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Department of Neuropsychiatry
Professor
Nobumasa Kato, M.D.
Associate Professors
Nobuo Nakayasu, M.D. Koichi Tsunashima, M.D.
Lecturer
Kiyoto Kasai, M.D.
Associates
Noriomi Kuroki, M.D. Masuhiro Sakata, M.D.
Koji Matsuo, M.D. Susumu Omae, M.D.
Tadashi Murakami, M.D. Keiichiro Watanabe, M.D.
Seiichiro Jinde, M.D. Michiko Ishijima, M.D.
The Department of Neuropsychiatry is Japan's oldest psychiatric
department which was established in 1886. "Anti-Psychiatry" movement for the
last 3 decades had highly negative effects on the progress in all aspects of our
activities. However, since 1994, our department has been normalized and
restarted to play a leading role in psychiatry in Japan. Now the Department of
Neuropsychiatry provides a wide-ranged clinical, training, and research
services. Since May 2002, we have been working in the new closed ward (34 beds)
and in the open ward (20 beds). Moreover, since 2000, we have been supported by
a government grant for basic and clinical neuroscience in stress-related
disorders including posttraumatic stress disorder (PTSD). One of our major
findings was the first MRI investigation of anterior cingulate cortex
abnormalities in PTSD patients following the Tokyo Subway Sarin Attack, which
was broadcasted in TV and reported by major newspapers.
Clinical Activities
General outpatient services:
We have more than 20 staff psychiatrists, 4 clinical psychologists, 2 trained
nurses, and 1 psychiatric social worker. Approximately 1100 new patients visited
yearly (2002), and the total visits per year was about 35,000 (140 per day).
Specialty clinics:
Clinic for patients with affective disorders:
The bipolar clinic is managed by two experienced psychiatrists (Drs. Tadafumi
Kato and Koji Matsuo). They mainly treat patients with bipolar disorder and
major depressive disorder. We also give some advice to patients with mood
disorders who ask for a second opinion. Dr. Matsuo directly receives some
requests from psychiatrists and physicians in other departments. The exchange
meetings for patients with bipolar disorder are held semiannually. He also
provide psychoeducation to inpatients with bipolar disorder.
Clinic for menopausal melancholia
It is well-known that depressive mood with specific somatic symptoms occurs at
climacteric in female and male. They commonly consult the physician or the
gynecologist and are treated with anti-depressant (mainly SSRI), but quite a few
patients still continue to feel melancholia in spite of the treatment. There are
many kinds of anti-depressant and the medical selections of drugs that require
the technical skill with the expert medical advice. This clinic was set up at
autumn 2003 and the patients were mainly introduced from other sections in
hospital or visited for consultation of their will. In the future, the
appropriate medication of anti-depressant for the menopausal patients with
taking account of the variation of some sex hormones will be investigated,
collaborated with Department of Gynecology.
Psychogeriatric clinic
In 2003, we started psychogeriatric clinic, one of the specialized outpatient
services in our department, on every Wednesday morning. We are accepting elderly
cases with various mental disorders including dementia, mild cognitive
impairment and other status to be distinguished from them such as depression. At
present (April, 2004), 40 patients are treated in our clinic for Alzheimer type
dementia (17 cases), mild cognitive impairment (7 cases), vascular dementia (4
cases), depression (4 cases), delusional disorder (3 cases), hallucinosis (2
cases), frontotemporal dementia (2 cases) and dementia with Lewy bodies (1
case).
Inpatient services:
The secluded ward has 34 beds including 3 seclusion rooms. We also have 20 beds
for psychiatric use in a general ward. Approximately 280 patients with various
psychiatric disorders were admitted in a year (2002), about one-third of whom
were referred from the emergency unit. Occupational therapy, recreational
therapy, group therapy, and art therapy are performed.
Child Psychiatry Division for children with pervasive developmental disorders
We established Japan's first child psychiatry day care unit in national
university hospitals in 1967. As children with Down's syndrome began to be
accepted into nurseries and kindergartens around the year 1975, the focus of
this division shifted to the psychological pedagogy of autism. Treatment of
autism changed along with the understanding of the clinical condition, from
behavioral therapy to cognitive development based therapy. Since 1997, our
division was reduced in size and an improved therapy system, "developmental
psychology outpatient clinic" was established. This outpatient clinic
encompasses individual treatment and psychological counseling by clinical
psychologists under the supervision of psychiatrists. Our staff includes 1
full-time psychiatrists, 4 part-time psychiatrists, and 3 clinical
psychologists. We provide care for 260 autistic or developmentally disabled
children per year. Since 2000, a short term therapy group program has started.
