Changes in health-related quality of life in patients admitted to emergency departments for attempted suicide: Findings from a large longitudinal study.

BACKGROUND: Studies of quality of life among suicide attempters are limited while it is considered important for preventing reattempt of suicide. We investigated health related quality of life (HRQoL) in suicide attempters immediately after the suicide attempt and in the long term. METHODS: This was longitudinal data from a randomized controlled multicenter trial. The Japanese version of the Short Form Health Survey-36 as HRQOL measured at 0, 6, and 12 months after randomization. RESULTS: 799 patients (356 men and 443 women) were analyzed. At baseline, the mean physical component summary (PCS) and the mental component summary (MCS) scores were 34.56 and 35.15, respectively, and they were significantly low compared with those of the general population. PCS scores significantly improved from baseline to 6 months (p = 0.003), from baseline to 12 months (p < 0.0001), and from baseline to 12 months (p = 0.002). MCS scores significantly improved from baseline to 6 months (p < 0.0001) and from baseline to 12 months (p < 0.0001). However, neither PCS nor MCS scores reached those of the general population norm at 12 months post-suicide attempt. LIMITATIONS: Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. CONCLUSION: This study presents a trajectory of HRQoL scores in suicide attempters from immediately after the suicide attempt to 1 year later. Further studies on HRQoL in suicide attempters are needed to elucidate the effective care for the attempters.

Reduced sociability in a prenatal immune activation model: Modulation by a chronic blonanserin treatment through the amygdala-hippocampal axis.

The environmental disturbances in a critical neurodevelopmental period exert organizational effects on brain intrinsic plasticity including excitatory and inhibitory (E/I) neurotransmission those can cause the onset of psychiatric illness. We previously reported that treatment of neural precursor cells with N-methyl-D-aspartate (NMDA) receptor antagonist MK-801 induced reduction of GABAergic interneuron differentiation, and these changes recovered by atypical antipsychotic blonanserin treatment in vitro. However, it remains unclear how this treatment affects neural circuit changes in hippocampus and amygdala, which might contribute to the prevention of onset process of schizophrenia. To elucidate the pathogenic/preventive mechanisms underlying prenatal environmental adversity-induced schizophrenia in more detail, we administered poly (I:C) followed by antipsychotics and examined alterations in social/cognitive behaviors, GABA/glutamate-related gene expressions with cell density and E/I ratio, and brain-derived neurotrophic factor (Bdnf) transcript levels, particularly in limbic areas. Treatment with antipsychotic blonanserin ameliorated impaired social/cognitive behaviors and increased parvalbumin (PV)-positive (+) cell density and its mRNA levels as well as Bdnf with long 3'UTR mRNA levels, particularly in the dorsal hippocampus, in rats exposed to maternal immune activation (MIA). Low dose of blonanserin and haloperidol altered GABA and glutamate-related mRNA levels, the E/I ratio, and Bdnf long 3'UTR mRNA levels in the ventral hippocampus and amygdala, but did not attenuate behavioral impairments. These results strongly implicate changes in PV expression, PV(+) GABAergic interneuron density, and Bdnf long 3'UTR expression levels, particularly in the dorsal hippocampus, in the pathophysiology and treatment responses of MIA-induced schizophrenia and highlight the therapeutic potential of blonanserin for developmental stress-related schizophrenia.

Implementations of an evidence-based assertive case management intervention for suicide attempters: Post-ACTION-J Study (PACS).

Aim: An assertive case management intervention program, ACTION-J, proved effective for preventing suicide attempters from reattempting suicide within 6 months. The ACTION-J randomized trial was conducted as part of the "National Strategic Research Projects." The program has been covered by the national medical payment system of Japan since 2016. The aim of the Post-ACTION-J Study (PACS) was to examine the current implementation status of assertive case management in a real-world clinical setting. Methods: PACS was a prospective, multicenter registry cohort study. The participants were suicide attempters admitted to the emergency departments of 10 participating medical facilities from October 2016 to September 2018. The assertive case management intervention developed by the ACTION-J Study was offered to all patients, and the primary outcome was the duration and frequency of use of the intervention at 6 months. Results: A total of 1159 patients were admitted to emergency departments after a suicide attempt during the study period, 144 of whom were included in our analysis. The proportion of participants who received the intervention for 6 months was 72.2% (104/144), and 63.9% (92/144) of the patients completed ≥7 case management interviews within 6 months. Conclusion: The findings of this study indicate successful implementation of an assertive case management intervention program based on the ACTION-J Study in a real-world clinical setting, following its integration with the national medical payment scheme in Japan. The study provided the useful information that could improve the implementation of assertive case management interventions in future.

