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Treatment of medical catatonia sometimes requires management of presenting psychiatric syndrome as well as treatment of causative medical illnesses. Treatment response to these approaches may, however, differ even in the same patient suffering a relapse of a similar clinical picture, and this presents a therapeutic challenge for physicians. We therefore report a case of medical catatonia due to Graves’ disease which responded to antithyroid therapy in the first episode but required electroconvulsive therapy (ECT) when relapsed, then discuss the possible mechanism which caused different treatment response.
We describe the clinical course with the laboratory findings of recurrent catatonic episodes of a patient with Graves’ disease.
A 25-year-old woman manifested stupor, catalepsy and echolalia accompanying goiter, proptosis and tachycardia. Laboratory findings on thyroid function were consistent with Graves’ disease. Treated with thyamazole (TMZ), her psychiatric and physical symptoms gradually subsided. She had remained euthyroid and symptom free for 10 years on TMZ 5 mg every other day. However, at age 35, she exhibited stupor with mannerism and stereotypy. Laboratory findings revealed mild exercerbation of thyroid function. Though antithyroid therapy regained euthyroid, her psychiatric symptoms persisted. Further treatment with neuroleptics did not ameliorate her symptoms. She was thus administered bitemporal ECT and recovered after 7th trial.
Aggravation of thyroid function associated with catatonic symptoms when relapsed was milder compared to the first episode. This suggested that dysregulation of thyroid homeostasis in the central nervous system might have persisted despite the peripheral euthyroid and could affect the treatment response.
The authors evaluated cerebral blood flow response in schizophrenia patients during face perception to test the hypothesis of diminished limbic activation related to emotional relevance of facial stimuli.
Thirteen patients with schizophrenia and 17 comparison subjects viewed facial displays of happiness, sadness, surprise, anger, fear, and disgust as well as neutral faces using the Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces (Matsumoto and Ekman, 1988). Functional magnetic resonance imaging was used to measure blood-oxygen-level-dependent signal changes as the subjects alternated between tasks of discriminating sex with an interleaved reference condition.
The groups did not differ in performance on the task. Healthy participants showed activation in the bilateral fusiform gyrus, medial temporal structures, occipital lobe, and inferior frontal cortex relative to the baseline condition. The increase was greater these regions in the right hemisphere than those in the left hemisphere. In the patients with schizophrenia, minimal focal response in the right fusiform gyrus, medial temporal structures, and occipital lobe was observed for the facial perception task relative to the baseline condition. Contrasting patients and comparison subjects revealed voxels in the left medial temporal structures, occipital lobe in which the healthy comparison subjects had significantly greater activation.
Impaired activation was seen in patients with schizophrenia for detection of facial attributes such as sex. Impairment in the medial temporal structure such as amygdale may lead to misunderstanding of social communication and may underlie difficulties in social adjustment experienced by people with schizophrenia.
In general, recent cognitive training has received increasing interest as a solution to age-related cognitive decline. Although the general public's interest in cognitive or brain training is increasing, the generalizing or transfer effect of such training remains unclear. We previously introduced a new cognitive intervention program for senile dementia, named learning therapy. The principle of learning therapy is to activate the prefrontal cortex by solving simple mathematical and language problems. The purpose of this study was to examine the beneficial effects of a new cognitive intervention program designed for normal aged people, the concepts of which are is derived from learning therapy.
We applied a similar daily cognitive training program to community-dwelling seniors to determine the effects of training on cognitive functions, particularly on the function of the prefrontal cortex, by a single-blind randomized controlled trial and a large scale cohort study. In these studies, neuropsychological measures were determined prior to and after six months of the intervention (post-test) by mini-mental state examination (MMSE), frontal assessment battery at bed side (FAB), and a digit-symbol substitution test (DST) of WAIS-R.
The results indicate that the transfer effect of cognitive intervention by reading and solving arithmetic problems on non-targeted cognitive functions was demonstrated in both studies, and are convincing evidence that cognitive training has the beneficial effects of maintaining and improving cognitive functions.
The psychological stimulations made possible by expertise and technology in brain science can improve the higher cognitive functions of seniors.
Although longitudinal magnetic resonance imaging (MRI) studies have shown that various brain regions undergo progressive tissue loss during the early phases of schizophrenia, regional pattern of these changes remain unclear.
Longitudinal MRI data were obtained from 18 (12 males and 6 females) patients with first-episode schizophrenia and 20 (11 males and 9 females) healthy controls and at baseline and follow-up with mean scan interval of 2.7 years. To compare gray matter changes over time between patients and controls were evaluated with voxel-based morphometry (VBM) using SPM8 following the longitudinal DARTEL protocol.
In both groups of patient and control longitudinal gray mater reduction was observed in various brain regions including lateral and medial frontal regions and superior temporal region. Excessive decrease in gray matter was found in patients as compared to healthy controls in the left superior temporal region and right inferior frontal region.
Our findings suggest that there are differing longitudinal gray matter changes in patients with schizophrenia during the early phases of the illness as compared to healthy individuals.
