Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

AIM To evaluate the reversibility of minimal hepatic encephalopathy(MHE) following liver transplantation(LT) in Egyptian cirrhotic patients. METHODS This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty ageand sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A(TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score(PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTS Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls(P < 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls(P < 0.001). The PHES detected MHE in 16 patients(80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching-4.5 ± 5(P < 0.001), and the number of patients with MHE decreased to 11(55%). The pre-transplant model for end-stage liver disease(MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE(P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15.CONCLUSION Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.

Studies on self-esteem of penile size in young Koreanmilitary men

Aim: To investigate the flaccid and stretched penile sizes of young Korean men and their complexes or pride about their penile size. Methods: After an explanation and agreement to the purpose and methods of this study, 123 Korean men in their early 20's visiting the Jinhae Military General Hospital were included in the study. The flaccid penile length, flaccid mid-shaft circumference, stretched length and pre-pubic bone fat pad depth were measured in a warm comfortable environment. The accuracy the subjects assessed their penile size was investigated by asking them to rate their penile size, as 'very small', 'small', 'normal', 'large' or 'very large'. All subjects were asked to complete the Minnesota multiphasic personality inventory (MMPI) test. Results: The mean flaccid length, flaccid circumference, stretched length and fat pad depth of the 123 subjects were (6.9 ± 0.8) cm, (8.5 ±1.1) cm, (9.6 ± 0.8) cm and (1.1 ± 0.4) cm, respectively. The answer distribution on penile size was 1 (0.8 %) 'very small', 29 (23.6 %) 'small', 86 (69.9 %) 'normal', 6 (4.9 %) 'large' and 1 (0.8 %) 'very large'. Subjects who underestimated their penile size showed significantly higher scores on the hypochondriasis (Hs), depression (D) and psychasthenia (Pt) subscales of the MMPI than those in the Unbiased Group (P<0.05). Conclusion: In consultation, with a patient requesting penile augmentation, the urologist should consider the psychologic attitude of the patient to his penile size.

Potential role of Limosilactobacillus fermentum as a probiotic with anti-diabetic properties: A review

Oxidative stress,inflammation,and gut microbiota impairments have been implicated in the development and maintenance of diabetes mellitus.Strategies capable of recovering the community of commensal gut microbiota and controlling diabetes mellitus have increased in recent years.Some lactobacilli strains have an antioxidant and anti-inflammatory system capable of protecting against oxidative stress,inflammation,and diabetes mellitus.Experimental studies and some clinical trials have demonstrated that Limosilactobacillus fermentum strains can beneficially modulate the host antioxidant and anti-inflammatory system,resulting in the amelioration of glucose homeostasis in diabetic conditions.This review presents and discusses the currently available studies on the identification of Limosilactobacillus fermentum strains with anti-diabetic properties,their sources,range of dosage,and the intervention time in experiments with animals and clinical trials.This review strives to serve as a relevant and well-cataloged reference of Limosilactobacillus fermentum strains capable of inducing anti-diabetic effects and promoting health benefits.

Oxidative stress-elevated high gamma glutamyl transferase levels, and aging, intake of tropical food plants, migration and visual disability in Central Africans

·AIM:To investigate the independent pathogenic role of high serum gamma-glutamyl transferase (GGT) levels, sociodemographic data, dietary and environmental risk factors for visual disability (VD). ·METHODS:This was a case-control study, run in 200 black Congolese patients managed in Saint Joseph Hospital Ophthalmology Division from Kinshasa town. Logistic regression model was used to identify determinants of VD (n = 58) among sex, age, cigarette smoking, alcohol abuse, rural-urban migration, education levels, aging ≥60 years, intake of red Beans, Safou fruit and Taro leaves, lipid profile, residence, socioeconomic status, and GGT. ·RESULTS:After adjusting for confounding factors, we identified migration (OR=3.7 95% CI:1.2-11.3; P =0.023), low education level (OR=3.1 95% CI 1.1-8.5; P =0.026), no intake of Safou fruit (OR=34.2 95% CI 11.5-102; P < 0.0001), age ≥60 years (OR=2.5 95% CI 1.01-6.5; P = 0.049), and serum GGT ≥10U/L (OR=3.6 95% CI 1.3-9.6; P = 0.012) as the significant and independent determinants of VD. ·CONCLUSION:VD appears as a major public health problem in Central Africa to be prevented or delayed by control of migration, lifestyle changes, antioxidant supplements, appropriate diet, nutrition education, and blocking of oxidative stress.

