PURPOSE: It is usually easy to judge whether amyloid PET images should be interpreted as positive or negative for amyloid deposits by visual inspection or quantitative measurement standard uptake value ratio (SUVR), but the findings are equivocal in some cases. As conventional mean cortical SUVR (mcSUVR) measures accumulation in both gray matter (GM) and white matter, it may mis-estimate amyloid deposits. The purpose of the study was to develop a regional GM-dedicated SUVR measuring (GMSUVR) system for amyloid PET images with 3D-MRI, and evaluate its utility for detecting amyloid deposits in equivocal cases. METHODS: Of 126 subjects who underwent amyloid PET with 11C-PiB and 3D-MRI, the area of amyloid-positive regions and the critical regional GMSUVR thresholds were first determined in 15 amyloid-positive and 15 amyloid-negative patients, using the automatic volumetric measurement of segmented brain images system. We then tested 36 amyloid-negative, 60 amyloid-positive, and 13 equivocal subjects with this GMSUVR system and with conventional mcSUVR. RESULTS: Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 100%, 92%, 97%, 95%, and 100% for the GMSUVR system; and 97%, 86%, 93%, 92% and 94%, respectively, for mcSUVR. In 24 cases in which the findings were equivocal or discordant, the sensitivity, specificity, accuracy, PPV, and NPV were all 100% for the GMSUVR system; and were 90%, 33%, 83%, 90%, and 33%, respectively, for mcSUVR. CONCLUSION: The regional GMSUVR measurement method was well able to discriminate between amyloid-positive and -negative subjects, even in cases where amyloid deposition was equivocal.

We have encountered occasional equivocal findings when assessing cerebral cortical amyloid retention with C-11-Pittsburgh compound B (PiB) PET. We investigated the diagnostic significance of equivocal PiB PET findings. This retrospective study included 101 consecutive patients complaining of cognitive disorders (30 Alzheimer's disease, 25 mild cognitive impairment, 8 Lewy body disease, 7 frontotemporal lobar degeneration, 31 others) who underwent both C-11-PiB PET and F-18-fluorodeoxy-d-glucose (FDG) PET. We visually classified PiB-positive, PiB-equivocal or PiB-negative ratings according to cortical uptake. For quantitative assessments of PiB PET, standard uptake values referred to cerebellar cortex (SUVR) were calculated in regional template volume of interests (frontal, temporoparietal, precuneus/posterior cingulate cortex, cerebral white matter and cerebellar cortex). The results of visual assessment were compared with the regional and mean cortical SUVRs and cortical-to-white matter ratio of PiB uptake, as well as clinical and FDG PET findings. Among the 101 scans, 41 were PiB negative, 11 were PiB equivocal, and 49 were rated PiB positive in the visual assessments. The mean cortical SUVR and cortical-to-white matter ratio were 0.97 +/- A 0.07 and 0.57 +/- A 0.21 in PiB-negative, 1.51 +/- A 0.17 and 0.75 +/- A 0.06 in PiB equivocal and 2.10 +/- A 0.33 and 0.97 +/- A 0.11 in PiB-positive group, respectively. Nine of 11 subjects with PiB-equivocal findings had cognitive impairments and FDG distribution compatible with Alzheimer's disease or dementia with Lewy bodies. We considered equivocal visual findings on PiB PET equivalent to PiB-positive with slight cortical uptake. In addition, slight cortical amyloid deposits were considered to cause cerebral metabolic abnormality and cognitive impairment. Although mean cortical SUVR was more sensitive than visual assessment because of low cortical-to-white matter contrast due to non-specific accumulation in white matter, it is important not to overlook small amounts of cortical uptake of PiB in visual inspection for exact diagnosis.

Aims: To clarify differences in objective activity levels between children with attention-deficit/hyperactivity disorder (ADHD) and those with pervasive developmental disorders (PDD) and hyperactivity. Method: Eighteen boys with combined type ADHD, 10 boys with PDD with hyperactivity, and 18 control boys wore actigraphs for 1 week while attending elementary school. In addition to the average activity level, the standard deviation in the activity levels were compared for two continuous situations: (i) in-seat classes, in which the participants were expected to sit in their own seats and learn quietly; and (ii) free recess periods following the in-seat classes. Results: All the groups were affected by the situational shift, the average activity level of each the groups was higher and the standard deviation was smaller than those during the in-seat classes. The boys with ADHD exhibited a still smaller standard deviation than the controls and the boys with PDD and hyperactivity during the free recess period; no difference between the controls and the boys with PDD was seen. The boys with PDD exhibited a significantly lower average activity level than the other groups. No differences among the groups in the average activity levels and standard deviation were seen during the in-seat classes. Conclusions: The observed objective activity levels in each group reflect the degree to which the boys are able to tolerate changes in situations. Objective measurement of activity levels may be useful to differentiate hyperactivity in children with ADHD from that in children without ADHD.