Parents participated in the treatment program alongside the staff members. This
not only emphasizes the therapy of the child, but assesses their developmental
level from many directions. The purpose of the therapy program is to help
parents gain a better understanding of children's disability and to help them to
acquire a more supportive role for their children in the home environment.
Day Treatment Center (Day Hospital) for persons with severe mental illness
The Day Hospital (DH) is a day care unit for young patients with schizophrenia.
It is characterized by the integration of "SEIKATSU RINSHO" hypothesis and
therapeutic community principles. It was established in 1974 by the doctor and
nurses, under Professor Hiroshi Utena's instruction. To date, approximately 480
consumers have attended this program. We have provided psychiatric
rehabilitation service to patients and conducted research related to this field.
Weekly programs include sports, cooking, hiking, and social skills training.
Family psychoeducation and job rehabilitation are also provided. Currently,
there are 5 full-time staffs: 1 psychiatrist, 2 nurses, 1 occupational
therapist, 1 clinical psychologist, and 4 special course students.
Currently, about 40 consumers with severe mental illness participate in the
program (mean age: 27 years old). Over 90% of the menbers are schizophrenia or
other psychotic disorders. Other members have Asperger disorder, somatization
disorder, and so on. Although there is no limit for the duration of the
participation, members usually go on to the following social resources in 2.5
years on average.
Consultation-Liaison Division
We have a team for consultation-liaison psychiatry, and provide service for
outpatients and inpatients in other departments including intensive care unit
(ICU).
Teaching Activities
For psychiatric residents
Clinical meetings on patients: every morning
Case conferences on inpatients: every week
Training for somatic treatment in Intensive Care Unit or Dept. Anesthesiology: 3
months
A series of lectures by teaching staffs on various aspects of psychiatry
For undergraduates
2nd year- Neuropsychiatry Comprehensive lectures
3rd year- Bedside Learning
Last year- Clinical Clerkship (elective)
Postgraduate
Currently more than 20 neuropsychiatry Ph.D. students
Research Activities
Neuroscience research
Stress
It is well accepted that neuropeptide Y (NPY) is involved in anxiolytic-like
effects and anti-stress effects. Pharmacological and behavioral studies have
consistently indicated that these effects are mainly mediated through an
activation of NPY Y1 receptor in the brain. To further elucidate the functional
role of Y1 receptor, we have evaluated the histological and behavioral changes
in Y1 receptor-deficient mice, after an exposure to 2h of restraint stress.
Trimethyltin (TMT), a neurotoxic organotin, has been shown to cause selective
loss of pyramidal neurons in the rat hippocampus, similar to stress-induced
hippocampal changes. Several recent studies in animal models of brain ischemia
revealed the neuroprotective properties of tacrolimus (FK506), a potent
immunosuppressant used in organ transplants. Therefore, we have investigated the
effect of FK-506 on the neuronal death and apoptosis in the hippocampus after
TMT intoxication, using immunohistochemistry and TUNEL method.
Epilepsy
Systemic injection of kainic acid in rat causes severe convulsions, increased
seizure susceptibility and seizure-induced neuronal death. Since precise
mechanisms of various anticonvulsants are still unclear, we have investigated to
elucidate whether these anticonvulsants demonstrate neuroprotective effects on
kainic acid-induced neuronal death in the hippocampus.
Environmental endocrine disrupter
Bisphenol-A (BPA), one of environmental endocrine disrupters, is released from
polycarbonate plastics, and is known to mimic oestrogens in their action. Recent
studies reported that prenatal and neonatal exposure to low-dose bisphenol-A
modulates the sexual differentiation of behavior and the central dopaminargic
effects in vivo and in vitro. We examine the effects of BPA on the behavior,
memory and the expression of estrogen-alpha receptor in the brain of rats
exposed to BPA during the fetal and suckling periods at a dosage far less than
the no-observed-adverse-effect level.
