Factors relating to place of death of Japanese people from a small town in a rural area

The objective of our retrospective study was to clarify factors relating to place of death of Japanese people from a small town in a rural area who had been bedridden for at least one week before dying. The caregivers of subjects aged 40 and above who died during a three-year period were surveyed by trained interviewers. Of 352 subjects who died, 312 caregivers responded and agreed to a face-to-face interview. A total of 213 subjects were considered as an eligible sample. The main outcome measures were odds ratios for death at home in relation to age, pain, cause of death, and home visit service. One hundred and two people died at home, while 112 people died in a hospital. Multivariate logistic regression analysis showed that the probability of home death increased with age of the bedridden, lack of pain during the bedridden period, not having cancer as a cause of death, having senility as a cause of death, and receiving regular home visits by a Public Health Nurse. In conclusion, expansion of the home visit programs by Public Health Nurses may enable people to die at home as they so desire. Further prospective research is needed to explore the association between the attitude toward terminal care and the place of death.

Stress vulnerability and climacteric symptoms: life events, coping behavior, and severity of symptoms

To explore a possible association between climacteric symptoms and ways of coping with stress, a comparative study was conducted among 19 menopausal women who sought treatment for climacteric symptoms (the study group) and 44 healthy menopausal women (the control group). Life stress was assessed using a life event method in which factor analysis extracted four ways that women cope with stress: avoidance-oriented coping, consultation-oriented coping, aggression-expression coping, and problem-solving coping. The study group had a higher symptom score and was more prone to avoidance-oriented coping than the control group despite experiencing the same number of undesirable life events. The severity of climacteric symptoms correlated positively with the number of undesirable life events and the degree of avoidance-oriented coping and correlated negatively with the degree of aggression- expression coping for the study group. These results suggest that vulnerability to stress contributes to worsening climacteric symptoms caused by stress.

Prevalence and background factors of maternity blues

To explore factors contributing to maternity blues, a longitudinal study was carried out on a group of 111 women who received obstetric care at Yamagata University Hospital from November 1994 to August 1995. Cases of maternity blues were found using Stein's Self-Rating Maternity Blues Scale. Mother-child relationships in the women's childhood were assessed using the Parental Bonding Instrument (PBI). Of the 111 women, 17 (15.3%) developed maternity blues during the first postpartum month. The PBI revealed that these depressed women appeared to be cared for less sufficiently in their own childhood than the non-depressed women. As revealed in interviews, they also seemed to receive less support from their families during pregnancy. These findings suggest that maternity blues may be related to insufficient maternal care in childhood, as well as to poor family support during pregnancy.

One-year prognosis of depressive illness in the elderly population in Japan

A 1-year prospective study of 43 elderly depressed residents (13 men and 30 women) in Nagai City in Japan is described. An initial survey was carried out in 1993 to find depressed residents. The subjects of the survey were 2056 residents of 65 years of age and older. The Japanese version of the Geriatric Depression Scale (GDS) was employed as a screening tool in the first phase of the survey. In the second phase, screened subjects and control subjects were interviewed by psychiatrists using the Structured Interview for DSM-III-R (SCID). The diagnosis of depression was made by the psychiatrists on the basis of the results of the SCID. Forty-three persons were judged to be depressed. At follow-up, 10 were still depressed and 15 were well. Four were demented. Fourteen dropped out due to death, hospitalization, absence from home or refusal. The results showed that approximately half of the elderly depressed persons seemed to recover by the time of the 1-year follow-up. One-year prognosis of dysthymia was the worst. Some types of depression seemed to be a precursor for dementia. The concern is with how the findings may be used as an aid in understanding and planning community mental health services strategies. The results indicate that it is very important to pay close attention to patients with depressive illness who do not meet the criteria for major depression.

