Jun Shigemura

Health effects of radiation and other health problems in the aftermath of nuclear accidents, with an emphasis on Fukushima

437 nuclear power plants are in operation at present around the world to meet increasing energy demands. Unfortunately, five major nuclear accidents have occurred in the past--ie, at Kyshtym (Russia [then USSR], 1957), Windscale Piles (UK, 1957), Three Mile Island (USA, 1979), Chernobyl (Ukraine [then USSR], 1986), and Fukushima (Japan, 2011). The effects of these accidents on individuals and societies are diverse and enduring. Accumulated evidence about radiation health effects on atomic bomb survivors and other radiation-exposed people has formed the basis for national and international regulations about radiation protection. However, past experiences suggest that common issues were not necessarily physical health problems directly attributable to radiation exposure, but rather psychological and social effects. Additionally, evacuation and long-term displacement created severe health-care problems for the most vulnerable people, such as hospital inpatients and elderly people.

Psychological Distress in Workers at the Fukushima Nuclear Power Plants

Rita F. Redberg, MD Mitchell H. Katz, MD Author Affiliations: Division of Cardiology, University of California, San Francisco (Dr Redberg; redberg@medicine.ucsf.edu); and Department of Health Services, County of Los Angeles, Los Angeles, California (Dr Katz). Dr Redberg is the Editor and Dr Katz is the Deputy Editor of the Archives of Internal Medicine. Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest none were reported.

Telepsychiatry: assessment of televideo psychiatric interview reliability with present‐ and next‐generation internet infrastructures

Objective: We assessed the reliability of remote video psychiatric interviews conducted via the internet using narrow and broad bandwidths.

Mental health issues of peacekeeping workers

The end of the Cold War has brought a dramatic change to the international political situation and the role of the United Nations peacekeeping operations (PKO) has drawn increased attention. While many reports on PKO have focused on political or sociologic considerations, the mental health of the peacekeepers themselves has received little attention and psychiatric problems that can have a negative impact on mission success have been largely ignored. Participation in PKO creates a number of stressors and serious psychiatric and/or physical disorders may result. Yet, there is little research on this topic, either domestically or globally, and the methodology for clinical intervention remains in an early stage of development. We have reviewed previous reports to determine how various stressors before, during and after deployment affect the participants. Research in associated fields (e.g. crisis workers and military personnel) are also reviewed and their application to peacekeeping psychiatry is discussed. It must be admitted that the significance of PKO is arguable and each PKO is unique in terms of the nature of its mission and the local situation. Yet, the relationship between the psychiatric status of the personnel and the characteristics of an individual mission has never been studied. At present, no clear consensus regarding a framework for psychiatric intervention exists. Studies that enhance the recognition and significance of peacekeeping psychiatry are likely to improve the efficacy of PKO.

The Great East Japan Earthquake, tsunami, and Fukushima Daiichi nuclear power plant accident: a triple disaster affecting the mental health of the country.

The Great East Japan Earthquake in 2011 caused 2 other serious disasters: a tsunami and a nuclear power plant accident. A chronic shortage of mental health resources had been previously reported in the Tohoku region, and the triple disaster worsened the situation. Eventually a public health approach was implemented by providing a common room in temporary housing developments to build a sense of community and to approach evacuees so that they could be triaged and referred to mental health teams. Japan now advocates using psychological first aid to educate first responders. This article extracts key lessons from relevant literature.

Activation time course of responses to illusory contours and salient region: A high-density electrical mapping comparison

Until recently, early visual areas (V1/V2) were believed to respond mainly to illusory contours (ICs). At present, however, functional neuroimaging suggests that the human lateral occipital complex (LOC), a higher tier than V2, responds strongly to ICs and that IC-related activation in V1/V2 in fact might be driven by feedback input from the LOC. When Kanizsa-type ICs are modified by rounding the corners of the inducers and misaligning them slightly, the impression of an enclosed salient region (SR) remains, although ICs no longer are perceived. Stanley and Rubin (Stanley, D.A., Rubin, N., 2003. fMRI activation in response to illusory contours and salient regions in the human lateral occipital complex. Neuron, 37, 323-331) found that the LOC responded to SR, suggesting that the LOC subserves a rapid but crude region-based segmentation process preceding boundary completion in V1/V2. The present study compared the time course of cortical responses to ICs with those to SR using high-density (74-channel) event-related potentials (ERPs). Scalp mapping and statistical analysis indicated that shared negative modulation for ICs and SR was distributed bilaterally over the lateral occipital scalp at a latency of 70 to 180 ms. Slightly later, a weak negative modulation occurred with ICs but not SR at the occipital pole scalp from 170 to 180 ms. Dipoles for early and late modulations were fitted optimally in the LOC and occipital pole, respectively. The present results suggested that IC-related cortical activation could be separated into region-based segmentation and subsequent boundary completion.

