Purpose : We investigated the cognitive function, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADLs) of elderly individuals admitted in care facilities. Moreover, the factors affecting the care burden experienced by facility staffs were examined. Method : 24 care facilities for elderly individuals participated in the study. The Revised Hasegawa Dementia Scale (HDS-R), Japanese version of the Neuropsychiatric Inventory (NPI), and Crichton Geriatric Behavioral Rating Scale (CGBRS) were used to evaluate cognitive function, BPSD, and ADL, respectively. The short Japanese version of the Zarit Burden Interview was used to assess the care burden. A multiple regression analysis was conducted with data obtained from 464 elderly individuals who fulfilled all the scales. Results : The care burden was correlated to the scores of HDS-R, but not with those of dysphoria/depression and disinhibition of NPI, restlessness of CGBRS, and subjective mood of CGBRS (R2 = 0.309, p < 0.005). Conclusion : Dysphoria/depression, disinhibition, restlessness, and subjective mood, but not cognitive decline, have an effect on the care burden experienced by facility staffs who manage elderly individuals. These results indicated that the appropriate diagnosis and treatment of BPSD are important in reducing the burden of facility staffs. J. Med. Invest. 67 : 236-239, August, 2020

Objective : The purpose of the present study is to examine clinical factors related to life skills in people with schizophrenia. Method : The participants were 51 stabilized outpatients with schizophrenia. Their mean age was 38.91 (SD = 10.73) years. Life skills were assessed using the Life skills profile (LSP). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). Results : Cognitive function was not correlated with the LSP scores at all. Among clinical symptoms, scores of the PANSS positive and negative syndrome scales, the CDSS, and the DIEPSS had negative correlations with the LSP total score and the subscales. Stepwise regression analyses showed that the CDSS and PANSS negative syndrome scale scores were independent predictors of the LSP total score and two of the subscales. Conclusions : These results indicate that cognitive function is not associated with life skills but clinical symptoms such as depressive and negative symptoms have considerable impacts on life skills in people with schizophrenia. J. Med. Invest. 67 : 75-82, February, 2020.

Purpose Recently, cognitive variables such as negative and positive self-belief and thoughts have attracted much attention because they are associated with functional outcomes and quality of life (QOL). However, it is unclear how cognitive variables affect subjective and objective QOL. This study aimed to investigate the relationship of negative and positive self-belief and thoughts with subjective and objective QOL. Participants and methods Thirty-six people with schizophrenia participated in this study. Subjective and objective QOL were assessed with the Schizophrenia Quality of Life Scale (SQLS) and Quality of Life Scale (QLS), respectively. Neurocognitive function was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Clinical symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia. Side effects were assessed with the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS). Negative and positive self-belief and thoughts were assessed with the Defeatist Performance Belief Scale and Automatic Thoughts Questionnaire-Revised. A generalized linear model was tested, with subjective and objective QOL as the response variable and symptoms, neurocognitive function, and cognitive variables that were significantly correlated with subjective and objective QOL as explanatory variables. Results In the schizophrenia group, the common objects score on the QLS was predicted by the composite BACS score, and the total QLS score was predicted by the DIEPSS score. Motivation and Energy, Psychosocial, and Symptoms and Side effects scores on the SQLS were predicted by depression and by negative automatic thought (NAT) and positive automatic thought (PAT). Conclusion Our results indicated that key targets for improving objective and subjective QOL in people with schizophrenia are side effects, neurocognitive function, depression, and NAT and PAT.

Purpose: The purpose of the present study was to examine clinical factors related to social function in people with schizophrenia. Patients and methods: The participants were 55 stabilized outpatients with schizophrenia. Their mean age was 39.36 (SD = 10.65) years. Social function was assessed using the Quality of Life Scale (QLS). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. Results: Neither the MCCB cognitive domain score nor composite score was correlated with the QLS scores. However, of the 10 MCCB subtests, the Trail Making Test Part A and the Brief Assessment of Cognition in Schizophrenia-Symbol Coding (BACS-SC) scores were positively correlated with the QLS scores. Among clinical variables, especially the PANSS negative syndrome scale score had a strong negative correlation with the QLS scores. Stepwise regression analyses showed that the PANSS negative syndrome scale score was an independent predictor of the QLS scores, and although the BACS-SC score predicted the QLS common objects and activities subscale score, the association was not so strong compared to the PANSS negative syndrome scale score. Conclusion: These results indicate that speed of processing evaluated by BACS-SC could predict some aspect of social function but negative symptoms have a much stronger impact on global social function in people with schizophrenia.

