[Delusion with a theme of generation in chronic schizophrenia].

For schizophrenics and persons at risk of developing schizophrenia, issues regarding the origin of self and paternity sometimes become pressing questions which jeopardize the formation of their subjects. We termed the system which gives rise to such questions as a theme of generation. Through the analysis of a peculiar delusion in a chronic male case, which included the reverse and alteration of the family relations, we clarified the location of a theme of generation in the psychopathology of schizophrenia. The delusion emerged on the death of his parents and successive alienation from his brothers and sisters, which confronted him with a question of generation. The important appearance mechanisms of the delusion were second person hallucinations and primary delusions through delusional ideas. Themes of feminization and monogenic reproduction playing a central role in the delusion were sustained by the concept of the female as a container to regulate the infinite chaos, which is characteristic to the delusion of feminization in schizophrenia (Kato, 2002). With reference to the findings of J. Lacan's structural psychoanalysis, we considered the delusion as a schizophrenic answer to a perplexing question of generation posed to the patient. Additionally, we discussed the delusional other as the responder to this question who had the following three characteristics: 1. the other was the place of the infinite production of signifiers, 2. the other took the position of a mysterious God-like figure and made the patient's body the object of "jouissance", and 3. the other also responded to the question of sexual difference.

Mental health status of Japanese-Brazilian children in Japan and Brazil.

AIMS: This study aimed to make a comparison of the mental health status between Japanese-Brazilian children in Japan and in Brazil. METHODS: A total of 331 Japanese-Brazilian children at five Brazilian schools in Japan (Japanese Group), and 172 Japanese-Brazilian children at one private school in São Paulo (Brazilian Group) were enrolled in statistical analyses. The Strength and Difficulties Questionnaire was applied for parents, teachers, and students who were aged over 11 years old. RESULTS: The total comparison of the Strength and Difficulties Questionnaire scores between the two groups demonstrated that all the average symptom scores except prosocial behavior were significantly higher in the Japanese Group by parent report. By teacher report, the average symptom scores of conduct problems, hyperactivity, peer problems and total difficulties were significantly higher in the Japanese Group, while that of the prosocial behavior was significantly higher in the Brazilian Group. Dividing parent and teacher reports into two age ranges, similar results to the total comparison were seen in the parent report in the age range of 4-10-year-olds and both parent and teacher reports in that of 11-16-year-olds, while in the teacher report for 4-10-year-olds, only conduct problems and total difficulties score showed significantly higher average scores in the Japanese Group. By self-report, the average symptom scores of emotional symptoms, peer problems and total difficulties score were significantly higher in the Japanese Group. CONCLUSION: The results indicate poorer mental health status in the Japanese Group than the Brazilian Group, and suggest the adverse circumstances of the former group both at their homes and schools.

[Delusional disorder in a chronic renal dialysis patient--deprivation and reclaiming of body and narrative].

We report a female case treated with hemodialysis over 20 years who demonstrated good social functioning, until she suffered from delusional disorder with persecutory delusions involving medical staff performing the dialysis and also auditory hallucinations involving them. We examined the bio-psycho-social invasiveness of the renal dialysis treatment, especially concerning the effects on the patient's self-image of her body resulting in the loss of a feeling of unity between her mind and body, or the sense of her body belonging to her, referring to J. Lacan's concept of "corps imaginaire= imaginary body". We supposed the situation of "body deprivation" on the ground of the patient's behavior when she developed persecutory delusions that the medical staff were trying to deprive her of her ideal body. In this case, her persecutory delusions should be regarded as a reclaim for her right not to be deprived of her self-body. We pointed out the general situation which the hegemony of modern medicine over patients brings about, where patients are deprived of chances to express their personal feelings about their illness and be listened to attentively by medical staffs. We recognized such a situation in the present patient and described the situation as "narrative deprivation". Her delusions seemed to have the aspect of the claim for her rebelling against the narrative deprivation. We emphasized the role of psychiatric staff to confirm the existence of the body-narrative deprivation situation on the side of the patient and listen attentively to the patient's personal narrative of illness in the practice of consultation-liaison psychiatry, especially when performing therapy in patients with persecutory delusions involving medical staff.

Migration and mental health: Japanese Brazilians in Japan and in Brazil

OBJECTIVE: Brazil is the country with the largest community of Japanese descendants in the world, from a migration movement that started in 1908. However, more recently (1988), a movement in the opposite direction began. Many of these descendants went to Japan for work purposes and suffered mental distress. Some of them sought treatment in Japan, while others returned to Brazil to seek treatment. The aim of the present study was to compare the sociodemographic profile and diagnoses of Japanese Brazilian psychiatric outpatients in Japan (remaining group) and in Brazil (returning group). METHOD: All consecutive Japanese Brazilian outpatients who received care from the psychiatric units in Japan and Brazil from April 1997 to April 2000 were compared. The diagnoses were based on ICD-10 and were made by psychiatrists. Sociodemographic data and diagnoses in Brazil and Japan were compared by means of the Chi-Squared Test. RESULTS: The individuals who returned to Brazil were mostly male and unmarried, had lived alone in Japan, had stayed there for short periods and were classified in the schizophrenia group. The individuals who remained in Japan were mostly female and married, were living with family or friends, had stayed there for long periods and were classified in the anxiety group. Logistic regression showed that the most significant factors associated with the returning group were that they had lived alone and stayed for short periods (OR = 0.93 and 40.21, respectively). CONCLUSION: We conclude that living with a family and having a network of friends is very important for mental health in the context evaluated.

