Association between negatively perceived parenting attitudes and dissociation: a cross-sectional study on the general population in Japan.

Objectives: Many studies have reported that early traumatic experiences, mainly abuse, are associated with forming dangerous attachments and a contributing factor to dissociation. On the other hand, other studies have investigated the association of non-abusive nurturing and attachment styles with dissociation. The aim of this study is to determine the frequency of dissociative experiences in the general Japanese population and investigate the effects of "overprotection" and "lack of care" as nurturing styles and "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation. Methods: A total of 1,042 residents aged 18 to 69 years were administered with the Dissociative Experiences Scale (DES), the Japanese version of the WHO-5 Well-Being Index (WHO-5-J), the Parental Bonding Instrument (PBI), and the Experiences in Close Relationships Inventory-the-generalized-other-version (ECR-GO). Hierarchical multiple regression analyses on the effects of "overprotection" and "care" as nurturing attitudes "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation (DES-NDI and DES-T) were conducted. Results: Based on the findings of this study, "care" and "overprotection" as nurturing attitudes were shown to be a contributing factor to dissociation (DES-NDI and DES-T). "Avoidance of intimacy" as an attachment style was shown to contribute to pathological dissociation. On the other hand, the influence of attachment style on the relationship between nurturing style and dissociation was not determined. Discussion: This study provided essential data on the distribution of dissociative experiences in the general Japanese population. It was indicated that nurturing style, particularly overprotection, may be linked to nonfunctional stress coping and interpersonal anxiety and could be a contributing factor to mental disorders, including dissociation. Furthermore, considering that the effect of nurturing styles on dissociation does not vary with attachment styles, the effect of nurturing styles on dissociation may be more profound.

Influence of posttraumatic stress reaction and posttraumatic cognition on dissociative experiences according to the nature of traumatic experiences: A survey on Japanese young adults.

OBJECTIVES: Although the relationship between dissociation and traumatic experiences has been debated, many studies focus on the context of traumatic experiences. Alternatively, basic research that examines the relationship of symptoms of posttraumatic experiences and cognitive characteristics of dissociation as an individual difference among experiencers has been lacking. To address this research gap, this study examines the influence of posttraumatic symptoms and cognition on dissociative experiences given the nature of traumatic experiences. METHOD: This study administered the Events Checklist, the Dissociative Experiences Scale (DES), the Impact of Event Scale-Revised (IES-R), and the Japanese version of the Posttraumatic Cognitions Inventory to 1,036 Japanese adolescents. It investigated differences in dissociative experiences according to the presence of and cumulative traumatic experiences. Hierarchical multiple regression analysis was conducted to determine the influence of sex and the nature of traumatic experiences, posttraumatic symptoms (IES-R), and cognition on dissociative experiences. RESULTS: The results demonstrated no differences in DES based on the number of traumatic experiences. Moreover, this study observed the impact of cognition in posttraumatic experience on dissociation. CONCLUSIONS: This study provides essential data on the distribution of dissociative experiences among Japanese adolescents with traumatic experiences and exposure to adversity. Finally, it highlights the importance of focusing on posttraumatic cognitive characteristics, particularly negative self-perception, and discusses the implications to enhance understanding of dissociative experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gender Biases Toward People With Difficulty in Balancing Work and Family Due to ADHD: Two Case Vignette Randomized Studies Featuring Japanese Laypersons and Psychiatrists.