Objective The objective of our study was to evaluate diagnostic ability and features of quantitative indices of three modalities: uptake rate on norcholesterol scintigraphy, computed tomography (CT) attenuation value, and fat suppression on chemical-shift magnetic resonance imaging (MRI) for characterizing adrenal adenomas. Methods Image findings of norcholesterol scintigraphy, CT, and MRI were reviewed for 78 patients with functioning (n = 48) or nonfunctioning (n = 30) adrenal masses. The norcholesterol uptake rate, attenuation value on unenhanced CT, and suppression on in-phase to opposed-phase MRI were measured for adrenal masses. Results The norcholesterol uptake rate, CT attenuation value, and MR suppression index showed the sensitivity of 60%, 82%, and 100%, respectively, for functioning adenomas of < 2.0 cm, and 96%, 79%, and 67%, respectively, for those of >= 2.0 cm. A statistically significant correlation was observed between size and norcholesterol uptake, and between CT attenuation value and MR suppression index. Regarding norcholesterol uptake, the adenoma-to-contralateral gland ratio was significantly higher in cortisol releasing than in aldosterone-releasing adenomas. Conclusions The norcholesterol uptake rate was reliable for characterization of adenomas among adrenal masses of >= 2.0 cm. CT attenuation value and MR suppression index were well correlated with each other, and were useful regardless of mass size.

The aim of this study was to determine whether the objective activity level of children with attention deficit/hyperactivity disorder (AD/HD) is associated with situational factors in elementary school. A total of 16 children with combined-type AD/HD (13 boys, 3 girls) and 20 controls matched for age and gender participated in the study. All the participants wore the objective measurement of activity level for 1 week while attending elementary school. The average activity levels were calculated for the morning and afternoon classes. The classes were categorized into four types: (i) in-seat classes, in which the participants were expected to learn quietly while sitting in their own seats; (ii) not-in-seat classes, in which the participants were not expected to sit in their seats; (iii) physical education classes; and (iv) lunch/recess periods. During the afternoon in-seat classes, the children with AD/HD were significantly more active than the controls. However, no significant differences based on the group (children with AD/HD or controls) were observed during the other morning or afternoon classes. These findings indicate that in naturalistic settings where the effects of situational demands involving inhibition and the effect of fatigue overlapped, the children with AD/HD exhibited an activity level that was different from that exhibited by the controls. Differences in the activity levels of children with AD/HD and normal controls were identified using an objective measurement of activity level when two situational factors overlapped.

Background: X-linked ichthyosis (XLI) is caused by deficiency of steroid sulfatase (STS) activity. About 90% XLI patients have Large deletions involving the entire STS gene and flanking regions. Recently, VCXA, which is located approximately 0.7 Mb telomeric to the STS gene, was reported as a candidate gene for mental retardation (MR) in patients with XLI. Objective: To delineate the X-chromosomal deletion of a XLI patient with borderline mental retardation. Methods: We carried out FISH analysis to show that the whole STS gene is deleted, and PCR analysis for fine-scale deletion mapping. Results: The deleted segment is approximately 1.6 Mb in size, and includes the entire STS and VCXB1 genes. VCXA itself is intact, but its promoter is deleted. Conclusion: A deletion that includes the VCXA promoter is associated with borderline mental retardation in a patient with XLI. (c) 2006 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. ALL rights reserved.

Background Alzheimer's disease and major depression are representative diseases that present forgetfulness and a depressive mood. It is often difficult to make a differential diagnosis between the two in the initial phase. Aim To evaluate the differential diagnosis method using regional cerebral blood flow patterns with a three-dimensional stereotactic surface projection technique. Methods Twenty early-elderly patients with mild and moderate forgetfulness were studied. Among them, 10 were diagnosed as having major depression (the MD group) and the other 10 as having Alzheimer's disease (the AD group). All patients underwent cerebral perfusion single photon emission computed tomography (SPECT) with [I-123] iodoamphetamine. A z-score was calculated for each pixel of the cerebral surface. Twenty-one circular regions of interest (ROIs) were placed on the z-score map. The significance of the statistical difference in ROI values between the two groups was determined by using the two-sided Mann-Whitney U-test. Results The z-scores for the lateral parietal, lateral temporal, bilateral precuneus and bilateral posterior cingulate gyrus were significantly reduced in the AD group compared with those in the MD group. The z-scores for the lateral frontal, left thalamus and bilateral medial frontal regions were significantly lower in the MD group than in the AD group. Conclusion Our study demonstrated a difference in regional cerebral blood flow patterns between the early elderly with Alzheimer's disease and those with major depression. All patients were classified into the appropriate categories using discriminant analysis and z-scores of frontal and parietal regions. Brain perfusion SPECT was a useful tool for the differential diagnosis between Alzheimer's disease and major depression.