Associations Between Regional Cerebral Blood Flow and Psychiatric Symptoms in Dementia With Lewy Bodies Without Parkinsonism.

Because dementia with Lewy bodies (DLB) has various psychiatric symptoms, early diagnosis in patients without parkinsonism is difficult. To reveal associations between regional brain perfusion and psychiatric symptoms in DLB patients without parkinsonism, we quantified brain perfusion using an automated brain perfusion single-photon emission computed tomography analysis program, FineSRT. We statistically analyzed the differences in brain perfusion between groups, divided by the presence or absence of psychiatric symptoms. In DLB patients with depression, there were significant brain perfusion increases in the left angular gyrus and right upper precuneus. In DLB patients with visual hallucinations, there were significant decreases in the left inferior parietal lobule, left superior temporal gyrus, and right primary visual cortex. In DLB patients with auditory hallucinations, there were significant increases in the right middle occipital and right inferior occipital gyri. Our findings provide clues about the pathomechanisms of psychiatric symptoms and may enable early diagnosis of DLB in the future.

Predictive factors for recurrent suicide attempts: Evidence from the ACTION-J study.

Aim: Risk factors for attempted suicide have been widely studied. However, there is limited evidence on predictive factors for suicide reattempts. We aimed to identify these in suicide attempters admitted to emergency departments. Methods: This is the second analysis from a randomized controlled multicenter trial, ACTION-J. Patient characteristics were extracted from baseline demographic data and clinical data of participants. Predictive factors for a recurrent suicide attempt in each gender were examined using Cox proportional hazards regression analysis. Dependent variables were months from trial entry to the first reattempt. Independent variables were characteristics regarded as potential predictive factors. Results: The study included 914 adults (400 men and 514 women). A visit to a psychiatrist within a month of the suicide attempt was significantly associated with reattempts in men (hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21-5.25). Substance-related disorders (HR 3.65, 95% CI 1.16-7.9.60), drinking alcohol less than once per month (HR 0.42, 95% CI 0.17-0.88), previous suicide attempts (HR 2.28, 95% CI 1.40-3.87), and taking a drug overdose for the first suicide attempt (HR 1.82, 95% CI 1.14-3.01) were significantly associated with reattempts in women. Conclusion: Our data highlight the importance of visits to a psychiatrist a short time before the first suicide attempt in men and substance-related disorder, previous suicide attempts, and drug overdose in the first suicide attempt in women as predictive factors for future suicide reattempts.

Effectiveness of assertive case management for patients with suicidal intent.

The aim of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients. We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicide intent admitted to emergency departments and with a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management or enhanced usual care. The primary outcome measure was the incidence of a first recurrent suicide attempt within 6 months. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group. The incidence of a first recurrent suicide attempt within 1 and 3 months was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period. Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group. Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.

Effectiveness of Electroconvulsive Therapy in Patients With Advanced Parkinson Disease.