Objective The gender gap in labor force participation is likely larger in adults with attention deficit hyperactivity disorder (ADHD) than that in the general population. Thus, we investigated whether gender affected the perception toward persons displaying ADHD symptoms and experiencing difficulty in balancing work and family. Methods Both Japanese laypersons and psychiatrists were recruited for web-based surveys in March and October 2020 via an online survey company, Cross Marketing Inc., and the secretariat of the Japanese Society of Psychiatry and Neurology, respectively. The participants were randomly assigned to read either a male or female case vignette. The vignettes were identical, except for the gender of the patient in the case. The primary and secondary outcomes were the respondents' opinions on the seriousness of the case and the degree to which the case's wish should be maintained, using sliding scales of 0-100. Results We included 560 laypersons and 585 psychiatrists. Neither cohort differed in most outcomes between the groups assigned to the male and female case vignettes. Among laypersons, the average score of seriousness was 58.8 in the female-vignette group and 58.6 in the male-vignette group (mean difference, 0.15; 95% confidence interval, -4.9 to 5.2). Among psychiatrists, the average score of seriousness was 53.9 in the female-vignette group and 53.7 in the male-vignette group (mean difference, 0.18; 95% confidence interval, -3.1 to 3.4). Similarly, between-group differences in the opinions on the degree to which the case's wish should be maintained were 1.2 in laypersons and 0.63 in psychiatrists. We found no significant interaction between the gender of the case and the respondent's gender in any of the outcomes. Conclusion Our results did not support the hypothesis that women were more likely to be pressured to prioritize family over work than men were when there was difficulty balancing work and family due to ADHD symptoms.

Effects of spatially filtered fearful faces and awareness on amygdala activity in adults with autism spectrum disorder: A magnetoencephalography study.

BACKGROUND: The amygdala is pivotal in emotional face processing. Spatial frequencies (SFs) of visual images are divided and processed via two visual pathways: low spatial frequency (LSF) information is conveyed by the magnocellular pathway, while the parvocellular pathway carries high spatial frequency information. We hypothesized that altered amygdala activity might underlie atypical social communication caused by changes in both conscious and non-conscious emotional face processing in the brain in individuals with autism spectrum disorder (ASD). METHOD: Eighteen adults with ASD and 18 typically developing (TD) peers participated in this study. Spatially filtered fearful- and neutral-expression faces and object stimuli were presented under supraliminal or subliminal conditions, and neuromagnetic responses in the amygdala were measured using 306-channel whole-head magnetoencephalography. RESULTS: The latency of the evoked responses at approximately 200 ms to unfiltered neutral face stimuli and object stimuli in the ASD group was shorter than that in the TD group in the unaware condition. Regarding emotional face processing, the evoked responses in the ASD group were larger than those in the TD group under the aware condition. The later positive shift during 200-500 ms (ARV) was larger than that in the TD group, regardless of awareness. Moreover, ARV to HSF face stimuli was larger than that to the other spatial filtered face stimuli in the aware condition. CONCLUSION: Regardless of awareness, ARV might reflect atypical face information processing in the ASD brain.

Efficacy of Group Cognitive Behavior Therapy Targeting Time Management for Adults with Attention Deficit/Hyperactivity Disorder in Japan: A Randomized Control Pilot Trial.

OBJECTIVE: Time-processing disorders in adults is a priority area for intervention. Time management program, which has been demonstrated to be effective in children with ADHD, has not been examined in adults. We anticipate the need for the development of specialized programs for adults. This is because it has been reported that time processing disorders have different patterns in childhood and adulthood. This study aimed to evaluate the therapeutic effect of a gCBT program focusing on time management for adults with ADHD. METHOD: Adults with ADHD were randomly assigned to gCBT (n = 24) or a treatment as usual group (n = 24). Outcome measures were masked clinically rated, self-reported, and family-reported ADHD symptoms. RESULTS: The gCBT group significantly reduced ADHD symptoms on all measures. CONCLUSION: Interventions focused on time management have been shown to be effective not only in children with ADHD but also in adult patients.

3-day intervention program for family members of hikikomori sufferers: A pilot randomized controlled trial.

Backgrounds: Hikikomori, pathological social withdrawal, is becoming a crucial mental health issue in Japan and worldwide. We have developed a 3-day family intervention program for hikikomori sufferers based on Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). This study aims to confirm the effectiveness of the 3-day program by a randomized controlled trial. Methods: This study was registered on the UMIN Clinical Trials Registry (UMIN000037289). Fifteen parents were assigned to the treat as usual (TAU) group (TAU only; Age Mean, 65.6; SD, 7.8), and 14 to the Program group (program + TAU; Age Mean, 67.9; SD, 8.6). This study was discontinued due to the COVID-19 pandemic; the recruitment rate was 36.3% of our target sample size of 80. Results: Perceived skills improved temporally and stigma temporally worsened in the TAU group. Confidence decreased and attitude showed no change in both groups. Aggressive behaviors of hikikomori sufferers were significantly worsened in the Program group; however, no serious domestic violence was reported. In the TAU group, Avoidance and irregular life patterns were improved. Activity levels were worsened in both groups. Two participants (16.7%) in the Program group and one participant (7.7%) in the TAU group reported actual behavioral changes (e.g., utilizing support). Conclusion: We could not draw general conclusions on the effectiveness of the program due to the study discontinuation. Nevertheless, this study indicates the necessity for revision of the program to improve family members' confidence in engaging with hikikomori sufferers, with safer approaching by families.

