematic study was to investigate the factors contributing to the efficacy and clinical outcomes of INT by assessing the background, psychological evolution, and treatment required after such therapy. METHOD: Twenty-eight anxiety disorder inpatients at Tottori University Hospital, 15 with general anxiety disorders (GAD) and 13 with panic disorders (PD), were treated with INT. Age, sex, duration of the present anxiety episode, and diagnosis were investigated. The Tokyo University Egogram (TEG), Yatabe-Guilford personality inventory (YG test) and Rosenzweig picture frustration (PF) study were conducted before and after INT to investigate psychological changes. The long-term efficacy of INT for PD and GAD was assessed with Global Assessment of Functioning (GAF). Whether the patients achieved awareness of others, awareness of egocentricity, feelings of love, and self reflection after INT were investigated. RESULTS: 1) All patients showed improved GAF; the average GAF score increased from 51 +/- 8 (before Naikan therapy) to 83.2 +/- 15 (after therapy). The clinical outcomes of INT were as follows: 17 patients showed extremely effective results (60.7%), 6 were effective (21.4%), 3 were slightly effective (10.7%), and 2 were unchanged (7.1%). Overall, 23 patients (82.1%) showed remarkable improvements as a result of INT (improved group) and 5 showed no remarkable improvements (not improved group). 2) The improved group included significantly more patients with obsessive tendencies or nervous personalities such as a premorbid personality. In addition, significantly more of the patients in this group underwent daily INT and improved more rapidly in the short-term. 3) According to the STAI (state trait anxiety inventory), both state-(S-anxiety), and trait-anxiety (T-anxiety) significantly decreased after INT. The PD group showed significantly reduced S and T-anxiety, but the GAD group only showed significantly reduced T-anxiety. The adult (A) and free child (FC) TEG scales significantly increased, and according to YG, nervousness (N) and depression (D) significantly decreased while general activity (G) and social extraversion (S) significantly increased. Furthermore, according to the PF study, extraggression (E -A) after INT significantly decreased and imaggression (I-A) significantly increased. In the improved group, significantly more patients became more aware of their partners (Naikan) and achieved an objective outlook, awareness of egocentricity, feelings of love and self-reflection after INT. CONCLUSIONS: Our results suggest that INT for PD and GAD is extremely effective, and a very important form of psychotherapy. Attainment of self-reflection caused psychological changes that motivated the patients to continue Naikan therapy daily. We consider this a key factor in maintaining the efficacy of INT.

[A case of Addison's disease presented with depression as a first symptom].

This report describes a 52-year-old male patient with idiopathic Addison's disease presenting depression as a first symptom. His psychomotor inhibition, depressive mood, sleep disturbances, general fatigue, muscular pain, and arthralgia were considered to be due to intense work in a stressful environment. Neither his physician nor his orthopedist found any physical disease. Therefore, he was diagnosed with endogenous depression by a psychiatric clinic, and antidepressants were prescribed. Antidepressants were not sufficient for improving his symptoms, and he was admitted to our hospital. Endocrine blood examination revealed primary adrenocortical insufficiency. Treatment with glucocorticoid induced rapid improvement in both the psychiatric and physical symptoms. It is well known that psychiatric symptoms occur in the progressive stage of Addison's disease. At present, however, the occurrence of psychiatric symptoms is very rare, mainly because of a decrease in the incidence of this disease or an increase in mild cases. In addition, Addison's disease presenting with psychiatric features in the early stage has the tendency to be overlooked and misdiagnosed. Thus, we suggest the necessity of blood work for ACTH and cortisol in the field of psychiatry.

[Naikan therapy for prolonged depression: psychological changes and long-term efficacy of intensive Naikan therapy].