OBJETIVO: O Brasil é o país com a maior comunidade de descendentes japoneses do mundo (migração iniciada em 1908). No entanto, mais recentemente (1988) um movimento migratório em direção oposta se iniciou. Muitos desses descendentes têm migrado para o Japão a trabalho e sofrem distúrbios mentais. Alguns deles procuram tratamento no Japão, enquanto outros retornam ao Brasil para se tratarem. O objetivo do presente estudo é comparar o perfil sociodemográfico e diagnósticos dos pacientes ambulatoriais brasileiros descendentes de japoneses que permaneceram no Japão com os que retornaram ao Brasil. MÉTODO: Todos os pacientes ambulatoriais atendidos de forma consecutiva nas unidades psiquiátricas no Japão e no Brasil de abril de 1997 a abril de 2000 foram comparados. Os diagnósticos foram realizados por psiquiatras de acordo com a CID-10. Os dados sociodemográficos e os diagnósticos no Brasil e no Japão foram comparados por meio do Teste Qui-Quadrado. RESULTADOS: O grupo que retornou ao Brasil era principalmente de homens, não casados, que viviam sós no Japão, tiveram uma breve estada neste país e foram classificados no grupo de esquizofrenia. O grupo no Japão era principalmente constituído de mulheres, casadas, morando com familiares ou amigos, estada longa no Japão e foram classificadas no grupo de ansiedade. A regressão logística mostrou que os fatores mais significativamente associados com o grupo que retornou foram o fato de morar sós e ficarem pouco tempo no Japão (OR = 0,93 e 40,21, respectivamente). CONCLUSÃO: Concluímos que morar em família e ter uma rede de amigos é muito importante para a saúde mental no contexto avaliado.

Long-term clinical course of patients with acute polymorphic psychotic disorder without symptoms of schizophrenia.

Few studies have investigated the long-term course of patients with acute polymorphic psychotic disorder, despite the clinical relevance. The present study focused on the frequency of acute polymorphic psychotic disorder without symptoms of schizophrenia (F23.0) and the prognosis of patients with the disorder over a long period. A total of 388 inpatients with nonaffective psychosis were examined and cases with F23.0 were retrospectively investigated regarding clinical course over 12 years with reference to clinical charts. A total of 16 cases were diagnosed with F23.0 according to first episode. After 12 years, five cases were rediagnosed with schizophrenia, and one case with borderline-type emotionally unstable personality disorder, although the diagnosis of F23.0 was not changed in 10 older patients. Of the four cases with >2 repeated episodes of F23.0, the same clinical picture as in the first episode was observed in three, while one case showed continuous residual symptoms. F23.0 does not represent a homogeneous clinical entity. In some cases, diagnosis changes to schizophrenia, but others display repeated episodes of F23.0.

[Psychopathological study of lie motif in schizophrenia].

The theme of a statement is called "lie motif" by the authors when schizophrenic patients say "I have lied to anybody". We tried to analyse of the psychopathological characteristics and anthropological meanings of the lie motifs in schizophrenia, which has not been thematically examined until now, based on 4 cases, and contrasting with the lie motif (Lügenmotiv) in depression taken up by A. Kraus (1989). We classified the lie motifs in schizophrenia into the following two types: a) the past directive lie motif: the patients speak about their real lie regarding it as a 'petty fault' in their distant past with self-guilty feeling, b) the present directive lie motif: the patients say repeatedly 'I have lied' (about their present speech and behavior), retreating from their previous commitments. The observed false confessions of innocent fault by the patients seem to belong to the present directed lie motif. In comparison with the lie motif in depression, it is characteristic for the lie motif in schizophrenia that the patients feel themselves to already have been caught out by others before they confess the lie. The lie motif in schizophrenia seems to come into being through the attribution process of taking the others' blame on ones' own shoulders, which has been pointed out to be common in the guilt experience in schizophrenia. The others' blame on this occasion is due to "the others' gaze" in the experience of the initial self-centralization (i.e. non delusional self-referential experience) in the early stage of schizophrenia (S. Kato 1999). The others' gaze is supposed to bring about the feeling of amorphous self-revelation which could also be regarded as the guilt feeling without content, to the patients. When the guilt feeling is bound with a past concrete fault, the patients tell the past directive lie motif. On the other hand, when the patients cannot find a past fixed content, and feel their present actions as uncertain and experience them as lies, the present directive lie motif is told. Lie motifs are considered to have the effect of restoring the patient's own subjectivity by the following ways: (a) by actualizing the structural constituents elementary for the establishment of subjectivity, (b) by conducting a kind of speech act for declaring themselves as an active lying subject to co-presenting others for the resettlement in our inter-subjective world.