Development of 5-day hikikomori intervention program for family members: A single-arm pilot trial.

BACKGROUNDS: Hikikomori, a severe form of social withdrawal, is increasingly a serious mental health issue worldwide. Hikikomori is comorbid with various psychiatric conditions including depression, social anxiety and suicidal behaviors. Family support is encouraged as a vital first step, however evidence-based programs have yet to be established. Mental Health First Aid (MHFA) is one of the most well-validated educational programs encouraging lay people such as family members, to support close persons suffering from various psychiatric conditions such as depression, anxiety and suicidal behaviors. METHODS: We newly developed an educational program for family members of hikikomori sufferers mainly based on MHFA and 'Community Reinforcement and Family Training (CRAFT)' with role-play and homework. As a single-arm trial, 21 parents (7 fathers and 14 mothers) living with hikikomori sufferers participated in our program with five once-a-week sessions (2 h per session) and six monthly follow-ups, and its effectiveness was evaluated using various self-rated questionnaires. RESULTS: Perceived skills toward a depressed hikikomori case vignette, stigma held by participants, and subscales of two problematic and one adaptive behaviors of hikikomori sufferers were improved throughout the sessions and follow-ups. In addition, positive behavioral changes of hikikomori sufferers such as improved social participation were reported by participants. LIMITATIONS: Single-arm design and evaluation using self-rated questionnaires are the main limitations of the present study. CONCLUSIONS: Our newly developed program has positive effects on family members in their contact and support of hikikomori sufferers. Future trials with control groups are required to validate the effectiveness of this program.

Oxytocin levels and sex differences in autism spectrum disorder with severe intellectual disabilities.

There were few reports of oxytocin (OXT) concentrations of autism spectrum disorder (ASD) patients with severe intellectual disabilities. We measured serum OXT concentrations in 79 hospitalized patients with severe intellectual disabilities (16-60 years old, 50 males and 29 females, 54 ASD patients) and investigated the associations between serum OXT concentration, symptom scores, sex differences, and autism spectrum disorder. There were no significant effects of diagnosis, severity of intellectual disabilities, and total score of the Japanese version of the Aberrant Behavior Checklist (ABC-J), the Childhood Autism Rating Scale-Tokyo Version (CARS-TV), and the Japanese version of the Repetitive Behavior Scale-Revised (RBS-R). However, there were sex differences in the correlations between OXT concentrations and subscale scores in the ASD group. The male ASD group (n = 39) showed negative correlations between RBS-R Self-injurious and Sameness subscale scores and serum OXT concentrations. In the female ASD group(n = 15), CARS-TV Nonverbal communication subscale scores and RBS-R Compulsive subscale scores were seen to positively correlate with serum OXT concentrations. These findings suggest that OXT functions differ in males and females with severe intellectual disabilities and that OXT partly affects autism and related to some of the repetitive behaviors and nonverbal communication, in ASD patients with severe intellectual disabilities.

Current viewpoints on DSM-5 in Japan.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, and its official Japanese version was published in 2014. The Japanese Government uses classifications from the 10th revision of the I nternational C lassification of D iseases (ICD-10) to categorize disorders and determine treatment fees. However, since the publication of the DSM-III, the use of the DSM system has become prevalent in research and educational settings in Japan. In addition to traditional psychiatry, both the ICD and the DSM are taught by many Japanese medical schools, and virtually all clinical research and trials refer to the DSM to define targeted disorders. Amid the current backdrop in which the reputation of the DSM-5 is being established, the editorial board of P sychiatry and C linical N eurosciences has asked Japanese experts across 12 specialties to examine the structure of the DSM-5, including the following categories: Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders, Major Depression, Bipolar Disorders, Obsessive-Compulsive Disorders, Somatic Symptom Disorder, Eating Disorders, Substance-Related and Addictive Disorders, Gender Dysphoria, and Neurocognitive Disorders. Although opinions were only obtained from these selected experts, we believe that we have succeeded, to a certain extent, in presenting views that are representative of each specialty.