OBJECTIVES: In addition to motor symptoms, patients with Parkinson disease (PD) experience various psychiatric comorbidities, including impulse control disorders (ICDs). Moreover, antiparkinsonian drugs sometimes cause psychiatric symptoms. Antiparkinsonian and antipsychotic drugs are competitive in pharmacodynamics, and psychotropic drugs, including antidepressants, may worsen motor symptoms or induce adverse reactions. Considering this conflicting situation, we examined the effectiveness of electroconvulsive therapy (ECT) on both motor and psychiatric symptoms in PD. METHODS: We retrospectively examined 12 PD patients with advanced motor symptoms and drug-resistant psychiatric symptoms, including ICDs, who had undergone ECT. Both before and after ECT, the severity of PD motor symptoms were evaluated using Hoehn and Yahr staging, while psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. The patients' doses of antiparkinsonian and antipsychotic drugs were also assessed before and after ECT. RESULTS: Both the mean Hoehn and Yahr and Neuropsychiatric Inventory scores were significantly decreased after ECT. The symptoms of ICDs, which were observed in 5 patients, disappeared following ECT. Improvements in motor symptoms and psychiatric symptoms lasted for more than 1 year in 5 cases and 9 cases, respectively. Furthermore, the daily dose of antiparkinsonian drugs was significantly decreased in 6 cases. CONCLUSIONS: Our results demonstrated that ECT was effective for both severe motor symptoms and psychiatric symptoms in advanced PD patients. ECT might be a solution for the conflicting problem of treating both motor and psychiatric symptoms in PD.

Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial.

BACKGROUND: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses. METHODS: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups. RESULTS: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40). CONCLUSIONS: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.

Neuroleptic malignant syndrome in patients with cancer: a systematic review.

BACKGROUND: Antipsychotics potentially cause a low incidence of the side effect called neuroleptic malignant syndrome (NMS), which has a high mortality rate. However, few studies on NMS among patients with cancer exist. AIMS: We aimed to examine the characteristics of antipsychotic-induced NMS among patients with cancer. METHODS: We conducted a systematic review of published reports on NMS described during the treatment of patients with any type of cancer. Articles were identified by a comprehensive search of PubMed, Web of Science, the Cochrane Library and reference lists from relevant articles published until 25 December 2019. Original articles or case reports on humans published in English were included. This review summarises the symptoms, characteristics, treatment course and prognosis of patients with cancer with NMS. RESULTS: Eleven patients with various cancer types from ten case reports published from 1988 to 2013 met the eligibility criteria. Mean age of the 11 patients was 52.5 (range, 32-83) years. NMS developed mostly during the postoperative period, and haloperidol and D2 receptor antagonists were determined as the common causative drugs. Ten patients survived following treatment that mostly involved discontinuing the causative drugs and administering dantrolene, if necessary. CONCLUSION: Although NMS intrinsically has a low incidence and high mortality, only few reports were available, with most patients surviving after early detection and appropriate treatment. Healthcare providers should consider NMS development while prescribing antipsychotics to ensure prompt recognition of the condition and rapid treatment for preventing unnecessary deaths.

Hopelessness is associated with repeated suicidal behaviors after discharge in patients admitted to emergency departments for attempted suicide.

BACKGROUND: Hopelessness may be associated with an increased risk of suicide. However, findings regarding the long-term predictive ability of the Beck Hopelessness Scale (BHS) for suicide are inconsistent. This study investigated the long-term predictive ability of BHS scores for subsequent self-harm episodes in individuals admitted to an emergency department after attempting suicide. METHODS: The BHS was administered to 805 adult patients with a DSM-IV-TR axis I disorder admitted to an emergency department following a suicide attempt. The patients were followed for at least 18 months and up to 5 years. The incidence of the first subsequent suicidal behavior (attempt or dying by suicide) was examined and the numbers per person-year of overall repeat self-harm episodes, suicide attempt episodes, and non-suicidal self-harm episodes were evaluated. RESULTS: The total BHS scores showed significant associations with the overall number of self-harm episodes per person-year (incidence rate ratio [IRR], 1.05; 95% confidence interval [CI], 1.03-1.07; p < 0.0001), the number of suicide attempt episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.08; p < 0.0001), and the number of non-suicidal self-harm episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.07; p < 0.0001). LIMITATIONS: The study excluded children and adolescents. The sample size, while large, was insufficient to ensure generalizability, or to allow subanalyses based on specific disorders. CONCLUSIONS: Hopelessness scores assessed in the emergency department after a self-harming episode were associated with a rate of repetition of suicidal behaviors after discharge. Additional strategies to address hopelessness of these patients are warranted.

Two-day assertive-case-management educational program for medical personnel to prevent suicide attempts: A multicenter pre-post observational study.