Eye movements in patients with schizophrenia: visual stimuli, semantic content and psychiatric symptoms

In order to explore a possible association between psychiatric symptoms and eye movements, 32 patients with schizophrenia were examined using an eye mark recorder in combination with the Positive and Negative Syndrome Scale, and were compared with 32 controls. Four types of figures were presented to the subjects: geometrical figures, drawings, story drawings, and sentences. Mean eye fixation time was significantly longer and mean eye scanning length was significantly shorter for the patients than for controls, not only in response to the geometric figures, but also in response to the story drawings. Eye fixation time and scanning velocity were positively correlated with degrees of thought disturbance. The number of eye fixations, eye fixation time and scanning velocity were negatively correlated with degree of depressive tendency.

Clinical evaluation of attention-deficit hyperactivity disorder by objective quantitative measures

This study assessed the diagnostic potential of the actigraph, the Continuous Performance Test, and the Matching Familiar Figures Test in diagnosing attention-deficit hyperactivity disorder (ADHD). Twenty boys previously diagnosed with ADHD and 52 controls were examined. By these measures the boys with ADHD were differentiated from the controls with sensitivity and specificity above 75%. We were able to classify ADHD into eight subtypes by combining the scores of the actigraph and the CPT: "hyperactive-impulsive", "hyperactive-inattentive", "impulsive-inattentive", "hyperactive", "impulsive", "inattentive", "mixed", and "unspecified" type. These classifications may be useful in diagnosing ADHD.

Prevalence of mood disorders according to dsm-iii-r criteria in the community elderly residents in Japan

The prevalence rates of mood disorders according to the DSM- III -R criteria in the community elderly were investigated with structured interviews conducted by psychiatrists. The subjects were 1,965 randomly selected residents aged 65 years or more who lived in Nagai City, Japan. In the first phase, a questionnaire including the short form of the Geriatric Depression Scale (GDS) was distributed to all subjects. In the second phase, all persons scoring 6 points or more on the GDS and approximately half as many of these persons randomly selected from the remaining respondents scoring 5 points or less were examined by psychiatrists using the A and D modules of the Structured Clinical Interview for DSM-III-R. The 1-month prevalence rates of major depression and bipolar disorder were estimated to be 0.9% and 0.0%, and the current prevalence of dysthymia was estimated to be 0.5%. By using additional unstructured clinical interviews, we also found the prevalence rates of adjustment disorder with depressed mood and other types of depression to be 3.8% and 2.5%. For these categories of depression, prevalence rates did not differ significantly by sex or age group, except that the prevalence of adjustment disorder with depressed mood was significantly higher in women than in men.

[Prevalence of affective disorders on the basis of DSM-III among the elderly in a rural community in Japan]

The prevalence rates of affective disorders among the elderly in a rural community according to the criteria of the third edition of Diagnostic and Statistical Manual of Mental Disorders were investigated. The survey used a two-phase method which combined a self-administered depression scale and diagnostic interviews by psychiatrists. The subjects were all 766 persons aged 65 years or older in a rural village in Japan. In the first phase, 698 persons completed a self-administered scale, the Center for Epidemiologic Studies Depression scale (CES-D). In the second phase, 83 persons scoring 12 points or more on the CES-D and an additional 8 persons who, for unknown reason, did not respond to the CES-D were assessed by psychiatrists using a modified version of the Diagnostic Interview Schedule. The subjects' physical health and life events, the presence of dementia, and other factors were taken into account when diagnoses were made. The point prevalence rates of depression without dementia as a comorbid condition by category were as follows: major depression, 0.5%; dysthymic disorder, 0.3%; and atypical depression, 0.4%. The point prevalence rates of depression with dementia as a comorbid condition were as follows: major depression, 0.7%; dysthymic disorder, 0.4%; and atypical depression, 0.4%. Major depression was more prevalent in women than in men and was more prevalent in persons aged 75 years of older than in younger subjects.

Stress and psychiatric disorders in local government officials in Japan, in relation to their employment level

In order to explore an association between psychiatric disorders and employment level, 283 local government officials in Japan were asked to complete a questionnaire consisting of a series of psychometric scales. The Daily Hassles Scale, General Health Questionnaire and Burnout Scale were used to measure stress, psychiatric disorders and burnout syndrome, respectively. As a result of canonical correlation analysis, the first canonical correlation indicated that the higher the level of stress under poorer support systems, the greater the likelihood of burnout syndrome. The second canonical correlation indicated that the stronger the support system, the smaller the tendency toward depression. Officials in higher levels of employment were supported less and were more severely depressed than officials at lower levels of employment.