[Threshold of Application of Antidepressant Drugs for Treatment of Depressive Disorder].

In recent years, along with the expansion of medical care for depressive disorder, there has been much controversy regarding the application of antidepressant drugs for its treatment. The aim of this paper is to consider critical issues concerning the threshold of application of antidepressant drugs for the treatment of depression. It was formerly important to diagnose the 'quality' of depression (melancholia or non-melancholia) in order to choose antidepressant treatment, whereas an assessment of the 'quantity' of depression (severity of symptoms) is crucial today to decide on the threshold. Recent guidelines for the treatment of major depressive disorder do not positively recommend the use of medication for the treatment of mild depression. The guidelines published by the Japanese Society of Mood Disorders also state that doctors have to give priority to treatments avoiding medication, although the effectiveness of antidepressant drugs for mild depression is controversial. Actually, in a clinical setting, doctors have to understand the conditions of individual cases and cope with many issues, such as a risk of suicide, comorbidity of other psychiatric disorders, target symptoms of pharmacotherapy, and choices of classes and doses of antidepressant drugs. The threshold of application of antidepressant drugs for the treatment of depression may vary according to the doctor-patient relationship and surrounding conditions. Doctors are required to provide treatment options other than pharmacotherapy.

[Evidence for the Efficacy of Behavioral Activation against Depressive Disorder: A Literature Review].

A growing body of evidence suggests the significant efficacy of behavioral activation therapy (BA) for the treatment of depression, although BA had formerly been regarded as only a part of the techniques for cognitive-behavioral treatment (CBT). The aim of this article is to review the effectiveness, indications, and limitations of BA for the psychosocial treatment of depression. The research group of Washington University in St. Louis, who previously suggested the marked efficacy of BA based on component analysis of CBT, performed a large-scale study to compare the effect of BA and cognitive therapy (CT) or antidepressant medication on the acute phase of depression. As the results, BA was superior to CT and comparable to antidepressant medication in acute-phase treatment for a subgroup of patients with relatively severe depression. Moreover, a long-term follow-up study revealed a benefit of BA compared to pharmacological treatment in regard to the persistence of the effect and cost-effectiveness. More recently, a number of meta-analyses have indicated no significant difference among BA and other psychotherapies regarding their efficacy for the treatment of depression. Because BA does not require patients or therapists to learn complex skills and is also time-efficient, it is recommended as the first-line treatment for mild or moderate depression. However, further studies are needed to consider indications, the timing of induction, and variation in BA techniques if it is applied for the treatment of depression in a general clinical setting in Japan.

A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole for the treatment of acute manic or mixed episodes in Asian patients with bipolar I disorder (the AMAZE study).

OBJECTIVES: To investigate the efficacy and safety of aripiprazole in Asian patients with manic or mixed episodes associated with bipolar I disorder. METHODS: Subjects were randomised to aripiprazole (24 mg/day; reduced to 12 mg/day if needed for tolerability; n = 128) or placebo (n = 130) for 3 weeks in this multicentre, double-blind study. The primary efficacy measure was mean change from baseline in Young Mania Rating Scale (YMRS) Total score. RESULTS: A total of 136 patients (aripiprazole 56.3%; placebo 49.2%) completed the study. The majority of patients (92.6%) received aripiprazole 24 mg/day. Aripiprazole produced statistically significant mean improvements in YMRS Total scores compared with placebo from Day 4 through to Week 3 (-11.3 vs. -5.3; P < 0.001). The most common adverse events (> 15% of patients; aripiprazole vs. placebo) were akathisia (22.0 vs. 5.6%) and insomnia (16.3 vs. 9.6%). Aripiprazole treatment resulted in no significant difference from placebo in change in mean body weight from baseline (-0.4 vs. -0.7 kg; P = 0.231). Aripiprazole was not associated with an elevated serum prolactin level. CONCLUSIONS: Aripiprazole had significantly greater efficacy than placebo for the treatment of acute manic or mixed episodes associated with bipolar I disorder in Asian patients. Treatment was generally safe and well tolerated.