AIM: Suicide attempters have a high risk of repeated suicide attempts and completed suicide. There is evidence that assertive case management can reduce the incidence of recurrent suicidal behavior among suicide attempters. This study evaluated the effect of an assertive-case-management training program. METHODS: This multicenter, before-and-after study was conducted at 10 centers in Japan. Participants were 274 medical personnel. We used Japanese versions of the Attitudes to Suicide Prevention Scale, the Gatekeeper Self-Efficacy Scale, the Suicide Intervention Response Inventory (SIRI), and the Attitudes Toward Suicide Questionnaire. We evaluated the effects with one-sample t-tests, and examined prognosis factors with multivariable analysis. RESULTS: There were significant improvements between pre-training and post-training in the Attitudes to Suicide Prevention Scale (mean: -3.07, 95% confidence interval [CI]: -3.57 to -2.57, P < 0.001), the Gatekeeper Self-Efficacy Scale (mean: 10.40, 95%CI: 9.48 to 11.32, P < 0.001), SIRI-1 (appropriate responses; mean: 1.15, 95%CI: 0.89 to 1.42, P < 0.001), and SIRI-2 (different to the expert responses; mean: -4.78, 95%CI: -6.18 to -3.38, P < 0.001). Significant improvements were found on all Attitudes Toward Suicide Questionnaire subscale scores, except Unjustified Behavior. The effect of training was influenced by experience of suicide-prevention training and experience of working with suicidal patients. CONCLUSION: The training program (which was developed to implement and disseminate evidence-based suicide-prevention measures) improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel. Specialized suicide-prevention training and experience with suicidal patients are valuable for enhancing positive attitudes and self-efficacy; furthermore, age and clinical experience alone are insufficient for these purposes.

Multi-institutional survey of suicide death among inpatients with schizophrenia in comparison with depression.

Suicide is a major cause of death among inpatients with schizophrenia. However, there are only a limited number of surveys of suicide among such patients, especially in Asia. Therefore, we conducted a multi-institutional survey on suicide death among inpatients with schizophrenia in Japan. We investigated the characteristics of patients with schizophrenia who died by suicide during hospitalization in psychiatric wards, and simultaneously, those of patients with depression. Forty-five suicides of patients with schizophrenia occurred in 27 hospitals, and 46 suicides of patients with depression occurred in 33 hospitals. Hanging was the most common suicide method in both diagnostic groups. More than half of the patients with schizophrenia had histories of suicide attempts, although there was no significant difference in previous suicide attempts or self-harm between both diagnostic groups. Medical staff should confirm whether inpatients with schizophrenia have such histories. In this study, there was no significant difference in characteristics between inpatients with schizophrenia or depression. In order to prevent suicides of patients with schizophrenia during hospitalization, nonspecific suicide attempt prevention needs to be undertaken, such as ensuring comprehension of the general risk factors of suicide among medical staff.

A return to work program improves parasympathetic activity and psychiatric symptoms in workers on sick leave due to depression.

BACKGROUND: People with depression have autonomic function disturbances. In Japan, workers who take leave due to depression often undergo a work-focused intervention program called the return to work (RTW) program at a mental health hospital during their leave of absence. However, its biological efficacy remains unclear. We investigated the biological efficacy of the RTW program, including changes in autonomic nervous system (ANS) activity, in workers on sick leave due to depression in Japan. METHODS: The study involved 104 workers on sick leave due to major depressive disorder or bipolar disorder who underwent the RTW program for 3 months in Yokohama City University Hospital. The ANS activity of all patients was evaluated using heart rate variability at the beginning and end of the 3-month RTW program. Psychiatric symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale-Japanese (MADRS-J) and Social Adaptation Self-evaluation Scale (SASS). We followed up 3 months after the end of the program and investigated the association between the success in returning to work within 3 months after the end of the RTW program and several factors, including ANS activity, depressive symptoms, and demographic factors. RESULTS: Parasympathetic activity was significantly higher and depressive symptom severity was significantly lower at program end than at baseline. Logistic regression analysis showed that the change in depressive symptoms was significantly associated with success in returning to work. CONCLUSION: We suggest that the RTW program improves parasympathetic activity as well as psychiatric symptoms. ANS activity was not a predictor of a successful return to work within 3 months after the end of the program in workers on sick leave due to depression, but further studies with a larger sample size are needed.