Purpose The purpose of the present study was to examine clinical factors related to social function in people with schizophrenia. Patients and methods The participants were 55 stabilized outpatients with schizophrenia. Their mean age was 39.36 (SD =10.65) years. Social function was assessed using the Quality of Life Scale (QLS). Cognitive function was evaluated with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia, and the Drug-Induced Extrapyramidal Symptoms Scale. Results Neither the MCCB cognitive domain score nor composite score was correlated with the QLS scores. However, of the 10 MCCB subtests, the Trail Making Test Part A and the Brief Assessment of Cognition in Schizophrenia-Symbol Coding (BACS-SC) scores were positively correlated with the QLS scores. Among clinical variables, especially the PANSS negative syndrome scale score had a strong negative correlation with the QLS scores. Stepwise regression analyses showed that the PANSS negative syndrome scale score was an independent predictor of the QLS scores, and although the BACS-SC score predicted the QLS common objects and activities subscale score, the association was not so strong compared to the PANSS negative syndrome scale score. Conclusion These results indicate that speed of processing evaluated by BACS-SC could predict some aspect of social function but negative symptoms have a much stronger impact on global social function in people with schizophrenia.

No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of Parkinson's disease. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.

Objective We investigated oxyhemoglobin change in the prefrontal cortex (PFC) of patients with obsessive–compulsive disorder (OCD) who showed different responses to pharmacotherapy during neuropsychological tasks with near-infrared spectroscopy. Subjects and methods A total of 42 patients with OCD (mean age: 35.6±9.6 years, 14 men, 28 women) and healthy control subjects (mean age: 35.4±9.7 years, 13 men, 29 women) were selected. Patients with OCD were divided into three groups (responders to selective serotonin-reuptake inhibitors (SSRIs), responders to SSRIs with antipsychotics, and nonresponders to SSRIs and SSRIs with antipsychotics) based on pharmacological response. We investigated oxyhemoglobin change in the PFC of subjects during Stroop tasks and a verbal fluency test with near-infrared spectroscopy. Results Responders to SSRIs showed smaller activation compared to control subjects during the Stroop incongruent task and verbal fluency test, but not during the Stroop congruent task. In contrast, responders to SSRIs with antipsychotics showed smaller activation compared to control subjects during all three tasks. Conclusion Our results suggest that activation of the PFC during Stroop tasks might predict responses to pharmacotherapy of patients with OCD.

AIM:Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, and it promotes the development and function of dopaminergic and serotonergic neurons. The Met allele of the BDNF Val66Met polymorphism is associated with a decrease in activity-dependent secretion of BDNF compared with the Val allele, and a number of studies have provided evidence for the association between this polymorphism and obsessive-compulsive disorder (OCD). The purpose of this study was to investigate whether this functional variant of the BDNF gene is associated with OCD and treatment response in patients with OCD in the Japanese population.METHODS:We first performed a case-control association study between the BDNF Val66Met polymorphism and OCD (175 cases and 2,027 controls). Then, we examined an association between this polymorphism and treatment response in 96 patients with OCD.RESULTS:We found no significant association between the Met allele and OCD risk or between the Met allele and treatment responses to selective serotonin reuptake inhibitors or serotonin reuptake inhibitor with an atypical antipsychotic (P>0.05).CONCLUSION:Our results suggest that the BDNF Val66Met polymorphism may not be associated as a risk factor for developing OCD or with therapeutic response in patients with OCD in the Japanese population.

