Yasuyuki Okumura

Prevalence of diabetes and antipsychotic prescription patterns in patients with schizophrenia: a nationwide retrospective cohort study.

INTRODUCTION Despite an increasing concern that atypical antipsychotics seem to have a stronger diabetogenic risk than conventional antipsychotics, little information is available on the prevalence of diabetes among schizophrenia patients, and prescription patterns for patients with comorbid schizophrenia and diabetes in Japan. OBJECTIVES To compare the prevalence of diabetes between schizophrenia patients and the general population and to investigate whether diabetes status correlates the prescription patterns of antipsychotics at hospital discharge. METHODS Schizophrenia patients who were discharged between April 2004 and March 2005 and who continued to receive outpatient treatment from 526 hospitals were included in this retrospective open cohort study. We collected information about the doctor diagnosis of diabetes during hospitalization, and drug prescriptions for schizophrenia at hospital discharge using medical charts. RESULTS The overall prevalence of diabetes was 8.6% among patients with schizophrenia. Compared with the general population, the estimates of diabetes prevalence in the schizophrenia population were 2.6-10.8 percentage point higher among males aged 30-49 years, and 1.9-9.9 percentage point higher among females aged 40-59 years. The odds of being prescribed conventional antipsychotics were about 2 times higher among patients with diabetes than without diabetes, relative to atypical and combination of conventional and atypical antipsychotics. These results were robust across various sensitivity analyses. CONCLUSION When treating schizophrenia patients with preexisting diabetes, psychiatrists need to monitor the occurrence of diabetes regularly regardless of antipsychotic class, strike a balance, and provide the most efficacious antipsychotic medication.

Cost of depression among adults in Japan.

OBJECTIVE The aim of this study was to estimate the annual national cost of major depressive disorder among adults 20 years and older in Japan in 2008. METHOD The analysis used was a top-down costing approach based on national health statistics. From the societal perspective, the costs examined were direct medical costs, depression-related suicide costs, and workplace costs for all members of society. Direct medical costs included both inpatient and outpatient medical costs, while workplace costs included both absenteeism and presenteeism costs. The authors performed 1-way sensitivity analyses to examine the extent to which results were affected by the choice of parameters used in the cost calculation. All costs were expressed in 2008 US dollar terms. RESULTS The economic burden of depression in Japan was approximately

Efficacy and acceptability of group cognitive behavioral therapy for depression: A systematic review and meta-analysis

11 billion, with

Hospital Readmission in First-Time Admitted Patients with Schizophrenia: Smoking Patients Had Higher Hospital Readmission Rate Than Non-Smoking Patients

1,570 million relating to direct medical costs,

Auditory verbal hallucinations increase the risk for suicide attempts in adolescents with suicidal ideation

2,542 million to depression-related suicide costs, and

Out-of-pocket expenditure burdens in patients with cardiovascular conditions and psychological distress: a nationwide cross-sectional study

6,912 million to workplace costs. Compared to previously published studies, this study adopted conservative key assumptions; this may have resulted in a conservative estimate of the annual national cost of depression. CONCLUSIONS Depression imposes a substantial economic burden on Japanese society, which highlights the urgent need for policymakers to allocate resources toward implementing strategies that prevent and manage depression in the Japanese population.

Characteristics, procedural differences, and costs of inpatients with drug poisoning in acute care hospitals in Japan

BACKGROUND Despite treatment guidelines for depression placing group cognitive behavioral therapy (group CBT) between low- and high-intensity evidence-based psychological interventions, the validity of the placement remains unknown. We aimed to systematically review evidence for the efficacy and acceptability of group CBT in patients with depression compared to four intensity levels of psychosocial interventions. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science and hand-searched the references in identified publications. We selected randomized controlled trials comparing group CBT with four levels of interventions for adult patients with depression. Two authors independently assessed risk of bias. RESULTS From 7953 records, we identified 35 studies that compared group CBT to non-active (k=30), low-intensity (k=2), middle-intensity (k=8), and high-intensity (k=1) interventions. Group CBT had a superior efficacy (standardized mean difference [SMD]=-0.68) and a similar acceptability compared to non-active controls. Pooled results showed a small but non-significant excess of group CBT relative to middle-intensity interventions (SMD=-0.21). LIMITATIONS Over 60% of studies did not report enough information to judge selection and selective reporting bias. CONCLUSIONS These results suggest the need for high-quality trials of group CBT compared to low- and high-intensity interventions.