Associations between Disaster Exposures, Peritraumatic Distress, and Posttraumatic Stress Responses in Fukushima Nuclear Plant Workers following the 2011 Nuclear Accident: The Fukushima NEWS Project Study

Background The 2011 Fukushima Daiichi Nuclear Power Plant accident was the worst nuclear disaster since Chernobyl. The nearby Daini plant also experienced substantial damage but remained intact. Workers for the both plants experienced multiple stressors as disaster victims and workers, as well as the criticism from the public due to their companys post-disaster management. Little is known about the psychological pathway mechanism from nuclear disaster exposures, distress during and immediately after the event (peritraumatic distress; PD), to posttraumatic stress responses (PTSR). Methods A self-report questionnaire was administered to 1,411 plant employees (Daiichi, n = 831; Daini, n = 580) 2–3 months post-disaster (total response rate: 80.2%). The socio-demographic characteristics and disaster-related experiences were assessed as independent variables. PD and PTSR were measured by the Japanese versions of Peritraumatic Distress Inventory and the Impact of Event Scale-Revised, respectively. The analysis was conducted separately for the two groups. Bivariate regression analyses were performed to assess the relationships between independent variables, PD, and PTSR. Significant variables were subsequently entered in the multiple regression analyses to explore the pathway mechanism for development of PTSR. Results For both groups, PTSR highly associated with PD (Daiichi: adjusted β, 0.66; p<0.001; vs. Daini: adjusted β, 0.67; p<0.001). PTSR also associated with discrimination/slurs experience (Daiichi: 0.11; p<0.001; vs. Daini, 0.09; p = 0.005) and presence of preexisting illness(es) (Daiichi: 0.07; p = 0.005; vs. Daini: 0.15; p<.0001). Other disaster-related variables were likely to be associated with PD than PTSR. Conclusion Among the Fukushima nuclear plant workers, disaster exposures associated with PD. PTSR was highly affected by PD along with discrimination/slurs experience.

Mental health and psychological impacts from the 2011 Great East Japan Earthquake Disaster: a systematic literature review

BackgroundOn March 11, 2011, Japan experienced an unprecedented combination of earthquake/tsunami/nuclear accidents (the Great East Japan Earthquake; GEJE). We sought to identify mental health and psychosocial consequences of this compound disaster.MethodA systematic literature review was conducted of quantitative research articles addressing mental health of survivors and the psychological impact of the GEJE. For articles between March 2011 and December 2014, PubMed, PsychINFO, and EMBASE databases were searched with guidance on literature review method.ResultsForty-nine studies met the inclusion criteria. A substantial proportion of the affected individuals experienced considerable psychological distress. Mental health outcomes included, but were not limited to, posttraumatic stress disorder, depression, and anxiety symptoms. Physical health changes, such as sleeping and eating disturbances, also occurred. In Fukushima, radioactive release induced massive fear and uncertainty in a large number of people, causing massive distress among the affected residents, especially among mothers of young children and nuclear plant workers. Stigma was additional challenge to the Fukushima residents. The review identified several groups with vulnerabilities, such as disaster workers, children, internally displaced people, patients with psychiatric disorders, and the bereaved.ConclusionsFollowing the GEJE, a considerable proportion of the population was mentally affected to a significant degree. The affected individuals showed a wide array of mental and physical consequences. In Fukushima, the impact of nuclear disaster was immense and complex, leading to fear of radiation, safety issues, and stigma issues.

Predictors of antidepressant adherence: Results of a Japanese Internet-based survey

Aim:  The purpose of the present study was to identify the psychosocial/pharmacological predictors of antidepressant (AD) adherence.

Lithium‐induced Hashimoto’s encephalopathy: a case report

OBJECTIVE To report on a patient with Hashimotos encephalopathy induced by lithium. PATIENT AND INTERVENTIONS: A 61-year-old woman with a type II bipolar disorder and a history of lithium-induced thyrotoxicosis associated with silent thyroiditis was hospitalized to treat a severe major depressive episode. Given long-term treatment with levothyroxine for hypothyroidism that had resulted from silent thyroiditis, endogenous hormone in thyroid follicles was assumed to be minimized by the negative feedback, decreasing risk of recurrent thyrotoxicosis if lithium were restarted. RESULTS Lithium clearly relieved the patients depressive symptoms, but after 40 days encephalopathy developed. Thyrotoxicosis was ruled out, and serum antithyroid antibody titers were elevated. In the cerebrospinal fluid, protein content was substantially elevated and antithyroid antibodies were detected. Encephalopathy resolved dramatically after course of intravenous pulse therapy with methylprednisolone. CONCLUSIONS We believe that autoantibodies against antigens shared by the thyroid gland and the brain were induced by exposure to lithium, causing the patient to develop Hashimotos encephalopathy.