Improvement in social skills in patients with schizophrenia following 6 months of day-care treatment

Using role-playing tests simulating real-life situations, we investigated improvement in the social skills, especially information processing, of patients with schizophrenia in response to day-care in psychiatry and social skills training. From 20 pair-matched schizophrenia patients, 10 were assigned to a day-care/SST group and 10 to a control group undergoing usual treatment. After 6 months, sending and receiving skills were assessed by means of role-playing tests, psychiatric symptoms, social function, and cognitive function. The day-care/SST group showed a significant improvement and a large effect size in sending skills. Receiving skills also improved, showing a medium effect size, but the difference from the control group was not statistically significant. No statistically significant changes were observed in the other measures. That no changes occurred in social function, psychiatric symptoms, or cognitive function leads to two conclusions: 1) cognition targeted, specialized training and comprehension of cognitive remediation, psychiatric rehabilitation, and social skill development are necessary for improvement in other domains, especially symptoms and social functions;and 2) improvement resulting from day-care in psychiatry and SST alone is limited. In addition, further investigations over a longer observation period and a greater sample size are needed.

D-Cell Hypothesis: Pathogenesis of Mesolimbic Dopamine Hyperactivity of Schizophrenia

In the present article, the author proposes a new “D-cell hypothesis” for mesolimbic dopamine (DA) hyperactivity of schizophrenia, of which relevant molecular mechanism has not yet been known. The “D-cell” is defined as “the non-monoaminergic aromatic L-amino acid decarboxylase (AADC)-containing cell”. The D-cell contains AADC but not dopaminergic nor serotonergic. D-cells produce trace amines, and also take up amine precursors and convert them to amines by decarboxylation. The author reported “dopa-decarboxylating neurons specific to the human striatum”, that is, “D-neurons” in the human striatum, and preliminarily the number reduction of D-neurons in the striatum and nucleus accumbens of postmortem brains of patients with schizophrenia. Trace amine-associated receptor, type 1 (TAAR1), a subtype of trace amine receptors, having a large number of ligands, including tyramine, β-phenylethylamine (PEA), and methamphetamine, is a target receptor for the latest neuroleptic discovery. Recent studies have shown that the decreased stimulation of TAAR1 on cell membranes or nerve terminals of DA neurons in the midbrain ventral tegmental area (VTA) increased firing frequency of VTA DA neurons. In brains of schizophrenia, dysfunction of neural stem cells in the subventricular zone of lateral ventricle may cause reduction of the number of D-neurons in the striatum and nucleus accumbens, and may result in decrease of trace amine synthesis. The decrease of stimulation of TAAR1 on terminals of VTA DA neurons caused by trace amine reduction may increase firing frequency of VTA DA neurons, and may finally cause mesolimbic DA hyperactivity. This innovative theory, “D-cell hypothesis” might explain mesolimbic DA hyperactivity in pathogenesis of schizophrenia.

Prevalence of Medication Non-Adherence among Psychiatric Patients in a Tertiary Hospital in Nigeria

Background: The consequences of non-adherence to prescribed medications by psychiatric patients for both patients and the health care system are myriad and grave. Aim: The study was designed to ascertain the prevalence of medication non-adherence among psychiatric patients and identify factors that aid this malady. Methods: This prospective, cross-sectional study was carried out within a 4 month period at the out-patient psychiatric clinic of the University of Port Harcourt Teaching Hospital;using the Medication Adherence Rating Scale (MARS) and a self designed questionnaire containing socio-demographic and psychiatric illness variables. Results: A total number of 111 patients who participated in the study were analyzed. The cohort comprises 22 (19.8%) schizophrenics, 38 (34.2%) mood disorder patients, 24 (21.6%) anxiety disorder patients, 10 (9.0%) patients suffering from substance abuse and 17 (15.3%) with other psychiatric diagnoses (somatoform and personality disorders). Most of the patients were male (53;47.7%), aged between 21 - 30 yrs (44;39.6%), unemployed (38;34.2%), as single (58;52.3%). The prevalence of non-adherence to medications among the cohort studied is 39.6%. There was a significant association between consistency in taking one’s medications and MARS scores but none between socio-demographic variables and MARS score. Conclusion: The rate of medication non adherence among the subjects in this study was 39.6%. The three most important reasons reported for this behaviour include: Feeling that they had recovered from their illness and hence have been cured, belief that their illness was of a spiritual origin and hence would not be amenable to orthodox medicine and the side effects of the medications. Non adherence to medication increases the risk of psychiatric morbidity and mortality and efforts at curbing this trend must be eclectic.