Interventions to prevent suicidal behavior and ideation for patients with cancer: A systematic review.

OBJECTIVE: This study aimed to summarize interventions for suicide prevention in patients with cancer and highlight any methodological issues. METHODS: We searched PubMed, PsycINFO, CINAHL, and the Cochrane database from their inception until July 2018. Additionally, we manually searched the references of included studies and recent systematic reviews of psychotherapy, antidepressants, and collaborative care for cancer patients with depression. RESULTS: Of the 1365 retrieved articles, 11 randomized controlled trials and 11 intervention studies met the inclusion criteria. These were categorized by type of intervention: psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation and therapeutic walking, and cancer treatment. The trials showed little evidence to confirm the effects of suicide prevention strategies. Seven trials were designed to assess the efficacy of interventions treating depression. In all studies, suicidal behavior or ideation was reported as one of the secondary outcomes. Three trials did not report information about suicidal ideation, despite assessing depressive symptoms using scales that contained suicidal ideation items. Most trials demonstrated inadequate study quality. CONCLUSIONS: Our review summarized interventions for suicide prevention in patients with cancer and revealed methodological issues. The findings highlighted a need to explore new treatment strategies that focus on unique suicide risk factors among patients with cancer.

Longitudinal observation of ten family members with idiopathic basal ganglia calcification: A case report.

BACKGROUND: Familial idiopathic basal ganglia calcification (FIBGC) is a rare autosomal dominant disorder that causes bilateral calcification of the basal ganglia and/or cerebellar dentate nucleus, among other locations. CASE SUMMARY: The aim of this study is to report 10 cases of FIBGC observed in a single family. Seven patients showed calcification on their computed tomography scan, and all of these patients carried the SLC20A2 mutation. However, individuals without the mutation did not show calcification. Three patients among the 7 with calcification were symptomatic, while the remaining 4 patients were asymptomatic. Additionally, we longitudinally observed 10 subjects for ten years. In this paper, we mainly focus on the clinical course and neuroradiological findings in the proband and her son. CONCLUSION: The accumulation of more case reports and further studies related to the manifestation of FIBGC are needed.

Antidepressant activities of escitalopram and blonanserin on prenatal and adolescent combined stress-induced depression model: Possible role of neurotrophic mechanism change in serum and nucleus accumbens.

BACKGROUND: There has been number of studies suggesting experiences of adversity in early life interrelated subsequent brain development, however, neurobiological mechanisms confer risk for onset of psychiatric illness remains unclear. METHODS: In order to elucidate the pathogenic mechanisms underlying early life adversity-induced refractory depression in more detail, we administered corticosterone (CORT) to adolescent rats with or without prenatal ethanol exposure followed by an antidepressant or antipsychotic and examined alterations in depressive and social function behaviors and brain-derived neurotrophic factor (BDNF) levels in serum, the hippocampus, anterior cingulate cortex, and nucleus accumbens. RESULTS: The combined stress exposure of prenatal ethanol and adolescent CORT prolonged immobility times in the forced swim test (FST), and increased investigation times and numbers in the social interaction test (SIT). A treatment with escitalopram reversed depression-like behavior accompanied by reductions in BDNF levels in serum and the nucleus accumbens, while a treatment with blonanserin ameliorated abnormal social interaction behavior with reductions in serum BDNF levels. LIMITATIONS: Further studies are needed to clarify the clinical evinces responding to these results, and many questions remain regarding the mechanisms by which refractory depression and antidepressant/antipsychotic treatments cause changes in serum and brain regional BDNF levels. CONCLUSION: These results strongly implicate changes in BDNF levels in serum and the nucleus accumbens in the pathophysiology and treatment of early life combined stress-induced depression and highlight the therapeutic potential of escitalopram and new generation antipsychotic blonanserin for treatment-resistant refractory depression.