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Aims: To clarify the differences between Japan and China regarding illness behavior of outpatients with somatoform disorders. Study Design: Cross-sectional study. Place and Duration of Study: A survey on psychiatric and psychological outpatients with somatoform disorders between Japan and China. Duration of this study was three months between April 1, 2011, and June 30, 2011. Methodology: The subjects of this research included 43 Japanese outpatients (49.7±10.5 yr., M/F:13/30) in psychiatry clinic at Saga Medical School Hospital, Saga 845-8502, Japan. It also included 38 Chinese outpatients (40.7±8.2 yr., M/F: 14/24) in psychiatry and psychology outpatient clinic in Dalian Medical University Hospital, Liaoning province, China. All psychiatric patients were diagnosed as the somatoform disorders according to the DSM-IV. To investigate the difference of psychological status and illness behavior, we examined them using two psychological instruments: Illness Behavior Questionnaire (IBQ) and General Health Questionnaire-30 (GHQ-30). Results: It can be found that there were the remarkable statistical differences between the Japanese and Chinese patients with somatoform disorders of each of the subscales of the GHQ-30. All GHQ-30 items were scored significantly higher by the Chinese than by the Japanese. Regarding the IBQ, the statistical differences of five subscales of IBQ between the two groups: General Hypochondriasis, Disease Conviction, Affective Inhibition, Affective Disturbance, and Irritability can be found. No obvious difference was found between the two groups of the subscale of Psychological versus somatic focusing (P/S) and Denial (D), however. Conclusion: The GHQ-30 and the other five subscales of IBQ (except for P/S and D) for Chinese was higher than for Japanese. This finding may be attribute to the socio-cultural and economic factors. P/S and D scores on the IBQ were not significantly different, suggesting the possibility of an essential symptom of somatoform disorders.

Aims: To investigate the difference of illness behavior with pain between psychiatric and pain clinic outpatient. Study Design: Cross-sectional study Place and Duration of Study: A survey on psychiatric and pain outpatients, Saga Medical School, Saga 849-8501, Japan. Duration of this study was three months between April 1, 2011, and June 30, 2011. Methodology: The subjects of this research included 40 patients (62.9±16.5 yr., M/F:15/25) in pain clinic outpatients and 43 patients (49.7±15.9 yr., M/F:13/30) in psychiatric clinic outpatient. Psychiatric patients were diagnosed as the somatoform disorders according to the DSM-IV. To clarify the difference of psychological status and illness behavior, we examined them using two psychological instruments: Illness Behavior Questionnaire (IBQ) and General Health Questionnaire-12 (GHQ-12). Results: Pain clinic patients’ group was significantly older than psychiatric patient’s group. In terms of IBQ, the scores of psychological vs. somatic perception and affective disturbance among psychiatric outpatient group were significantly higher than those of pain clinic group. On the other hand, the score of denial among pain clinic group was significantly higher than those of psychiatric outpatient group. Conclusion: According to the IBQ, the subscale of denial has significant difference between the pain clinic patients and the psychiatric patients with pain. Pain clinic patients tend to deny their psychological problem.

Although preliminary neuroimaging research suggests that patients with hoarding disorder (HD) show widespread abnormal task-related activity in the brain, there has been no research on alterations in the white matter tracts in these patients. The aim of this study was to investigate the characteristics of the major white matter tracts in patients with HD. Tract-based spatial statistics were used to search for white matter tract abnormalities throughout the brain in 25 patients with HD and 36 healthy controls. Post hoc analysis of regions of interest was performed to detect correlations with clinical features. Compared with the controls, patients with HD showed decreased fractional anisotropy and increased radial diffusivity in anatomically widespread white matter tracts. Post hoc analysis of regions of interest revealed a significant negative correlation between the severity of hoarding symptoms and fractional anisotropy in the left anterior limb of the internal capsule and a positive correlation between the severity of these symptoms and radial diffusivity in the right anterior thalamic radiation. Patients with HD showed a broad range of alterations in the frontal white matter tracts, including the frontothalamic circuit, frontoparietal network, and frontolimbic pathway. The findings of this study indicate associations between frontal white matter abnormalities related to the severity of hoarding symptoms in HD and the cortical regions involved in cognitive dysfunction. The insights provided would be useful for understanding the neurobiological basis of HD.