近畿大学医学部奈良病院メンタルヘルス科は外来1診療室,常勤医1名のみの診療科である.今回われわれは1999年10月1日の開院から2003年12月31日に当科を初診した患者2362人について調査し,同時期に近畿大学医学部附属病院メンタルヘルス科を初診した患者4625人と比較検討した.受診経路別に,他施設より紹介なく受診したものを直接受診,他施設より紹介のあったものを院外紹介,院内他科外来より紹介のあったもの院内外来,院内他科入院中に紹介のあったものを院内入院と分類した.奈良病院の初診者数は,2001以降は年平均517.7人であった.直接受診群は年平均337.0人,院外紹介群は年平均77.3人,院内外来群は年平均67.3人,院内入院群は年平均36.0人であった.附属病院と比較して,直接受診群は女性が多くICD-10による診断分類ではF3,F4が多いことが当科の特徴であった.院外紹介群の比率は附属病院と比較して少なかった.院内外来群は附属病院と比較して性差や診断割合に差はみられず,ほぼ同様のコンサルテーション・リエゾン活動を行っていた.院内入院群は附属病院よりも高齢者の精神疾患に対応しており,当科の特徴であった.今後の課題として,複数の常勤スタッフを配置することや病床を所有することおよび救命救急科へのメンタルヘルス科常勤医を配置するといった専門性の向上が望まれる(著者抄録)

総合病院精神科の大きな役割の一つはコンサルテーション・リエゾン活動である。近年、総合病院精神科においては、自殺予防、緩和ケアに対する診療報酬改訂にあらわされるように、その働きにより一層大きな期待が寄せられるようになった。また、当院においては平成14年にDPCが適用され、入院治療の日数や治療内容において劇的な変化があった。このようなリエゾン活動の変遷について、過去10年間の紹介科および診断について検討した。

卵巣癌に対する手術及び化学療法後にうつ病を発症し、緩和ケアチームの関わりが有効であった症例を報告した。

長期間統合失調症として治療されており、その経過中にけいれん発作を併発した症例について報告した。けいれんに先行して気分高揚、浪費といった躁症状が認められていた。搬送後の頭部MRIおよび造影CTにて左前頭葉に硬膜動静脈瘻を認めた。また静脈性梗塞による浮腫性変化も認められ、けいれん発作の原因と考えられた。脳外科により瘻孔閉鎖術が施行された後には、愁訴や抑うつを伴うもとの病像に戻り、躁症状のエピソードには器質性の要因が強く関連していることが示唆された。

平成15年8月1日から平成20年7月31日までの5年間に当院救命救急センターおよびメンタルヘルス科に自殺企図及び自傷行為で受診した20歳未満の患者について分析を行った。これらの多くは深刻な家族問題を有していた。企図手段自体は致死的でなく、外来処置のみで帰院するものが多く、救急現場での関わりがごく短期的なものとなりがちであった。このことから思春期の自殺企図症例に対しては介入の方法についてさらに検討する必要があるものと考えられた。

【目的】広汎性発達障害についての知見が広まるにつれ、患者数が増加しつつある。それに伴い、発達障害、あるいはその存在を疑わせる自殺企図患者が搬送されてくることも珍しくなくなった。その企図に至る背景は時に了解困難であり、対応を巡ってスタッフが混乱することが少なくない。 【方法】平成15年から当院CCMCに搬送された発達障害患者の自殺企図症例を呈示し、他の精神疾患に伴う自殺企図との相違について検討した。なお発表の大意に影響のない範囲で症例の内容について改変した。 【結果】発達障害における自殺企図症例では、必ずしも死を意図して行われていないことがある。また死に対するイメージが乏しい中で企図が行われているために、企図後必然的に起こる状況、例えば入院しなければならないこと、家人に反省を迫られることなどとの関連づけが難しく、介入する上で困難がある。 【結論】自殺企図後の介入に際しては、発達障害の特性についての

精神疾患を持つ患者の芸術作品や夢などに、円や四角からなる左右対称のモチーフが出現することがある。これらはマンダラと呼ばれ、C.G.Jungによれば全体性を取り戻す心の働きである。このような図形の色塗りを試み、その疾患別の特徴について述べた。

Alzheimer型痴呆の画像診断は統計学的画像解析により大きく変化し、早期の血流低下も診断が可能となってきた。3D-SRT(Three-demensional stereotaxic ROI template)は、SPMの標準化機能を利用し、あらかじめ決められた関心領域の局所脳血流を自動的に解析できるが、これらの関心領域についてAlzheimer群、正常群の2群間で比較を行った。