Object: Selective serotonin reuptake inhibitors (SSRI) are well-established first-line pharmacological treatments for obsessive-compulsive disorder (OCD), and serotonin transporter (5-HTT) may be the target of antidepressants and involved in the pathophysiology of OCD. In this study, we determined mRNA expression levels of the 5-HTT gene in the peripheral blood leukocytes of patients with OCD and control subjects (n = 53, each). Methods: Total RNA was extracted from the peripheral leukocytes of whole blood samples using the PAX gene Blood RNA kit. Real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis was performed with the ABI 7500 Fast Real-Time System. Expression differences between OCD patients and controls were tested using Student’s t-test. All subjects signed written, informed consent forms that were approved by the institutional ethics committees of the University of Tokushima Graduate School. Results: The 5-HTT mRNA levels in patients were significantly higher than in healthy controls (P = 1.77 × 10–5). Conclusion: Our result may suggest that the elevated mRNA levels of 5-HTT might be implicated in the pathophysiology of OCD. PT615 Altered White Matter Fronto-Striatal Connectivity in Obsessive-Compulsive Disorder Seoyeon Kwak1, Tae Young Lee2, Kang Ik Cho1, Minah Kim2, Je Yeon Yun2, Sung Nyun Kim2, Jun Soo Kwon1,2* 1 Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Korea 2 Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea Abstract Objective: Obsessive-Compulsive disorder (OCD) is a chronic psychiatric disorder defined by recurrent thoughts, intrusive and distressing impulses, or images and ritualistic behavior; frontostriatal pathways are hypothesized to be involved in the major pathophysiology of Obsessive-Compulsive Disorder. Although focal regional abnormalities of white matter integrity have been studied in populations with OCD, alterations in the structural connectivities among them, especially non-medicated patients, remain poorly understood. Method: A total of 92 patients with non-medicated OCD and 92 matched healthy controls underwent diffusion-weighted (DWI) and T1-weighted magnetic resonance imaging. Bilateral orbitofrontal cortex (OFC) and two subcortical ROIs (caudate and putamen) were extracted from their own T1 image using Freesurfer. Using AFNI mini-probabilistic tractography on the DWI data with the extracted ROIs, connectivities between OFC and each subcortical region were calculated. Results: RD value between the right OFC and putamen was significantly increased in OCD compared to that of healthy controls. No significant group differences in FA or MD value. Conclusion: The current study suggested evidence providing that individuals with OCD show demyelination in orbitofrontal-putamen white matter tract compared with controls. The results are consistent with previous research on abnormal fronto-striatal function and demyelination in the frontal lobe in OCD. Further study is needed to explore tracts from dorsal frontal regions to the dorsal striatum, and the relationship between fronto-striatal structural connectivity and clinical/neuropsychological function.Objective: Obsessive-Compulsive disorder (OCD) is a chronic psychiatric disorder defined by recurrent thoughts, intrusive and distressing impulses, or images and ritualistic behavior; frontostriatal pathways are hypothesized to be involved in the major pathophysiology of Obsessive-Compulsive Disorder. Although focal regional abnormalities of white matter integrity have been studied in populations with OCD, alterations in the structural connectivities among them, especially non-medicated patients, remain poorly understood. Method: A total of 92 patients with non-medicated OCD and 92 matched healthy controls underwent diffusion-weighted (DWI) and T1-weighted magnetic resonance imaging. Bilateral orbitofrontal cortex (OFC) and two subcortical ROIs (caudate and putamen) were extracted from their own T1 image using Freesurfer. Using AFNI mini-probabilistic tractography on the DWI data with the extracted ROIs, connectivities between OFC and each subcortical region were calculated. Results: RD value between the right OFC and putamen was significantly increased in OCD compared to that of healthy controls. No significant group differences in FA or MD value. Conclusion: The current study suggested evidence providing that individuals with OCD show demyelination in orbitofrontal-putamen white matter tract compared with controls. The results are consistent with previous research on abnormal fronto-striatal function and demyelination in the frontal lobe in OCD. Further study is needed to explore tracts from dorsal frontal regions to the dorsal striatum, and the relationship between fronto-striatal structural connectivity and clinical/neuropsychological function. PT617 Plasma oxytocin levels in OCD patients Donatella Marazziti, Stefano Baroni, Federico Mucci, Liliana Dell’Osso Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa Abstract Objective: Given the paucity of information on the possible role of oxytocin (OT) in the pathophysiology of obsessive-compulsive disorder (OCD), our study aimed at evaluating plasma OT levels in a group of 44 OCD outpatients of both sexes, as compared with healthy control subjects. Methods: Diagnosis was assessed according to DSM-IV-TR criteria, while OCD severity was measured by the Y-BOCS rating scale. All patients were drug-free and not depressed. The romantic attachment was assessed by means of the Italian version of the “Experiences in Close Relationships” questionnaire (ECR). Plasma OT levels were evaluated by means of a standard RIA kit. Results: The OT levels (mean ± SD, pg/ml) were significantly higher in the patients than in the control subjects (4.30 ± 1.36 vs 2.55 ± 2.18, p > 0.001). The comparison of the ECR anxiety and avoidance scales showed that their mean scores were significantly higher in the patients than in control subjects (4.4 ± 0.2 vs 3.1 ± 0.3, p > 0.01, and 2.9 ± 0.2 vs 2.0 ± 0.3. p>0.01, respectively). Positive correlations were detected between OT levels and the fearful-avoidant (r= 0.352, p= 0.054) and the dismissing (r=0.379, p=0.044), but only in male patients. Conclusions: The main findings of our study showed that OT levels were increased in OCD patients, as compared with healthy subjects. In addition, we observed higher ECR scale scores in the patients than in healthy subjects. Positive relationships were detected between OT levels and the fearful-avoidant and dismissing styles of romantic attachments, but only in male OCD patients. Although it is difficult to make any firm hypothesis, we would suggest with cautions that OT might regulate differently the romantic attachment in the two sexes, at least in OCD patients. Taken together, these findings suggest that OT may play a role in OCD pathophysiology and also in romantic attachment of patients with gender specificity.Objective: Given the paucity of information on the possible role of oxytocin (OT) in the pathophysiology of obsessive-compulsive disorder (OCD), our study aimed at evaluating plasma OT levels in a group of 44 OCD outpatients of both sexes, as compared with healthy control subjects. Methods: Diagnosis was assessed according to DSM-IV-TR criteria, while OCD severity was measured by the Y-BOCS rating scale. All patients were drug-free and not depressed. The romantic attachment was assessed by means of the Italian version of the “Experiences in Close Relationships” questionnaire (ECR). Plasma OT levels were evaluated by means of a standard RIA kit. Results: The OT levels (mean ± SD, pg/ml) were significantly higher in the patients than in the control subjects (4.30 ± 1.36 vs 2.55 ± 2.18, p > 0.001). The comparison of the ECR anxiety and avoidance scales showed that their mean scores were significantly higher in the patients than in control subjects (4.4 ± 0.2 vs 3.1 ± 0.3, p > 0.01, and 2.9 ± 0.2 vs 2.0 ± 0.3. p>0.01, respectively). Positive correlations were detected between OT levels and the fearful-avoidant (r= 0.352, p= 0.054) and the dismissing (r=0.379, p=0.044), but only in male patients. Conclusions: The main findings of our study showed that OT levels were increased in OCD patients, as compared with healthy subjects. In addition, we observed higher ECR scale scores in the patients than in healthy subjects. Positive relationships were detected between OT levels and the fearful-avoidant and dismissing styles of romantic attachments, but only in male OCD patients. Although it is difficult to make any firm hypothesis, we would suggest with cautions that OT might regulate differently the romantic attachment in the two sexes, at least in OCD patients. Taken together, these findings suggest that OT may play a role in OCD pathophysiology and also in romantic attachment of patients with gender specificity. PT618 Impaired learning and memory in adolescent obsessive-compulsive disorder Gottwald J 1, Apergis-Schoute A 1, Morein-Zamir S 2, 5, de Wit S 3, Kaser M 1, Sule A 1, Limmer W 1, Conway Morris A 4, Robbins TW 5, Sahakian BJ 1 1. Dept of Psychiatry and Behavioural and Clinical Neuroscience Inst, University of Cambridge 2. Dept of Psychology, Anglia Ruskin University 3. Dept of Clinical Psychology, University of Amsterdam 4. Cambridgeshire and Peterborough NHS Foundation Trust 5. Dept of Psychology and Behavioural and Clinical Neuroscience Inst, University