Genetic Research
The Genetic Research Group of the department is investigating genetic as well as
environmental mechanism of psychiatric disorders. A major focus of the studies
is exploration of susceptibility genes of the disorders including schizophrenia,
infantile autism, their spectrum disorders and anxiety disorder (mainly panic
disorder). A number of candidates of the susceptible genes are studied using
case-control and TDT (transmission disequilibrium test) designs. We are at
present achieving most interesting results in the investigations of DISC1,
Neuregulin1 and other candidate genes in schizophrenia and the chromosome 7
genes in infantile autism. Another focus is investigation of genes that affect
the development of personality. These studies are undertaken through
collaboration with facilities including the Department of Human Genetics and the
Health Service Center, University of Tokyo, Aichi Children's Health and Medical
Center, the Asunaro-Gakuen, the Department of Psychiatry, Tokai University,
several departments of the Tottori University, Department of Psychiatry, Mie
University, the Brain Research Center of the Riken and others. We are also very
grateful to several mental hospital around Tokyo for their collaborations.
Several papers on these study issues have been published in the last few years.
In addition to the molecular genetic studies, studies of environmental factors
which affect the development of the disorders, interacting with the genetic
components. Among several clues to study the environmental factors, the special
focus is on the seasonality of birth in schizophrenia. We are attempting to
elucidate specific factors that cause the seasonality through collaborations
with facilities across the nation.
Neuroimaging
Our group plays a leading role in psychiatric neuroimaging in Japan. Our
research aims at multi-modality neuroimaging (structural and functional MRI, MR
spectroscopy, EEG, MEG, near-infrared spectroscopy (NIRS), PET) in
schizophrenia, mood disorders, pervasive developmental disorders, and
posttraumatic stress disorder (PTSD).
Our projects include (arranged by neuroimaging techniques):
Structural MRI/diffusion tensor imaging (DTI)
Volumetric and DTI studies in schizophrenia, unipolar depression, autism
spectrum disorders, and PTSD, mainly using voxel-based morphometry; Gene-MRI
endophenotype association studies in collaboration with the Psychiatric Genetics
Group and RIKEN
Functional MRI
Functional MRI studies of PTSD using subliminally presented threatening stimuli
MR spectroscopy
1H-MRS in patients with schizophrenia (not currently in use).
EEG
High-resolution (64 channel) event-related potentials (ERPs) studies in patients
with schizophrenia using auditory mismatch negativity (MMN) and Go No-go
paradigms.
MEG
Whole-head (204-channel) MEG studies in schizophrenia and autism spectrum
disorders, using MMN and face perception paradigms.
Near-infrared spectroscopy (NIRS)
Prefrontal activation studies in mood disorders, schizophrenia, and PTSD.
PET
FDG-PET studies in unipolar depression.
Neuropsychological assessment
Neuropsychological test battery in schizophrenia and autism spectrum disorders.
Clinical Pharmacology
The atypical neuroleptics have been widely prescribed in our country. They
contribute to the reduction of uncomfortable side effects and the improvement of
the patient's QOL. But the typical neuroleptics still have been used because of
their sedative effects particularly in acute state of Schizophrenia. We have
been investigating a voluntary clinical research, which contain the practical
evaluation to the treatment of atypical neuroleptics for acute psychotic state
in Schizophrenia.
Recently the abnormal glucose tolerance induced by atypical neuroleptics had
been reported and some accidental hyperglycemia had happened in our country,
too.. Though there are many reports involving to this problem in foreign
country, few detailed investigation was performed in Japan until now. We are
preparing to examine the glucose tolerance of inpatients that are treated by
neuroleptics in collaboration with many hospitals and expect that the frequency
of risk and some actual factors will be revealed.
Geriatric psychiatry
Neuropathological study of dementias
Our interest is neuropathological background of dementia, especially NFT-predominant
form of dementia (NFTD). NFTD is a sporadic subset of dementia pathologically
characterized by abundant and almost exclusive appearance of NFTs in the limbic
areas with scarcity of senile plaques. Our study suggests that pathogenetic
background of NFTD may be different from that of AD and cognitive decline in NFT-SC
may be affected not only by severity of NFT pathology but also by coexisting
vascular lesions and/or argyrophilic grains.
Prospective study of mild cognitive impairment (MCI)
We are participating in a prospective, multicenter study on mild cognitive
impairment (MCI). MCI is defined as the intermediate state between normal
cognition and dementia. The aim of this study is to establish highly effective
diagnostic method for pre-symptomatic dementia and to enable appropriate medical
intervention in the MCI stage, utilizing clinical examinations such as
biological marker of cerebrospinal fluid and statistical SPECT.