Latent Structure of Depression in a Japanese Population Sample: Taxometric Procedures:

Objectives: To consider smoke-free policies for the patients with schizophrenia, the present study examined how smoking behavior is related to hospital readmission among patients with schizophrenia. Methods: A retrospective study was conducted in 2007 on 460 discharged patients with schizophrenia who voluntarily admitted in the participating psychiatric hospitals at first time. We reviewed smoking status, readmissions, and other variables including socio-demographic characteristics, process of care, and social functioning at discharge using the Global Assessment of Functioning scale (GAF). Results: The rate of cigarette smoking in this study was 42.2%. The rate of smoking was significantly higher in males (56.1%) than in females (26.2%). Mean GAF score at discharge was slightly higher in smoking patients than non-smoking patients (g = 0.18). Cox proportional hazard model revealed that hospital readmission rate was significantly higher in smoking patients than non-smoking patients after controlling for all other variables (HR = 1.78). Conclusions: Non-smoking patients had fewer hospital readmissions than smoking patients. This finding could be a reason to promote cessation of smoking which might provide positive influences on prognosis of schizophrenia.

Comparison of emergency hospital admissions for drug poisoning and major diseases: a retrospective observational study using a nationwide administrative discharge database.

OBJECTIVE It is important to prevent patients with suicidal ideation from actually attempting suicide. A school based cohort study suggested that auditory verbal hallucinations (AVHs) might play an important role in driving young people with mental health problems to attempt suicide. However, no clinical study to date has specifically investigated the association between AVHs and suicide attempts among young patients with suicidal ideation. METHOD We conducted a cross-sectional study of first-visit psychiatric referrals aged 10-15years at two general child and adolescent mental health hospitals in Japan. We administered self-reported questionnaires to measure suicidal ideation and suicide attempts, AVHs, and depression in the two weeks prior to the date of first-visit. RESULTS Among 188 patients with suicidal ideation, the presence of AVHs was associated with increased odds of suicide attempts (OR 3.4, 95% CI 1.7-6.9; p<0.05); however, depression was not associated with a significant change of odds (OR 0.7, 95% CI 0.4-1.3; p=0.29). CONCLUSIONS AVHs may increase the risk of suicide attempts made by adolescents with suicidal ideation. Clinicians should consider AVHs when adolescent patients present with suicidal ideation.

Prevalence, prescribed quantities, and trajectory of multiple prescriber episodes for benzodiazepines: A 2-year cohort study☆

OBJECTIVES This study aimed to estimate the prevalence of psychological distress in individuals with and without cardiovascular risks and events [cardiovascular disease (CVD) conditions] and the incremental effects of psychological distress on the out-of-pocket health care expenditure burdens. METHODS We used data from the Comprehensive Survey of Living Conditions 2007, a nationally representative cross-sectional survey in Japan. Psychological distress assessed by the K6 scale, the presence of treated CVD conditions and out-of-pocket health care expenditures as a share of household consumption expenditures were self-reported by 20,763 individuals living alone and aged between 20 and 59 years. RESULTS Individuals with obesity [adjusted odds ratio (AOR), 4.3], stroke (AOR, 3.2), ischemic heart disease (AOR, 2.3), hyperlipidemia (AOR, 1.8) or diabetes (AOR, 1.7) were more likely than those without to have serious psychological distress (SPD). With the exception of ischemic heart disease, less than half of CVD patients comorbid with SPD received treatment for mental illness. Patients comorbid with SPD and obesity (AOR, 6.1), SPD and ischemic heart disease (AOR, 3.4), and SPD and hypertension (AOR, 2.6) had higher out-of-pocket burdens than patients with only CVD conditions. CONCLUSIONS Our findings suggest the need for physicians to identify and manage SPD in patients with CVD conditions and for policymakers to find solutions to reduce the high out-of-pocket burdens among these patients.