Nobuo Anzai

Interrater reliability of the Japanese version of the Positive and Negative Syndrome Scale and the appraisal of its training effect

The purpose of the present study is to test interrater reliability of the Japanese version of the Positive and Negative Syndrome Scale (PANSS) and to examine factors possibly affecting the reliability. The study group conducted the PANSS rating on 20 patients with DSM‐IV schizophrenia. For the analysis of interrater reliability, intraclass correlation coefficient (ICC) was calculated. The ICC for individual items of the PANSS ranged from 0.26 to 0.92, and those for the positive, negative, and general psychopathology subscales were 0.85, 0.83 and 0.75, respectively. The Cronbachs alpha coefficient for the subscales were 0.84, 0.87 and 0.76, respectively. The interrater reliability and the internal consistency were satisfactory and similar to those obtained in the antecedent studies. No salient training effect was found in a sequential analysis of the concordance rate. It is concluded that the Japanese version of the PANSS is a reliable and efficient tool for comprehensive assessment of the schizophrenic syndrome.

Effect of the medication management module evaluated using the role play test

Abstract Training in social skills has been shown to have a strong, positive impact, according to behavioral measures, on social skills, self‐rated assertiveness, and the hospital discharge rate. It is important to establish a system of assessing social skills because it is necessary for the effects of social skills training to be assessed in Japan. In Project 1, we devised a Japanese version of the role play test to quantify social skills using a standard method. We tested 30 patients attending the day hospital who were considered to need intensive rehabilitation. We found the role play test had high inter‐rater and test‐retest reliability, and had construct validity and criterion related validity. Thus, the role play test was thought to be a useful tool for assessing social skills. For Project 2, eight inpatients who were ready for discharge but who needed to improve their skills in self‐managed medication participated in this study. The social skills of self‐managed medication assessed using the role play test were significantly improved after the subjects participated in the Medication Management Module of the UCLA social and independent living skills program. Knowledge of self‐managed medication also tended to improve after training. This study is preliminary and it should be confirmed that improved skills influenced by the medication management module decreases the relapse rates.

Development of a clinical pathway for long-term inpatients with schizophrenia

Clinical pathways have been defined as an optimal sequencing and timing of interventions by staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care and minimize delays. The aim of the present study was to develop a clinical pathway for long‐term inpatients with schizophrenia. A review of clinical records was conducted for 17 patients with schizophrenia who had stayed in one psychiatric hospital for >1 year, and who remained in the community >3 months after hospital discharge. A review of clinical routine records was conducted. The discharge process of each patient was expressed in a clinical pathway around phases and care components. They were integrated into one clinical pathway. The discharge process was divided into assessment and goalsetting, preparation, and discharge phases. Care components included discharge planning, daily activity, living environment, health management, and basic life skills. Discharge planning was an important care component that was combined with all three phases. A clinical pathway was developed from reviewing past patient records, and discharge planning was found to be an important care component, which was combined with all three phases: assessment and goalsetting, preparation, and discharge. Further study is needed to examine the validity of the pathway for use in other hospitals.

Effects of psychosocial program for preparing long‐term hospitalized patients with schizophrenia for discharge from hospital: Randomized controlled trial

The aims of the present study were to revise the Community Re‐entry Program–Japanese version and to review the effectiveness of the revised Program, named the Discharge Preparation Program.

Adoption and dissemination of social skills training in Japan: a decade of experience (1988-1997)

Psychiatric rehabilitation has been slow to develop in Japan, in part because of traditional stigma against community-based treatment of the seriously mentally ill and a prevailing biological approach to schizophrenia. In the past decade, however, rehabilitation methods have been introduced, spearheaded by social skills training. The rapid dissemination of social skills training in Japan has been promoted by the publication of a national newsletter, the development of a Japanese Social Skills Training Association, reimbursement of social skills training by the national health insurance, and an active schedule of workshops, seminars, lectures and training programs. Research on social skills training has paralleled its development as a clinical modality. When skills training has been delivered with fidelity, it has been possible to measure the acquisition of skills by persons with schizophrenia. A role-play test has been validated after its cultural adaptation to Japan and correlations have been found betwe...