Psychopathology
Phenomenological-structuralistic psychopathological research on schizophrenia
The disturbance of the pre-descriptive level or "tacit" dimension
phenomenological psychopathology pointed out in people with schizophrenia has
clinical relevance when we try to achieve deeper insight into what cognitive
researches designate as the disturbance of association, the deficit of holistic
cognitions and the weakening of working memory. Normative dimension pointed out
by structuralistic psychopathology, through which a human subject enters the
linguistically institutionalized world should also be taken into consideration
when we try to understand the lack of self-confidence and the positive symptoms
of people with schizophrenia. Tsuda pointed out the relevance of the
phenomenological-structuralistic approach to understand above all the "basic
symptoms" (Huber) of schizophrenia. Sumida and Tsuda pointed out the possible
contamination of the ambivalence of "good" and "bad" into the apparently neutral
intentionality (Husserl) and emphasized the importance of Bleuler's concept of
ambivalence as phenomena appearing on the junction between pre-descriptive and
linguistically institutionalized dimension. Hattori and Tsuda disclosed on a
case study, taking note of ambivalence and Benedetti's psychotherapeutic
approach to schizophrenia, how the symptoms of schizophrenia can be really
influenced by the interpersonal relation between therapists and patients.
Anthropological and empirical research of mood disorder
Although the discussion of the melancholic type personality (Tellenbach)
continues to have relevance to the core group in today's clinical practice of
mood disorder, quite a few cases have marginal personality traits. Tsuda
proposes the typological description of these marginal traits and possible
revision of Kasahara's "Initial psychotherapeutic approach to mood disorder
patients" taking these marginal types into consideration. Ohmae discussed the
differential diagnosis of the patients with mood change, taking notice of the
nosological neutrality of mood disturbances in psychiatric practice. The
problems of temporality and the loss of object are fundamental when we consider
the psychopathology of mood disorder. Shimoda proposed the concept of "shuuchaku
temperament (statothymia)" in 1940. Tsuda reconsidered the original Japanese
meaning of the word "shuuchaku" and disclose how the specific disturbances of
temporality and object relation are interrelated with each other in the
psychopathology of mood disorder. Classical descriptions by Reiss and Kraepelin
on the "fundamental state" of mood disorder deserve new attention when we
approach these marginal types. Questionnaire TEMPS developed by Akiskal can be
used for this purpose. Akiyama, Matsumoto, Sakai and Tsuda in collaboration with
Akiskal, using TEMPS, performed the empirical researches integrating Kraepelin's
fundamental state, Kretschmer's concept of cycloid and schizoid temperament and
Tellenbach's melancholic type on normal and clinical people. They also verified
the significant relation between temperament and the subjective awareness of the
quality of job stress among working people. The relation between job stress and
depressive traits varies between men and women. To approach this difference it
is indispensable to take the concept of gender in socio-cultural context.
Ogiwara, Tsuda and Akiyama, combining a quantitative empirical method and a
qualitative interview method made research on the job stress and depression of
working people in Japan.
Spatiality of psychiatric patients
Private region and officially institutionalized region are interrelated in each
subject. In psychiatric patients this interrelation is afflicted with specific
deviations varying in each types of psychiatric disorder. Matsunami and Ohmae
discussed these various types of deviation as characteristic spatiality of
psychiatric patients.
Dialogue between philosophy and psychopathology
Such philosophical contributions as Phenomenology, Bergson's discussion on
memory and "Lebensphilosophie" (philosophy of life) by Bergson, Merlo ponti and
Deleuze have been developed through the dialogue with psychiatric phenomena and
are suggestive of the understanding of psychopathology. Utsumi and Tsuda
participated in the COE project of the department of philosophy of Keio
University and contributed for the dialogue between philosophy and
psychopathology.
Psychotic continuum from the view of inpatient treatment of university hospital
The old German concept of "Einheitspsychose" has never been obsolete and is now
drawing attention as psychotic continuum. Especially among inpatients of the
university hospitals located in big cities there are lots of those who do not
belong to the core typical group of each nosological entity. This motivated us
to revisit the concept of "Einheitspsychose". We have begun the descriptive
psychopathological approach to the inpatients of our university hospital
concerning the following issues; the continuity and discontinuity among personal
disorder and mood disorder, the relation between psychogenic, depressive and
organic (demented) disturbances among senile patients and the atypical
symptomatology of bipolar patients.
