Chiaki Kawanishi

The usefulness of combined brain perfusion single‐photon emission computed tomography, Dopamine‐transporter single‐photon emission computed tomography, and 123I‐metaiodobenzylguanidine myocardial scintigraphy for the diagnosis of dementia with Lewy bodies

Current diagnostic criteria recommend neuroimaging as a diagnostic support tool for the clinical diagnosis of dementia with Lewy bodies (DLB). Because DLB causes characteristic impairments and disabilities, such as neuroleptic hypersensitivity, which may significantly increase morbidity and mortality, its prompt and correct diagnosis is very important. The aim of this study was to evaluate the extent to which diagnostic accuracy can be increased by using different combinations of brain perfusion single‐photon emission computed tomography (bp‐SPECT), 123 I‐metaiodobenzylguanidine myocardial scintigraphy (MIBG scintigraphy), and DAT‐SPECT. Taking finances and patient burden into consideration, we compared the tests to determine priority.

Effects of NRG1 genotypes on orbitofrontal sulcogyral patterns in Japanese patients diagnosed with schizophrenia

Numerous reports have described differences in the distribution of orbitofrontal cortex (OFC) sulcogyral patterns between patients with schizophrenia (SZ patients) and healthy controls (HC). Alterations in OFC morphology are also observed in those at high risk for developing SZ and in first‐episode SZ, suggesting that genetic associations may be extant in determining OFC sulcogyral patterns. We investigated the association between single nucleotide polymorphisms (SNP) in NRG1 and OFC sulcogyral patterns.

Effectiveness of assertive case management on repeat self-harm in patients admitted for suicide attempt: Findings from ACTION-J study

BACKGROUND Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. METHODS This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). RESULTS The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). LIMITATIONS Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. CONCLUSIONS The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm.

A large-scale survey of inpatient suicides: comparison between medical and psychiatric settings

Suicide is one of the common severe accidents occurring in hospitals. This study aimed to investigate inpatient suicides simultaneously in medical and psychiatric settings in a large number of hospitals and to examine the prevalence of common suicide risk factors, related symptoms in inpatients who had died by suicide and the differences in inpatient suicides between both settings. We conducted a survey of hospitals in Japan that belonged to the nationwide standard-setting and accrediting body. The questionnaire covered the: 1) presence or absence of inpatient suicides in each hospital from 2012 to 2015; 2) number of inpatient suicides; 3) method, location, and timing of inpatient suicides; and 4) characteristics of inpatients who died by suicide. In total, 529 hospitals reported 262 inpatient suicides during the 3-year period: 131 were in medical settings and 131 were in psychiatric settings. The prevalence of common suicide risk factors was frequent in inpatient suicides. Inpatients had characteristics and suicide risk factors specific to those settings such as worsening of physical health in medical settings. Therefore, recognizing common suicide risk factors and understanding differences in inpatient suicides between both settings are important to prevent inpatient suicides.

Approaches to suicide prevention: Ideas and models presented by Japanese and international early career psychiatrists: Letters to the Editor

Each year since 2006, 12 early career psychiatrists from around the world are selected to participate in the Japanese Society of Psychiatry and Neurology (JSPN) fellowship award symposium to form friendships and stimulate academic collaborations. This article is protected by copyright. All rights reserved.

Prevalence rate of Internet addiction among Japanese college students: Two cross-sectional studies and reconsideration of cut-off points of Young's Internet Addiction Test in Japan: Prevalence rate of Internet addiction

Due to variation in estimates of the prevalence of Internet addiction (IA) in prior research, we conducted two cross‐sectional studies over 2 years investigating the prevalence rate of IA in college students in Japan and reconsidered appropriate cut‐off points of a self‐rating scale to screen possible IA.

Psychiatric Consultations at an Emergency Department in a Metropolitan University Hospital in Northern Japan

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.

