Hidehito Niimura

Long-term course of cognitive function in chronically hospitalized patients with schizophrenia transitioning to community-based living

Schizophrenia is associated with impairments in social interactions, and the conditions under which patients live and undergo treatment appear to have an important role in the course of the disease. However, the influences of care settings on the course of cognition remain controversial. The closure of psychiatric hospitals and the transition to community-based living is a golden opportunity to address this issue. The aims of the present study were to examine (1) the longitudinal course of cognition as well as the psychopathology and social functioning of schizophrenia patients who had been chronically hospitalized and then discharged, and (2) the key cognitive predictors of the functional outcome of such patients. Seventy-eight patients were transferred to the community after the closure of a psychiatric hospital. These patients were followed-up for 5 years and underwent annual examinations that included measures of cognition, psychiatric symptoms, and social functioning. Fifty-six patients completed all the assessments. Although consistent improvements were shown in the cognitive domains for attention and memory, the initial improvements in global cognition and processing speed ultimately began to decline. Symptoms and global functioning improved almost consistently over the course of the follow-up period. Stepwise multiple regressions revealed category fluency at baseline predicted social functioning at 5 years. However, this correlation was no longer significant when psychopathological variables were included as predictors. These results suggest that care settings affect the course of cognition, and addressing these conditions may lead to a certain degree of cognitive improvement even among schizophrenia patients who have been chronically institutionalized.

Cognitive insight and functional outcome in schizophrenia; a multi-center collaborative study with the specific level of functioning scale–Japanese version

The Specific Levels of Functioning Scale (SLOF) has been reported to provide a measure of social function in patients with schizophrenia. The aim of this multi-center study was to determine convergent validity of the Japanese version of SLOF, and if cognitive insight would be associated with social function. Fifty-eight patients with schizophrenia participated in the study. Social function, neurocognition, and daily activity skills were evaluated by the Social Functioning Scale (SFS), Brief Assessment of Cognition in Schizophrenia (BACS) and UCSD Performance-based Skills Assessment-Brief (UPSA-B), respectively. We also assessed cognitive insight with the Beck Cognitive Insight Scale (BCIS). Significant relationships were noted between scores on the SLOF vs. those of the SFS, BACS, UPSA-B, and BCIS. Specifically, the correlation between performance on the UPSA-B and SLOF scores was significantly more robust compared to the correlation between performance on the UPSA-B and scores on the SFS. Similarly, the correlation between scores on the BACS and SLOF tended to be more robust than that between the BACS and SFS. Importantly, while the correlation between scores on the BCIS and SLOF reached significance, it was not so between scores on the BCIS and SFS. The SLOF Japanese version was found to provide a measure of social consequences in patients with schizophrenia. Importantly, this study is the first to indicate the relationship between cognitive insight and social function evaluated by the SLOF. This finding is consistent with the observation that SLOF scores were considerably associated with performances on objective functional measures.

Successful aging in individuals with schizophrenia dwelling in the community: A study on attitudes toward aging and preparing behavior for old age

Aim:  ‘Successful aging’ in individuals with schizophrenia has been attracting attention. We examined two forward‐looking factors of successful aging among schizophrenia patients: ‘attitude toward aging’ and ‘preparing behavior for old age’.

Social cognition and metacognition contribute to accuracy for self-evaluation of real-world functioning in patients with schizophrenia

Enhancement of social function is an important goal in the treatment of schizophrenia. To designate appropriatemeasures of real-world functioning, the Validation of Everyday Real-World Outcomes initiative recommended the Specific Levels of Functioning-Scale (SLOF). The SLOF has been developed as an interview-based assessment tool; the scores by clinicians are based on information frombothpatients and caregivers (Leifker et al., 2009). The SLOF covers interpersonal functioning, everyday activities, and vocational functioning (Schneider and Struening, 1983). Factors affecting SLOF scores evaluated objectively (by clinicians or caregivers) or subjectively (by patients) have been investigated. Durand et al. (2015) observed that scores on the SLOF rated by clinicians were correlated with performance on the UCSD Performance-based Skills Assessment-Brief (UPSA-B), representing daily-living skills, while scores reported by patients were associated with depression (Durand et al., 2015). Specifically, Ermel et al. (2017) examined the discrepancy between caregiverand patient-evaluated SLOF scores, and found its relationship with depressive emotion and work function (Ermel et al., 2017). However, little is known about other clinical factors affecting the judgment of his/her own real-world functioning. Specifically, we considered social cognition and metacognition may influence evaluation of social function. In fact, social cognition has been shown to mediate neurocognition and social function (Schmidt et al., 2011), while metacognition has been associated with real-world functioning (Sumiyoshi et al., 2016). In this study, we sought to determine if social cognition and metacognition contribute to the difference between SLOF scores provided by patients and those by caregivers/clinicians.Wehypothesized that social cognition, as measured by the Social Cognition Screening Questionnaire (SCSQ) (Roberts et al., 2011) and meta-cognition, as evaluated by the Beck Cognitive Insight-Scale (BCIS) (Beck et al., 2004)would explain the discrepancy between self-reporting and objectively-rated scores on the SLOF.