[Psychotherapeutic considerations regarding medication treatment for refractory cases].

The aim of this paper is to consider the psychotherapeutic approach to refractory cases in a psychiatric clinic. Although standardized, formulated psychotherapies, i. e., CBT and IPT, have a limited efficacy against antidepressant-resistant or chronic depression, psychotherapy and medication treatment may complement each other in combination. However, the first step in the psychotherapeutic consideration of refractory depression is to give up seeking "a specific medicine" which does not exist. On the other hand, a doctor should give his/her patient new hope for recovery and stimulate their motivation for treatment. In the dialogue between a doctor and patient, the following points are to be focused on : 1) The essential part of treatment is not medicine but the patient him-/herself. 2) Recommendation of medication should not further reduce the patient's pride. 3) It should be clear that medication treatment is a collaborative activity between patients and doctors. It is preferable for topics of an interview to extend from a reconsideration of the prescription contents to reconstruction of the daily life. It may be helpful for patients to obtain detailed advice on basic lifestyle aspects, such as sleep, meals, and daily activities.

[Serum of transthyretin as a treatment-responsive biomarker for schizophrenia].

We investigated the changes in protein profiles of treatment responsive biomarkers in three subjects with first-onset schizophrenia using the surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) technology. Our results showed that eight protein peaks were down-regulated or up-regulated during the acute phase, and returned toward the control values during the recovery phase. In particular, a 13,761Da protein peak was markedly down-regulated during the acute phase, and returned during the recovery phase. This protein was identified as unmodified transthyretin using two-dimensional electrophoresis followed by peptide mass fingerprinting based on matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). However, we failed to show transthyretin changes with the treatment using enzyme-linked immunosorbent assay (ELISA) and two-dimensional electrophoresis. The distinction between unmodified and modified subtypes of transthyretin was difficult with these methods because of similar molecular weights and isoelectric points in these subtypes. The present study showed that the application of SELDI-TOF-MS technology has higher precision for the distinction of detailed molecular weight than conventional proteomics techniques such as ELISA and two-dimensional electrophoresis. The dynamic changes in transthyretin have been reported to be associated with acute-psychosis condition; the present study suggested that unmodified transthyretin has the potential to be a treatment responsive biomarker for schizophrenia.

[Does the neurobiology of depressive syndrome converge to a dimensional model?].

The aim of this paper is to consider the nosological issues of depressive syndrome predominantly from the viewpoint of the modern neurobiology of psychiatric disorders. The author particularly addresses the following two questions for general psychiatrists to facilitate their understanding: "Can the response to medication treatment distinguish each subcategory of depressive syndrome?" and "Can we clearly define a boundary between the grief reaction due to bereavement and major depressive disorder?" For the former, the categorical classification based on the response to different psychotropic drugs is losing the significance it had at the time DSM-III was published in 1980. The discrimination of melancholia and atypical depression based on a differential response to the specific type of antidepressant drugs (e. g., tricyclic antidepressants or monoamine oxidase inhibitors) is unlikely to be proven. Moreover, because melancholia and atypical depression overlap each other longitudinally in clinical features, that may continue for both mood disorder subtypes in pathophysiology. For the latter question, the DSM-5 draft contains a proposal deleting the exclusion criteria of bereavement from major depressive disorder. Although this proposal has become controversial, the functional brain imaging studies suggest a potential continuity between the bereavement reaction and major depression. In conclusion, a growing body of evidence from biological research does not seem to support the validity of the categorical diagnosis of the depressive syndrome subdivision. At present, such biological studies may require the current DSM designers to incorporate a dimensional approach in DSM-5.

Regional and temporal changes in proteomic profile after middle cerebral artery occlusion with or without reperfusion in rats.