The Efficacy and Safety of Yokukansankachimpihange for Treating Behavioral and Psychological Symptoms of Dementia in Patients with Alzheimer’s Disease: An Open-Label Pilot Study

Previous clinical trials have demonstrated the efficacy of yokukansan, a traditional Japanese medicine, for the treatment of behavioral and psychological symptoms of dementia (BPSD). However, less evidence is available for the treatment of BPSD with yokukansankachimpihange (YKSCH), which consists of yokukansan and two additional herbal ingredients. The present study was conducted to investigate the efficacy and safety of YKSCH for treating BPSD in patients with Alzheimer’s disease (AD). We enrolled outpatients with mild-to-moderate AD who exhibited BPSD and obtained a Neuropsychiatric Inventory (NPI) score of >3 including subscale scores for “agitation”, “anxiety”, “irritability”, and “sleep and night-time behavior change”. A daily YKSCH dose of 7.5 g was administered for 12 weeks with concomitant administration of anti-dementia medication. BPSD was evaluated using the NPI at baseline and every 4 weeks during the intervention. We also examined apathy using the Japanese translation of the Apathy Scale, the short version of the Japanese version of the Zarit Caregiver Burden Interview, and the Modified Crichton Rating Scale for Predicting Activities of Daily Living. Cognitive dysfunction was evaluated using the Mini Mental State Examination and the AD Assessment Scale-Cognitive (Japanese version). Five participants were enrolled. The NPI total score tended to decrease between the baseline and 8-week evaluations during the YKSCH intervention (Wilcoxon signed rank test, P = 0.063). In terms of the NPI subscale scores, “apathy”, “agitation”, “delusions”, and “sleep and night-time behavior change” decreased after the intervention in those who exhibited each symptom at baseline. There were no significant differences in the other scores examined. No serious adverse events were observed. YKSCH could ameliorate BPSD in patients with mild-to-moderate AD with agitation, anxiety, irritability, and sleep and night-time behavior change, and it was well-tolerated.

Dopamine receptor D3R and D4R mRNA levels in peripheral lymphocytes in patients with schizophrenia correlate with severity of illness

Schizophrenia is a disease that affects many areas of the brain. The dopamine hypothesis is one of the most widely-accepted ideas in the pathophysiology of schizophrenia. Besides alterations in the dopaminergic system in the central nervous system, there have been several reports of changes in dopaminergic systems in the peripheral blood of schizophrenic patients. Several reports have shown that dopamine receptor expression by lymphocytes is altered in patients with schizophrenia, but the results have been conflicting. We therefore re-assessed D3R and D4R mRNA levels in 11 patients with schizophrenia and 12 healthy subjects and correlated levels with severity of symptoms. D3R and D4R expression in lymphocytes and granulocytes was measured by quantitative RT-PCR and the severity of symptoms and cognitive impairment were assessed using the PANSS and BACS-J. There were no significant differences in mean D3R or D4R mRNA levels in lymphocytes from schizophrenic patients and controls and no significant difference in mean D4R mRNA levels in granulocytes (D3R mRNA undetectable). In patients with schizophrenia, D3R expression was inversely correlated with the total PANSS score (r = 0.768, p = 0.009), while D4R expression was positively correlated with working memory scales (r = 0.895, p = 0.001). In conclusion, these results imply that lymphocyte D3R and D4R are involved in the mechanisms of the disorder and could be used as target markers in the treatment of schizophrenia.

“D-cell hypothesis” of schizophrenia: possible theory for mesolimbic dopamine hyperactivity

The author proposes a new “D-cell hypothesis” for mesolimbic dopamine (DA) hyperactivity of schizophrenia. The “D-cell” is defined as “non-monoaminergic aromatic L-amino acid decarboxylase (AADC)-containing cell”. D-cells produce trace amines, such as tyramine and β-phenylethylamine, and may also take up amine precursors and convert them to amines by decarboxylation. Trace amine-associated receptor, type 1 (TAAR1), a subtype of trace amine receptors, has a large number of ligands, including tyramine, β-phenylethylamine and methamphetamine, that influence on human mental states, and is now regarded to be a target receptor for novel neuroleptics. Recent studies revealed that the reduced stimulation of TAAR1 on DA neurons in the midbrain ventral tegmental area (VTA) increased firing frequency of VTA DA neurons. The author and her colleagues reported the decrease of D-neurons in the striatum and nucleus accumbens of postmortem brains of patients with schizophrenia. This may imply the decrease of trace amine synthesis, resulting the reduced stimulation of TAAR1 on terminals of midbrain VTA DA neurons, and may lead to mesolimbic DA hyperactivity in schizophrenia. The decrease of striatal D-neurons of postmortem brains of schizophrenia is supposed to be due to neural stem cell dysfunction in the subventricular zone of lateral ventricle. The decrease of striatal D-neurons and acts of TAAR1 signals on DA neurons-might explain mesolimbic DA hyperactivity of schizophrenia.