References
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An MRI study of temporal lobe abnormalities and negative symptoms in chronic
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Pitman RK. (2002) Smaller hippocampal volume predicts pathologic
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- Ishikura N, Tsunashima K, Watanabe K, Nishimura T, Minabe Y, Kato N.
(2002) Neuropeptide Y and somatostatin participate differently in the
seizure-generating mechanisms following trimethyltin-induced hippocampal
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Y(1), Y(2) and Y(5) receptors in the hippocampus of an epileptic mutant rat:
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Psychophysiological index during auditory selective attention correlates
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(2002) No effect of gender on tonal and phonetic mismatch negativity in
normal adults assessed by a high-resolution EEG recording. Brain Res Cogn
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- Matsuo K, Kato N, KatoT. (2002) Decreased cerebral hemodynamic response
to cognitive and physiologicai tasks in mood disorders as shown by
near-infrared spectroscopy. Psychol Med, 32: 1029-1037
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M, Hata A, Honda M, Watanabe A, Kato N. (2002) The effects of
benzodiazepines on ERP indices of automatic and controlled processing in
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Masui K, Sugahara Y, Kanamori R, Juji T, Kato N, Tokunaga K, Sasaki T (2002)
Human leukocyte antigen-A specificities and its relation with season of
birth in Japanese patients with schizophrenia. Neurosci Lett, 329: 201-204
- Tochigi M, Umekage T, Otani T, Kato T, Iwanami A, Asukai N, Sasaki T,
Kato N. (2002) Serum cholesterol, uric acid and cholinesterase in victims of
the Tokyo subway sarin poisoning:: A relation with post-traumatic stress
disorder. Neurosci Res, 44: 267-272
- Tomita H, Yamada K, Ghadami M, Ogura T, Yanai Y, Nakatomi K, Sadamatsu
M, Masui A, Kato N, Niikawa N (2002) Lancet Mapping of the wet/dry earwax
locus to the pericentromeric region of chromosome 16., 359: 2000-2002
- Tsutsumi S, Akaike M, Arimitsu H, Imai H, Kato N. (2002) Circulating
corticosterone alters the rate of neuropathological and behavioral changes
induced by trimethyltin in rats. Exp Neurology, 173: 86-94
- Watanabe A, Kasai K, Nagakubo S, Kamio S, Murakami T, Hata A, Iwanami A,
Nakagome K, Fukuda M, Kato N. (2002) Verbal and procedural memory in
schizophrenia with milder symptoms: implications for psychosocial
intervention. Schizophr Res, 53: 263-265
- Watanabe A, Kato N, KatoT. (2002) Effects of creatine on mental fatigue
and cerebral hemoglobin oxygenation. Neurosci Res, 42: 279-285
- Yamasue H, Fukui T, Fukuda R, Yamada H, Yamasaki S, Kuroki N, Abe O,
Kasai K, Tsujii K, Iwanami A, Aoki S, Ohtomo K, Kato N, Kato T. (2002) 1H-MR
spectroscopy and gray matter volume of the anterior cingulate cortex in
schizophrenia. NeuroReport, 13: 2133-2137
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Yurgelun-Todd D, Kikinis R, Jolesz FA, McCarley RW. (2003) Progressive
decrease of left superior temporal gyrus gray matter volume in first-episode
schizophrenia. Am J Psychiatry, 160: 156-164
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Yurgelun-Todd D, Kikinis R, Jolesz FA, McCarley RW. (2003) Progressive
decrease of left Heschl's gyrus & planum temporale gray matter volume in
schizophrenia.A longitudinal MRI study of first-episode patients. Arch Gen
Psychiatry, 60: 766-775
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D, Kikinis R, Jolesz FA, McCarley RW: (2003) Differences and similarities in
insular and temporal pole MRI gray matter volume abnormalities in
first-episode schizophrenia and affective psychosis. Arch Gen Psychiatry 60:
1069-1077
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Itoh K, Koshida I, Abe O, Kato N. (2003) Neuromagnetic correlates of
impaired automatic categorical perception of speech sounds in schizophrenia.