Although DNA microarray studies showed up-regulation of various genes, failures of translation of many genes are expected to occur under ischemic conditions even in the penumbra with mild reduction in cerebral blood flow. We applied surface enhanced laser desorption/ionization-time of flight mass spectrometry (SELDI-TOF-MS) technology to study proteomic profile at 6, 12, and 24 h after photothrombotic middle cerebral artery (MCA) occlusion with or without YAG laser-induced reperfusion in adult male spontaneously hypertensive rats. Of the 43 protein peaks that differed from the sham-operation group with a criterion (no overlap of peak intensities between the two groups), 36 peaks (84%) were down-regulated, and seven were up-regulated. All increased peaks showed greater than twofold increases (up to 8.1 fold) compared with those in the sham-operation group. Effects of reperfusion were observed mainly at 24 h after 1 h of MCA occlusion only in the penumbra, where 23 of 32 peaks returned toward the control values, whereas none of 33 peaks showed such attenuation in the ischemic core. Major ischemia-induced changes in protein peaks detected with SELDI-TOF-MS were down-regulations. The present study showed that dynamic changes of protein profile were associated with progression and recovery of the ischemic core and penumbra.

Duration effect of obsessive-compulsive disorder on cognitive function: a functional MRI study.

BACKGROUND: The inconsistency of previous reports examining cognitive function in obsessive-compulsive disorder (OCD) suggests its heterogeneity. In this study, we examined the effect of illness duration on cognitive function in OCD. METHODS: We examined the cognitive function of 32 OCD patients and 16 healthy volunteers by neuropsychological tests and functional magnetic resonance imaging while they performed the Stroop and N-back tasks to assess attention and nonverbal memory. The patients were divided into two groups by illness duration: a short-term group (n=17, 5.5+/-3.1 years) and a long-term group (n=15, 20.3+/-6.1 years). Statistical analysis was performed to determine the differences between these two groups and the normal control group (n=16). RESULTS: The long-term group showed attention deficit and nonverbal memory dysfunction on the neuropsychological tests. In contrast, on functional magnetic resonance imaging, the short-term group showed weaker activation of the right caudate during the Stroop task and stronger activation of the right dorso-lateral prefrontal cortex during the N-back task than the long-term and normal control groups. CONCLUSIONS: The results suggested that abnormal brain activation occurs in the early phase of OCD and that the long-term persistence of OCD might involve a decline in cognitive function.

Working memory dysfunction in obsessive-compulsive disorder: a neuropsychological and functional MRI study.

Previous neuropsychological studies indicate that OCD subtypes such as checking rituals might be associated with a working memory deficit. On the other hand, functional neuroimaging studies found functional abnormalities of the frontal cortex and subcortical structures in OCD. Combined with functional imaging method, we applied neuropsychological batteries to demonstrate a working memory deficit in OCD by comparison with normal controls. In addition, working memory and brain activation were further examined with symptom-based analysis. Forty patients with OCD and 25 normal controls were examined using neuropsychological tests including the WAIS-R, WCST, WMS-R, and R-OCFT and functional MRI (fMRI) during the N-back task including 0- and 2-back task. On fMRI, the brain regions activated during the performance and the differences in the activation between patients and controls were identified. Additional analyses of severity and subtypes were conducted by using Y-BOCS severity score, symptom-checklist and Leckman's four-factor model, respectively. On the neuropsychological tests, the OCD patients had significantly lower scores on the delayed recall section of the WMS-R and the immediate recall section of the R-OCFT compared to the controls. On fMRI, the patients showed greater activation in the right dorsolateral prefrontal cortex (DLPFC), left superior temporal gyrus (STG), left insula, and cuneus during two-back task compared to the controls. Right orbitofrontal cortex activity showed a significant positive correlation with Y-BOCS scores in OCD. Furthermore, patients with obsessions/checking rituals (n=10) showed severer memory deficits and decreased activity in the postcentral gyrus than patients with cleanliness/washing rituals (n=14). In conclusion, we found neuropsychological dysfunction and brain abnormalities in OCD. Furthermore, our results suggested that symptom severity and symptom subtype such as obsessions/checking might affect neuropsychological dysfunction and related brain activities.