Comparisons of temperament and character between problematic internet users and problematic drug users in Korean adolescents

Objective: It has been suggested that some internet users spend so much time on the internet that their personal and/or professional lives suffer. This study compared the temperament and character of problematic internet users (PIU) with that of problematic drug users (PDU) among Korean adolescents and aimed to examine the personality characteristics of adolescents with internet use problems. Method: We enrolled participants from high schools (n = 487), internet cafés (n = 89), and an adolescent-substance abuse consultation office (n = 45). All subjects were assessed using the Korean Internet Addiction Scale (KIAS), the Korean Adolescent Drug Addiction Screening Test-2 (KOADAST-2), and the Korean version of the Temperament and Character Inventory (K-TCI). Subjects were classified into the following four groups based on the KIAS and KOADAST-2 results: normal controls, pure PIUs, pure PDUs, and dual problematic users. Differences in the subscale scores on the K-TCI were analyzed by group. Results: Scores for Reward dependence (RD) were significantly lower in pure PIUs than in pure PDUs (13.85 ± 4.07 versus 15.44 ± 3.56, p < 0.05). Scores for Self-Directedness (SD) were lower in pure PIUs (18.21 ± 6.90) and pure PDUs (18.22 ± 6.03) than in normal controls (20.88 ± 6.60), although the scores did not differ significantly between pure PIUs and pure PDUs. Scores for Cooperativeness (C) were lower in pure PIUs than in normal controls (23.97 ± 7.02 versus 26.57 ± 6.67, p < 0.05). Conclusions: The results of this study suggest that PIUs are more socially insensitive and that they may experience more inter-personal problems than PDUs.

Pimavanserin for the treatment of psychosis in Alzheimer’s disease: A literature review

BACKGROUND Alzheimer’s disease(AD)is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed(AD+vascular)dementias.Approximately 25%-50%of individuals with AD develop psychosis sometime during their illness.The presence of psychosis in AD worsens outcomes.Currently there are no United States Food and Drug Administration(FDA)approved medications for the treatment of psychosis in AD.Pimavanserin,a novel atypical antipsychotic medication,was approved by the FDA for the treatment of hallucinations and delusions associated with Parkinson disease psychosis and is currently in clinical trials for the treatment of psychosis in AD.AIM To evaluate the existing literature regarding the use of pimavanserin for treating psychosis among individuals with AD.METHODS A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Trials were identified by systematically searching PubMed,MEDLINE,EMBASE,Cochrane Central Register of Controlled Trials,Web of Science,and Scopus through October 2019.The 5-point Jadad scoring system was used to assess the methodologic quality of the randomized placebo-controlled trials.RESULTS A total of 499 citations were retrieved and pooled in EndNote and de-duplicated to 258 citations.This set was uploaded to Covidence for screening.Two separate screeners(Srinivasan S and Tampi RR)evaluated the titles,abstracts,and full text of eligible articles.Of the identified 258 abstracts,98 articles underwent full text review and 2 publications from 1 randomized controlled trial(RCT)were included in the final analysis.The quality of evidence was assessed to be of good methodologic quality,scoring 4 out of 5 using the 5-point Jadad questionnaire with the Jadad Scoring calculation.This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD.This phase 2 trial resulted in two publications,the second of which was a subgroup analysis from the original study.The evidence from these two publications showed that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at week 6.CONCLUSION Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD.Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment.