Diagnostic reliability and significance of irregular beta patterns

Abstract: We designated EEGs with marked and irregular beta waves in basic patterns as “irregular beta patterns” on the basis that these patterns are related with particular symptoms such as dysphoria, irritability and autonomic symptoms and they implicate choice of therapeutic agents. Because of good response to antiepileptic agents in patients with “irregular beta patterns” along with EEG characteristics, we hypothesized that the prevalence of “irregular beta patterns” is higher in epileptics than in other psychiatric patients. In the present study, we tested this hypothesis, investigating actual frequencies of these patterns among different diagnostic categories for all patients whose EEG were recorded in all the first‐visit patients to the Outpatient Clinic, Deparmtent of Neuropsychiatry of the Tokyo University Hospital during one year period of 1986. Before starting this investigation, we checked the interrater reliability for these patterns. Therefore, two studies are reported here. In Study 1, five raters judged 98 EEG recordings blindly (43 epileptics and 55 healthy subjects). As a result, the generalized Kappa of 0.473 was obtained, indicating our agreement level was moderate or fair. This result lends support to our contention that irregular beta patterns are reliably judged. In Study 2, we judged the EEG recordings (137 schizophrenics, 62 affective disorders, 43 epileptics and 55 healthy controls) and calculated the prevalence rate of “irregular beta patterns” among the diagnostic categories. The results show that the prevalence rates of “irregular beta patterns” among psychiatric disorders and normal controls were 13% (18/137) in schizophrenics, 11% (7/62) in affective disorders, 14% (6/43) in epileptics and 4% (2/55) in healthy controls. These rates did not differ significantly among the three disorders. Thus, our hypothesis was not supported. The clinical significance of these patterns is discussed.

Linkage Analysis between Familial Myoclonus Epilepsy and Short Arm of Chromosome 6 Using HLA Phenotype as Genetic Marker

Genetic factors have been implicated in the etiology of epilepsies, specifically for familially transmitted ones. Recent development in molecular biology has provided US with various genetic markers available for a linkage study of genetically transmitted disorders. Using such markers, a linkage between seizure susceptibility and chromosome 9 was reported in El mouse.’ In linkage analyses of human epilepsies, the gene locus in chromosome 20 was suggested for benign familial neonatal convulsion3, the short arm of chromosome 6 for juvenile myoclonic epilepsy using human leucocyte antigen (HLA) as a marker (JME)’, and chromosome 21 for progressive myoclonus epilepsy of the Unverricht-Lundborg type2 as well as both Baltic and Mediterranean types4. Here, we studied the genetic linkage be275

Effects of risperidone and aripiprazole on neurocognitive rehabilitation for schizophrenia

Methods to improve neurocognitive impairments are of important research interest. This study sought to examine the synergistic effects of neurocognitive rehabilitation and antipsychotics for schizophrenia.

Compensotory function of central dopaminergic system for suppressing psychic seizures — repeated plasma homovanillic acid measurement in refractory temporal lobe epilepsy

Abstract Repeatedly measured plasma homovanillic acid concentration, as a clinically available index of central dopaminergic activity in a patient with temporal lobe epilepsy during a drug-free period, was significantly correlated with seizure frequency in the weak immediately following, but not preceding, blood sampling days. This result suggest a compensatory function of the dopaminergic system in suppressing refractory psychic seizures.

Training Long-Term Schizophrenic Inpatients in Illness Self-Management: A Randomized Controlled Trial

Although far behind that of other developed countries, Japanese psychiatry has started shifting from hospital-based to community-based services. For many long-term inpatients, it is necessary not only to provide welfare work but also to strengthen their ability to live outside the hospital. In order to determine whether long-term inpatients with schizophrenia could learn and retain knowledge related to self-management of illness, we conducted a randomized controlled trial. The subjects were 32 inpatients with schizophrenia (ICD-10) who agreed voluntarily to participate in this study. Their mean age was 46.8 years, the mean number of years after onset was 20.5, and the mean duration of current hospitalization was 4.0 years. They were randomly assigned to the training group of the Community Re-Entry Program or to occupational rehabilitation activities. Each program consisted of 18 1-h sessions, twice a week. The results showed that knowledge of self-management of illness was significantly better in the training group than in the control group immediately and 1 year after training. Retention of knowledge 1 year after training was negatively correlated with the number of years after onset of illness. REHAB scores were significantly better in the training group than in the control group after training. Discharge rates 1 year after training were significantly higher in the training group (10/14; 71.4%) than in the control group (3/15; 20.0%). We conclude that improvement of knowledge and the high rate of discharge in the training group suggest the effectiveness of the program. Of the 10 patients in the training group who were discharged after training, 9 lived alone in the community and 8 received home-visit service by psychiatric nurses of the ward from which they were discharged. This suggests that the high discharge rate of patients in the training group was the result of the improvement of relationships between patient and nurses and/or improvement of the patients’ attitude to treatment from training in self-monitoring of warning signs.