BACKGROUND:Previous studies of patients with bipolar disorder (BD) using magnetic resonance spectroscopy (MRS) have shown neurophysiological abnormalities related to the glutamate (Glu)-glutamine (Gln) cycle, membrane turnover, and neuronal integrity, although the results were neither consistent nor conclusive. Recently it has been reported the Gln/Glu ratio is the most useful index, quantifying neuronal-glial interactions and the balance of glutamatergic metabolites In this MRS study, we elucidated the abnormalities of metabolites in a larger sample of patients with BD with a high-field MRI system. METHODS:Sixty-two subjects (31 patients with BD and 31 healthy controls [HC]) underwent 3T proton MRS (1H-MRS) of the anterior cingulate cortex (ACC) and left basal ganglia (ltBG) using a stimulated echo acquisition mode (STEAM) sequence. RESULTS:After verifying the data quality, 20 patients with BD and 23 age- and gender-matched HCs were compared using repeated-measures analysis of covariance (ANCOVA). Compared to the HC group, the BD group showed increased levels of Gln, creatine (Cr), N-acetyl aspartate (NAA), choline (Cho), and an increased ratio of Gln to Glu in the ACC, and increased Gln and Cho in the ltBG. These findings remained after the participants with BD were limited to only euthymic patients. After removing the influence of lithium (Li) and sodium valproate (VPA), we observed activated glutamatergic neurotransmission in the ACC but not in the ltBG. LIMITATIONS:The present findings are cross-sectional and metabolites were measured in only two regions. CONCLUSIONS:Our results support a wide range of metabolite changes in patients with BD involved in glutamatergic neurotransmission, membrane turnover, and neuronal integrity. Moreover, the elevation of Gln/Glu ratio suggested that hyperactivity of glutamatergic neurotransmission in the ACC is a disease marker for BD.