Idiopathic basal ganglia calcification (IBGC) is a neuropathological finding known to manifest motor disturbance, cognitive impairment and psychiatric symptoms. Pathophysiology of psychiatric symptoms, however, remains controversial. Previous biochemical study suggests that dopaminergic impairment is involved in IBGC. We therefore performed positron emission tomography (PET) to elucidate the pre- and postsynaptic dopaminergic function and glucose metabolism in two IBGC patients.
Case 1 is a 44 years old woman presented with disorganized thought, echolalia, verbigeration and parkinsonism. She was administered bitemporal electro-convulsive therapy (ECT). Case 2 is a 35 years old woman with persecutory delusion. Computed tomography showed bilateral symmetric calcification of striatum, globus pallidus and dentate nucei. Other causes of intracranial calcification were excluded. PET scans were obtained using [11C]-labeled 2β-carbomethoxy-3β-(4-flurophenyl)-tropane, [11C]-labeled raclopride and [18F] fluorodeoxyglucose.
The decreased binding potential was severe in bilateral head of caudate nuclei and anterior putamen. In case 1, the decline was also found in posterior putamen. There were widespread decreases of glucose uptake in frontal, temporal and parietal cortices bilaterally in case 1. Significant hypometabolism was observed in the right frontal, temporal and parietal cortices. After the ECT session, the previous areas of significant hypometabolism in the right hemisphere had improved. In case 2, there was no significant change of glucose metabolism in cerebral cortex.
The difference in affected region within basal ganglia might be associated with the diverse clinical pictures in IBGC. Particularly, in the psychiatric manifestation, dopaminergic dysfunction in caudate nucleus and anterior putamen could be participated.
Fronto-temporal connections have long been thought to be involved in schizophrenia. Two fronto-temporal connections of interest are uncinate fasciculus (UF) and cingulum bundle (CB), which recently have been investigating using Diffusion Tensor Imaging (DTI), a new technique that affords an opportunity to evaluate white matter fiber integrity in vivo. Using this technique, we previously reported abnormalities in UF and CB in chronic patients. Additionally, we noted that schizotypal personality disordered subjects showed UF but not CB abnormalities.
Here, we sought to determine whether or not UF and CB white matter integrity are altered at initial onset of illness, and are specific to schizophrenia. We evaluated twelve first-episode schizophrenia, 12 first-episode affective psychosis and 12 controls using DTI on a 1.5T magnet. Fractional anisotropy (FA) and mean diffusivity (Dm) were used to quantify water diffusion, and cross-sectional area was defined with a directional threshold method.
Findings showed bilateral reduction of UF FA, but not Dm, in first-episode schizophrenia compared with controls and first-episode affective psychotic patients. For CB, there were no statistically significant group differences for either FA or Dm.
These findings suggested that UF white matter integrity, but not CB white matter integrity, is altered at initial onset of schizophrenia and may be specific to schizophrenia. In contrast, CB abnormalities are not present at first episode of schizophrenia and may reflect progressive changes that occur over the course of the illness. The latter will need to be investigated using a longitudinal design.
Impaired self-awareness has been noted as a core feature of schizophrenia. Recent neuroimaging studies examining self-referential process in schizophrenia have yielded inconsistent results. We aimed to examine the self-referential neural network using the self- and other-evaluation tasks in schizophrenia.
Fifteen schizophrenia patients and fifteen age-, sex- and parental education-matched healthy subjects underwent functional magnetic resonance imaging. Subjects were required to make a decision whether the sentence described their own personal trait (self-evaluation) and that of their close friends (other-evaluation).
Both patients and healthy groups showed significant activation in multiple brain regions including the medial- and lateral-prefrontal, temporal and parietal cortices during self- and other-evaluation tasks. The control subjects showed higher activations in left posterior cingulate and parahippocampal gyri during self-evaluation than other-evaluation, whereas there was no difference in activated regions between self- and other-conditions in the patients. As compared with the controls, the patients showed higher activations in the right superior frontal and right supramarginal gyri during self-evaluation.
These findings provide evidence for neural basis for deficits in self-awareness in schizophrenia and may underlie core clinical symptomatology of schizophrenia.
This study characterized cremated bone to better understand isotope exchanges during burial, using archeological samples. The cremated bones of Jokei, a Buddhist monk (AD 1155–1213), found in an urn from the Jisho-in Temple, Nara Prefecture, Japan, were used for the analysis. 14C dates were determined for eight of Jokei bone fragments of different colors (black, gray, and white). The white fragments had the highest x-ray diffractometry (XRD) crystallinity index (CI) values (0.89–1.05), Fourier-transform infrared spectroscopy (FTIR) splitting factor values (IRSF) of 5.3–7.1, and the lowest Ba concentrations. The calibrated date of the white bone fragments is 1152–1216 cal AD, consistent with Jokei’s lifespan, showing these fragments yield reliable 14C ages. Meanwhile, the black and gray fragments, which probably experienced lower temperatures during cremation, had lower CI and IRSF values of 0.25–0.46 and 4.2–4.9, respectively, and higher Ba concentrations. The black and gray fragments tended to show unreliable younger 14C dates and higher 87Sr/86Sr values close to the soil value due to soil contamination. The results in this study indicate that it is important to check crystallinity of apatite and soil contamination using chemical indexing methods such as Ba capture, to clarify the reliability of 14C dates for cremated bone samples.
