Masaaki Murakami

A self-reported instrument for prodromal symptoms of psychosis: testing the clinical validity of the PRIME Screen-Revised (PS-R) in a Japanese population.

OBJECTIVE Early intervention for psychosis requires an easy, useful assessment instrument to identify subjects with prodromal symptoms at an early stage. The aim of this study was to test the clinical validity of the PRIME Screen-Revised (PS-R), a 12-item self-reported instrument for prodromal symptoms of psychosis, by comparing the results for a non-clinical population with those for a clinical population. METHOD The PS-R was administered to 1,024 subjects (496 students and 528 outpatients). Of the 528 patients, 115 were randomly recruited and tested using the Structured Interview for Prodromal Syndromes (SIPS) to determine the concordant validity of the PS-R. The predictive validity of the PS-R was measured by determining the transition rate to psychosis during a 6-month follow-up period. RESULTS The specificity and sensitivity of the PS-R, using the SIPS as a gold standard, were 0.74 and 1.00. The concordant validity of the PS-R against the SIPS was 0.43. The predictive validity of the PS-R and the SIPS, defined as the transition rate to psychosis, were 0.11 and 0.25, respectively. None of the patients with negative PS-R results developed psychosis. CONCLUSIONS Our findings showed that the PS-R was highly valid and that its usage is feasible in both general practice and clinical settings. This self-reported instrument represents a useful screening tool for alerting clinicians to subjects with psychotic prodromal symptoms.

Duration of untreated psychosis and pathways to psychiatric services in first-episode schizophrenia

Abstract  The aim of the present study was to examine the duration of untreated psychosis (DUP) in first‐episode schizophrenia patients in Japan and to investigate the available pathways to psychiatric services. Eighty‐three patients who visited Keio University Hospital (n = 54) or Oizumi Mental Hospital (n = 29) were evaluated retrospectively with regard to their DUP, living situation, social participation level, referral pathway, reason for seeking treatment, and their global assessment of functioning (GAF) score. The mean DUP was 13.7 months (median, 5.0 months) overall. No significant difference in DUP was found between subjects living alone and those living with others; however, employed patients had a significantly shorter DUP (8.1 months) than unemployed patients (18.7 months). Pathways to psychiatric services were totally different between the two institutions. Fifty‐two subjects (62.7%) came to the services directly: 40 patients (74.1%) came to the university hospital and 12 patients (41.4%) came to the mental hospital. At the mental hospital, nine patients (31.0%) had been admitted because of a legal obligation, and six (20.7%) had been referred through public health centers. None of the patients had been referred to either of the services by general practitioners. The main reason for seeking treatment was psychiatric symptom aggravation (59.3%) at the university hospital and acting out (64.3%) at the mental hospital. Some universal psychosocial factors appear to influence the DUP but the characteristics of specific psychiatric services may also affect treatment delays.

Clinical practice and research activities for early psychiatric intervention at Japanese leading centres.

Aim: To describe clinical practice and research activities for early psychiatric intervention in Japan, a country with a huge number of psychiatric beds and a history of long‐stay, hospital‐based psychiatry.

Lack of association between psychosis-like experiences and seeking help from professionals: A case-controlled study

BACKGROUNDS It still remains unclear whether individuals who experience attenuated psychotic symptoms are likely to seek help, whereas depressive symptoms are more likely to be associated with help-seeking behavior than these symptoms themselves. The aims of our study were to compare the profile of these symptoms between clinical and community samples and to investigate to what extent help-seeking behavior depends on the severity of psychosis-like symptoms and/or depressive symptoms. METHODS The clinical sample consisted of help-seeking outpatients aged 16-30 years who had approached a community mental health clinic (N=750, mean age: 23.3±4.2 years, 62.4% females). The community sample was comprised of students from two universities and two high schools (N=781, mean age: 18.1±1.7 years, 59.2% females). Psychosis-like experiences were assessed using the PRIME Screen-Revised (PS-R), a self-reported screening instrument for assessing the risk of psychosis. Depressive symptoms were assessed using the Zung Self-rating Depression Scale (ZSDS), a 20-item self-reported questionnaire. RESULTS Among the clinical and community samples, 27% and 10% had positive PS-R results respectively. No significant difference in the PS-R total score or the frequency of PS-R-positive items was observed between the clinical and community samples. A logistic regression analysis revealed that none of the psychosis-like experiences were significantly associated with help-seeking behavior, after controlling for the effect of depressive symptoms. CONCLUSIONS Our findings showed that attenuated psychotic symptoms do not contribute significantly to help-seeking behavior, suggesting that the relationships among PLEs, depressive symptoms, and help-seeking behavior should be reconsidered.