Headache and stress in a group of nurses and government administrators in Japan

We surveyed a group of 311 nurses and 283 mid-level government administrators in Yamagata Prefecture, Japan, to determine the prevalence and character of their headaches. We investigated the relationship of headaches to the subjects' stress, and their behavior and coping patterns. The questionnaire we administered explored background factors, as well as the state of the respondents' mental health, life events, work motivation, support system, and interpersonal relationships. The questionnaire was completed by 76.8% of nurses and 100% of administrators. Of these, 40.6% of nurses and 19.1% of the administrators reported recurrent headaches. Furthermore, the number of headache sufferers among the women administrators was significantly higher than in the men. The nurses and the administrators who reported headache scored significantly higher than the nonheadache groups on the questions measuring symptoms of burnout, General Health Questionnaire, and learned helplessness. The group of nurses with headache had higher scores for life events, decreased work motivation, and nervous behavior than the nonheadache group; the administrators with headache scored higher for daily hassles than those of the nonheadache groups. In this study of a Japanese sample, the character of the subjects' headache and the possible inducing factors are consistent with those reported in studies of Europeans and Americans using similar testing methods. However, the high prevalence of headache among nurses and women administrators seems to be related to psychological stress, particularly work stress, which may be characteristic in Japan.

An epidemiological study of eating disorders in a northern area of Japan

A total of 97 patients with eating disorders who visited the Department of Neuro-Psychiatry, Yamagata University Hospital, between 1978 and 1992 were studied. According to the diagnostic criteria of DSM-III-R, there were 48 cases of anorexia nervosa (AN). 38 cases of bulimia nervosa (BN) and 11 cases with both AN and BN. Both the number of patients and the ratio to all out-patients in each year increased four times during the period 1988-1992 compared to the previous period. With regard to their places of residence, the number of patients with AN and with BN from every district appeared to increase at almost the same rate, although the majority of the patients were from medium-sized cities. These findings may indicate that eating disorders are influenced by urbanization.

[Bedridden period before death (BPbd) and factors relating to it in a rural community in Yamagata Prefecture]

The purpose of this study is to analyze the 'Bedridden period before death (BPbd)' and factors relating to it in a community. In the period from January 1986 through December 1988, 352 persons aged 40 years and over were recorded as having died in a rural town with a population of 13,000 in Yamagata Prefecture. The care-givers of 312 subjects (88.6%) were interviewed regarding the BPbd, and demographic, medical, social and familial factors were also investigated. Results obtained are as follows; 1) Subjects who had more than six months BPbd were more frequent in females than in males. 2) Neither age of death nor age of the bedridden had any significant relationship to BPbd in either sex. 3) Positive significant factors relating to BPbd were, occupation (male), history of cerebrovascular diseases (both sexes), care-giver knowledge of health or social services in the town (both sexes) and the presence of pressure sores (both sexes). 4) About half of the subjects had less than two weeks BPbd, though less than 20% of the subjects had more than six months BPbd. This result agreed with that of the national report, "TSUI-NO MITORI CHOSA", where subjects ranged in age from 70 to 85. These results indicate that in the study community most of the adults, including the elderly, have a fairly short BPbd.

Correlation of regional cerebral blood flow with performance on neuropsychological tests in schizophrenic patients

Regional cerebral blood flow (rCBF) was determined by the 133Xe inhalation technique (Headtome II: ring detection SPECT) in 53 DSM-III schizophrenic patients. The rCBF values were corrected by using end-tidal carbon dioxide concentration values (PECO2). After rCBF measurement, neuropsychological tests--Word Fluency Test, Maze Test and Wisconsin Card Sorting Test--were performed. There were significant correlations between frontal rCBF and scores on each neuropsychological test. In particular, a moderate correlations between the frontal rCBF and the performance on the Wisconsin Card Sorting Test was noted. It seems likely that decrease of rCBF in prefrontal regions at rest reflects a disturbance of frontal lobe function in schizophrenic patients.