Preparing for a paradigm shift in aging populations: listen to the oldest old

ABSTRACT Purpose: Current healthcare systems are not suitable for serving future societies in which the oldest old are commonplace. The objective of this study was to understand what the oldest old care most about in their daily lives. Methods: Semi-structured in-depth interviews and thematic analysis were used. Face-to-face interviews were conducted in 17 elderly residents (≥ 95 years) of Arakawa-ku, Tokyo, Japan from July to November 2017. Results: Three themes emerged from the interview responses: “unshakable beliefs and social ties,” “natural acceptance,” and “my day-to-day life with precious moments.” The oldest old strongly believe in diligence and compassion and maintain strong relationships with people around them. Despite their small social networks, they are concerned about future society. They accept their selves and their lives, including their impending deaths. Despite their functional decline, they control their lives by making very small decisions. They live on a moment-to-moment basis, cherishing simple events. Conclusion: Maintaining autonomy through making small decisions and enjoying small pleasures are important to the oldest old. Understanding the needs of the oldest old is the first step towards developing optimal geriatric care for an aging population.

Relationships between socio-clinico-demographic factors and global cognitive function in the oldest old living in the Tokyo Metropolitan area: Reanalysis of the Tokyo Oldest Old Survey on Total Health (TOOTH)

Despite a steady increase in life expectancy, a few studies have investigated cross‐sectional correlates and longitudinal predictors of cognitive function, a core domain of the successful aging, among socio‐clinico‐demographic factors in the oldest‐old exclusively.

Successful institutional care for behavioral and psychological symptoms of dementia in a repopulated area after the 2011 Fukushima disaster: A case report

Caregiving in a long‐term facility played a key role in improvements of this patients behavioral and psychological symptoms of dementia, which also led to a reduced caregiver burden on her family members. Considering the global population aging trend, the lesson from this case may apply to other settings beyond disasters.

Is it possible to implement community care based on mental health in Japan? A comparison between decade ago and present on Duration of Untreated Psychosis (DUP)

INTRODUCTION In recent years, the early detection and treatment of the first episode of schizophrenia (FES) has attracted worldwide attention. In Japan, psychiatric care has changed to an open and accessible framework over the past decade. Therefore, the duration of untreated psychosis (DUP) is thought to have been shortened. The purposes of this study were to investigate whether recent DUP periods are shorter than they were 10 years ago and whether the DUP at present differs among psychiatric facilities. We investigated the recent DUP at a psychiatric hospital and its satellite clinic. MATERIAL AND METHODS We examined the differences in DUP, age, sex, referral pathway, living companions, social participation, and schooling history among 3 groups of FES patients: (i) a psychiatric hospital during 1999-2001 and (ii) during 2009-2011, and (iii) a psychiatric clinic during 2009-2011. RESULTS The average DUP was 14.3 (SD = 17.5) months for the psychiatric hospital during 1999-2001, 16.0 (SD = 18.7) months for the psychiatric hospital during 2009-2011, and 24.4 (SD = 30.0) months for the psychiatric clinic during 2009-2011. No significant differences were found in the DUP for each facility and during this decade. Also, the differences in the DUP could not be attributed to factors such as living companions or social participation. DISCUSSION Increases in the numbers of patients and psychiatric clinics have not led to the early detection of FES. To shorten the DUP in the future, closer cooperation among the medical field, the educational field, and the health and welfare will be needed.