Recent evidence suggests that presupplementary motor area (pre‐SMA) and inferior frontal gyrus (IFG) play an important role in response inhibition. However, no study has investigated the relationship between these brain networks at resting‐state and response inhibition in obsessive–compulsive disorder (OCD). We performed resting‐state functional magnetic resonance imaging scans and then measured the response inhibition of 41 medication‐free OCD patients and 49 healthy control (HC) participants by using the stop‐signal task outside the scanner. We explored the differences between OCD and HC groups in the functional connectivity of pre‐SMA and IFG associated with the ability of motor response inhibition. OCD patients showed a longer stop‐signal reaction time (SSRT). Compared to HC, OCD patients exhibit different associations between the ability of motor response inhibition and the functional connectivity between pre‐SMA and IFG, inferior parietal lobule, dorsal anterior cingulate cortex, insula, and anterior prefrontal cortex. Additional analysis to investigate the functional connectivity difference from the seed ROIs to the whole brain voxels revealed that, compared to HC, OCD exhibited greater functional connectivity between pre‐SMA and IFG. Also, this functional connectivity was positively correlated with the SSRT score. These results provide additional insight into the characteristics of the resting‐state functional connectivity of the regions belonging to the cortico‐striato‐thalamo‐cortical circuit and the cingulo‐opercular salience network, underlying the impaired motor response inhibition of OCD. In particular, we emphasize the importance of altered functional connectivity between pre‐SMA and IFG for the pathophysiology of motor response inhibition in OCD., Obsessive–compulsive disorder patients had significantly different associations between the abilities of motor response inhibition and the resting‐state functional connectivity from pre‐SMA to IPL, IFG, dACC and anterior‐insula. Additionally, compared to healthy control, OCD exhibited greater functional connectivity between pre‐SMA and IFG, and this functional connectivity was correlated with the the abilities of motor response inhibition.

Background It is gradually becoming clear that obsessive-compulsive disorder (OCD) patients have aberrant resting-state large-scale intrinsic networks of cingulo-opercular salience (SN), default mode (DMN), and front-parietal network (FPN). However, it remains unknown whether unaffected first-degree relatives of OCD patients have these alterations as a vulnerability marker to the disorder. Methods We performed resting-state functional magnetic resonance imaging (rsfMRI) scans of 47 medication-free OCD patients, 21 unaffected healthy first-degree relatives of OCD patients, and 62 healthy control (HC) participants. We explored differences between the three groups in the functional connectivity from SN (seeds: anterior-insula (AI) and dorsal anterior cingulate cortex (dACC)), DMN (seeds: medial prefrontal cortex (MPFC) and posterior parietal cortex (PCC)), and FPN (seeds: dorsolateral prefrontal cortex (DLPFC)). Results Compared to HC, both OCD patients and first-degree relatives showed significantly greater functional connectivity between AI and PCC and between DLPFC and the thalamus. Compared to first-degree relatives and HC, OCD patients showed reduced functional connectivity between PCC and DLPFC, and this altered functional connectivity was negatively correlated with anxiety and depressive symptom within OCD group. Conclusions OCD patients and unaffected first-degree relatives of OCD patients showed overlapping alterations in resting state functional connectivity between the regions of SN and DMN and between DLPFC and the thalamus. Our results suggested that alterations between large-scale intrinsic networks and within the dorsal cognitive cortico-striato-thalamo-cortical (CSTC) circuit could represent endophenotype markers of OCD.

To examine the different patterns in utilization of psychological services between Japanese and American college students, a total of 316 American students (122 men and 194 women) and 362 Japanese students (147 men and 215 women) participated in this study. We used the following psychological instruments: Attitude Toward Seeking Professional Psychological Help scale, Interpersonal Openness (openness regarding professional psychological help) and Confidence Self-construal scale, Sex Role Inventory, and Recognition of Psychological Help. This study concluded that collectivism is a significant predictor of recognizing the need for mental health services in the U.S., while it is not in Japan. Compared to American and female participants, Japanese and male participants feel greater stigmas toward mental health professionals. Openness to psychological help collectivism was a significant predictor for openness among the American sample, while it was not in the Japanese sample. Collectivism was a significant predictor for openness among the American sample, while it was not in the Japanese sample. Individualism was a significant predictor for confidence in America, but it was not in Japan. As predicted, Japanese participants feel greater stigma and less recognition, openness, and confidence toward mental health services than Americans. It is important for mental health professionals to educate college students that individual who seek help have high masculine traits to ameliorate the negative attitude toward mental health professionals.

Previous studies have reported clinical characteristics of hoarding disorder (HD), such as early onset, a chronic course, familiality, high unmarried rate, and high rates of comorbidities. However, clinical research targeting Japanese HD patients has been very limited. As a result, there is a low recognition of HD in Japan, leading to insufficient evaluation and treatment of Japanese HD patients. The aim of the current study was to delineate the clinical characteristics of Japanese HD patients. Thirty HD patients, 20 obsessive-compulsive disorder (OCD) patients, and 21 normal controls (NC) were targeted in this study. The HD group had a tendency toward higher familiality, earlier onset, and longer disease duration compared to the OCD group. In addition, the HD group showed a significantly higher unmarried rate than the NC group. The top two comorbidities in the HD group were major depressive disorder (56.7%) and attention-deficit/hyperactivity disorder (26.7%). The HD group had significantly higher scores on hoarding rating scales and lower scores on the Global Assessment of Functioning Scale than the other two groups. The current study showed a clinical trend in Japanese HD patients similar to previous studies in various countries, suggesting that HD may be a universal disease with consistent clinical symptoms., Public health; Psychiatry; Health sciences; Clinical research; Diagnostics; Hoarding disorder; Japanese patients; Clinical characteristics.