Schizophr Res, 59: 159-172
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(2003) Mechanisms of altered Ca2+ signaling in transformed lymphoblastoid
cells from patients with bipolar disorder Int J Neuropsychopharmacol, 6:
379-389
- Kato T, Iwamoto K, Washizuka S, Mori K, Tajima O, Akiyama T, Nanko S,
Kunugi H, Kato N. (2003) No association of mutations and mRNA expression of
WFS1/wolframin with bipolar disorder in humans. Neurosci Lett, 338: 21-24
- Kohda K, Kamiya Y, Matsuda S, Kato K, Umemori H, Yazaki M (2003)
Heteromer formation of δ2 glutamate receptors with AMPA or kainite receptors
Mol Brain Res, 110: 27-37
- Matsuo K, Kato T, Taneichi K, Matsumoto A, Ohtani T, Hamamoto T, Yamasue
H, Sakano Y, Sasaki T, Sadamatsu M, Iwanami A, Asukai N, Kato N. (2003)
Activation of the prefrontal cortex to trauma-related stimuli measured by
near-infrared spectroscopy in posttraumatic stress disorder due to
terrorism. Psychophysiology, 40: 492-500
- Matsuo K, Taneichi K, Matsumoto A, Ohtani T, Yamasue H, Sakano Y, Sasaki
T, Sadamatsu M, Kasai K, Iwanami A, Asukai N, Kato N, Kato T (2003)
Hypoactivation of the prefrontal cortex during verbal fluency test in PTSD:A
near-infrared spectroscopy study. Psychiatry Res Neuroimaging, 124: 1-10
- Mori T, Sasaki T, Iwanami A, Araki T, Mizuno K, Kato T, Kato N (2003)
Smoking habits in Japanese patients with schizophrenia. Psychiatry Res, 120:
207-209
- Morinobu S, Fujimaki K, Kawano K, Tanaka K, Takahashi J, Ohkawa M,
Yamawaki S, Kato N (2003) Influence of Immobilization Stress on the
Expression and Phosphatase Activity of Protein Phosphatase 2A in the Rat
Brain. Biol Psychiatry, 54: 1060-1066
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FA, McCarley RW. (2003) Fusiform gyrus volume reduction and facial
recognition in chronic schizophrenia. Arch Gen Psychiatry, 60: 349-355
- Tsuda H, Utsumi T, Heinze M (2003) Die gegenwartigee Situation der
japanischen Psychopathologie Nervenarzt, 74: 1025-1029
- Umekage T, Tochigi M, Marui T, Kato C, Hibino H, Otani T, Kohda K, Kato
N, Sasaki T (2003) Serotonin transporter-linked promoter region polymorphism
and personality traits in a Japanese population. Neurosci Lett, 337: 13-16
- Washizuka S, Ikeda A, Kato N, Kato T. (2003) Possible relationship
between mitochondrial DNA polymorphisms and lithium response in bipolar
disorder. Int J psychopharmacol, 6: 421-424
- Watanabe A, Matsuo K, Kato N, Kato T (2003) The cerebral blood volume in
healthy adult during congnitive task and hyperventilation measured by
Near-infrared spectroscopy. J Neuropsychiatry Clin Neurosci, 15: 442-9
- Yamasue H, Fukui T, Fukuda R, Kasai K, Iwanami A, Kato N, Kato T. (2003)
Relationship between drug-induced parkinsonism and choline-containing
compounds measured by 1H-MR-spectroscopy in putamen of chronic medicated
schizophrenia. Int J Neuropsychopharmacol, 6: 353-360
- Yamasue H, Kasai K, Iwanami A, Ohtani T, Yamada H, Abe O, Kuroki N,
Fukuda R, Tochigi M, Furukawa S, Sadamatsu M, Sasaki T, Aoki S, Ohtomo K,
Asukai N, Kato N. (2003) Anterior cingulate gray matter volume reduction
demonstrated with voxel-based analysis of MRI in posttraumatic stress
disorder due to terrorism. Proc Natl Acad Sci USA, 100: 9039-9043
- Yokoyama T, Kato N, Yamada N (2003) Development of a high-throughput
bioassay to screen melatonin receptor agonists using human melatonin
receptor expressing CHO cells. Neurosci Lett, 344: 45-48
- Hamakawa H, Murashita J, Yamada N, Inubushi T, Kato N, Kato T. (2004)
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Annual Report of the Graduate School of Medicine and The Faculty of Medicine
The University of Tokyo Reports for the Period April 2002 - March 2004
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