Background Selective serotonin reuptake inhibitors (SSRI) are established first-line pharmacological treatments for obsessive-compulsive disorder (OCD), while antipsychotics are used as an augmentation strategy for SSRI in OCD patients who have either no response or a partial response to SSRI treatment. The goal of the present study was to identify genetic variants and pathways that are associated with the long-term clinical response of OCD patients to SSRI or SSRI with antipsychotics. Methods We first performed a genome-wide association study of 96 OCD patients to examine genetic variants contributing to the response to SSRI or SSRI with antipsychotics. Subsequently, we conducted pathway-based analyses by using Improved Gene Set Enrichment Analysis for Genome-wide Association Study (i-GSEA4GWAS) to examine the combined effects of genetic variants on the clinical response in OCD. Results While we failed to detect specific genetic variants associated with clinical responses to SSRI or to SSRI with an atypical antipsychotic at genome-wide levels of significance, we identified 8 enriched pathways for the SSRI treatment response and 5 enriched pathways for the treatment response to SSRI with an antipsychotic medication. Notably, the calcium signaling pathway was identified in both treatment responses. Conclusions Our results provide novel insight into the molecular mechanisms underlying the variability in clinical response to SSRI and SSRI with antipsychotics in OCD patients.

The Stroop task is sometimes used in psychiatric research to elicit prefrontal activity, which presumably reflects cognitive functioning. Although there are two Stroop tasks (Kana script and Kanji script) in Japan, it is unclear whether these tasks elicit the same hemoglobin changes. Moreover, it is unclear whether psychological conditions or characteristics influence hemoglobin changes in the Japanese Stroop task. The aim of this study was to clarify whether hemoglobin changes elicited by the two Japanese Stroop tasks accurately reflected cognitive functioning. Hemoglobin changes weremeasured with multi-channel near-infrared spectroscopy (NIRS) in 100 healthy Japanese participants performing two Japanese Stroop tasks. The Beck-Depression Inventory (BDI), State-Trait-Anxiety Inventory (STAI), and Maudsley Obsessive Compulsive Inventory (MOCI) were administered to participants to identify psychological conditions or personality characteristics. Compared with the Kanji task, the Kana task produced a greater Stroop effect and a larger increase in oxyhemoglobin (oxyHb) concentration. Moreover there were no significant correlations between oxy-Hb concentration and BDI, STAI-trait, STAI-state, or MOCI scores. Therefore we found that a participant's psychological conditions or characteristics did not influence the hemodynamic changes during either task. These data suggest the Kana Stroop task is more useful than the Kanji Stroop task for NIRS studies in psychiatric research. J. Med. Invest. 62 : 51-55, February, 2015

Objective Catechol‐O‐methyltransferase ( COMT ) is an enzyme that participates in the metabolic inactivation of dopamine and norepinephrine, and the Met allele of the COMT Val158Met polymorphism is associated with lower enzymatic activity. The purpose of the present study was to investigate whether this functional variant is associated with obsessive–compulsive disorder (OCD) and the clinical responses in OCD. Methods We first performed a case‐control association study between the COMT Val158Met polymorphism and OCD (171 cases and 944 controls). Then, we examined the association between this polymorphism and the clinical responses in 91 of the OCD patients. Results Our study did not find a significant association between the Met allele and OCD risk or between the Met allele and clinical responses ( p > 0.05). Conclusion The present case‐control/pharmacogenetic study did not provide clear evidence that the COMT Val158Met polymorphism is a predictor of OCD or of OCD patients' clinical responses. Copyright © 2015 John Wiley & Sons, Ltd.