OBJECTIVE: Many studies have shown that a considerable number of patients with prolonged depression are refractory to drug therapy or supportive psychotherapy. A few studies have shown the short-term effectiveness of intensive Naikan therapy for prolonged depression, but the long-term effects have not been reported. For other psychotherapies also, few studies have demonstrated their long-term effectiveness for prolonged depression. The purpose of the present study was to assess the long-term efficacy of intensive Naikan therapy for patients with prolonged depression and to investigate the factors contributing to its efficacy. METHOD: At Tottori University Hospital, 23 inpatients with prolonged depression were treated with intensive Naikan therapy. The age, sex, age at onset, number of depressive episodes, duration of the present episode, diagnosis and family history were investigated. The Tokyo University Egogram (TEG), Yatabe-Guiltora personality inventory (YG test) and Rosenzweig picture-frustration (PF) study were conducted before and after intensive Naikan therapy to investigate psychological changes. The long-term efficacy (average: 24.5 +/- 10.6 months) of intensive Naikan therapy for prolonged depression was assessed with Global Assessment of Functioning scale (GAF). "Improvement" was defined as a post-therapy GAF score of 61 or higher. The Hamilton Depression Rating Scale (HAM-D) was applied to confirm the GAF results. Whether the patient achieved awareness of other's viewpoint, awareness of egocentricity, feeling of love, breaking out from self and sense of fulfillment after intensive Naikan therapy was investigated. RESULTS: Fifteen patients (65.2%) showed improvement in GAF and HAM-D (improved group) and eight patients showed no improvement (non-improved group). The average GAF score changed from 46.1 (before Naikan therapy) to 81.8 (at outcome assessment) in the improved group and from 45.3 to 52.8 in the non-improved group. The improved group had significantly shorter average duration of the present depressive episode and significantly less depressive episodes compared to the non-improved group. Only the improved group showed significantly lower scores on the critical parent (CP) scale of TEG, cyclic tendency (C) on the YG test and extraggression (E-A) in PF study. In the improved group, significantly more patients achieved deep insight (Naikan); and significantly more patients achieved awareness of other's viewpoint, awareness of egocentricity, feeling of love, breaking out from self and sense of fulfillment after intensive Naikan therapy. CONCLUSIONS: Our results suggested that intensive Naikan therapy for prolonged depression was equally as effective as Morita therapy, interpersonal therapy or group psychotherapy, and the effects of intensive Naikan therapy continued for a long term. Attainment of deep Naikan brought psychological changes in patients showing improvement, motivating them to continue Naikan therapy in daily life. We consider that this is the key factor that maintains the long-term efficacy of intensive Naikan therapy.

Diagnostic evaluation of 2', 5'-oligoadenylate synthetase activities and antibodies against Epstein-Barr virus and Coxiella burnetii in patients with chronic fatigue syndrome in Japan.

To investigate the association of viral infections with chronic fatigue syndrome (CFS), we assayed 2', 5'-oligoadenylate synthetase (2-5AS) activities in peripheral blood mononuclear cells from CFS patients in Japan. These patients were diagnosed in two hospitals, H1 and H2, located in different areas of the country. The activities were detected in 19 (86%) and 7 (32%) of each of the 22 patients in H1 and H2, respectively, while they were detected in only four (11%) out of the 38 healthy controls. IFN-alpha was similarly detected in a few CFS patients and healthy controls. We also assayed the antibody titers against Epstein-Barr virus (EBV) and Coxiella burnetii in these patients. The EBV anti-EA-IgG antibodies were detected in two (9%) and seven (32%) of each of the 22 patients in H1 and H2, respectively. Anti-C. burnetii IgG antibodies were detected in six (27%) out of 22 patients in H1 but not in 22 patients in H2, while they were detected in one (11%) of the nine healthy controls. Some CFS patients may be associated with EBV or C. burnetii infection. There were some statistical correlations between the 2-5AS activities and antibody titers of EA-IgG (P < 0.05, Student's t-test) but not to the antibody titers of C. burnetii. The up-regulation of 2-5AS activities suggests immunological dysfunctions with some virus infections in the CFS patients. Our results indicate that 2-5AS activities are useful for a diagnostic marker of CFS and for exploring the complicated pathogenesis of CFS.

[The current situation of the internationalization of the Naikan therapy].