Efficacy of Cognitive Remediation in Schizophrenia: A Short Review of Its Variable Effects According to Cognitive Domain

Cognitive impairment is a symptom of schizophrenia and strongly associated with impaired social function. In recent years, cognitive interventions (cognitive remediation therapies) have been implemented and their results have also been reported. Intervention studies have been conducted using a variety of methods that differ in terms of terminology, approach, and targeted cognitive domains. In this study, we examined trends in recent cognitive remediation research conducted subsequent to the meta-analyses of McGurk et al. (2007) and Wykes et al. (2011). We identified studies conducted between 2009 and 2013 to examine computer-assisted cognitive remediation and collated and analyzed the literature describing their major results and trends. Our results indicated improved cognitive performance subsequent to cognitive remediation therapy using computer programs. We found promising outcomes, particularly in reasoning and problem solving, verbal learning and memory, verbal working memory, and attention and vigilance, which replicated the findings of Wykes et al. (2011).

NSC-induced D-neurons are decreased in striatum of schizophrenia: Possible cause of mesolimbic dopamine hyperactivity

Neural stem cell (NSC) hypofunction is an etiological hypothesis of schizophrenia. Although dopamine (DA) dysfunction is also a widely accepted hypothesis, molecular background of mesolimbic DA hyperactivity has not yet been well known. Here, the author proposes “D-cell hypothesis”, accounting for molecular basis of mesolimbic DA hyperactivity of schizophrenia, by NSC hypofunction and decrease of putative NSC-induced D-cells. The “D-cell” is defined as “non-monoaminergic aromatic L-amino acid decarboxylase (AADC)-containing cell”. D-cells produce trace amines, and also take up amine precursors and convert them to amines by decarboxylation. The author reported “dopa-decarboxylating neurons specific to the human striatum”, that is, “D-neurons” in the human striatum, and decrease of striatal D-neurons in patients with schizophrenia. Trace amine-associated receptor, type 1 (TAAR1), a subtype of trace amine receptors, having a quite number of ligands such as tyramine, β-phenylethylamine (PEA) and methamphetamine, has modulating functions on monoamine neurons. It has been known that reduced binding of ligands to TAAR1 receptors on DA terminal of DA neurons of the midbrain ventral tegmental area (VTA) increased firing frequency of VTA DA neurons. In brains of schizophrenia, NSC hypofunction in the subventricular zone of lateral ventricle may cause decrease of D-neurons in the striatum and nucleus accumbens, and may result in decrease of trace amine signals. Decrease of trace amine signals to TAAR1 on VTA DA neurons may increase firing frequency of VTA DA neurons, and may finally cause mesolimbic DA hyperactivity. Increased stimulation to DA D2 receptors of NSCs might suppress NSC proliferation, and may induce additional mesolimbic DA hyperactivity as well as D-cell decrease. This novel theory, “D-cell hypothesis”, possibly explains mesolimbic DA hyperactivity in pathogenesis of schizophrenia.

Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Patients with Chronic Pain

Aims: To investigate rates of attention-deficit hyperactivity disorder (ADHD) in patients with chronic pain attending a pain clinic, the effects of a screening measure for ADHD in patients with chronic pain, and the effects of ADHD drugs on both pain and ADHD symptoms. Methods: We retrospectively surveyed 110 patients with chronic pain visiting the Anesthesiology and Pain Relief Center at the University of Tokyo in Japan, who had also consulted a psychiatrist, between April 2012 and July 2015. Results: Of the total of 110 patients with chronic pain, 35 (31.8%) were also diagnosed with ADHD, and the average Wender Utah Rating Scale (WURS) score among the ADHD patients was 39.0 ± 22.1 (n = 25). Only 36.0% of these patients exceeded the cutoff value, suggesting that 64.0% of the patients with ADHD were not identified by screening with the WURS. Twenty-six patients initiated treatment with ADHD medication, with dosage adjustment completed in 21. Of these 21 patients 20 (95.0%) had improved ADHD symptoms. Improved pain symptoms were observed in 14 patients (66.6%), with a reduction in the pain numerical rating scale of 64.7% ± 30.1%. Conclusions: This is the first study investigating the comorbidity of ADHD and chronic pain at pain clinics showing a high level of comorbidity and amelioration of pain and ADHD symptoms with treatment. Careful interpretation is required when the WURS is used to screen patients with chronic pain.

Longitudinal observation of ten family members with idiopathic basal ganglia calcification: A case report

BACKGROUND Familial idiopathic basal ganglia calcification (FIBGC) is a rare autosomal dominant disorder that causes bilateral calcification of the basal ganglia and/or cerebellar dentate nucleus, among other locations. CASE SUMMARY The aim of this study is to report 10 cases of FIBGC observed in a single family. Seven patients showed calcification on their computed tomography scan, and all of these patients carried the SLC20A2 mutation. However, individuals without the mutation did not show calcification. Three patients among the 7 with calcification were symptomatic, while the remaining 4 patients were asymptomatic. Additionally, we longitudinally observed 10 subjects for ten years. In this paper, we mainly focus on the clinical course and neuroradiological findings in the proband and her son.CONCLUSION The accumulation of more case reports and further studies related to the manifestation of FIBGC are needed.