OBJECTIVE:Refeeding in patients with anorexia nervosa (AN) is associated with a risk of refeeding syndrome, which is a disruption in metabolism with a variety of features including hypophosphatemia. We evaluated the risk factors for refeeding hypophosphatemia (RH) during nutritional replenishment in Japanese patients with AN.METHODS:We retrospectively examined clinical data for 99 female inpatients (mean age 30.9 ± 10.7 years; range, 9 - 56 years).RESULTS:RH (phosphate < 2.3 mg/dL) occurred within 4.8 ± 3.7 days of hospital admission and was still observed at 28 days after admission in 21 of the 99 cases (21.2%). Oral or intravenous phosphate was given to some patients to treat or prevent RH. Patients with RH had a significantly lower body mass index, were older, and had higher blood urea nitrogen than those without RH. Severe complications associated with RH were recorded in only one patient who showed convulsions and disturbed consciousness at Day 3 when her serum phosphate level was 1.6 mg/dL.CONCLUSIONS:The significant risk factors for RH that we identified were lower body mass index, older age, and higher blood urea nitrogen at admission. No significant difference in total energy intake was seen between the RH and no RH groups, suggesting that RH may not be entirely correlated with energy intake. Precisely predicting and preventing RH is difficult, even in patients with AN who are given phosphate for prophylaxis. Thus, serum phosphate levels should be monitored for more than 5 days after admission.

AIM:The aim of this study is to examine the hemodynamic changes induced by the cognitive process of facial expression by using multi-channel near-infrared spectroscopy in healthy subjects with varying degrees of autism tendency. METHODS:Subjects were 38 volunteers, 20 men and 18 women. Autism tendency was measured by the Autism Spectrum Quotient. The hemodynamic changes in the prefrontal cortex were measured by 24-channel near-infrared spectroscopy system, while subjects were asked to judge their own emotional response to standardized pictures of eight kinds of facial expressions on a computer screen. RESULTS:There were significant negative correlations between Autism Spectrum Quotient scores and accuracy of fearful expression recognition as well as increases in the concentration of oxygenated hemoglobin in response to four kinds of emotional faces (fear, contempt, sadness and disgust). CONCLUSION:Our findings suggest that the greater tendency to autism that subjects have, the more difficulty they have in recognizing a fearful expression and the less hemodynamic change in the prefrontal cortex they show in response to negative facial expressions.

We report a 59-year-old man with isolated adrenocorticotropin (ACTH) deficiency. The patient presented with sudden onset of delusions and hallucinations at the age of 54, which resolved gradually without treatment. Subsequently, the patient manifested stereotypy, wandering, hypobulia, and autistic symptoms, and was treated with antipsychotics for 1 year without any improvement. He suffered from neuroleptic malignant syndrome-like symptoms at the age of 59. A thorough endocrine assessment revealed isolated ACTH deficiency. After hydrocortisone supplementation, the physical and psychiatric symptoms improved dramatically. Clinicians should consider this rare disease when diagnosing patients with refractory psychiatric symptoms and unique physical symptoms of isolated ACTH deficiency.

The purpose of the present study was to investigate the activity of frontal lobe of patients with schizophrenia during performance of two Japanese versions of the Stroop task (kana and kanji) by measuring changes in the concentration of oxygenated hemoglobin (oxyHb) with near-infrared spectroscopy (NIRS). Fourteen schizophrenia patients and 14 age- and gender-matched healthy control subjects participated in the study after giving consent. The relative changes of concentrations of oxyHb were measured by NIRS during performance of the Stroop task. Significant Stroop effects, as measured by the number of correct responses, were observed with both the kana and the kanji versions. Analysis of NIRS data revealed that the schizophrenia patients showed reduced activation in the prefrontal cortex compared to healthy controls during performance of the kana Stroop task, and that both schizophrenia patients and healthy controls showed lack of activity in the prefrontal cortex during performance of the kanji Stroop task. The results of the present study suggest the possibility that the kana Stroop task cause a greater Stroop effect than the kanji Stroop task, and schizophrenia patients show decreased prefrontal vascular reactivity associated with the inhibition required during the performance of the kana Stroop task.