Background Hoarding disorder (HD) is a disease concept newly presented in DSM-5. As far as we know, no studies have examined the structural changes relevant to hoarding by applying the diagnostic criteria of HD in DSM-5. In the present study, we aimed to find abnormalities in gray matter (GM) structures of patients with HD. Methods Seventeen patients who met the DSM-5 criteria for HD, 17 obsessive-compulsive disorder (OCD) patients, and 17 healthy controls (HCs) participated in this study. All participants underwent MRI scanning of the brain by a 3.0-Tesla MRI scanner. In a voxel-based morphometric procedure, preprocessed GM structural images were used to compare the three groups. Thereafter we investigated the correlation between the clinical data (age of onset, symptomatic severity) and GM volume. Results The HD group showed a significantly increased GM volume compared to the OCD and healthy control groups (p

Background Impaired cognitive flexibility has been implicated in the genetic basis of obsessive-compulsive disorder (OCD). Recent endophenotype studies of OCD showed neural inefficiency in the cognitive control network and interference by the limbic network of the cognitive control network. Exploring the relationship between the functional brain network and impaired cognitive flexibility may provide novel information about the neurobiological basis of OCD. Methods We obtained resting-state functional magnetic resonance imaging (rsfMRI) scans and measured the cognitive flexibility of 37 medication-free OCD patients and 40 healthy control (HC) participants using the Wisconsin Card Sorting Test (WCST). We explored the difference between OCD and HC groups in the functional brain network related to impaired cognitive flexibility from the amygdala and dorsal striatal regions of interest (ROIs) by using a seed-based approach. Results Significant differences between the OCD and HC groups were identified in the resting state functional network from the dorsal caudate. Increased functional connectivity from the dorsal caudate to the dorsal anterior cingulate cortex (dACC) and anterior insula (AI) was associated with poorer cognitive flexibility in the OCD group, but better cognitive flexibility in the HC group. Conclusions These results provide evidence that the impaired cognitive flexibility of OCD may be associated with dysfunctions of the brain network from the dorsal caudate (DC) to important nodes of the salience network. Our results extend the neuropsychological model of OCD by showing intrinsically different associations between OCD and HC in functional network and cognitive flexibility., Highlights • Increased functional connectivity from the dorsal caudate to the dorsal anterior cingulate cortex and anterior insula was associated with poorer cognitive flexibility in the OCD group, but better cognitive flexibility in the HC group. • Our results may suggest that the dysfunction from DC to SN is associated with impaired cognitive flexibility of OCD. • These findings could provide additional insights into the important role of cooperative interactions between the dorsal striatum and the large-scale intrinsic brain networks in human cognitive function.

This article describes the background and recent changes in French forensic mental health. The literature suggests that three law reforms have been crucial to changes in the mental health system. First, the Penal Code of 1992 redefined the provisions of criminal responsibility and introduced the category of diminished responsibility. Second, a controversial law for preventive detention (rétention de sûretê) was enacted in 2008, according to which criminals with severe personality disorders are subject to incarceration even after the completion of their prison sentences if they are still considered to pose a danger to the public. Third, the revision of mental health laws in 2011 altered the forms of involuntary psychiatric treatments, stipulating a judge's authority to decide treatment. In parallel with these legal reforms, the psychiatric treatment system for offenders with mental disorders has been reconstructed. The number of difficult patient units (unités pour malades difficiles) has increased from four to ten across the nation in order to meet the needs of patients transferred from general psychiatric institutions for the reason of being unmanageable. In the penitentiary system, new facilities have been established to cope with the growing number of inmates with mental disorders. As background to these changes, it is pointed out that the current psychiatric system has undergone deinstitutionalization and become less tolerant of aggressive behavior in patients. In the broader context, public sensitivity towards severe crime, as shown by the sensation triggered by serious crimes conducted by pedophiles, seems to urge tough policies. In the 2000 s, several homicides committed by psychiatric patients had a great impact on the public, which led President Sarkozy to issue a statement calling for stronger security in psychiatric institutions. The harsh attitude of courts towards psychiatric practices is illustrated by a 2012 ruling; after a patient escaped from the hospital and hacked an elderly man to death, his psychiatrist was sentenced to a one-year suspended prison sentence for failing to recognize the danger that the patient posed to the public. Another lawsuit was raised against a psychiatrist following this case. Apparently, a sense of crisis is growing among psychiatric professionals. Their concerns are based on several points. Introduction of diminished responsibility may narrow the possibility of acquittal by reason of insanity, and lead to the criminalization of those with mental disorders. Dangerousness (dangerosité), pivotal in the procedure of preventive detention, is not a medical concept, but is instead based on the erroneous identification of criminality and mental disorders. Therefore, it is unreasonable to entrust the evaluation of dangerousness to psychiatric expertise. Court intervention in the process of deciding appropriate treatment may intensify judicialization (judiciarisation) of psychiatry. Establishment of facilities for prisoners within the mental health system would create a new segregating function of psychiatry. Thus, French experience seems to be figuring out all the challenges that contemporary metal health is facing. Above all, effective measures should be taken to prevent patients from entering the criminal justice system. Following this recommendation would be helpful in Japan, where a new forensic mental health system has just started.