In Japan, there are 27 Naikan medical institutions in which are included 5 clinics, 5 general hospitals and 17 mental hospitals. As for Naikan meditation center, there are 32 places. Generally, Naikan medical institutions and Naikan meditation center coexist in Japan. It is rare to see institutions for Naikan therapy in more north than Kanto area. Around Nara prefecture, which is Naikan therapy cradle, fairly numbers of Naikan meditation center are located. Surprisingly, no Naikan medical institutions are located. Naikan medical institutions and Naikan meditation center are distributed over the world. Total Naikan medical institutions are 32 and it only located in Japan and China. Total Naikan meditation center are 38 and 32 in Japan, 3 in Austria, 2 in Germany, and 1 in U.S.A. I would like to make suggestions as follows. At first, it is important to make cooperating with Naikan medical institution and Naikan meditation center. Also, it is necessary to enhance the technique ability of Naikan therapy. Secondary, we should guide medical workers to make understand useful of Naikan therapy as many as possible. Third, in order to do so, it is desirable to establish international Naikan Medical Association. Fourthly, it is necessary to systematize theory of the disease, therapeutic theory and therapeutic mechanism in Naikan therapy.

Visual hallucinations as REM sleep behavior disorders in patients with Parkinson's disease.

To clarify whether visual hallucinations in patients with Parkinson's disease (PD) are related to rapid eye movement (REM) sleep, nocturnal polysomnographic variables were compared between a group with hallucinations (hallucinators, n = 14) and a group without hallucinations (nonhallucinators, n = 8). A multiple sleep latency test (MSLT) was performed on 3 hallucinators, and the content of dreams during daytime REM sleep was investigated. The efficacy of clonazepam, a standard treatment choice for REM sleep behavior disorders, was investigated in 8 hallucinators. Nocturnal polysomnograms of the hallucinators showed a higher amount of stage 1-REM sleep with tonic electromyogram (stage 1-REM) than the nonhallucinators, and the reported occurrences of nocturnal hallucinations corresponded with the periods of stage REM or stage 1-REM in most hallucinators. The frequency of sleep onset REM periods (SOREMP) on the MSLT were pathologically high in the hallucinators, and the content of the dreams during the MSLT period was quite similar to their hallucinations. During clonazepam treatment, the frequency of hallucinatory symptoms decreased in 5 of 8 hallucinators. These results indicate that visual hallucinations in PD are likely to be related to a REM sleep disorder manifested as the appearance of both stage 1-REM during the night and SOREMP in the daytime.

[Efficacy of intervention with externalization therapy for eating disorders].

Externalization has been one of the effective methods in the fields of brief therapy, family therapy, and psycho-education in recent years. In this study, we investigated the efficacy of intervention with externalization at the first stage of therapy in 25 patients with eating disorders. The subjects consisted of 11 patients with anorexia nervosa (AN) and 14 with bulimia nervosa (BN). The Eating Disorder Inventory (EDI) was evaluated at the first session, the 10th session, and six months later. The obtained results showed intervention with externalization resulted in significant decreases in not only total EDI score but also all the EDI subscale scores. We also found that there were great differences between the EDI subscale scores of anorexia nervosa and bulimia nervosa patients. Therapy was significantly less effective for patients with anorexia nervosa than for those with bulimia nervosa, and much less effective for the restricting type of anorexia nervosa. In addition, all the EDI subscale scores were significantly decreased, irrespective of the complication of personality disorder. The efficacy of intervention with externalization continued for six months. Especially in patients with anorexia nervosa, there were significant decreases in the EDI subscale scores when compared with the scores in the 10th session. The present findings indicates that initial intervention with externalization is effective for treating eating disorders, regardless of the severity of illness.

Relationships between serum magnesium levels and clinical background factors in patients with mood disorders.

We measured serum magnesium (Mg) levels in 71 in-patients and out-patients with mood disorders and in 30 healthy controls and investigated the relationships between serum Mg levels and clinical background factors. Serum Mg levels were found to be significantly higher in patients with mood disorders than in controls. Serum Mg levels showed no significant correlation with patient sex, age, diagnosed subtype and disease phase in the mood disorder group. Serum Mg levels in patients with major depressive disorder who were taking psychotropic drugs were not significantly different from levels seen in patients with major depressive disorder who were not taking psychotropic drugs. These results suggest that the high serum Mg levels noted in patients with mood disorder are related to the underlying disorder itself and are not influenced by clinical background factors.