[Mental disorders among Japanese-Brazilians in Japan: relationships to pre-migration and acculturative factors].

The current population of Japanese-Brazilians living in Japan consists mainly of second- and third-generation Japanese immigrants to Brazil. In the last 10 years, they have migrated to Japan, their ancestral country, mostly as industrial workers. The objective of this study was to examine possible relationships between mental disorders and both pre-migration psychosocial factors and acculturative status, among Japanese-Brazilians in Japan. We developed our own Portuguese acculturation-questionnaire to assess the their adaptation to Japanese society and their ethnic-cultural identity. Using the acculturation-questionnaire, the Portuguese version of the self-reporting questionnaire (SRQ-20) and an identification form with socio-demographic and clinical data, a community sample of 131 Japanese-Brazilian immigrants in Utsunomiya and outpatient sample of 32 Japanese-Brazilians in the psychiatric department of a medical school in the same region were compared. Analysis was done by chi 2 Fisher and multiple logistic regression. The socio-demographic data indicated that the outpatients were most likely to have past medical history (OR = 12.3), traumatic experience (OR = 10.1) in Brazil before immigration, short duration of residence in Japan (OR = 3.76), no occupation in Brazil (OR = 4.78) and to be living alone in Japan (OR = 5.71). The findings from the acculturation-questionnaire showed that outpatients were most likely to have sociability in Japan with either Brazilians or Japanese only (OR = 3.94) and to hope to hand down either Brazilian or Japanese culture only to their posterity (OR = 5.31). The findings from the acculturation-questionnaire showed that the community sample showed a higher acceptance of both the Brazilian and Japanese culture than the patient sample. We suggested that mentally healthy individuals have a stronger integration orientation as an adaptation modes i.e. to keep the original ethnic-cultural identity on one hand, and to accept the cultural values, attitudes, norms and customs of the host society on the other, than individuals predisposed to- or with mental disorders among Japanese Brazilians in Japan.

Mental health of two communities of Japanese-Brazilians: a comparative study in Japan and in Brazil.

The aim of the present study was to assess the mental health status of Japanese-Brazilians living in Kiyoharadai, Japan and compare the findings with the Japanese-Brazilians living in Bauru, Brazil. A comparative community-based mental health survey was conducted from November 1997 to April 1999 on a randomly selected sample of Brazilians of Japanese descent living in Bauru, Brazil (n=213) and on the entire Brazilian community of Kiyoharadai, Utsunomiya, Japan (n=158), using the self-reporting questionnaire (SRQ-20). Analysis was done by chi2, Fisher and multiple logistic regression. Scores indicating probable cases of minor psychiatric disorders, were found in 3.2% of the community in Bauru city and 17.8% (OR=7.01) of the community in Kiyoharadai. The sociodemographic data indicated that those with high SRQ-20 scores were most likely to be female (OR=2.98), smokers (OR=2.76), and those whose former occupation was student when living in Brazil (OR=9.57). The mental health status of the Japanese-Brazilians living in Kiyoharadai, Japan is significantly worse than that of the community living in Bauru, Brazil, particularly among women, smokers and those who were students when living in Brazil. Further research concerning the mental health of this community is necessary and assistance provided.

[Classification of long-term clinical course of 'atypical psychosis': a 20-year follow-up study at a medical school hospital].

To study the long-term clinical course and outcomes of atypical psychosis, 8 patients diagnosed with atypical psychosis were observed for more than 12 years (mean, 20 years). Retrospective examination was performed, particularly with respect to clinical features at each episode. The overall course of each case was classified as one of the following three types: Type I--"Recurrent confused state" type. Patients frequently repeated acute transient confused or dream-like states in a similar way, sometimes and/or for part of the episode accompanied by a floating paranoid-hallucinatory state. Duration of psychotic episode was short, persisting for a few days to about one month. Type II--"Manic-depressive illness similar" type. After a long course of disease, the predominantly early middle-aged patients (30- to 40 years-old) demonstrated fewer original characteristic features of acute confused or dream-like states. Instead, manic or depressive episodes tended to predominate. Duration of psychotic episodes exceeded the duration of type I episodes, to a maximum of about 3 months. Type III--"Appearance of residual state" type. After several episodes characterized by transient confused state during middle age, residual states consisting of a slight depressive state, reduced spontaneity and flattening of emotions appear. These states become durable and the periodicity of the disease disappeared. We conclude that the core group of atypical psychosis patients presents with confused symptoms as a clinical feature of episodes, and with the recurrent confused state type representing the long-term clinical course. "Shift to manic-depressive illness similar" and "appearance of residual state" types were considered to be derived from the core group, according to the interplay of personality structure and viable dynamics.