Perceptions of the effectiveness of ethical guidelines: an international study of physicians

The intent of ethics is to establish a set of standards that will provide a framework to modify, regulate, and possibly enhance moral behaviour. Eleven focus groups were conducted with physicians from six culturally distinct countries to explore their perception of formalized, written ethical guidelines (i.e., codes of ethics, credos, value and mission statements) that attempt to direct their ethical practice. Six themes emerged from the data: lack of awareness, no impact, marginal impact, other codes or value statements supersede, personal codes or values dictate, and ethical guidelines are useful. Overall, codes were valued only when they were congruent with existing personal morality. The findings suggest the need to re-evaluate the purpose, content, and delivery of codes for them to improve their function in promoting ethical conduct.

Idealism and Relativism Across Cultures: A Cross-Cultural Examination of Physicians’ Responses on the Ethics Position Questionnaire (EPQ)

This article represents one of the first cross-cultural explorations of ethical ideology among physicians. The study involved a total of 1,109 physicians from six countries (Canada, China, India, Ireland, Japan, and Thailand) who responded to the Ethics Position Questionnaire. A comprehensive Bayesian Confirmatory Factor Analysis demonstrated robustness of the ethical dimensions of idealism and relativism as fundamental across cultures, with noteworthy cross-cultural variation. In particular, a four-factor construct was revealed and suggested more complex ethical dimensions for Chinese physicians.

Ethical decision-making about older adults and moral intensity: an international study of physicians

Through discourse with international groups of physicians, we conducted a cross-cultural analysis of the types of ethical dilemmas physicians face. Qualitative analysis was used to categorise the dilemmas into seven themes, which we compared among the physicians by country of practice. These themes were a-theoretically-driven and grounded heavily within the text. We then subjected the dilemmas to an analysis of moral intensity, which represents an important (albeit novel within healthcare research) theoretical perspective of ethical decision making. These constructs (ie, culture and moral intensity) represent salient determinants of ethical behaviour and our cross-cultural sample afforded us the opportunity to consider both the pragmatic aspects of culture, as they are perceived by physicians, as well as the theory-driven concept of moral intensity. By examining both culture and moral intensity, we hope to better elucidate the complexities of ethical decision-making determinants among physicians in their daily practice. Doing so may potentially have practical implications for ethics training of medical students and foreign physicians.

Correlation between attenuated psychotic experiences and depressive symptoms among Japanese students.

Aims: To examine the emergence of attenuated psychotic experiences, self‐disturbance or affective symptoms among younger subjects in the general population and to investigate the intergroup differences on each symptom between adolescents and post‐adolescents.

Religiosity and Ethical Ideology of Physicians: A Cross-Cultural Study

In this study of ethical ideology and religiosity, 1,255 physicians from Canada, China, Ireland, India, Japan and Thailand participated. Forsyth’s (1980) Ethical Position Questionnaire and Rohrbaugh and Jessor’s (J Pers 43:136–155, 1975) Religiosity Measure were used as the survey instruments. The results demonstrated that physicians from India, Thailand and China reported significantly higher rates of idealism than physicians from Canada and Japan. India, Thailand and China also scored significantly higher than Ireland. Physicians from Japan and India reported significantly higher rates of relativism than physicians from Canada, Ireland, Thailand and China. Physicians from China also reported higher rates of relativism than physicians from Canada, Ireland and Thailand. Overall, religiosity was positively associated with idealism and negatively associated with relativism. This study is the first to explore the differences between ethical ideology and religiosity among physicians in an international setting as well as the relationship between these two constructs. Both religiosity and ethical ideology are extremely generalized, and the extent to which they may impact the actual professional behaviour of physicians is unknown. This paper sets up a point of departure for future research that could investigate the extent to which physicians actually employ their religious and/or ethical orientation to solve ambiguous medical decisions.

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.