Knowledge and Attitude about Mental Illness of Students in a University in Southern Nigeria

Objective: To ascertain the knowledge about mental illness and attitude of undergraduate students in a university in southern Nigeria, towards the mentally ill. Methods: This descriptive cross-sectional study was conducted at a Catholic University in Nigeria over a three-month period. 215 subjects were selected randomly from the total student population of 5045. A questionnaire containing socio-demographic variables and three subscales: The Knowledge about mental illness scale, Attitude to mental illness scale, Social Distance scale was administered to each subject. The data was analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0. Results: Males (62.3%), Christians (91.2%), Igbos (49.5%) and Single (93.0%) constituted the largest proportions of the subjects. A majority of the subjects supported some of the common inaccurate stereotypes about mental illness. They exhibited obvious gap in knowledge with respect to symptoms of specific mental disorder. 42.8% were not sure of the biological cause of mental illness. Even though 80% of the subjects agreed that those suffering from mental illness should be helped, 48.8% maintained that they have little in common with them. Only 33% were willing to make friends with someone with a mental illness. Conclusion: Better ways of educating the youths to dissolve deeply entrenched negative cognitions about mental illness should be given premium attention by all stakeholders, especially in Africa.

Investigation of Prefrontal Cortex Activity in University Students with Presenteeism: A Near-Infrared Spectroscopy (NIRS) Study

Presenteeism refers to impaired performance attributed to attending work with health problems. There has been no study examining the state of presenteeism with objective measures. We compared cerebral hemodynamic changes, measured by near-infrared spectroscopy (NIRS), during neuropsychological tests conducted by university students with presenteeism and healthy controls. Twenty-two university students participated in the study;11 of them with impaired performance caused by mental health problem were allocated to the presenteeism group and 11 without health problems to the control group. Presenteeism was assessed by the Presenteeism Scale for Students. To evoke hemodynamics changes, the participants completed a Word Fluency Test (WFT) and a Trail Making Test (TMT). The NIRS probes were located over the bilateral prefrontal area. Students with presenteeism had significantly higher incidences of depression than controls. However, there was no significant difference in behavioral performance examinations between the two groups. With regard to hemodynamics changes, the repeated measures analysis of covariance of the NIRS signals revealed significant interactions between group and task activation. Although we observed a significant increase in oxygenated hemoglobin concentration during the WFT among controls (simple main effect;left channel, F(1, 19) = 27.34, P F(1, 19) = 22.05, P < 0.001), no changes were found in students with presenteeism during either the WFT (simple main effect;left channel, F(1, 19) = 0.12, P F(1, 19) = 0.08, P t = ﹣0.94, P with Bonferroni correction = 0.745;right channel, t = ﹣2.19, P with Bonferroni correction < 0.113). This is the first study to reveal differences in activity in the cerebral cortex associated with presenteeism. The fact that students with presenteeism have prefrontal dysfunction might reinforce the concept of presenteeism.

DNA methylation of the Monoamine Oxidases A and B genes in postmortem brains of subjects with schizophrenia

Aims: We focused on DNA methylation of the promoter regions of the Monoamine Oxidase (MAO) A and B genes from postmortem brains of subjects with schizophrenia. Methods: We determined levels of DNA methylation using genomic DNA samples purified from four brain areas: prefrontal cortex (PFC), hippocampus, occipital cortex and nucleus accumbens (NAc), by a bisulfite sequencing method from seven normal subjects and six subjects with schizophrenia. Results: Although very few methylated CpGs of the MAOA and MAOB genes were detected in male samples, various DNA methylation patterns were present in female samples, and some differences were found in such patterns between normal subjects and subjects with schizophrenia. In the PFC, the average level of methylation of both genes was significantly higher in subjects with schizophrenia than in normal subjects. The content of highly methylated alleles of the MAOA gene in the NAc was significantly associated with schizophrenia, with similar results obtained for the MAOB gene in both the NAc and PFC. Some CpG sites showed higher levels of methylation in schizophrenia than in normal subjects. Conclusions: Levels of methylation were quite high in NAc and PFC in female subjects with schizophrenia compared with those in female normal subjects.

Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.