Retrospective Study of Trazodone Monotherapy Compared with Ramelteon and Trazodone Combination Therapy for the Management of Delirium

Background: Accumulating evidence supports the efficacy of antipsychotics in patients with delirium. However, extrapyramidal symptoms caused by antipsychotic medications represent a major concern in the pharmacotherapy of delirium, meaning that therapeutic alternatives using drugs other than antipsychotics are required. The aim of this study was to compare the efficacy and tolerability of trazodone monotherapy with ramelteon and trazodone combination therapy for the management of the symptoms of delirium. Methods: A case-control study was conducted in a general hospital setting. Delirium Rating Scale-revised-98 (DRS-R-98) scores were measured at the initial examination and at 3–7 days after starting the study drugs. Adverse drug reactions were also assessed. Results: Thirty-three patients were retrospectively enrolled to the trazodone monotherapy group (T group) and 59 patients were enrolled to the ramelteon and trazodone combination therapy group (RT group). No significant differences in demographic characteristics were observed between the groups. Following treatment, the total DRS-R-98 scores were significantly reduced in both groups (22.0 ± 5.5 to 13.5 ± 8.5 in the T group and 23.7 ± 6.1 to 11.4 ± 8.6 in the RT group). However, the proportion of patients meeting the remission criteria was significantly higher in the RT group than in the T group (71% vs. 48%; chi-square=4.681, p=0.030). The most commonly reported side effect was somnolence, in the RT group (3%). Conclusion: Our findings indicate that both trazodone monotherapy and combination therapy of ramelteon and trazodone were effective in managing the symptoms of delirium. However, more patients met the remission criteria following combination therapy with ramelteon and trazodone. In both groups, the incidence of adverse drug reactions was very low.

Protocol for a prospective multicentre registry cohort study on suicide attempters given the assertive case management intervention after admission to an emergency department in Japan: post-ACTION-J Study (PACS)

Introduction Suicide attempt is the most important risk factor for later suicide. A randomised-controlled, multicentre trial of postsuicide attempt case management for the prevention of further suicide attempts in Japan, named ACTION-J, has established effective interventions for prevention of suicide reattempts. The ACTION-J assertive case management intervention programme was adopted by the Japanese Ministry of Health, Labour and Welfare in 2016, when medical fees were revised. This nationwide programme is provided to patients who attempt suicide and who are admitted to emergency departments in Japan. The aim of the present study is to examine the current implementation status of the ACTION-J programme. The present study also aims to clarify which patients’ and hospitals’ factors affect the implementation of the programme. Methods and analysis This is a prospective, multicentre, patient registry cohort study. Participants will be suicide attempters admitted to the emergency departments of medical facilities with both psychiatry and emergency departments. The assertive case management programme will be delivered to participants by a case manager for up to 24 weeks, based on psychiatric diagnoses, social risks and patient needs. The core feature of the programme is to encourage patients to participate in psychiatric treatment. The primary outcome will be the proportion of patients still participating in the case management intervention at 24 weeks after registration. The secondary outcomes will include measures of the fidelity of the case management intervention. The fidelity will be evaluated using a fidelity assessment manual developed by the study group. Ethics and dissemination This observational study has been approved by the ethics board of Sapporo Medical University. Enrolment began in October 2016 and will continue until December 2018. Dissemination plans include presentations at scientific conferences and scientific publications. Trial registration UMIN000024474.

Antipsychotics promote GABAergic interneuron genesis in the adult rat brain: Role of heat-shock protein production

Current antipsychotics reduce positive symptoms and reverse negative symptoms in conjunction with cognitive behavioral issues with the goal of restoring impaired occupational and social functioning. However, limited information is available on their influence on gliogenesis or their neurogenic properties in adult schizophrenia brains, particularly on GABAergic interneuron production. In the present study, we used young adult subventricular zone (SVZ)-derived progenitor cells expressing proteoglycan NG2 cultures to examine the oligodendrocyte and GABAergic interneuron genesis effects of several kinds of antipsychotics on changes in differentiation function induced by exposure to the NMDA receptor antagonist MK-801. We herein demonstrated that antipsychotics promoted or restored changes in the oligodendrocyte/GABAergic interneuron differentiation functions of NG2(+) cells induced by the exposure to MK-801, which was considered to be one of the drug-induced schizophrenia model. We also demonstrated that antipsychotics restored heat-shock protein (HSP) production in NG2(+) cells with differentiation impairment. The antipsychotics olanzapine, aripiprazole, and blonanserin, but not haloperidol increased HSP90 levels, which were reduced by the exposure to MK-801. Our results showed that antipsychotics, particularly those recently synthesized, exerted similar GABAergic interneuron genesis effects on NG2(+) neuronal/glial progenitor cells in the adult rat brain by increasing cellular HSP production, and also suggest that HSP90 may play a crucial role in the pathophysiology of schizophrenia and is a key target for next drug development.