Transnasal inferior meatal antrostomy is increasingly used for the treatment of post-Caldwell–Luc mucoceles in maxillary sinus. This study aimed to report the outcomes after inferior meatal antrostomy with a mucosal flap for recurrent mucoceles.
The records of patients who had undergone transnasal inferior meatal antrostomy with or without a mucosal flap were reviewed.
Transnasal endoscopic inferior meatal antrostomy with or without a mucosal flap was performed in 21 and 49 patients, respectively. No complications were observed. A closing of the antrostomy was found in 9 (18.4 per cent) of the 49 patients who underwent antrostomy without a mucosal flap. No closings were observed in the 21 patients who underwent antrostomy with a mucosal flap. There was a significant difference in the rate of closing for surgery with and without the mucosal flap.
Transnasal endoscopic inferior meatal antrostomy with a mucosal flap is a safe method for the treatment of post-Caldwell–Luc maxillary mucoceles that effectively prevents recurrence.
We obtained radiocarbon (14C) dates with accelerator mass spectrometry (AMS) of vascular plant samples and a charcoal sample collected from peat deposits near the prehistoric village site informally designated CR-03 on Carlisle Island in the Islands of Four Mountains group, Alaska, to determine the eruption age of the CR-02 tephra. A fine vitric ash erupted from Okmok caldera, Umnak Island (ca. 2 ka BP) was also discovered in the bog. The ages of the CR-02 tephra and Okmok II ash are estimated to be 1050 and 2000 cal BP, respectively. Because both tephras are distinctive and widespread, these are important chronostratigraphic markers for archaeological sites in this island group. The 14C dates obtained from this bog are 800 years younger than the dates of the charcoal fragments from cultural layers in the Unit 3 of prehistoric village site CR-02 (AMK-0003).
Although organised haematoma often induces bone thinning and destruction similar to malignant diseases, the aetiology of organised haematoma and the optimal treatment remain unclear. This paper presents the clinical features of individuals with organised haematoma, and describes cases in which a novel modified approach was successfully applied for resection of organised haematoma in the maxillary sinus.
Pre-operative examination data were evaluated retrospectively. Modified transnasal endoscopic medial maxillectomy was employed.
Fourteen patients with organised haematoma were treated. Contrast-enhanced computed tomography showed heterogeneous enhancement in all patients. Eight patients underwent modified transnasal endoscopic medial maxillectomy, without complications such as facial numbness, tooth numbness, facial tingling, lacrimation and eye discharge. Dissection of the apertura piriformis and anterior maxillary wall was not necessary for any of these eight patients. No recurrence was observed.
Pre-operative examinations can be helpful in determining the likelihood of organised haematoma. Modified transnasal endoscopic medial maxillectomy appears to be a safe and effective method for organised haematoma resection.
The Universe is permeated by hot, turbulent, magnetized plasmas. Turbulent plasma is a major constituent of active galactic nuclei, supernova remnants, the intergalactic and interstellar medium, the solar corona, the solar wind and the Earth’s magnetosphere, just to mention a few examples. Energy dissipation of turbulent fluctuations plays a key role in plasma heating and energization, yet we still do not understand the underlying physical mechanisms involved. THOR is a mission designed to answer the questions of how turbulent plasma is heated and particles accelerated, how the dissipated energy is partitioned and how dissipation operates in different regimes of turbulence. THOR is a single-spacecraft mission with an orbit tuned to maximize data return from regions in near-Earth space – magnetosheath, shock, foreshock and pristine solar wind – featuring different kinds of turbulence. Here we summarize the THOR proposal submitted on 15 January 2015 to the ‘Call for a Medium-size mission opportunity in ESAs Science Programme for a launch in 2025 (M4)’. THOR has been selected by European Space Agency (ESA) for the study phase.
Combining atmospheric Δ14CO2 data sets from different networks or laboratories requires secure knowledge on their compatibility. In the present study, we compare Δ14CO2 results from the Heidelberg low-level counting (LLC) laboratory to 12 international accelerator mass spectrometry (AMS) laboratories using distributed aliquots of five pure CO2 samples. The averaged result of the LLC laboratory has a measurement bias of –0.3±0.5‰ with respect to the consensus value of the AMS laboratories for the investigated atmospheric Δ14C range of 9.6 to 40.4‰. Thus, the LLC measurements on average are not significantly different from the AMS laboratories, and the most likely measurement bias is smaller than the World Meteorological Organization (WMO) interlaboratory compatibility goal for Δ14CO2 of 0.5‰. The number of intercomparison samples was, however, too small to determine whether the measurement biases of the individual AMS laboratories fulfilled the WMO goal.